Postnatal (puerperal, postpartum) psychiatric disorders are mental conditions that arise in women within the first 42 days after childbirth. Based on the degree of severity, these conditions have been grouped into three; postnatal blues, postnatal depression, and postnatal psychosis, although they overlap to some extent.
Blues
Majority of women experience this with the symptoms manifesting by the third day of childbirth. These symptoms which include anxiety, mood swings, tearfulness and absent-mindedness are most pronounced on the fifth day after delivery and subsequently subside. Because it has a high incidence and usually wears off without serious medical attention, postnatal blues has been perceived by some people as a norm and not a disease.
Depression
This condition has attracted a lot of attention lately because it is more severe than postnatal blues and has a higher incidence than postnatal psychosis which is the most severe form of postnatal psychiatric disorder. The symptoms of postnatal depression include sadness, anxiety, poor concentration, and apathy to usual activities. The woman finds it hard to sleep and eat, and may feel disappointed with herself. The depression can be so severe that she begins to have suicidal thoughts. If left untreated, postnatal depression can persist for weeks or even months.
Psychosis
This is the rarest and most severe postnatal disorder occurring in between one and two, in every one thousand puerperal women (puerperium is the period of 42 days from childbirth). It is a medical emergency which if left unmanaged becomes a serious health and social hazard. A woman that has developed postnatal psychosis loses control over herself and loses contact with reality. She develops extreme mood swings, severe depression, sleeplessness, and auditory and visual hallucinations (she hears or sees things that are actually not there). She may be silent for hours or days, not even responding to a statement directed to her. Some women feel energetic, unbeatable, amazing and on top of the world for some time and then suddenly become depressed and frustrated. Delusions are also observed.
Other symptoms are severe anxiety and paranoia; the woman becomes unreasonably suspicious of people around her who may include her spouse, doctors, nurses and family members, even the government. She nurses fears of them harming her or her baby. She may also begin to blame herself for distasteful situations in the family or past events. All of these eventually put the woman in a state of confusion and she may be at risk of harming herself or the baby, therefore, she needs to be constantly monitored. Although suicide and infanticide are rare in cases of postnatal psychoses, they do occur.
Causes of Psychiatric Disorders
The exact cause of these disorders has not been ascertained although the following factors have been implicated:
• The fall in blood level of pregnancy hormones (oestrogen and progesterone) after childbirth
• Stressful and complicated delivery
• History of depression or bipolar disorder ( a psychiatric disorder that is characterized by extreme mood swings from euphoria to severe depression)
• Recent traumatic experiences
• Marital problems
• Genetic factors- women whose mothers or relatives have had postnatal depression or psychosis are at a higher risk of developing these disorders.
Women who have had postpartum psychosis have a high risk of having another episode.
Incidence in Nigeria
Several studies have shown that not less than 25% of Nigerian women develop postnatal depression. However, there is little awareness about postnatal psychiatric disorders amongst the general population; some women go through these distressing symptoms without ever understanding what is wrong with them. Their spouses and family members may also not be of help; because they do not understand the woman’s condition, they find it hard not to be angry or upset with the new mother who seems to be acting irrational or crazy. Indeed, a good number of these cases are attributed to evil spirits and witchcraft and instead of seeking medical help, concoctions and rituals are administered. For example, in Yoruba societies, the severe forms of postnatal psychiatric disorders are referred to as Àbísínwín and are usually treated as spiritual attacks. Moreover, the stigma associated with mental disorders prevents some women and their families from coming out to seek medical help.
A number of children in Nigerian orphanages and motherless babies home were actually taken from mothers who were suffering from postnatal depression or postnatal psychosis and have been left to roam the streets and market places or locked up in asylums that do not provide them adequate care.
Management
To a very good extent, postnatal psychiatric disorders are treatable and can be well managed if they are attended to early. However, it is important for people to be well informed about them. If the people around woman suffering from any of these disorders understand her condition, they are more efficient in patiently caring for her and the baby until she recovers. It is also helpful to make the woman understand what is wrong with her and give her necessary counsel.
Symptoms of postnatal psychiatric disorders should be promptly reported to medical personnel. Moreover, women who have had postnatal depression, postnatal psychosis, or other psychiatric conditions previously and are planning to bear more children ought to make their doctors aware of their mental health history. Prophylactic (preventive) measures can then be taken to prevent them from developing postnatal psychiatric disorders with their next childbirth.
Recovery from postpartum psychosis is often followed by a period of depression, anxiety, and low social confidence. It can take time for the woman to come to terms with what has happened to her, therefore, she would need the understanding, patience and support of people around her, and no the stigma, segregation and gossip that she often meets with in a society like ours.