2.2.2 Disorders Related to Childbirth

Assessment and Management of Disorders Related to Childbirth

Baby blues:

Approximately 75% of new mothers may undergo a brief phase of emotional instability and tearfulness, beginning 2-3 days postpartum and persisting for 1-2 days. Midwifery staff can readily identify this, and it typically resolves with reassurance and monitoring. The phenomenon has been tentatively linked to decreased levels of estrogen, progesterone, and prolactin around 72 hours after giving birth, though the evidence is limited.

Post-natal depression:

A notable depressive episode connected to childbirth affects 10-15% of women within six months postpartum, peaking at 3-4 weeks. Its symptoms resemble those of standard depressive episodes but may involve concerns about the baby’s well-being or coping abilities, as well as significant anxiety. Most cases (90%) resolve within a month, while 4% persist for over a year.

Risk factors for post-natal depression:

• Personal/family history of depression
• Older age
• Single mother
• Poor relationship with own mother
• Ambivalence towards or unwanted pregnancy
• Poor social support
• Additional psychosocial stressors
• Severe ‘baby blues
• Previous post-partum psychosis (no evidence for association with obstetric complications)

Management involves early identification, close monitoring of at-risk individuals, education, support, pharmacological intervention, and treatment with antidepressants and/or brief CBT. In severe cases or those involving harmful thoughts, hospitalization may be necessary.

Post-partum psychosis:

Postpartum psychosis is a severe mental health condition that can occur in the days or weeks following childbirth. It is a rare but serious condition that can have significant consequences for the mother, the infant, and the wider family. The following text will discuss the prevalence/incidence, aetiology, presentation, treatment, and outcome of postpartum psychosis.

Postpartum psychosis is a rare condition, with an estimated incidence of 1 to 2 per 1000 births (Kendell, Chalmers, & Platz, 1987). It is more common in women with a history of bipolar disorder or a previous episode of postpartum psychosis (Jones et al., 2014).

The exact causes of postpartum psychosis are not well understood, but it is thought to be a multifactorial condition with both genetic and environmental factors playing a role. Hormonal changes during and after childbirth are thought to be a trigger for the condition, as are sleep deprivation, stress, and social isolation (Suto et al., 2019).

Postpartum psychosis typically presents within the first two weeks following childbirth, although it can occur up to 12 weeks after delivery (Munk-Olsen et al., 2016). Symptoms can include delusions, hallucinations, confusion, disorientation, agitation, and suicidal thoughts. Women with postpartum psychosis may also have difficulties with bonding with their infants and may exhibit behaviours that are harmful to themselves or their infants (Jones et al., 2014).

The treatment of postpartum psychosis should be tailored to the individual woman’s needs and circumstances. Inpatient hospital admission is often necessary to ensure the safety of the mother and infant and to provide intensive treatment and support. Medications such as antipsychotics and mood stabilizers may be used to manage symptoms, and psychological interventions such as cognitive-behavioural therapy (CBT) and family therapy may be helpful in promoting recovery and reducing the risk of recurrence (National Institute for Health and Care Excellence, 2014).

With appropriate treatment and support, the majority of women with postpartum psychosis make a full recovery. However, there is a risk of recurrence with subsequent pregnancies, and women with a history of postpartum psychosis should be closely monitored during subsequent pregnancies and after delivery (Munk-Olsen et al., 2016).

Postpartum psychosis is a rare but serious mental health condition that can have significant consequences for the mother, infant, and family. It typically presents within the first two weeks following childbirth and requires prompt treatment and support. With appropriate treatment, the majority of women make a full recovery, but there is a risk of recurrence with subsequent pregnancies.

References:

1. Jones, I., Chandra, P. S., Dazzan, P., & Howard, L. M. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet, 384(9956), 1789-1799. doi: 10.1016/S0140-6736(14)61278-2
2. Kendell, R. E., Chalm ers, J. C., & Platz, C. (1987). Epidemiology of puerperal psychoses. British Journal of Psychiatry, 150(6), 662-673. doi: 10.1192/bjp.150.6.662
3. Munk-Olsen, T., Laursen, T. M., Mendelson, T., Pedersen, C. B., Mors, O., & Mortensen, P. B. (2016). Risks and predictors of readmission for a mental disorder during the postpartum period. Archives of General Psychiatry, 73(9), 928-935. doi: 10.1001/archgenpsychiatry.2016.1133
4. National Institute for Health and Care Excellence. (2014). Postnatal care up to 8 weeks after birth: Clinical guideline. Retrieved from https://www.nice.org.uk/guidance/cg37
5. Suto, M., Murray, L., Mehta, R., Cooper, P. J., & Fearon, P. (2019). Hormonal regulation in mothers with postpartum psychosis. The British Journal of Psychiatry, 214(3), 149-157. doi: 10.1192/bjp.2018.289
6. National Institute for Health and Care Excellence (NICE). (2014). Antenatal and postnatal mental health: Clinical management and service guidance. Retrieved from https://www.nice.org.uk/guidance/cg192
7. Molyneaux, E., Howard, L. M., McGeown, H. R., Karia, A. M., Trevillion, K., & Brockington, I. F. (2014). Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Reviews, (9), CD002018. doi: 10.1002/14651858.CD002018.pub2
8. Stewart, D. E., Robertson, E., Dennis, C.-L., Grace, S. L., & Wallington, T. (2014). Postpartum depression: Literature review of risk factors and interventions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147943/