Following
the birth of a child, particularly the first, the mother frequently
becomes unaccountably miserable. This is a very common situation
and varies enormously in severity. The so-called “baby-blues” affects about 50% of women and appears on the second or third day after delivery. There is fleeting misery and tearfulness, which is brought on, probably, by the stress of the birth and the hormonal changes that accompanied it. Another fairly common, and, sometimes very distressing form of depression, is seen by doctors and care workers 6 to 8 weeks after birth. All the congratulations over, the young mother is sometimes left to cope, perhaps in a situation of emotional and material poverty. Feelings of anxiety, inadequacy and exhaustion can easily lead to depressive illness (see Depression) with all its attendant symptoms and dangers. The condition must not be put down to being " a bit tired and fed up" and can simmer away, unresolved, for many years, resulting in a long term personality change and loss of libido. There may be a deterioration in relations with the partner and lack of bonding with the child. The most severe form of post-natal depression , though fortunately rare, occurring on the second or third day post-partum, is puerperal depression. Like “baby blues” this might be quite unexpected, although there is, sometimes, a history of past depression or a long and painful confinement. Puerperal depression can be a severe illness. Usually, if recognised, it can be dealt with but, for a few individuals, a full-blown psychosis develops and the mother has to be admitted to a psychiatric unit as an emergency. In this severity of disease there is both risk of the mother’s suicide and her killing the baby. So the “baby blues” must be distinguished from puerperal depression. One early clue is rejection of the baby by the mother. Puerperal depression usually resolves itself in a couple of months but can last much longer.
Management is all about recognition of severity. Cuddles, love, reassurance, understanding and practical help will soon see off the “baby blues”. Sometimes hormone treatment will help. A mother with severe puerperal depression may conceal the true despair she feels, however, because a mother is expected to be happy. This can result in sudden unexpected tragedy. Both puerperal depression and the later post-natal depression need careful medical monitoring and, almost certainly, appropriate antidepressant medication. Sometimes, in the later variety, social problems may be anticipated and dealt with. Mothers of twins, for example, quite often become depressed through sheer exhaustion. |
