Although pregnancy and childbirth are usually joyful times for women, in some patients they are associated with significant emotional distress. In order to effectively solve these problems, it is important to timely identify risk factors for postpartum depression and effectively address them. Approximately 25% of patients who had a mental disorder after a previous birth relapse after a subsequent birth.
A third of patients with mental disorders in the postpartum period have a history of mental illness. The exact cause of most emotional abnormalities in the postpartum period is unknown, although a certain role is supposed to be played by fluctuations in hormone levels (as in premenstrual syndrome), difficulties in adapting to a new lifestyle, and maternal stress.
There is a wide range of psychopathological reactions to pregnancy and childbirth. This may be mild emotional depression (“postpartum depressed mood”, which occurs after 50% of births, usually occurs 2-3 days after birth and ends in 1-2 weeks) or significant depression (on average in 10% of women), to the extreme reaction in the form of suicidal thoughts and attempts (approximately 1 case per 2000 births).
In general, depression after childbirth is not much more common than under any other circumstances and events. The early symptoms of depression are drowsiness, decreased self-esteem, irritability, and mood instability. More severe symptoms include anorexia, a sense of threat, panic, and delirium. The most alarming symptom is the mother’s alienated attitude towards the baby.
The cause of postpartum mental disorders can be both external and internal factors. Patients with reduced resistance to stress are especially sensitive to such potentially traumatic circumstances as previous infertility, complications before, during and after childbirth or the conflict between her new role as a mother and her former role as wife. The support and care of a spouse and family members can reduce the severity of symptoms.
A sense of anxiety often begins to appear on the eve of childbirth. It can be significantly reduced by involving the patient as an active participant in the planning and management of labor. Prepared labor and rational minimal anesthesia allow the woman in labor to feel her control over what is happening. Nursing staff has been monitoring the patient longer than obstetricians, so he should actively participate in the timely recognition of signs of anxiety and depression.
Treatment should be carried out on a purely individual basis, in accordance with the characteristics of each individual patient. The vast majority of mild postpartum depressions are eliminated by the attending and supervising physician in conjunction with other hospital staff and social workers. The mother should not be forced to communicate with the newborn if she experiences fear or negative emotions. In such situations, a special treatment is carried out together with a clinical psychologist or psychiatrist, including psycho- and drug therapy with antidepressants or lithium carbonate. If outpatient treatment does not produce an effect and the patient’s condition worsens, inpatient treatment is required.
At whatever stage the symptoms of anxiety and depression (before, during or after childbirth) arise , they should be considered as a very serious problem. However, it should be remembered that this condition is not necessarily associated exclusively with pregnancy or its complications. In general, women are twice as likely to be depressed as men. Anxiety is accompanied by depression in 3/4 cases. The key to recognizing signs of early depression is the inability to experience pleasure or joy (agedonia).
Particularly predisposed to depression are women who already have young children, living in poverty, using drugs or pursuing a professional career.
There is a certain hereditary predisposition to the development of anxiety states. It occurs in 10-15% of all people. Since everyone is more or less stressed, almost everyone feels a sense of anxiety, and mood changes are part of everyday life. Like depression, anxiety can lead to special disturbances when a person perceives the world as a hostile and dangerous environment. Unexplained nervousness, panic, irritability, fear of losing control indicate significant disorders that require special treatment.
During the first postpartum visit, the patient should find out the following questions: the nature of breastfeeding, the restoration of menstruation, the resumption of sexual activity, the use of contraceptives, relationships with the baby and family, the restoration of physical activity and return to work. In most cases, by this time the involutional changes have already ended (or are ending). Inflammatory changes in the cervix during the healing process may manifest some atypia during a Pap test. If there is no history of previous severe dysplasia , a cytological examination should be repeated after 3 months.