Postnatal Blues and Depression
What is "postnatal blues" and what cause it?
This is the mildest and arguably most common problem in the puerperium. It has also been called "third day blues" because it tends to happen around the third to fifth day following delivery. It is characterized by weepiness, feeling down, irritability and anxiety. There is no evidence of any underlying disease and most experts agree that it is brought about by the major changes to the system brought about by the arrival of a fragile, demanding and totally dependent being. The responsibility may initially prove too much, unleashing all these emotions.
So what does a mother suffering from postnatal blues require?
Support. The situation should be patiently and sympathetically explained to her. A partner has a crucial role to play, as well as the rest of the family. The midwife will be there to give expert advice, if this is required. The situation clears up in a matter of days. Only occasionally is a short course of sedatives required. A small percentage of affected mothers go on to have postnatal depression.
What causes postnatal depression?
There are no specific causes. It is known for certain that women with a previous history of depression in a non-pregnant state or following a previous delivery are more at risk. Recent or ongoing marital conflict has also been associated with postnatal depression.
What are the symptoms of postnatal depression?
There are similar to those experienced with postnatal blues, except they are far more pronounced. Moreover, the mother may complain of palpitations, lack of appetite and inability to sleep.
The most prominent symptom, however, is the feeling of profound lack of love for the newborn. Because of this, the mother may feel extremely guilty. She may also feel unable to love the other children, if she has any, and cannot feel any warmth towards other members of her family.
It is through such a sense of utter hopelessness that feelings of suicide are not uncommon. Even though actual attempts at this are rare, this symptom should never be ignored.
How is postnatal depression managed?
This requires intensive support for the affected mother. A psychiatrist is usually involved and takes the leading role in medical management.
Hospital admission may be necessary and, because the partner is crucial in the supporting role, if logistically possible, arrangements are made to enable him to stay with her. Attempts are made not to separate the baby from the mother.
Medication will usually be commenced and this could continue for several weeks, even months.
What role do hormonal preparations such as progesterone have in preventing postnatal depression?
For many years, progestogens were considered to be the logical form of treatment for this condition. This was based on the theory that it is the sudden withdrawal of progesterone after delivery which causes depression.
Experience and numerous studies have shown that there is no evidence that this has any effect. While it is still being used in some places, the mother has a right to know that the expected benefit is not supported by any scientific evidence. Many obstetricians and their psychiatry colleagues alike simply don't offer this.