Doctor…..My wife slapped me !!! Post delivery blues ?
Oh my god is this PND / PDD?
POST DELIVERY BLUES OR POSTNATAL DEPRESSION (PND )
Post delivery blues are commoner than perceived and many times ignored. sometimes PND can take serious turns and we need to be aware of this entity. Here’s a recent experience I wish to share …..
Sharon had just delivered with me six weeks back and it was a wonderful experience as quoted by her. A busy professional Sharon had decided to plan a family after 3 years of marriage and she was now 36 and her husband 37 years of age. Her pregnancy was relatively uneventful with mild anemia, some glucose intolerance, and mild hypertension. These all were tackled with proper care and excellent compliance by Sharon. She delivered a lovely baby girl at 36 weeks of pregnancy which did not require any NICU. The family and especially Sharon and her husband were jubilant. All pink balloons, festoons, future plans ensued. Breastfeeding was a challenge which was overcome by lactation counseling.
She came for follow up once after a week and then after a fortnight during which she looked a little overwhelmed and anxious about her ability to care for the baby and I guided her and counseled her for the same. They decided to go to their hometown near Bengaluru, to be with the family which was agreed upon and they left and didn’t come for review after that. She did send me some pics of her baby after reaching there and then there was silence. No news is always a good news.
Out of the blue, I saw a text message from Michael, Sharon’s husband, that she suddenly walked up to him when he returned from the office that day and gave him a tight slap and went to her room crying hysterically. With the fear that something may be wrong with the newborn, he rushed to find the baby sleeping peacefully and found out that Sharon was all alone at home and the rest of the family had gone out and Sharon was unaware where. Sharon was disturbed after she started living with her in-laws and everyone attributed it to, missing her work and freedom. I guided them to a friend and she was diagnosed with PND/ PDD which means Postnatal or post-delivery depression. Let’s learn more about this condition.
1.What is PPD/ PND?
Postnatal depression is a type of postpartum psychiatric disorder. Postpartum means post delivery.
2. Is it very common?
As a doctor, my observation is, it is prevalent and many times new mothers go into a shell and do not seek help. Postnatal blues are commoner. Scientific published data mentions the prevalence of blues to be at the rate of 300-650 per 1000 delivered women. Approximately 100-150 per 1000 women can suffer from depression needing therapy and 2 -5 women per 1000 suffer from psychosis needing hospitalization.
3. What is the cause? Is it the hormones?
Hormones or withdrawal of the same does not seem to be the associated cause. Social, cultural and environmental factors seem to be the fuel for Postpartum psychiatric disorders ( PPD).
4. How can one manage the blues?
Blues are commoner than other postpartum disorders and they are also handled easily. A feeling of helplessness, worry about the baby, self-doubt, lack of help and understanding from the family, self-image can cause postnatal blues. The condition is more common in the first time mother. This is characterized by irritability, loneliness, crying spells, feeling left out. These are usually experienced during the first-week post delivery. Once the mother is stabilized in her new role and the lactations sets in well, the baby starts thriving, the blues disappear. Best way to address this is by accepting this as a passing phase, positive thinking reinforcement or by asking for help from a doctor or a counselor or a friendly relative
5. Are any women susceptible to these disorders?
First-time mothers, older women or very young women, associated with morbid conditions such as obesity, diabetes, raised blood pressure, premature births, if mother has conceived with infertility therapy, are identified as predisposing factors
6. Which social factors can cause PPD?
Isolation from the family, restriction of movements, financial aspects, lack of household help, a small family with no assistance can be a cause
7. How can PPD be identified?
Clinically a doctor can screen the postpartum mothers for such an occurrence by a tool that consists of a questionnaire. There also is a simple self-assessment 3 question tool which the mother can take and seek help through a clinician.
Following 3 questions can be asked:
All that goes wrong is because of me
I am terribly worried about no obvious reason
I am scared and tend to panic often
8.What about depression and psychosis?
Depression needs to be diagnosed and treated and psychosis needs intense treatments and hospitalization
Like the prenatal period, a postnatal period is a vital phase in the mother’s life as she has to now completely adjust to a new set of emotional and physical challenges. Nuclear families, lack of knowledge, emotional fragility, impatience can be the cause of this malady.
Following important tips can help
Accept the new role and share your feelings with your immediate family
Actually, speak out what you wish they could do for you
Don’t feel saddened if the family cannot cope with your new role
Try to find some help whether from your spouse, family or hire one
Modulate your thinking and always channelize your mind towards positive thinking
Stop worrying about the baby and get your facts cleared from the doctor
Prepare your mind for the new arrival with positivity on
Maintain your physical health through appropriate diets, supplements, and exercise
Maintain your mental health with positive thinking and prayers
Seek help from your doctor asap
Do not ever suffer in silence. Always ask for help and timely intervention helps.