During the postpartum period, it isn’t uncommon for women to feel a swinging change in moods within the first week after delivery. According to the Massachusetts General Hospital Center for Women’s Mental Health, around 85% of women will experience some type of mood disturbance but these are usually mild and short-lived. However, there is about 10 to 15% of women who will develop more significant mental health issues. Most of us would have likely heard of postpartum depression but this is not the only mental health issue to develop. Postpartum mental health issues usually fall on a continuum ranging from mild ‘postpartum blues’ to the most severe, ‘postpartum psychosis’.
What it is: Women who develop postpartum blues are more likely to report mood swings, anxiety, irritability and tearfulness with little or no sadness. Such symptoms are more typical within the first week and may last a few hours to a couple of days and will wear off after a couple of weeks.
What you can do: Postpartum blues are often the result of a sudden change in schedule. It is best to get as much rest as possible. In the meantime, accept help from family and friends with daily household chores so that you can focus more attention in bonding with your baby. Make sure to set aside time for yourself to look after your own needs as well. Keep well away from alcohol and recreational drugs, which can make mood swings worse.
Postpartum Depression (PPD)
What it is: Symptoms are similar to postpartum blues but may develop into more serious symptoms, such as feelings of guilt, poor concentration and suicidal thoughts. Externally, a symptomatic mother with PPD may show very little interest in their newborn, and may even have possible thoughts of harming the baby. Some mothers may develop an obsession over their baby’s health, which may lead to other postpartum disorders, such as postpartum obsessive-compulsive disorder and postpartum post-traumatic stress disorder. In addition to these, some women may develop significant anxiety. There are some doctors who will categorise PPD separate from postpartum anxiety but most are diagnosed and treated the same way.
What you can do: After diagnosis, doctors are likely to prescribe psychotherapy where trained psychiatrists or psychologists help women with PPD find better ways to cope with feelings, solve problems and set realistic goals. Sometimes other family members may be involved. Psychiatrists may also recommend antidepressants. There are a number of antidepressants that are safe to use during breastfeeding. With appropriate treatment, PPD usually goes away within six months but it is important to continue treatment after you begin to feel better to prevent a relapse or worsening of condition.
Postpartum Obsessive Compulsive Disorder (PPOCD)
What it is: PPOCD affects approximately 3-5% of new mothers. Sufferers of PPOCD are likely to have intrusive thoughts of harming their newborn child intentionally or accidentally. A common thought among mothers with PPOCD is that they are not ready or unfit to be mothers. These thoughts usually develop into compulsions, such as throwing out sharp objects, avoiding chemicals, excessively checking in on baby, or even avoiding interaction with baby for fear of hurting the child.
What you can do: Mothers should not worry that their child will be taken away from them if they remain truthful and share these anxiety problems with their doctors. This will definitely aid in refining treatment therapies early on. Exposure and Response Prevention (ERP) is a specific type of cognitive-behavioural therapy (CBT) that has proven to be successful in treating OCD. Under trained psychologists, ERP allows mothers to face fears in a controlled environment and they are carefully guided in managing their escape response till it becomes a habit.
Postpartum Post-Traumatic Stress Disorder (PP-PTSD)
What it is: PP-PTSD affects about 9% of new mothers. There are two key elements that trigger PTSD: firstly, experiencing or witnessing an event involving actual or threatened danger to self or others, and secondly, a response to the event with intense fear, helplessness or horror. For new mothers, these key elements are often the result of difficult births, including an unplanned c-section, and having to send baby to NICU, or experiencing a complicated pregnancy that may put baby in danger, such as severe preeclampsia. Women who have previously experienced trauma, such as sexual abuse, are also at a higher risk of PP-PTSD. Women who suffer from PP-PTSD are likely to have recurring flashbacks and nightmares of the event that may even paralyse them with fear. They would also avoid stimuli associated with the event. In the case of PP-PTSD, this could mean skipping follow up appointments with doctors, or refusing to have anything to do with baby. PP-PTSD sufferers are also likely to experience anxiety and panic attacks frequently.
What you can do: PP-PTSD is temporary and treatable. There are various methods of treating PP-PTSD that are similar to the treatments of PTSD. This includes therapy, such as psychotherapy, CBT or group therapy, where psychologists will help to reframe the experience to be less intimidating. Patients can also try medication, such as anti-anxiety and antidepressants but caution should be exercised if breastfeeding.
Postpartum Psychosis (PPP)
What it is: The medical term may sound scary but it only occurs in 0.1-0.2% of births. The onset of PPP is usually sudden and occurs within the first two weeks of delivery. PPP is also more likely to develop if the mother has a personal or family history of bipolar disorder, or has experienced a previous psychotic episode. Some mothers with PPP may wrongfully diagnose themselves as normal as they would feel extremely energetic, especially for someone who has just had a baby. However, this energy is often coupled with irritability, rapid mood swings and insomnia. Then there are the more serious symptoms of PPP, such as delusions, hallucinations, and paranoia. PPP sufferers will have difficulty communicating at times, especially when discussing their delusions, as these will often only make sense to her only. Her delusions will not necessarily be violent but the mood swings and hyperactivity may nudge her to act irrationally.
What you can do: If a mother begins to show signs of PPP, it is imperative that she seeks treatment immediately. PPP is temporary and treatable with professional help and requires a psychologist or psychiatrist familiar with this disorder to be properly diagnosed. Typically, various medications, such as antidepressants, antipsychotics (neuroleptic) and mood stabilising drugs (lithium) are prescribed to balance neurotransmitters. Follow up with therapies are encouraged so that mothers are able to get back to looking after their child with confidence.
A version of this article was published in Singapore’s Child Issue 179, titled “Postnatal Mental Health”, written by Raewyn Koh.
Have you had to battle with any of the above conditions? Share how you coped in the comments section below!