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What Is Postpartum Depression? The term postpartum (or post-partum) comes from the Latin post partum meaning ‘after childbirth’. So ‘postpartum depression’ is the depression that is linked to pregnancy and childbirth. It is one of the most common complications of pregnancy. Postpartum depression is a complex mix of physical, emotional and behavioural changes that happen in a woman during pregnancy and/or after giving birth. According to the DSM V, a manual used to diagnose mental disorders, postpartum depression is a form of major depression that has its onset during pregnancy or within four weeks after delivery. What Are The Symptoms Of Postpartum Depression? Symptoms of postpartum depression are so similar to what normally happens after the birth of a baby, that they are often not identified as postpartum depression. They include: - Lack of sleep - Appetite changes - Excessive fatigue - Decreased libido - Frequent mood changes. However, the symptoms of postpartum depression above are also accompanied by other symptoms of major depression, which may include: - Depressed mood (subjective or observed) - Loss of interest or pleasure, most of the day - Change in weight (5 percent change over 1 month) or appetite - Insomnia or hypersomnia (sleeping too much) - Psychomotor retardation or agitation (observed) - Loss of energy or fatigue - Feelings of worthlessness or guilt - Impaired concentration or indecisiveness - Recurrent thoughts of death or suicidal ideation or attempt. Depressed mothers are often weepy, anxious and easily upset, exhausted but unable to sleep. They may have physical symptoms typical of anxiety as well, such as racing heart, rapid breathing, tremors, dizziness, and even panic attacks. They worry obsessively about their baby’s health, while feeling guilty about their own insufficient love and inadequacy as caretakers. Some fear they will harm their baby, although few do. Sadly, many new mothers are too ashamed to talk about their symptoms, except the physical ones. For more information on mood disorders please read my articles: Understanding Bipolar Disorder Are There Different Types Of Postpartum Depression? There are three types of mood changes women can have after giving birth: Postpartum Blues (Baby Blues) is estimated to affect about 70 percent of women during the first week after delivery and is considered normal. A new mother has sudden mood swings, such as feeling very happy and then feeling very sad. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely and sad. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues does not usually require treatment from a health care provider. It goes away on its own and rarely requires more than a few days of rest and support. Often, joining a support group of new moms or talking with other moms helps. Postpartum Depression occurs during pregnancy or within four weeks after childbirth and can happen after the birth of any child (not just the first child). A woman can have feelings similar to the baby blues - sadness, apathy, despair, anxiety and irritability, but she feels them much more strongly than she would with the baby blues. Postpartum depression will affect the woman’s ability to function (hinder her ability to do the things she needs to do every day) because symptoms can include lack of appetite, inability to sleep and highly impaired concentration and decision-making. Experts say that if the symptoms of postpartum depression persist for more than two weeks the woman should seek professional help, because if she doesn’t the symptoms can get worse. While postpartum depression is a serious condition, it can be treated successfully with medication and counselling. Postpartum Psychosis is a very serious mental illness that can affect new mothers. At the other end of the spectrum from the baby blues, it progresses quickly from irritability to irrationality. This condition, which affects about one in a thousand women, can happen quickly, most often in the first four weeks after delivery. Symptoms include: - Mental confusion - Loss of touch with reality - Auditory hallucinations (hearing things that aren't actually happening, like a person talking) - Delusions (strongly believing things that are clearly irrational to others) - Visual hallucinations (seeing things that aren't there) - Insomnia (not being able to sleep) - Feeling agitated (unsettled) and angry - Strange feelings and behaviour. Women who have postpartum psychosis need treatment right away and almost always need medication. Sometimes women are put into the hospital because they are at risk for hurting themselves and/or their baby. What Causes Postpartum Depression? Researchers have speculated that an unplanned pregnancy, a difficult pregnancy, complications during delivery and giving birth to twins or triplets make a woman more prone to postpartum depression, but studies have not borne out or proved these theories. Instead, researchers now suspect that postpartum depression is linked to chemical, social and psychological changes associated with pregnancy and having a baby. The chemical changes involve a rapid drop in hormones after delivery. The actual link between this drop and depression is still not clear, but what is known is that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy then drop sharply after delivery (within three days of giving birth the levels of estrogen and progesterone drop back to what they were before the woman fell pregnant). Researchers say that it is likely that with some women, the precipitous drop in estrogen and progesterone after birth disrupts the normal functioning of neurotransmitters in the brain, resulting in depression. The social and psychological changes are brought about by the stress of the major life change associated with having a baby. Who Is At Risk For Postpartum Depression? Most new mothers experience the ‘baby blues’ after delivery. About one out of every 10 of these women will develop a more severe and longer-lasting depression and about one in 1,000 women will develop the more serious condition of postpartum psychosis. Figures available from abroad indicate that some 10 to 15 percent of women will be afflicted by postpartum depression in the first year after giving birth. Local experts agree that these figures are also representative of the South African population. A study carried out by the Postpartum Depression Support Group also showed that depression can begin before the baby is born. Fifty percent of the women in the study were depressed during pregnancy and in no case was it picked up! A tragedy when you consider that postpartum depression is highly treatable and avoidable. A number of factors can increase the risk of postpartum depression, including: - Having had postpartum depression during a previous pregnancy - having a history of depression or premenstrual dysphoric disorder - having a family history of depression - age at time of pregnancy - the younger you are, the higher the risk - ambivalence about the pregnancy - children - the more you have, the more likely you are to be depressed in a subsequent pregnancy - limited social support - living alone - marital conflict. When Should A New Mom Seek Professional Treatment? Experts agree that early treatment is the key; while the worst symptoms may ease over time, some doctors believe that untreated depression leaves women and their children vulnerable to future depression. Experts also warn that mothers with postpartum depression have a higher proportion of babies with health problems, including failure to thrive. Studies have shown that if the mother is treated, the babies recover too. A new mom should seek professional help when: - symptoms persist beyond two weeks - she is unable to function normally - she can't cope with everyday situations - she has thoughts of harming herself or her baby - she is feeling extremely anxious, scared and panicked most of the day. How Is Postpartum Depression Treated? Postpartum depression is treated differently depending on the type and severity of a woman's symptoms. Treatment options include anti-anxiety or anti-depressant medications, psychotherapy and participation in a support group for emotional support and education. In the case of postpartum psychosis, drugs used to treat psychosis are usually added. Hospital admission is usually necessary in this case. Though physiology is involved in postpartum depression, treatment with psychotherapy may be all that is required for women with mild symptoms. Counselling often includes the spouse and sometimes an evaluation of the mother-infant interaction. The mother is helped to develop coping skills and to resolve any interpersonal conflicts, such as the level of her husband’s involvement with the child. This is often a source of conflict, given the traditional approach adopted by many South African fathers whereby the wife takes care of the children’s needs. For new mothers with more severe symptom, the treatment usually entails a combination of psychotherapy and anti-depressants. Mothers who opt for medication usually start feeling at least marginally better after a month or so, but they should expect to stay on medication for up to a year after their symptoms disappear. Breastfeeding mothers must not assume that they cannot take medication for their depression, anxiety or psychosis. Although it may not be ideal for the breastfeeding baby, it is a far greater risk to the mother and her family, to leave the illness untreated. Under a doctor's supervision, many women take medication while breastfeeding. This is a decision to be made between the mother and her doctor. Women who choose to stop breast-feeding may be able to use oestrogen therapy as an alternative to anti-depressants. The use of oestrogen patches, while still experimental, has produced very positive results. But experts agree that the most important aspect of the problem is the need to educate patients and doctors. Patients should be taught to recognise the symptoms and doctors to ask about a new mother’s well-being. The condition is generally glossed over in childbirth preparation classes and pregnancy guidebooks and is not routinely screened for in postpartum check-ups. During the check-ups, the focus is very much on a mother’s physical health rather than her emotional wellbeing. Dr Frans Korb, a South African expert, says it is important that the medical profession does not overlook this very common problem with a new mother’s health. Failure to do so means that a new mother is left to struggle alone with her feelings. However, studies show that the women who do speak out often battle to find a practitioner who takes their complaint seriously. This often stems from ignorance on the part of the medical practitioner or lack of time or unwillingness to ask more probing questions. Some pilot studies carried out abroad show that doctors can achieve a very high rate of prevention by administering anti-depressants to high-risk women immediately after delivery. Further studies are necessary to confirm these findings so, for now, the watchwords are education for mothers-to-be and medical practitioners asking questions about a mother’s emotional well-being. Mothers too must speak up and speak out. Postpartum Depression and Anxiety Disorders Symptoms of obsessive-compulsive disorder may appear or worsen in the postpartum period. The obsessions are usually related to concerns about the baby or harming the baby. Panic disorder may also occur. Both conditions often coexist with depression. For more information about anxiety disorders please read my article Axe Anxiety . Tips for Coping After Childbirth Here are some tips that can help you cope with bringing home a new-born baby: - Ask for help - let others know how they can help you - Be realistic about your expectations for yourself and baby - Exercise; take a walk and get out of the house for a break - Expect some good days and some bad days - Follow a sensible diet; avoid alcohol and caffeine - Foster the relationship with your partner - make time for each other - Keep in touch with family and friends - do not isolate yourself - Limit visitors when you first go home - Screen phone calls - Sleep or rest when your baby sleeps.
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कुनै पनि दम्पतिले बच्चा जन्माउँदै गर्दा उत्साह र आनन्ददेखि डर र चिन्तासम्मका भावनाहरू महसुस गर्छन्। तर बच्चा जन्मिसकेपछि तपाईंले कहिल्यै अपेक्षा नगरेको समस्या पनि निम्तिन सक्छ। त्यो हो; डिप्रेसन। धेरैजसो नयाँ आमाहरूले सुत्केरी पछि ‘बेबी ब्लुज’ अनुभव गर्छन्, जसमा सामान्यतया मुड स्विङ हुने, रोइरहने मन लाग्ने, चिन्ता र सुत्न गाह्रो हुन्छ। बेबी ब्लुज सामान्यतया सुत्केरीपछि पहिलो दुईदेखि तीन दिनभित्र सुरु हुन्छ, र दुई हप्तासम्म रहन सक्छ। तर केही नयाँ आमाहरूले पोस्टपार्टम डिप्रेसन भनिने अझ लामो समयसम्म चल्ने गम्भीर समस्या अनुभव गर्छन्। केहीमा बच्चाको जन्म पछि पोस्टपार्टम साइकोसिस भनिने एक मूड डिसअर्डर पनि विकास हुन सक्छ। पोस्टपार्टम डिप्रेसन कुनै कमजोरी होइन। यो केवल बच्चालाई जन्म दिई सकेपछिको एक जटिलता हो। यदि तपाइँलाई पोस्टपार्टम डिप्रेसन छ भने, तुरुन्त उपचारले तपाइँको लक्षणहरू व्यवस्थापन गर्न र तपाइँको बच्चासँग रमाउन मद्दत गर्दछ। उपचार नगरेमा पोस्टपार्टम डिप्रेसन धेरै महिना वा लामो समयसम्म रहन सक्छ। बेबी ब्लूजका लक्षणहरू बेबी ब्लुज तपाईंको बच्चा जन्मेको केही दिनदेखि एक वा दुई हप्तासम्म मात्र रहन्छ। यसका लक्षणहरू यस्ता छन्; -चिन्ता -दु:ख लागिरहने -चिडचिडाहपन -चकित महसुस गर्ने -रुन मन लाग्ने/ रुने -कम एकाग्रता -भोक सम्बन्धी समस्याहरू -सुत्न समस्या पोस्टपार्टम साइकोसिस पोस्टपार्टम साइकोसिस एक दुर्लभ अवस्था हो जुन सामान्यतया प्रसवपछि पहिलो हप्ताभित्र विकसित हुन्छ। यसका संकेत र लक्षणहरू गम्भीर हुन्छन्। पोस्टपर्टम साइकोसिसले नराम्रा विचार वा व्यवहार निम्त्याउन सक्छ सोहिकारण यसको तत्काल उपचार गरिहाल्नु पर्छ। जस्तै; -अन्योल र भ्रामकता -बच्चाको बारेमा नराम्रा विचारहरू -भ्रम -निद्रा गडबड -अत्यधिक ऊर्जा -पागलपन -आफैलाई वा बच्चालाई हानि पुर्याूउने प्रयास पोस्टपर्टम डिप्रेसनको लक्षणहरू पोस्टपार्टम डिप्रेसनलाई कतिपयले सुरुमा बेबी ब्लुज भनेर बेवास्ता गरिरहेका हुन्छन्। तर लक्षणहरू लामो समयसम्म रहन्छ, र तपाईंको बच्चाको हेरचाह गर्ने र अन्य दैनिक कार्यहरू गर्ने क्षमतामा बाधा पुग्न थाल्छ भने त्यो पोस्टपर्टम डिप्रेसन हो। यसका लक्षणहरू गर्भावस्थाको समयमा वा बच्चा जन्मिएपछि केही हप्ताभित्र विकसित हुन्छन्। जसमा यस्ता लक्षणहरू देखा पर्छन्; -उदास मूड वा मूड स्विङ्स -अत्याधिक रुनु - बच्चासँग रमाउन नसक्नु -परिवार र साथीभाइहरू टाढा बस्न खोज्ने -भोक नलाग्ने वा सामान्य भन्दा धेरै खाने -सुत्न नसक्ने (अनिद्रा) वा धेरै सुत्नु -अत्यधिक थकान -अरु समयमा रमाइलो लाग्ने गतिविधिहरूमा रुचि र आनन्द कम हुनु -तीव्र चिडचिडापन र क्रोध -असल आमा हुन सक्दिनँ भन्ने डर -आशाहीनता -मूल्यहीनता, लाज, अपराध वा अपर्याप्तताको भावना -स्पष्ट रूपमा सोच्ने, ध्यान केन्द्रित गर्ने वा निर्णय गर्ने क्षमतामा कमी -बेचैनी -गम्भीर चिन्ता -आफैलाई वा बच्चालाई हानि पुर्या्उने विचारहरू आउने -मृत्यु वा आत्महत्याको बारम्बार विचारहरू आउने बुवाहरूमा पोस्टपार्टम डिप्रेसन सामान्यतया आमाहरुलाई मात्रै पोस्टपार्टम डिप्रेसन हुन्छ भनिन्छ तर नयाँ बुबाहरूले पनि पोस्टपार्टम डिप्रेसनको अनुभव गर्न सक्छन्। बुवाहरूमा पनि आमाहरूमा देखिए जस्तै लक्षणहरू देखिने, उदास वा थकित महसुस गर्ने, चिन्ता गर्ने वा सामान्य खानपान र सुत्ने बानीमा परिवर्तनहरू हुन सक्छन्। सानो उमेरमा बुवा भएकाहरू, डिप्रेसनको हिस्ट्री भएकाहरु, सम्बन्धमा समस्या भईरहेकाहरू वा आर्थिक रूपमा संघर्ष गरिरहेका केटा मान्छेहरु पोस्टपर्टम डिप्रेसनको सबैभन्दा जोखिममा हुन्छन्। यसलाई प्याट्रनल पोस्टपर्टम डिप्रेसन पनी भनिन्छ। आमाहरूमा हुने पोस्टपर्टम डिप्रेसनले जस्तै यसले पनि पति पत्नीको सम्बन्ध र बच्चाको विकासमा नकारात्मक असर पार्न सक्छ। यदि तपाइँ नयाँ बुवा हुनुहुन्छ र तपाइँको पार्टनरको गर्भावस्थाको समयमा वा तपाइँको बच्चाको जन्मिएको पहिलो वर्षमा चिन्ता वा डिप्रेसनको लक्षणहरू अनुभव गर्दै हुनुहुन्छ भने एकपटक काउन्सिलरलाई भेट्नु या मनोपरामर्श लिनु जरुरी छ। कारणहरू पोस्टपार्टम डिप्रेसनको कुनै एउटै कारण छैन, तर शारीरिक र भावनात्मक परिवर्तनले यसमा भूमिका खेल्न सक्छ। शारीरिक परिवर्तनहरू- बच्चा जन्माएपछि, तपाईंको शरीरमा हर्मोन (एस्ट्रोजेन र प्रोजेस्टेरोन) को कमीले पोस्टपार्टम डिप्रेसन हुन सक्छ। तपाइँको थाइरोइड ग्रन्थी द्वारा उत्पादित अन्य हर्मोनहरू पनि तीव्र रूपमा घट्न सक्छ, जसले गर्दा थकान, सुस्त र निराश महसुस गर्न सक्छ। भावनात्मक परिवर्तनहरू- जब तपाईं राम्रोसंग निदाउन सक्नु हुन्न तपाईंलाई सानातिना समस्याहरू पनि ह्यान्डल गर्न असहज हुन सक्छ। नवजात शिशुको हेरचाह गर्ने क्षमताको बारेमा चिन्ता लाग्न सक्छ। आफू बच्चा जन्मिए पछि अर्कै हुन्छुकी भन्ने, जीवनमा आफ्नो नियन्त्रण गुमाएको महसुस गर्ने हुन सक्छ। यी मध्ये कुनै पनि समस्याले पोस्टपर्टम डिप्रेसनलाई बढाउन सक्छ। जोखिम कुनै पनि सुत्केरीले पोस्टपर्टम डिप्रेसन अनुभव गर्न सक्छ। पहिलो बच्चा जन्मिदा मात्रै होईन यो कुनै पनि बच्चाको जन्म पछि हुन सक्छ। यद्यपि, यसको जोखिम निम्न अवस्थाहरुमा बढ्छ; - गर्भावस्थाको समयमा वा अन्य समयमा डिप्रेसन भएकाहरुमा -अघिल्लो गर्भावस्था पछि पोस्टपार्टम डिप्रेसन भएकाहरुमा -परिवारका सदस्यहरूमा जसलाई डिप्रेसन वा अन्य समस्याहरू भएमा -गत वर्षमा तनावपूर्ण घटनाहरू अनुभव गरेकाहरुमा, जस्तै गर्भावस्था जटिलताहरू, बिरामी वा जागिर गुमाउनु -बच्चालाई स्वास्थ्य समस्या भएकाहरुमा - जुम्ल्याहा, तीन वा अन्य धेरै जन्महरू जन्मिएको अवस्थामा -स्तनपान गराउन कठिनाई भएमा -पति वा परिवारका अन्य संग सम्बन्धमा समस्या भएमा -आर्थिक समस्या भएमा -गर्भावस्था अनियोजित भएको अवस्थामा रोकथाम यदि तपाइँलाई पोस्टपार्टम डिप्रेसन या डिप्रेसनको हिस्ट्री छ भने, गर्भवती हुने योजना बनाउने समयमा या गर्भवती भएको थाहा पाउने बित्तिकै डाक्टरलाई भन्नुपर्छ। कहिलेकाहीँ हल्का डिप्रेसनलाई परामर्श वा अन्य उपचारहरूद्वारा व्यवस्थित गर्न सकिन्छ। नत्र गर्भावस्थाको समयमा पनि एन्टिडिप्रेसन औषधिहरू खान सकिन्छ। बच्चा जन्मेपछि, डाक्टरले पोस्टपर्टम डिप्रेसनका लक्षणहरू र लक्षणहरूको लागि स्क्रिनमा प्रारम्भिक पोस्टपर्टम चेकअप सिफारिस गर्न सक्छ। जति चाँडो यो पत्ता लाग्यो, पहिले नै उपचार सुरु गर्न सकिन्छ। उपचार नगर्दा के हुन्छ? पोस्टपर्टम डिप्रेसनको उपचार नगर्दा आमा र बच्चाको सम्बन्धमा असर पुग्न सक्छ र पारिवारिक समस्याहरू निम्त्याउन सक्छ। आमाहरूको लागि: उपचार नगरिएको पोस्टपर्टम डिप्रेसन महिनौं वा लामो समयसम्म रहन सक्छ।भविष्यमा दीर्घकालीन डिप्रेसनको जोखिम बढाउँछ। बुबाहरूको लागि: पोस्टपर्टम डिप्रेसनले नयाँ बच्चाको नजिकका सबैलाई भावनात्मक तनावको हुन सक्छ। नयाँ आमा डिप्रेसनमा पर्दा बच्चाको बुबामा डिप्रेसनको जोखिम पनि बढ्न सक्छ। बच्चाहरुको लागी: उपचार नगरी पोस्टपर्टम डिप्रेसन भएका आमाका बच्चाहरूलाई सुत्न र खान कठिनाइ, अत्याधिक रुनु, र भाषा विकासमा ढिलाइ जस्ता भावनात्मक र व्यवहारिक समस्याहरू हुने सम्भावना बढी हुन्छ। डाक्टरलाई कहिले भेट्ने? यदि तपाइँ आफ्नो बच्चाको जन्म पछि निराश महसुस गर्दै हुनुहुन्छ भने, यो कुरालाई स्वीकार गर्न असहज लाग्न सक्छ। तर यदि तपाईंले पोस्टपार्टम बेबी ब्लुज वा पोस्टपार्टम डिप्रेसनको कुनै लक्षण अनुभव गर्नुभयो भने, डाक्टरलाई भेटिहाल्नु पर्छ। यदी तपाईको लक्षणहरू दुई हप्ता पछि नहराएमा, बच्चाको हेरचाह गर्न गाह्रो भएमा,दैनिक कार्यहरू पूरा गर्न गाह्रो भएमा र आफैलाई वा बच्चालाई हानि पुर्याोउने विचारहरू आएमा अस्पताल गईहाल्नु पर्छ। एजेन्सी