Mental health of the mother – baby blues, postnatal depression and puerperal psychosis

There are high expectations of motherhood and often the assumption is that mothers will cope with caring for a baby and find the experience fulfilling and satisfying. However, a number of mental health issues can develop after the birth of child, ranging from feelings of despondency and mild depression (often called baby blues) to postnatal depression and the more rare puerperal psychosis. Baby blues and postnatal depression is not uncommon and 10-20% of women are affected. It can occur very soon after the baby is born, or many months later. Women of all ages and backgrounds are affected, including both first time mothers and those with other children. It is important that practitioners from all sectors look out for the signs of mild depression, postnatal depression and puerperal psychosis when working with women as these can present at later stages after the initial postnatal depression screening by the health visitor.

Baby blues

Around 70% of new mothers can feel down or despondent after the birth of the baby and this includes mild feelings of depression and tearfulness. This often begins two to three days after the birth and may last for as little as a few hours or a few days. Women and their families should be aware of baby blues and encouraged to understand and get support while it lasts. Baby blues is different from postnatal depression and it is important that women, their partners and families discuss feelings of depression that don’t pass within a few days.

Postnatal depression (PND)

Postnatal depression can have a negative impact not only on the woman who is affected but on her child and family as well. It is essential that women suffering from postnatal depression, or other mental health issues before and after birth, receive support and treatment, and that support extends to the whole family.

While it is primarily the responsibility of health services and practitioners to diagnose and treat postnatal depression, the whole of the early years workforce can take responsibility for knowing the signs and symptoms (which may include overwhelmingly negative feelings of loneliness, guilt, anxiety, irritability, tearfulness, exhaustion, anger and frustration), raising awareness and supporting women and their families when it is identified. The NHS Health Scotland publication Talking About Postnatal Depression is a resource for practitioners to use with women and their families.

Puerperal psychosis

Very rarely, mothers can suffer from a condition called puerperal psychosis, which is a severe mental illness and differs from PND. It affects one to two out of 1,000 new mothers and can involve severe mood changes, loss of touch with reality and hallucinations. Puerperal psychosis often begins within a few days after childbirth (and almost always within three months of the birth) and women typically show signs of being obviously ill and in need of psychiatric care.

The risk of puerperal psychosis is greater for women who have had a similar illness before pregnancy or with a previous pregnancy, and for women who suffer from a manic-depressive disorder.

Edinburgh postnatal depression scale (EPDS)

The EPDS is an accredited tool for screening postpartum women in outpatient, home visiting settings, or at the 6-8 week postpartum examination for postnatal depression.

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