After Child-birth Madness? Part 2

This Article was featured in HALA Magazine

There is a medical condition called Postpartum Psychosis which causes women to lose touch with reality after child birth.

Postpartum Psychosis is the rarest and most severe form of the possible aftert childbirth mental disorders which includes milder forms such as postpartum blues and postpartum depression (these are more common). Postpartum Blues usually does not impair the mother’s ability to care for her child and spontaneously terminates within the first 2 weeks after birth.

Postpartum Depression usually develops later with symptoms like anxiety, fatigue, changes in sleep pattern and appetite. It can be treated using psychotherapy, family support and drugs only when needed.

The symptoms of postpartum psychosis include:

  • Severe loss of appetite, insomnia, extreme anxiety and agitation.
  • Delusions defined as fixed, unshakable beliefs that are not subject to logic. They can be paranoid or grandiose in nature e.g. the mother may believe that her healthy infant is deformed, or demonic or God.
  • Hallucinations which can be auditory e.g. she hears voices which tell her to kill the infant or herself.
  • Depersonalisation in which case she withdraws from her surroundings and the people around her.
  • Disorders of thought which can manifest as a difficulty in verbal communication.
  • Lack of insight hence she does not realize that there is something wrong with her feelings or actions.
  • Suicidal or Homicidal thoughts of either herself or her baby

There are many theories as to what the actual cause of postpartum psychosis is, the most commonly implicated cause being a decrease in the levels of hormones such as oestrogen, progesterone and cortisol and the sensitivity of the person to these changes as the same changes occur in all women postpartum.  The illness is also more likely to occur in women with a personal or familial past medical history of schizophrenia, bipolar disorders and other psychosis. A personal past history of postpartum psychosis increases one’s risk of having the illness by 20-50 percent in the next pregnancy.  Other contributory factors include social and financial stressors such as inadequate emotional and physical support from her support system, low self esteem due to post pregnancy appearance and financial constraints.

Post-partum psychosis is an emergency but it is important to note that it is treatable. The treatment can be pharmacological and non- pharmacological. Drug treatment is guided by the patient’s symptom profile; examples of drugs used are mood stabilizers (such as Valproic acid, Lithium, Carbamazepine), Antipsychotics and Benzodiazepines (such as Lorazepam). It should be noted that these drugs are excreted in breast milk and it would advisable to discourage breastfeeding while the mother is on these medications because of possible side effects on the infant.

Non pharmacologic modes of treatment include the education of her support system to enable them cope and give adequate support to the mother. It may also involve the use of Electroconvulsive therapy which is well tolerated and rapidly effective.

Typically, hospitalization may be required particularly in severe cases in which case the mother and child can both be admitted, to aid mother and child bonding.

The importance of an adequate social and emotional support system and seeking prompt and correct medical treatment cannot be overemphasized.

This is evidenced by the different true life stories of females who have suffered through this illness with tragic stories to be told, such as Andrea Yates a mother who drowned her five children and Melanie Stokes who committed suicide while suffering from this condition.

In the developed world, advocacy for, and research on the causes and treatment has begun, but not much has been done in our environment for the condition. This may be because of our religious beliefs; hence the unfortunate cases of this illness in our environment are treated as demonic attacks, thereby subjecting mother and child to further abuse.

Advocacy and research is on-going in developed countries unlike here where the few cases are treated as demonic attacks hence subjecting both mother and child to further abuse!

Prevention of this illness is the key, and this can be through detecting high risk patients during ante-natal visits. These include women with a prior history of unipolar or bipolar depression, previous postpartum depression or psychosis, women who have experienced depression during pregnancy. Another approach in the prevention of the illness is to place women with a past history of bipolar disorder or postpartum psychosis on prophylactic lithium either prior to or within 24 hours of delivery though this is controversial and still being studied.

FREQUENTLY ASKED QUESTIONS:

Q:    If I am diagnosed with this illness, for how long will I receive treatment?

A:    The duration of the treatment varies for different women; it also depends on factors such as how soon one accesses medical help and how much support she experiences during her treatment. The actual duration would be at the discretion of your physician.

Q:   What are the warning signs of postpartum psychosis?

A:   They include sleeplessness even when the baby is asleep, irrational and excessive talk, anxiety, abnormal behaviour, withdrawal from family and friends.

Q:   What do I do about feeding my child while I receive drug treatment?

A:   We advise that while on medications such as lithium, antipsychotics, babies should not be breastfed as these drugs are present in breast milk. Such infants can be placed on infant formula until the mother is fit to resume certain roles.

Q:  How does someone who had an episode of postpartum psychosis prevent it from happening again?

A:  You need to inform your obstetrician about your past illness, at which point a proper post birth plan can commence. It’s important for your family to be involved as they have to aid with most of the baby care in the initial stage post delivery. The actual drugs used will be determined by your doctors.

Q:  What is the impact of postpartum psychosis on child care from the ill mother?

A:  As long as the mother receives prompt treatment and adequate familial assistance, there is no evidence that suggests any adverse effects on the child. This is because with proper help she will be able to function at her best when she fully recovers.

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