The birth of a child can be a joyous and exciting time, but following childbirth, some women exhibit behavioural changes that tend to blight the moment. They may experience baby blues, a mental health challenge, which occurs during and immediately after childbirth. Experts say that this condition is very common and treatable, reports Sade Oguntola.
Looking at Aishat Adekunle, a mother of two, it was obvious that all was not well. She sat at the far end of the room looking at her baby, lost and uninterested in the people around her. Her mother was holding the baby as she talks to the doctor on several attempts to get Mrs Adekunle involved in the care of her baby that proved abortive.
Motherhood is often thought of as a time of bliss, with mother and baby quickly forming a joyful bond. But sometimes, a mother may experience an array of confusing and frightening symptoms for which she is completely unprepared. She might find herself unable to sleep or eat, be subject to sudden panic attacks, or feel nothing toward the baby she had expected to enjoy. Often, mothers feel inadequate and guilty, afraid to admit their feelings, especially in an age where women are expected to be “super moms”.
Now researchers understand that early motherhood is a time of great stress considering the biological confusion from the pregnancy combined with sleep deprivation, and the strain of changing daily routines. The mood swings, a new study published in JAMA Psychiatry, which could start during pregnancy or in the first months after giving birth, said can increase her child’s risk for depression 18 years later.
Research shows that half to as many as 85 per cent of new mothers, experience what’s called “baby blues” — an intermittent sadness early in the baby’s life. But about 14 per cent of these new mothers show signs of sorrow that is deeper and lasting more than a few weeks, and they have lost interest in their daily activities, often including the baby.
A fraction develops a condition called postpartum psychosis. They hear voices, sometimes telling them to harm themselves or their new baby.
New mothers who suffer depression or psychosis probably have a genetic vulnerability to the hormone disruptions of pregnancy, or to a major mood disorder, or have fewer reserves to cope with the stress of new parenthood. Of course, some of its signs may have been showing during pregnancy, but now get worse after pregnancy because of some situations.
The prevalence and the significant risk factors for maternity blues seem to differ across culture. For instance in Ile-Ife in Osun State, a study puts the prevalence of maternity blues at 31.3 per cent, and its symptoms peaked on the fifth day after delivery.
Dr Chinedu Nwokocha, a consultant obstetrician and gynaecologist, University College Hospital (UCH), Ibadan, Oyo State said, “quite a number of cases of women who develop maternal blues, a mental health problem after delivery, go unnoticed because they are mild. But where it goes beyond this, into what is termed puerperal psychosis or frank madness, such is easily noticed.”
“Such new mothers will not be interested in taking care of their babies and might want to harm their babies. They might be withdrawn, not wanting to see their husbands or even experience crying spells,” he said.
Recalling a case he had handled before, the medical practitioner said, “the woman had no manifestation throughout pregnancy. But she developed puerperal psychosis four days after childbirth and had to be admitted. She was a banker. This means it can affect any woman, irrespective of her social status.”
Although mental illnesses such as frank madness or schizophrenia is not reason a woman should not get pregnant and have a baby, Dr Nwokocha said, however, “if a patient for some reason default in her treatment and eventually gets pregnant, such could result into puerperal psychosis. Of course, this would affect the way they take care of themselves and their babies.
“In fact, at that period, some of them might not even want to see their husbands. In fact, there was a lady in China who stabbed her baby 90 times because the baby bit her nipple while breastfeeding.
“To the outside world, the situation may look ridiculous, but to the medics, they know that the woman obviously had puerperal psychosis. So it is important that people should actually embrace orthodox medicine rather than dismissing this obvious medical condition that has a solution.”
For him, the case of a mother in Osun State who committed suicide 11 days after delivering a set of twins by jumping into a river put a question mark on the health system in Nigeria.
The medical expert expressed the possibility of the woman failing to access antenatal care at the hospital during pregnancy, thereby preventing the problem from being detected early. According to him, “It is important that pregnant women access proper care and the doctors should watch out for things that suggest a problem.”
Why baby blues, depression or even puerperal psychosis in pregnant women and can their husbands help in its prevention?
According to Dr Nwokocha, “we normally encourage the men to accompany them to antenatal clinic so that we can tell them things to expect so that these things can easily be taken care of or even prevented.
“Sometimes, it is the continuous pressure that they could have and without the support and understanding of their partner that will trigger the full blown puerperal psychosis, which is not palatable.
“There are so many behaviours that we see in pregnancy due to increasing hormones such as a woman craving to eat sand. Such things if not taken care off early can tip some women over to a serious mental issue after delivery. So we need to note, recognise and do something about them. Most importantly, they need support, they need understanding in pregnancy.”
Also speaking, Dr Jibril Abdulmalik, a consultant psychiatrist at the same hospital, stated that mental illness or psychological problems had to do with the brain. “Every part of our body can develop problems at any point in time. The brain, too, can also develop problems in terms of thinking, emotion and behaviour at any time. Some disorders are commoner at specific periods. There are some that are peculiar to women at different stages of life and these include depression and psychosis.”
Just as there are medical conditions that are specific to pregnancy such as eclampsia, Dr Abdulmalik said depression has implications both for the mother and the baby. Studies have shown that women who have depression have a higher chance of having complications.
“When the mental problem starts in pregnancy, they may give birth to small or premature babies. Where the woman is feeling sad, crying all the time, feeling hopeless and had lost interest in looking after herself or the baby, in its extreme form, it could lead to suicide or killing her baby,” said Dr Abdulmalik.
“In our environment, we usually attribute many things such as tiredness to pregnancy. Although some of these symptoms occur in pregnancy, when they are quite severe, it may be that there is actually a depression, and not merely symptoms of pregnancy.”
People need to know that this is actually a medical problem. It is as a result of certain chemicals in the brain which affect their behaviour. So, it is not enough to tell them to be strong or be critical about them, treatment would be required if it is severe,” Abdulmalik stated.
Some of the symptoms to watch out for, according to the expert, are excessive feeling of sadness, moodiness and tiredness all the time; hopelessness or pessimism about the future, poor appetite and problems with sleeping, all lasting for a long period of time.