What other mental health disorders can affect you after childbirth

Post-traumatic stress disorder (PTSD)

If you have a difficult labour with a long and painful delivery, an unplanned caesarean section or emergency treatment, you may experience a form of posttraumatic stress rather than postnatal depression. The impacts of this are often underestimated, as people may feel that the baby is adequate compensation for the trauma, and that, as a new mother, you will soon forget the ordeal in the joy of motherhood.

However, a traumatic childbirth may impair your relationships with both your baby, and your partner. You may feel acute disappointment that childbirth was not the wonderful experience you were hoping for, and feel angry with the medical staff if you felt that the delivery was not handled well. Many mothers even avoid further pregnancy after a negative birth experience like this.

If you have experienced a traumatic delivery, you can ask for help via your doctor to deal with the trauma. This can make it easier to put the experience behind you and minimise the risk of developing long- term depression.

Puerperal psychosis

This is a serious, but rare, psychiatric illness, occurring in less than one in 1,000 births. It is similar in some ways to bipolar disorder. If you are diagnosed with this disorder, you may experience the following symptoms:

  • Mania
  • Severe depression with delusions
  • Confusion or stupor
  • Rapid changes in mood between mania and depression
  • Delusions
  • Hallucinations

It usually starts quite suddenly a few weeks after the birth. You may feel very restless, excited or elated, and unable to sleep. You may feel confused and disorientated, and find it difficult to relate to your environment, or fail to recognise friends or family members. This can make it difficult for you to bond with your baby.

You may have delusions or hallucinations. You may misinterpret what is happening around you – for example, you may think your baby is being taken away from you, when staff are simply taking it for a nap or to be fed. You may be manic (for example, cleaning the house at three o’clock in the morning), or have wild mood swings from high to low. Your behaviour may become increasingly disturbing to those around you, and you may lose touch with reality. It is likely that you will need help, and medical and social support.

Causes and risk factors

There is some evidence that puerperal psychosis runs in families, and if you have had a previous experience or family history of mental health problems (for example, a diagnosis of bipolar disorder), you are at a higher risk of developing it. However, it often appears with no warning.

It is slightly more common in first rather than later pregnancies, and one experience of puerperal psychosis does not necessarily mean that you are likely to have it again after subsequent pregnancies.

Available treatments

It is important to get appropriate help as quickly as possible, as there is an increased risk that you might not be able to care for your baby without support from others.

Treatment may involve you staying in a hospital, in a mother and baby unit within a psychiatric ward where this is available, and will usually include antipsychotic drugs such as olanzapine or quetiapine, or antidepressants. As many psychiatric wards or hospitals do not have mother and baby units, you may have to be away from your baby while you are being treated.

Clearly this is undesirable, and if you have to be away from your baby, this should be for as short as possible.

Sometimes it may be necessary for you to be treated with certain drugs. All published advice states that antipsychotics should be avoided while breastfeeding. However, many experts believe that if women can be managed with a low dose of a single antipsychotic drug, the benefits of breastfeeding are likely to outweigh the risk of harmful effects.

Doctors may suggest using electroconvulsive therapy (ECT) which can be effective, and does mean that breastfeeding can continue. If you are offered this treatment, it will be given under general anaesthetic. Because there is a risk of side effects – headaches and short- and long-term memory loss, your treatment should be carefully monitored. If you experience memory loss, the treatment should be stopped. ECT should only be offered if other treatments have not worked.

Most women recover within a few weeks, but it may take a long time to get over it completely.

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