Some weeks ago, we had a counsellor talk to our community about mental health during pregnancy and after birth. The counsellor, Rebecca Wamwene offered expert advice and answers to questions asked in the chat. In this article, we’ll share answers to questions on taking care of your mental health after birth.
What is the major cause of puerperal psychosis in pregnant women?
These are very severe depressive episodes characterized by the presence of psychotic features which are different from Postpartum Depression in etiology.
Severity, symptoms, treatment and outcomes
Though it is majorly suggested that Puerperal psychotic is genetic, other factors include hormonal imbalances and children bearing complexities. Note: it does not happen to pregnant women but happens a few days after delivery. While puerperal psychosis can happen to anyone, there are those who are at a higher risk of developing it especially those with a history of bipolar disorders, depression, stress during pregnancy etc.
Are women who go through it predisposed to other forms of depression in later life?
It has serious consequences such as child neglect, hallucinations and or delusions, infanticide and suicide. Due to its severity, it needs hospitalization for treatment. Although the prognosis is generally favourable and women fully recover, they are at risk of developing puerperal psychosis and non puerperal psychosis episodes of bipolar affective disorder (BAD). This may need further explanation in a future session.
If treated early, someone should not worry about having developed psychosis but that one puts you at risk of psychiatry conditions. Risk factors mean you are likely to get other forms of depression but it may also never happen.
How would you advise a mum on signs to look out for with regard to postpartum depression (PPD)?
Postpartum depression is the most common complication of childbearing affecting women and their families. It affects the mother, her marital relationship, and her children.
Signs and Symptoms
Clinical studies suggest that mood disturbances following childbirth are not significantly different from illnesses that occur in women at other times. PPD is characterized by
- Emotional instability
- Feelings of guilt
- Loss of appetite
- Sleep disturbances
- Feeling inadequate and unable to cope with the infant
- Poor concentration and memory
N/B Some women may worry excessively about the baby’s health or feeding habits and see themselves as ‘bad’, inadequate, or unloving mothers.
How do I manage my anger towards my son? He is only 6 months old. I find myself shouting at him and sometimes even wanting to hit him when crying uncontrollably.
Anger is a natural human emotion. Once it goes unmanageable then it is reason enough to worry. The following tips could help a mother manage explosive anger:
- Self-awareness: What is the real cause of the anger (is it the son himself his uncontrollable cry, is it repressed anger maybe from the father, how you got pregnant etc, is the anger a result of postpartum Blues, postpartum Depression etc). Do a thorough evaluation of your anger.
- Recognising signs of anger: It’s really important to know and say that you’re angry, even if it’s just to yourself. e.g, ‘This is making me angry’ or ‘I can feel myself getting angry.
- Try to calm down: Take a deep breath count ten then release with a count of ten puffs. Do this a few times until your heart rate slows down.
- If your child is being very loud, try blocking your ears or putting on noise-cancelling headphones for a moment. Then take a few deep, slow breaths.
- Talk to someone about how you are feeling and reflect on the situation: Once you’ve calmed down, reflect on what has just happened. This can help you learn from the experience and handle similar situations better in the future. Ask yourself: ‘How important is this? Why was I so upset about it? ’How do I want to sort out this situation?’‘Do I need to do something about this, or can I just let it go?’
Why is it difficult to recognize or admit to being depressed or anxious during pregnancy or postpartum?
I am not sure if someone would actually tell when they are starting to lose their mind, but as a family, if you notice someone detaching from their baby, excessive mood, mania like depression should seek or consult a doctor or counsellor. Women need to be educated about complications of birth before birth and during their prenatal period.
Basically all women, rather most women experience maternal blues/ baby blues.- excessive emotions, tearfulness, anxiety, lack of sleep etc. Some people experience a worse form of it which is termed as Puerperal psychosis or depression. Good prenatal care with a gynaecologist and psychologist should identify maternal stressors during pregnancy or history of such mood disorders or psychological issues before. That way a follow up on the same immediately after childbirth would help with early diagnosis.
I am a new mom and adjusting has not been easy. I am constantly worried about my son and I feel I am not good enough. How do I best handle postpartum anxiety?
Postpartum anxiety disorder is a cousin to postpartum depression (PPD) that affects about 10 % of new moms. Anxiety is a natural response to protect one’s baby, and often that’s expressed with hyper-alertness and hyper-vigilance.
Be sure it is PPA. One must have the following 2 or more persistent symptoms for a period of not less than 2 weeks
- Excessive worry
- Feelings of dread
- Racing thoughts
- Lack of concentration
- Changes in eating and sleeping patterns
- Hot flashes
- Rapid heartbeat
Examine your thought process. Discard the negative thoughts and embrace positive thoughts.
Examine the mental voices that tell you you aren’t good enough. Are they hallucinations, are the external voices from friends, relatives etc?
Examine your self-esteem. When you say you aren’t good enough whom do you compare yourself with? Exercise, check on your diet and seek counselling.
How do you help a baby when she takes more than 3 days to poop?
It is not unusual for a neonate to go up to 5 days without passing stools since they may be absorbing most of the breast milk, however, if they have not passed the very first stool (meconium) in the first 48 hours need to seek medical care as this could indicate – imperforate anus, intestinal obstruction from meconium plug syndrome, Hirschsprung (lack of nerve cells in the bowel causing difficulties with bowel movements).
Do you think that COVID caused adverse mental issues especially with pregnant women during this pandemic or those who gave birth just as it was starting? Do you think the mental stress has lessened as the months have gone by?
Covid 19 being one of the worst pandemic experiences worldwide caused a lot of anxiety to all humankind. Some of the worst hits were pregnant mothers and new mothers. It may have increased with the current changes because of financial constraint and the fear of the second wave.
However, this depends on individuals. People give paracetamol for pain and fever after vaccines- some researchers and medics discredit this citing that it reduces immunity It is always good to confirm with your Doctor.
My sister is sharing that she’s anxious, feels unsafe at home, very sensitive to what’s said to her and says things like, “I’m not suicidal, I’m not saying I’m suicidal but all I’m saying is this is how people get depressed and pushed into suicide because of not being listened to”. She doesn’t know why she feels like she’s not mentally 100%. Why would that be? How can I help her?
Kindly get immediate counselling for her. A suicidal case is never to be wished away.
When a new mum has thoughts of harming the baby is that a sign of PPD?
It may not be termed so before you see a doctor verify that. It could be another mental disorder or even underlying issues surrounding pregnancy and birth. Kindly see a doctor and a counsellor.
What’s the key difference between a Counselor and Psychologist? How can one determine whom they should see?
Counsellors and counselling psychologists perform similar duties, but there are some key differences between the two professions. Both help people live better lives, but counsellors and counselling psychologists have different educational backgrounds, areas of focus and specialization, and work settings.
What has been the biggest contributor to the mental state of women especially with the pandemic?
- Fear of the unknown
- Financial constraint
- Having to stay home with spouses and children. A thing that was not so common.
Can one self-diagnose on Depression and take medication?
No. You can’t and shouldn’t self medicate. See a doctor and a counsellor.
Stress: In medical or biological context stress is a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure). Stress can initiate the “fight or flight” response, a complex reaction of neurology and Endocrinol systems.
Stress can cause or influence the course of many medical conditions including psychological conditions such as depression and anxiety. Medical problems can include poor healing, irritable bowel syndrome, high blood pressure, poorly controlled diabetes and many other conditions.
Kindly seek advice from a counsellor or a doctor who will do a psychological Assessment Test to help you know where you are at.
Can one have a mental health condition and not be aware of it?
Yes. It isn’t always obvious but if you have unusual feelings and behaviour visit a doctor or a counsellor.
Is there a preferred mode to treat mental health issues i.e. medication vs therapy?
This can only be prescribed by an expert. Either a doctor or a counsellor/therapist.
Do you have advice on some questions we can ask someone to make sure they’re mentally okay? That they’re not struggling or suffering?
I would like to bring to our attention the seriousness of any word spoken or actions done to a person who is mentally unstable. What you think is a simple statement is enough to throw them off balance. An expert will be able to ask questions that are not offensive.
How long can postpartum depression last if not addressed?
Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems. For mothers, untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder.
After birth is it normal to have thoughts about your child getting hurt? Not necessarily you hurting them… But them getting hurt in some way that devastates you and leaves you feeling empty?
It’s normal and natural maternal instinct to be overprotective over your newborn and there is nothing wrong with that.
How does someone going through anxiety or depression ask for help? Especially if they’re scared of the stigma attached to this?
Just gather courage and talk to someone. It’s more about your wellness than the Stigma that may be attached to it.