Sydney Pelvic Floor Health

Postnatal Depression

Psychological consequences of traumatic childbirth

For most women, the birth of a child is a wonderful experience. For some, however, it is the most stressful experience of their entire life, and many are poorly prepared for such a crisis. Antenatal care and education provides virtually no information on possible complications, even though a perfectly smooth birth process is actually not that likely in developed societies today, given that first- time mums are getting older and older, and due to the obesity epidemic. More and more first time mothers suffer from gestational diabetes, need an induction of labour or have complicated labours, because the older and bigger you are, the less smooth things are likely to go. In a recent study of ours, only about 25% of all first- time mothers had a normal birth without any complications or trauma.

Of course, a birth ending in a Caesarean can be quite traumatic. However, the worst experiences often occur with difficult vaginal births, especially Forceps. Often, the bodily consequences of such a birth, that is, tears to the pelvic floor, the perineum and the anal sphincter, don't just cause pain and ongoing discomfort. Symptoms arising from such trauma, that is, pelvic organ prolapse, urinary and fecal incontinence and vaginal laxity, provide a constant reminder of a very stressful experience. This can interfere with bonding, change family dynamics, and influence the decision to have more children.

It is likely that a traumatic birth experience can contribute to postnatal depression (see below) or even posttraumatic stress disorder.


Postnatal Depression (PND)

Many women experience mood swings after the birth of a baby. However, postnatal depression (PND) describes more severe or prolonged symptoms of depression that last more than a week or two and interfere with the mother’s ability to function on a daily basis with normal routines including caring for a baby. It is important to note that PND is different from the baby blues that is common during the first week after childbirth.

Stresses and emotional changes that accompany women’s postnatal experiences can be intense and include strong depressive mood swings, anxiety, social withdrawal, irritability and loss of enjoyment in usual activities. Postnatal depression can interfere with the developing relationship between a mother and her baby after birth and impose strains upon the relationship between the parents, as well as causing distress for women themselves.

Severe disorders require treatment and it is very important to tell your doctor or midwife about current symptoms of distress as well as any past history of depression or other mental problems, and medication or substance use. Symptoms of anxiety and depression that start during pregnancy or the postnatal period are similar to those that occur at any other time in a woman’s life, but the focus of the fears and depressive concerns can be the wellbeing of the baby, or feelings of inadequacy as a parent.

Common PND symptoms:

 * Loss of enjoyment in usual pursuits

* Loss of self-esteem and confidence

* Loss of appetite and weight

* Broken sleep (irrespective of baby)

 * Sense of hopelessness and being a failure

* A wish not to be alive

 * Frank suicidal thoughts or ideas

* Panic attacks

* Loss of libido

* Fears for the safety or wellbeing of the baby and/or the partner.

Women who experience PND may have feelings of guilt and shame, their self-esteem is often low and they see themselves as bad mothers. They may not tell clinicians or family and friends about these feelings, as they fear that something is seriously wrong with them, especially if they are thinking of harming themselves and/or the baby. They may fear that their baby will be removed from their care or are worried about having a psychiatric disorder on their record.

PND Risk Factors include:

 * Anxious pregnancy

 * Marital Unhappiness

 * Lack of close friends

 * Previous history of postnatal depression

 * Previous history of other mood disorders/psychiatric illness

 * Depression earlier in pregnancy

 * Traumatic life events

* Lack of bonding with mother or bereavement during own childhood

 * Temperament of the baby

Treatment for PND

* Counselling and/or drug therapy

 Another alarming condition following childbirth is puerperal psychosis, which is thought to be caused by hormonal changes. The symptoms can include severe delusions and also hallucinations. It is important that it is not confused with PND.

 For further information see:

 http://www.blackdoginstitute.org.au/public/depression/inpregnancypostnatal/postnataldepressionpnd.cfm