Don’t brush off baby blues
'Depressed mothers are more likely to not want to nurture or spend time with their babies. This may result in a neglected baby.'
For many women the associated stress of pregnancy and childbirth is simply too much to bear, which results in maternal mood disorders that may cause havoc in their lives.
Maternal mood changes and maternal health disorders before and after child birth are common, Dr Lavinia Lumu, a psychiatrist at Akeso Crescent Clinic, points out.
Postnatal depression in South Africa is as high as 34.5%.
According to the World Health Organisation, 10% of pregnant women and 13% of women who have just given birth, have a risk of developing a mood disorder.
Occurrence
Maternal mood disorders may occur during pregnancy (antenatal) or up to 12 months after delivery.
Mood disorders that are likely to occur before or after childbirth include depression and bipolar disorder, which may present with either a manic or a depressive episode.
Pregnancy, childbirth
‘Pregnancy is a vulnerable time. There is a surge in reproductive hormones during pregnancy. The increase in reproductive hormones can precipitate or worsen an underlying mood disorder.
‘Childbirth is an intensely physiologically stressful period. After birth, there is a drop in reproductive hormones and this becomes a very high-risk time for the development of postnatal depression and bipolar disorder – which could also present as a postpartum psychosis.’
Stressors
Psychological stressors can predispose a mother to a mood disorder.
‘Financial problems, intimate-partner violence and a lack of social support can all predispose a mother to a mood disorder.’
Effect on mother and child
‘The mother may have symptoms of depression such as lack of enjoyment in activities, severe anxiety or excessive worry, severe insomnia, poor appetite and concentration, negative ruminations, excessive guilt and suicidal preoccupation can impair a mother’s ability to care for her new-born.’
Data suggests that mothers with antenatal depression may have a small increased risk of pre-eclampsia and a moderately increased risk of giving birth to a baby with low birth weight.
Manic episodes in bipolar disorder may be associated with an increase in risky behaviours such as promiscuity or substance use, which could affect the unborn foetus during pregnancy.
Bipolar disorder has been associated with placental or foetal abnormalities and antepartum haemorrhages, restricted birth weight or gestational age.
Maternal role
When a mother has a severe mood disorder, she may be unable to fulfil her maternal role in the family, Dr Lumu adds.
‘Her mood may become unpredictable and this may cause distress to the children. In severe depression, mothers may feel fatigued and lack energy; this may result in the children’s needs being neglected.’
Mothers with severe mood disorders need support and assistance with the care and nurturing of children in the family, Dr Lumu advises.
Treatment paramount
Mood disorders do not resolve spontaneously and tend to get worse if left untreated, Dr Lumu cautions.
‘Untreated depression, for example, can result in severe symptoms such as suicidal thoughts, thoughts of infanticide or psychosis.’
Depressed mothers or mothers with a suspected mood disorder must seek professional help so as to receive effective treatment.
This will ensure that they are able to continue to care for their babies, Dr Lumu stresses.
This said, having a mood disorder does not mean that one cannot be a good mother, Dr Lumu adds.
But, if the mood disorder is untreated, the neonatal outcomes are poor.
‘Depressed mothers are more likely to not want to nurture or spend time with their babies. This may result in a neglected baby.’
Worsen
Mood disorders during pregnancy and after delivery may worsen if left untreated.
An untreated mood disorder can carry on for months.
Depressive symptoms that may occur during the perinatal period include a low or depressed mood for at least two weeks, associated changes in sleep, appetite and energy levels, associated symptoms such as impaired concentration and memory, feelings of guilt and hopelessness and social isolation.
Recurrence
Mothers who have had postnatal depression in past pregnancies are at risk of having postnatal depression in their next pregnancies.
Mothers with bipolar disorder are at high-risk of relapse during pregnancy or after delivery.
Professional care and appropriate treatment, as well as family support can help mothers with mood disorders on the way to recovery so that they, along with their families, can enjoy happy, fulfilled lives.
Anyone who thinks that they may have a mood disorder, should seek help at their nearest primary healthcare clinic or healthcare provider.
There are organisations that can also assist with any information or queries, such as Akeso Clinics across SA or SADAG (South African Depression and Anxiety Group – 0800 567 567 or SMS 31393).
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