The red flags of baby blues

Most new moms experience postpartum "baby blues" after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty in bonding with the baby, write Dr Prabha S Chandra & Dr Ashlesha Bagadia

There is more to postpartum mental health than Postpartum Depression (PPD) as even though PPD may be the commonest and rates in India range from 10–18%, mothers may also have other disorders. In fact, the first three months after postpartum carry the highest lifetime risk for a psychiatric disorder for any woman. What symptoms should one look out for?

Postpartum anxiety & obsessions

Postpartum anxiety and obsessions affect 10% of women after childbirth and are as common as PPD. Mothers may have excessive worries about their own health or the baby’s health, an inability to relax and feelings of extreme tension. She may also be overprotective and feel very uncomfortable when others look after the baby. Some mothers have obsessions which are repeated doubts that she is unable to control. She may fear being alone with the baby because of unwanted thoughts that she might harm the baby, or she might check again and again to see if the baby is breathing properly.

Postpartum post-traumatic
stress disorder

This usually happens if the mother has had a difficult delivery, has felt unsupported by the labour room staff or felt helpless and powerless during the obstetric procedures. Women with a past history of sexual trauma may have a worsening of anxiety. Panic attacks, flashbacks of the difficult childbirth and nightmares may be some of the symptoms. These may also surface during subsequent pregnancies.

Postpartum depression

The commonest mental health problem after childbirth starts anywhere from a few weeks to a few months after childbirth and often in late pregnancy. The mother feels sad, tired, has poor self-worth, and is not able to enjoy motherhood or bond with the baby.

Self-harm in postpartum

The risk is high in the presence of these factors — if depression is severe, if there has been a suicide attempt in the past, if there is domestic violence or if the mum has psychosis. A mother with psychosis may hear voices asking her to kill herself or she may feel she has a serious illness. In many high-income countries, suicide is now the number one cause of maternal mortality. It is therefore important that PPD is detected early and appropriate treatment is started.

Bipolar disorder

Postpartum bipolar disorder and postpartum psychosis are less common conditions but need immediate treatment and should not be mislabelled as depression. Mothers may have mood swings, irritability, high energy levels, rapid speech, racing thoughts, sleeplessness, and aggression or complete withdrawal and may often neglect the infant. Postpartum psychosis usually starts within the first two months after childbirth.

Bonding disorders

Some mothers may not feel affection for the baby, have poor motivation to breastfeed and may be indifferent to the baby’s needs. Many women with bonding problems report past trauma in their lives and difficulties in relationships with partners or their own parents. It is often difficult for mothers to open up about this due to fear of judgement and an expectation that all mothers should immediately be able to bond with their babies.

(Dr Prabha S Chandra is a senior professor of psychiatry and in-charge of Perinatal Psychiatry Services, NIMHANS, Bengaluru while Dr Ashlesha Bagadia is a consultant perinatal psychiatrist at The Green Oaks Initiative, Annaswamy Mudaliar General Hospital, Bengaluru.)