What is the greatest fear of a new mother
Mental disorders after childbirth
The depressive disorders that occur after childbirth can be roughly divided into three categories: The period of moody instability and depressive mood in the first three to five days after the birth is called “postnatal blues” or “baby” in English called blues ”. According to studies by various authors, such changes can be observed after around 50 to 70% of all deliveries. On the other hand, so-called postnatal depression or postnatal depression, with a frequency of around 1 in 10 births, is much less common. They usually occur in the first few weeks after discharge from the maternity hospital and can usually be treated on an outpatient basis. There are transitions from postpartum depression to the very rare postpartum psychoses (after about 1 to 2 in 1,000 births).
As part of a depressive mood after childbirth, a variety of different symptoms can occur, such as depressive mood with frequent crying, brooding, hopelessness, feelings of inferiority and guilt, fear, inner restlessness, lack of interest, listlessness, concentration disorders, inhibition of thinking, inner emptiness and difficulties, To make decisions or to feel feelings such as love or sympathy (often resulting in the problem of not yet having “mother feelings” towards the child).
The physical well-being is also usually disturbed, e.g. by sleep disorders, loss of appetite, constipation, headaches, heart problems, tightness in the chest, feeling of lump in the throat as well as a variety of other physical discomfort and decreased sexual interest. These physical symptoms can also be in the foreground of the symptoms and are then often explained with the consequences of childbirth, the stress caused by the child, breastfeeding, lack of sleep, etc. Depression after childbirth is usually associated with sleep disorders (difficulty falling asleep and staying asleep and possibly also premature awakening). There can be typical fluctuations during the day with low mood in the early morning and mood lightening during the day.
The occurrence of obsessive thoughts and impulses (recurring unpleasant thoughts and impulses that are usually regarded as nonsensical) - such as the thought or impulse to harm the child, perhaps, can be very tormenting for the affected mother killing, etc. Such obsessive thoughts usually terrify the mother; she sees it as proof that she is a bad mother and does not love her child, and lives in fear that one day she might do the terrible thing. Feelings of guilt and shame often prevent mothers from reporting such thoughts - they believe they are "the only bad mother" in the world.
The symptom of suicidality, which occurs almost regularly in severe depression and must then lead to inpatient treatment, must be taken very seriously (approx. 10 to 15% of the depressed die by suicide, with young mothers there is also the risk of extended suicide, see below).
In the so-called psychotic depressions after childbirth, the patient can also be delusional (that is, absolutely and uncorrectable) convinced that she did not take care of the child properly, that she is a bad mother and that the child is harmed as a result, etc. The consequence of such serious problems In tragic individual cases, psychotic depression is the killing of the child (infanticide, total frequency about 1: 50,000 births) as part of a so-called “extended suicide”. The focus is on the mother's suicidality, who from her depressive point of view no longer sees any hope for herself or her child or wants to release the child from his supposed suffering and first kills the child and then herself.
In the context of such postpartum psychoses, depression can also mix with other psychotic symptoms, such as disorders of the formal train of thought, delusions of persecution and impairment, hallucinations (optical or acoustic perception without external stimuli, e.g. voices with a commenting or commanding character) or disorders of I experience (Belief that thoughts or body movements are being influenced from outside). In these so-called schizodepressive postpartum psychoses, the subject of the delusional symptoms is very often the conviction that they are being persecuted or killed, or the idea that the child has been mixed up, the child is a Satan, etc. This can also lead to a dramatic development.
If the opposite manic symptoms to depression occur, namely an elevated mood with euphoria, increased drive, disinhibition, reduced need for sleep, size ideas, etc., it is most likely a manic or schizomaniac psychosis after childbirth. In these cases, a risk results from improper handling of the child or a disruption of general judgment.
In the first few days after delivery, the howling days with mood swings etc., which can be regarded as “normal”, are most likely to occur. The risk of developing psychosis is greatest within the first two weeks; around 70% of all psychoses after childbirth begin during this time. Postnatal depression, on the other hand, can begin immediately after delivery as well as weeks and months later.
Postpartum psychosis and depression most often occur after the first delivery. Age, marital status, school education, occupation, delivery method or gender of the child have no direct influence on the occurrence. However, the risk of illness is greater if there is a history of psychological disorders or a family history, e.g. if women have already suffered from postnatal depression or psychosis, or if psychological disorders have occurred in the family as a whole.
In the first few weeks of pregnancy, the hormones progesterone and estrogen do not decrease as they usually do in the second half of the menstrual cycle, but continue to rise to a high level and stay there throughout the pregnancy. After delivery, the loss of hormones produced in the placenta leads to a very abrupt drop in hormones. It makes sense to blame these rapid hormonal changes after childbirth for the psychological disorders that then occur. The intensive research on this topic could not show any compelling connection; Most likely, the hormonal changes are still responsible for the mood lability after delivery (howling days) mentioned above.
Since postnatal depression does not occur in all, but only in about one in 10 women after childbirth and postpartum psychoses are even more rare, the hormonal change after the birth is probably just one factor in a multifactorial process. Various other factors can play a role in depression and psychoses post partum: the aforementioned family burden with mental disorders, the physical burden of childbirth in general, possibly increased by caesarean section or infections, etc., sociobiographical parameters such as an unwanted pregnancy or otherwise difficult social situation, relationship problems, the new mother's attitude to her changed role, often associated with withdrawal from professional life, and finally the psychological stress that can be associated with childbirth, such as illness or death of the child or other additionally occurring relevant life events. It must be said, however, that in a number of sick women no stress factors whatsoever are recognizable.
The treatment of mental disorders after childbirth depends on the severity and severity: The "crying days" usually do not require treatment and pass by themselves. Postpartum depression, on the other hand, is too seldom recognized and treated, often because the complaints that occur are viewed as “normal” for a young mother or because she is ashamed to report her complaints and fears. Depending on the symptoms, a combined psychotherapeutic / pharmacotherapeutic treatment is recommended. The use of medication (antidepressants) is usually indispensable for severe depression, but this is made more difficult if the mother wants to continue breastfeeding (most medications pass into the breast milk).
The aim of the psychotherapeutic measures is to cope with the symptoms of the disease, to educate about the disease with the involvement of the husband, to learn how to deal with symptoms (especially important when fears and obsessive thoughts arise), but also to adapt to the new situation in family and work.
In the case of psychotic depression or schizodepressive postpartum psychosis, inpatient treatment is essential (e.g. because of the risk of suicide); here, drug treatment comes first. The same applies to psychoses with manic symptoms - inpatient treatment is absolutely necessary, even if the affected mother has no feeling of illness herself. After the psychotic symptoms have subsided, the treatment must also be supplemented by psychotherapeutic measures in these cases, since those affected and their relatives often have great difficulty coping with the experience of this disease. Contact with other affected persons can also be helpful, e.g. within the framework of self-help groups.
- Ann Dunnewold, Diane G. Sanford: "I would love to be so happy!" Upsetches and depression after childbirth. Help for mothers and fathers. Trias Verlag 1996
- Elisabeth Geisel: “Tears after the birth”. Kösel Verlag 1997
- Petra Nispel: “Mother's happiness and tears. Understanding and Overcoming Postpartum Depression ”. Herder Verlag 1996
More articles by the author in our family handbook
Prof. Dr. med. Anke Rohde
University Hospital Bonn
Tel .: 0228 / 287-4737
Study on the psychosocial counseling of pregnant women in the context of prenatal diagnostics
Self-help group “Schatten & Licht” e.V.
Created on June 22, 2001, last changed on February 19, 2010
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