December 16, 2017

FROM THE MATERNAL WARD TO THE PSYCHE WARD: A LOOK AT PARTUM DEPRESSION 

I had a vague idea that women who suffer puerpural psychosis (serious mental illness following childbirth) are more a danger to themselves and their babies than to their spouses.

Can infidelity and domestic violence contribute to the development of postpartum depression and puerperal psychosis in a mother? Absolutely! The fact however is that it is well documented that neonates and children are infinitely more at risk of being killed by their psychotic mother.

“There is a reason it is called Post Partum Depression.

The CAUSE of the depression……..IS THE BABY.”

In dispelling the myth of the above statement, let us look at the evidence:

“Although it has been suggested that postnatal depression is caused by low levels of progesterone or estrogen or high levels of prolactin, no consistent relationships have been found  ( Harris, 1994;  Hendrick, Altshuler, &  Suri, 1998).” Hence we can say with some measure of confidence that postpartum depression has no KNOWN CAUSE. That leaves us with contributory or so – called risk factors.
“In their meta-analysis, O’Hara and  Swain (1996) included 13 studies comprising over 1350 subjects that examined the effects of obstetric factors. They concluded that obstetric factors had a small effect (0.26) on the development of postpartum depression.”
“The evidence relating to Caesarean section and postpartum depression suggests that there is no association between the two variables. Warner et  al. (1996) and Forman et al. (2000) found no  significant association between elective or emergency caesarean section and subsequent postpartum  depression. Johnstone et  al. (2001) reported a insignificant trend between postpartum depression and caesarean section.”
“Unplanned or  unwanted pregnancy as a risk factor for postpartum depression  should be interpreted very cautiously.”
“There’s little question that the history of psychopathology puts women at  risk for depression in the postpartum period. The average effect size is one of the largest for the risk factors of postpartum  depression.”
Strong to moderate risk factors for the development of postpartum depression are depression during pregnancy, anxiety during pregnancy, stressful recent life events (e.g death of a loved one, divorce). Additional potent risk factors include lack of social support (either perceived or received) from spouse, friends and relatives, and a previous history of depression.
So to be clear, the lack of support from a husband could be one important factor in the development of a frank psychosis in a nursing mother. However, saying the man deserves his fate is rather a long stretch. Of course the woman could plead the insanity defence and ultimately be absolved of murder, but the victim is no less a victim, and the woman might spend the rest of her life in the psyche ward, unable to care for her child. Our focus should be educating people on how to prevent ugly incidents such as a woman stabbing her husband after childbirth.

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Author: Dr. Charles Uzor (Medical Practitioner).

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