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When the cradle falls: the cost of perinatal illness

 

Felicia Boots, a new mother of a baby boy, has been arrested on suspicion of murder after her two children were dead in the family home, apparently smothered. The story has attracted considerable media attention, not just because of the horror of the loss of these young lives, but also because the family were affluent and were described by neighbours as ‘the typical middle class couple’. A friend has reported to the press that Felicia was suffering from postnatal depression, and had also been ill with this disorder after the birth of her daughter Lily.

Postnatal depression is common and experienced by up 1 in 10 new mothers. Though it is more often seen in mothers from underprivileged backgrounds , it is no respecter of class or status. Recently, celebrities such as Jennifer Lopez and Gwyneth Paltrow have spoken out about their difficulties and Diana, Princess of Wales suffered from the disorder after the birth of Prince William. Symptoms such as difficulty sleeping, tearfulness, anxious ruminations about the baby and irritability start typically in the first 4-6 weeks after the birth of the baby and can be crippling and terrifying for the sufferer and their family. Many new mothers report feeling ashamed that they are not able to take pleasure in their new arrival and have the ‘picture-perfect’ time with their baby that the media depicts. In its most severe form – puerperal psychosis – mothers may develop the idea that they may harm their baby, or that their baby is abnormal in some way. Thankfully, stories such as the above are extremely rare and the vast majority of mothers with postnatal depression take diligent care of their babies, often at the expense of their own health.

There are effective treatments available for the condition that can swiftly return mothers to their previous level of functioning. Treatments may include the use of antidepressant medication, but also talking treatments such as brief interpersonal psychotherapy have been found to be helpful [2]. Certain women need to be aware they are greater risk and should ask to be monitored carefully. Women with a history of previous post-natal depression are twice as likely to become unwell [1], and those with bipolar disorder have a 1 in 2 chance of relapse after delivery [3]. Another – often neglected – risk factor is depression in pregnancy; women who feel low and anxious when they are expecting are at much greater risk of postnatal depression [4]. The key message for new mothers is – don’t be afraid to speak out as early help predicts better recovery, and reaps dividends not just for you but also for your baby. For more information on postnatal depression visit the Royal College of Psychiatrists website.

1. O’Hara M, Swain A: Rates and risk of postpartum depression – a meta-analysis. International Review of Psychiatry 1996, 8 :37-54.

2. Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev. 2011 Jul;31(5):839-49.

3. Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz GE, Wright R, Keck PE Jr. The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatry. 2002 Apr;63(4):284-7.

4. Evans, J., Heron, J., Francomb, H., Oke, S., Golding, J., 2001. Cohort study of depressed mood during pregnancy and childbirth. BMJ 323, 257–260.

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