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After giving birth, several women experience some symptoms, which can take a while to return to normal:
– Urinary:
Pain when passing urine and stress incontinence
– GI:
Inability to pass stool for a few days after birth and increased risk of haemorrhoids
– Genital:
Pass Lochia (this is vaginal discharge containing blood, mucous and uterine tissue
Can continue for 6 weeks after birth and slowly turns brownish colour before finally stopping
However, there are situation where women experience longer term, more serious symptoms after pregnancy
Postpartum Thyroiditis
This is a condition where there is dysfunction of the thyroid gland in the year after giving birth.
– During pregnancy, the immune system is in a partial state of immunosuppression
– Once the baby is born, the system rebounds which can lead to autoimmune damage of the thyroid gland
– As thyroid cells are attacked and destroyed, this causes leakage of T4 which leads to hyperthyroidism
– However, it then progresses to hypothyroidism after as there are fewer functioning thyroid follicle cells
Symptoms:
There are usually 3 phases which occur in the 1st year
i) Hyperthyroid phase –> irritability, palpitations, heat intolerance (from 2-6 months)
ii) Hypothyroidism –> low energy, cold intolerance, weight gain, impaired concentration
iii) Normal thyroid function restored after 1 year
Management:
– Manage each phase separately
– For hyperthyroid phase –> propranolol if needed to stabalise heart (most require no treatment)
– For hypothyroid –> levothyroxine
Baby blues
A period of low mood and irritability which normally starts a few days after birth, last around a week
– It is a very common condition, which is more commonly experienced after the first pregnancy
Symptoms:
– Increased anxiety
– Feelings of low mood, tearfullness
– Sleep problems
Management:
– No formal management required –> most mothers have complete resolution by 2 weeks
Postnatal depression
This is a disorder affecting both sexes defined as a depressive episode within the first 12 months after pregnancy
– This comes on later than baby blues, but the key difference is that symptoms will persist for months
Risk factors:
– Previous episodes of postnatal depression, mental illness, complications of childbirth
Symptoms:
– Gives classic features of depression (low energy, low mood and anhedonia) plus:
– Emotional –> persistent sadness, low self-esteem, guilt, thoughts of self-harm
– Behavioural –> low libido, changes in appetite, insomnia, fatigue
Diagnosis:
– This is done clinically
– The Edinburgh postnatal depression scale may be used –> Score of >13/30 indicates a depressive illness
Management:
– Social support if mild.
– If moderate or severe –> Psychotherapy (CBT) + SSRIs (sertraline is used in breastfeeding mothers)
Puerperal psychosis
This is a psychiatric emergency where the mother exhibits symptoms of mania, depression, hallucinations and delusion after giving birth to her child
– Whilst it is a relatively uncommon condition, half of women who experience it have no risk factors
– Women can exhibit a range of psychotic symptoms, but postpartum bipolar disorder (characterised by bouts of depression and mania) is the most common subtype in high income countries.
Risk factors:
– Previous episodes of postpartum psychosis, mental illness
– Complications of childbirth
Symptoms:
– Severe mood swings (like bipolar disorder) with periods of mania and depression
– Auditory hallucinations
– Agitation and distress
– Suicidal ideation (thoughts about harming baby)
– Delusions and bizarre ideas
Diagnosis:
– Clinical diagnosis (condition not recognised as distinct disorder in DSM-5 or ICD-10)
Management:
– Likely requires admission to psychiatric hospital
– Mood stabilising drugs (lithium) + Antipsychotic drugs
