Motherhood and Mental Health reviewed published work up to the end of 1995, citing over 2000 articles on postpartum disorders. For this review, I used PubMed to screen articles published in the past 7 years, under the headings “postpartum depression” (760 articles since 1995), “mother-infant relationship disorders” (290 articles), “postpartum anxiety” (370 articles, overlapping considerably with postpartum depression), “postpartum post-traumatic stress disorder” (26 articles), and
SeminarPostpartum psychiatric disorders
Section snippets
Postpartum psychoses
The sudden onset of psychosis after childbirth has intrigued medical practitioners for centuries. More than 2000 papers have been published. This group of disorders is diverse, including psychogenic and organic psychoses.1 Only one form is commonly seen in countries with modern obstetric services. This form is generally called puerperal psychosis and takes the form of mania, severe depression (with delusions, confusion, or stupor), or acute polymorphic (cycloid) psychosis. Record-linkage studies
Disorders of the mother-infant relationship
Childbirth presents many challenges to the mother: trauma, sleep deprivation, breastfeeding, adjustments in conjugal and other relationships, and social isolation. However, the central and most important psychological process is development of the relationship with the infant. Disturbances in this process were recognised long ago, when hatred of children12, 13 and child abuse14 were described. Various terms have been used for these disturbances. “Bonding” is a useful lay term, but neither
Depression
Although puerperal melancholia has been recognised for centuries, American research in the 1950s drew attention to the prevalence of milder postpartum depression.31 A concept of postnatal depression emerged, which has been useful as a lay term. It reduces stigma and enables mothers with various postpartum psychiatric disorders to recognise that they are ill and to seek help. It is a focus for self-help groups and lobbying to improve services.
As a medical concept, however, it is less useful.
Post-traumatic stress disorder (PTSD)
Bydlowski and Raoul-Duval93 described PTSD after childbirth in 1978. Long ordeals during labour led to secondary tocophobia, and the recurrence of tension, nightmares, and flashbacks towards the end of the next pregnancy. There are now about 40 publications on this disorder, which has been called the fourth postpartum mental disorder.94 The stressful experience is pain in most cases, but loss of control and fear of death can be the focus.95, 96 There have been eight quantitative studies (Table 3
Various morbid preoccupations
Distress about the bodily changes resulting from pregnancy and childbirth are common. Such women complain of weight gain, stretch marks, or scars. They are reluctant to undress in front of their partners, avoid looking at themselves naked, and can even avoid being seen in public. In an unpublished prospective interview study of over 200 patients in the UK and New Zealand, this distress amounted to dysmorphophobia in 14% of clinic patients.
Conjugal jealousy is another disorder sometimes linked
Anxiety disorders specific to the puerperium
Several studies have reported the effect of pregnancy on panic disorder. A review of eight studies showed no overall effect: in 41% pregnancy brought an improvement, but in 44% there was an exacerbation in the postpartum period and in 10% new onset in the puerperium.107 Recent studies suggest that postpartum anxiety disorders are underemphasised and are more common than depression.108, 109 There could be a biological basis for some postpartum anxiety. McIvor and colleagues110 studied the
Obsessions of child harm
Obsessions of infanticide were one of the first postpartum disorders to be described,117 and several recent series have been published.118, 119, 120 The central symptom is of impulses to attack the child, but the setting is different from the pathological anger that precedes child abuse. The mother is gentle and devoted. She experiences extravagant infanticidal impulses, together with fantasies of the family's horror and grief, causing intense distress and leading to reduced contact with the
Specialist teams
Given the diversity of postpartum mental illness and its risks for infants, there is a case for setting up specialist services for pregnant and puerperal women. In the UK, after the pioneering initiative of Main 50 years ago,127 a wealth of experience has been gained, through the concentration of severe cases in mother and baby units. However, in the absence of service evaluation, good clinical practice is based on ideas and innovation, rather than rigorous outcome data. The essence of these
Search strategy
References (129)
- et al.
A comparison of clinical response to electroconvulsive therapy in puerperal and non-puerperal psychoses
J Affect Disord
(1999) - et al.
Postpartum depression and mother-infant relationship at 3 months old
J Affect Disord
(2002) - et al.
The infant's response to entrapment between contradictory messages in face-to-face interaction
J Am Acad Child Adolesc Psychiatry
(1978) - et al.
Massage therapy for infants of depressed mothers
Infant Behav Dev
(1996) - et al.
Infant massage improves mother-infant interaction for mothers with postnatal depression
J Affect Disord
(2001) - et al.
Postpartum depression: the lived experiences of Middle Eastern migrant women in Australia
J Nurse Midwifery
(1999) - et al.
An international study exploring levels of postpartum depressive symptomatology
J Psychosom Res
(2000) - et al.
The relation between condition-specific morbidity, social support and material deprivation in pregnancy and early motherhood
Soc Sci Med
(1997) - et al.
Does the Edinburgh Postnatal Depression Scale measure anxiety?
J Psychosom Res
(2001) - et al.
Respiratory depression caused by N-desmethyldoxepin in breast milk
Lancet
(1985)
Transdermal oestrogen for treatment of severe postnatal depression
Lancet
The use of folliculin in involutional states
Am J Obstet Gynecol
Postpartum depression and companionship in the clinical birth environment: a randomized, controlled study
Am J Obstet Gynecol
Counselling of postnatal depression: a controlled study on a population based Swedish sample
J Affect Dis
Effects of support group intervention in postnatally distressed women: a controlled study in Taiwan
J Psychosom Res
Effects of redesigned community postnatal care on womens' health 4 months after birth: acluster randomised controlled trial
Lancet
A two-centred pragmatic randomised controlled trial of two interventions of postnatal support
Br J Obstet Gynaecol
Post-traumatic stress disorder after childbirth: a cross sectional study
J Anxiety Disord
Motherhood and mental health
Epidemiology of puerperal psychoses
Br J Psychiatry
Post-partum psychoses: clinical diagnoses and relative risk of admission after parturition
Br J Psychiatry
Postpartum and postabortion psychotic reactions
Fam Plann Perspect
Menstrual psychosis
Arch Women Ment Health
Puerperal psychosis: evidence for familiarity of the puerperal trigger
Mol Psychiatry
Puerperal psychosis. PhD thesis
Neuroleptic malignant syndrome in a case of postpartum psychosis
Br J Psychiatry
Prophylactic lithium in puerperal psychosis: the experience of three centres
Br J Psychiatry
Misopédie ou lésion de l'amour de la progéniture
Ann Médico-psychol
Über misopädie
Z Gesamte Neurol Psychiatr
Etude médico-légale sur les sévices et mauvais traitements exercés sur des enfants
Ann Hygiène
Children from unwanted pregnancies in Prague, Czech Republic, revisited at age thirty
Acta Psychiatr Scand
Unwantedness of a pregnancy and schizophrenia in the child
Br J Psychiatry
Birth complications combined with early maternal rejection at age 1 year predispose to violent crime at age 18 years
Arch Gen Psychiatry
The cognitive development of 5-year-old children of postnatally depressed mothers
Child Psychol Psychiatry
Maternity blues and attachment to children in mothers of full-term normal infants
Acta Psychiatr Scand
A screening questionnaire for mother-infant bonding disorders
Arch Women Ment Health
Mother-child relationship: FIRST score
JAdv Nurs
Maternal psychopathology and prediction of outcome based on mother-infant interaction ratings
Br J Psychiatry
Individual differences in the development of some attachment behaviours
Merrill Palmer Quart
Rejection of a child by his mother, successfully treated after 3 years
Br J Psychiatry
The role of an early intervention on enhancing the quality of mother-infant interaction
Child Dev
Impact of a mother-infant intervention in an indigent peri-urban South African context
Br J Psychiatry
Some social-psychiatric aspects of pregnancy and childbearing
J Med Soc NJ
Identification and classification of postpartum psychiatric disorders
J Psychosoc Nurs Ment Health Serv
Non-psychotic psychiatric disorder after childbirth: a prospective study of prevalence, incidence, course and nature
Br J Psychiatry
A controlled study of the onset, duration and prevalence of postnatal depression
Br J Psychiatry
Postnatal depression: myth and reality: maternal depression before and after the birth of a child
Soc Psychiatry Psychiatr Epidemiol
Suicides after pregnancy in Finland 1987–1994: register linkage study
BMJ
Worldwide trends in suicide mortality, 1955–89
Acta Psychiatr Scand
Cited by (429)
Stability of maternal postnatal bonding between 3 and 6 months: Associations with maternal mental health and infant temperament
2023, Infant Behavior and DevelopmentCase-control study of postpartum anxiety and maternal-infant bonding in NICU and non-NICU mothers
2023, Journal of Neonatal NursingMaternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States
2024, Research in Nursing and Health