PSYCHOLOGICAL PROBLEMS ENCOUNTERED DURING PREGNANCY AND POSTPARTUM PERIOD
Psychological disorders, including depression and distress, are common during pregnancy and the postpartum period. These diseases prevent the woman from taking care of herself during pregnancy and from being an adequate mother to her baby after birth. These diseases, which we may encounter in many different forms and severities, may exist before pregnancy or may occur during pregnancy and the postpartum period. We can group these problems under 3 headings, from mild to severe;
1. Postpartum Blues:
It is the mildest of postpartum psychological problems. 3rd-5th week following birth. It starts between days and lasts from a few hours to a few days. On the 10th day after birth, the complaints disappear completely. Mood instability and crying attacks are the most common symptoms. In addition, restlessness, feeling of distress, headache, sleep and concentration disorders are observed. Although the cause is not clear, hormones and other biological changes that suddenly decrease after birth are held responsible. It is reported that it is seen in 30% to 80% of women.
Since the condition is mild and temporary, it goes away on its own without requiring any treatment. It does not leave any sequelae. It is important to know that such a problem exists, to provide the necessary support and follow-up when it occurs. Her husband and other family members should support the mother and not leave her alone.
2. Postpartum Depression:
Depression may exist before pregnancy, but it may also occur during pregnancy and after birth. The disease usually lasts 3-4 months, rarely lasts longer than 1 year. The main symptoms are a depressed psychological structure, decreased interest in the environment, increased or decreased appetite, insomnia or excessive sleeping, feeling inadequate (thinking that oneself cannot be a good enough mother and that the child suffers for this reason) and worthless, decreased ability to think and concentrate, It can be considered as having recurrent thoughts of suicide and death. It is reported that depression during pregnancy and postpartum occurs at a rate of 16-18%.
The main risk factors include depression in a previous pregnancy, a family history of depression, becoming a mother at an early age, low economic status, poor spouse and family relationships, having experienced a stressful event in the last 6-12 months, and having been subjected to violence in the past or present. More women experience depression during pregnancy alkol, cigarette ve addictive substances They use alcohol and eat poorly. Complaints of nausea and vomiting are common and pregnancy periods are unhealthy. This negatively affects the baby's development and increases the risk of premature birth. These babies are born with low birth weight. Mothers with postpartum depression may be at risk of harming their babies. Therefore, they need to be treated both during pregnancy and the postpartum period. Treatment can be summarized as medication, psychotherapy and supportive treatment. Today, many antidepressant drugs can be used during pregnancy and after birth. Sometimes it may be necessary to add anti-anxiety medications (anxiolytics) to the treatment. Adding psychotherapy to drug therapy increases the rate of recovery. In addition, the understanding and supportive approach of their spouses and families to these mothers is very important in the treatment of the disease.
3. Postpartum Psychosis:
It is a severe psychological disorder triggered by various psychosocial events and hormonal changes following birth. It occurs at a rate of 1000-1 in every 3 births. The risk increases in those with manic-depressive illness. Once seen, the risk of recurrence in other pregnancies varies between 21-75%.
Symptoms typically begin within the first two weeks postpartum. The main symptoms can be listed as a severe depressive psychology, feelings of guilt and worthlessness, confusion in thinking, overconfidence and self-aggrandizement, auditory and visual hallucinations (seeing and hearing things that are not real), insomnia and excessive activity, distraction and agitation in thinking. In severe forms, there may be behavior that tends to kill. These behaviors may be towards the person or their baby. For this reason, postpartum psychosis should be considered as a medical emergency and the patient should be hospitalized for at least a short period of time and treated.
In the treatment, drugs that stabilize (correct) mood (lithium, acproic acid) and antipsychotic drugs are used. Psychotherapy can also be added to the treatment after a certain improvement is achieved in the patient's condition.