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Postnatal depression

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

Postnatal depression is a nonpsychotic depressive illness of mild to moderate severity arising within 3 months of childbirth. Main characteristics are:

  • Diurnal mood changes and sleep disturbance - waking early in the morning; the woman will feel most depressed and her symptoms will be worse at the start of the day.
  • Impaired concentration, disturbed thought processes, indecisiveness and an inability to cope with everyday life.
  • Emotional detachment and profound lowering of mood
  • Loss of ability to feel pleasure (anhedonia)
  • Feelings of guilt, incompetence and of being a 'bad' mother
  • In approximately one-third of women, distressing, intrusive obsessional thoughts
  • Commonly, extreme anxiety and even panic attacks
  • Impaired appetite and weight loss.
  • In a small number, depressive psychosis, morbid, delusional thoughts and hallucinations.

The Edinburgh Postnatal Depression Scale is a useful screening tool but can lead to 'false positives' and medicalisation of low mood and situational distress, and should not replace clinical judgement.

The Practising Midwife featured articles

Well informed midwives can help: perinatal mental health 2013; 16(6): 35 - 37 Author: Louise Rafferty

How midwives can help with perinatal deperession 2014; 17(3):22-23 Author: Joanne Morton

Perinatal mental health: midwives and health visitors working together 2014; 17(3): 25 - 27 Author: Bridget Halnan

Further reading

Royal College of Midwives. Maternal mental health. Improving emotional wellbeing in postnatal care. https://www.rcm.org.uk/sites/default/files/Pressure%20Points%20-%20Mental%20Health%20-%20Final_0.pdf

MIND. Postnatal depression. http://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression/#.VwKlhsfg_bo

Association for Postnatal Illness. Postnatal Depression. http://apni.org/leaflets/post-natal-depression/

Edinburgh Postnatal Depression Scale https://psychology-tools.com/epds/

 

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