Keywords: Sad, maternity blues, post partum blues, baby blues, maternity, social support, Nigeria.

Introduction.

Feeling Sad after Delivering a Baby – Nigeria. What is maternity blues? Can men also have maternity blues? Are there complications to maternity blues? How does one resolve this post partum conditions? Are there preventions for this condition?

Childbirth which should be joyful is usually accompanied by physical, emotional and social stress for the woman. Thus, the following days to weeks and even up to one year, most women have mental disturbances. And these mental disturbances, range from mood issues to full blown psychosis.  

The post partum period, is the period from the day the woman gives birth to the end of six weeks after. But for some women, it can last up to 6 to 8 months and this is called delayed post partum period. The post partum period is commonly known by non medical peoples as the maternity period.

What is maternity blues?                                   

Maternity blues is also known as post partum blues or baby blues. This is a brief mood disorder in the woman, which presents as a psychological issue within a few days after delivery.  It actually starts within the first 3 to 5 days after delivery and before two weeks it is over.

The prevalence rate for maternity blues in Nigeria ranges from 15% to 85% in women who just delivered children. And for women who delivered female children the prevalence rate is up to 45.5%. We know that in Nigeria the preferred child gender is the male gender. So the rate of women feeling sad after delivering a baby in Nigeria is high.

Causes of maternity blues.

Things that can cause or predispose women who have just delivered a baby, to maternity blues are complex. They include:

Hormonal issues –

That is the abrupt changes of certain hormones. After delivery, there is sudden withdrawal of the estrogen and progesterone hormones, while cortisol increases in level. Even the thyroid hormones may decrease sharply. These hormones affect mood. There is also transient adrenal suppression and increase in prolactin. And there is increased tryptophan breakdown. Tryptophan is necessary for the production of serotonin, a neurotransmitter needed for stable mood.

Mental health and genetic  issues –

Note that not all women develop the blues after delivery. It is only those who have the genetic predisposition. That means that those with the family genes for depression are those that will be affected by hormonal issues. Even the women who had untreated depressive disorders in the present pregnancy can have the blues after delivery.

Issues with infant-maternal bonding –

Usually after delivery the baby and the mother are set to increase physical bonding and attachment. But under certain stressors, instead of bonding, sadness occurs.

Stressors –

These stressors or risk factors include poor social support, lack of marital harmony or intimate partner violence or other relationship strains, domestic violence, and adverse childhood experiences.

Poor social support can come from the husband’s inability to help the pregnant wife or help out during the maternity period. Subjecting the woman to take care of the baby alone and do house chores, is a risk factor.

Other stressors include having female birth, especially when the previous births were females. Having previous hospital admissions during pregnancy is a risk factor. Being a single mother as well as poverty or any form of financial stress are predisposing factors. Societal or cultural pressure to bounce back quickly after pregnancy and child birth are stressors.

Being excessively tired out or fatigued after delivery is a stressor. Being deprived of sleep by the baby or other reasons can predispose to maternity blues. Also being excessively worried about the baby and the competence to care for the baby can lead to the blues.

Previous obstetric complications like emergency cesarean section, forceps or vacuum assisted births, etc. are risk factors as well.  Even having a premature baby or low birth weight baby are risk factors.

Symptom presentation.

When a woman begins to cry within the first 5 days of delivery, she could be having the blues. The symptoms of maternity blues include sadness, crying spells, mood swings, poor appetite and poor sleep. She could also be restless, grumpy and anxious about her baby. The crying comes about for no visible reasons and the mood swings from sadness to intense happiness for no reason. There is also excessive tiredness and poor concentration.

Maternity blues in men?

It may sound like a fairy tale to know that men too can have maternity blues. Yes, fathers can have the blues. They can develop sadness after their wives deliver a baby. Such men feel angry, moody and anxious and they want to be alone. They can also lose interest in work and hobby, as well as get frustrated. These men can feel hopeless and have problems with sleep and in making decisions.

This is because the men too have hormonal changes when their wives deliver babies. The hormone testosterone level decreases, while the estrogen level increases. Other hormones such as cortisol, vasopressin, and prolactin increase in their levels.

Complications.

Baby blues is actually a mental health disorder that is short lived. By 2 weeks the symptoms are over and the woman bounces back. But for some women it does not just disappear, rather it will continue beyond the two weeks to become post partum depression. Post partum depression is a more serious mood disorder. This risk for developing into post partum depression will be most likely if the blues starts on the 5th day. The earlier the symptoms start, the better the outcome. The later it starts the more the risk of complications.

Prevention of maternity blues.

It is important that medical personnel screen pregnant women for mental health conditions. Maternity blues is more prevalent with women who have mental illness in their families, or who have suffered past depression.

It is also important that the medical personnel are aware of the symptoms of this illness. This is because early identification by the medical personnel can lead to counseling of patient and family.  The personnel should also educate the pregnant women on this during antenatal, to help them prepare for it. The families should also be educated on this to ensure that the support the women adequately.

It is also very important to treat pregnant women of depressive disorders, before they deliver. This will help prevent the baby blues after delivery.

Treatment.

Post partum blues is self limiting, meaning that it goes away on its own without treatment. The signs and symptoms should go away within 2 weeks of starting.

Self help:

It is important that the woman gets enough sleep, by being ready to sleep whenever the baby sleeps. She should be able to get 6 hours and above sleep in a day. This means that she sleeps during the day and during the night, as the baby sleeps.

She should get help from members of the family like her mother, her husband, etc. Also trusted friends can help in looking after her baby while she sleeps. Let those helping know the specific things to do. Some can help with cooking, shopping, washing, etc. Employing a domestic servant will be of great help.

The woman should avoid alcohol and other substances of abuse. These will make her condition worse and make it difficult for her to care for her baby.

The woman should have time for herself to do the things she enjoys, like going out to take fresh air, etc. Home exercise is important as well as good diet. And if the symptoms do not clear within 2 weeks, seek medical help.

Medical treatment:

There is actually no medication for the treatment of post partum blues. All it requires is reassurance, counseling and help. Medication treatment will only come up if complications set in.

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