The life of a woman is far more complicated than that of a man. During her reproductive age, month after month she experiences a roller coaster ride of the hormonal changes. Pregnancies and deliveries are unique physiological and psycho-social experiences which fall in the exclusive domain of the female gender.

It is well established that during pregnancy and in the postpartum period, a woman is prone to a variety of serious medical and emotional problems. Though such problems have been described long back in ayurvedic texts — and Hippocrates, the Greek physician, gave a detailed description of such problems in 700 BC, even today it is highly unfortunate that a major part of such sufferings remains unidentified and untreated. Millions of women suffer in silence in our country. The victims and their families should be motivated and encouraged to seek timely medical and psycho-social help and get themselves back on the path of recovery.

Common psychiatric problems:

1. Postpartum stress: These are called transitory mood disorders. The common symptoms occurring in the first week following delivery are frequent crying, poor sleep, irritability and mood changes. These may continue for a few weeks. More than 50 per cent women have these blues. Maternal blues are more common after the first delivery. The clinical state does not need any treatment.

2. The common depressive syndrome: It is more debilitating than the blues. The woman may have the feeling of severe sadness, tearfulness, and the perception of guilt, inadequacy, anxiety, irritability and fatigue. If these go untreated, the situation can be prolonged and may play havoc with the life of the patient.

3. Postpartum psychosis or puerperal psychosis: It is relatively an uncommon disorder occurring after child birth. Its symptoms are confusion, agitation, alteration in moods, the feeling of hopelessness, suspiciousness, auditory hallucinations (hearing voices), rapid speech, an occasional hilarious mood and hyperacidity. These symptoms need urgent psychiatric attention.

4. Postpartum post-traumatic stress syndrome: In some women, childbirth may mean caesarian birth, the death of an infant, the birth of a female child etc. These are quite traumatic and trigger postpartum illnesses.

The following factors predispose a woman to various postpartum problems:

1. Hormonal changes: During the postpartum period, there is a sharp drop in the levels of hormones like estrogen and progesterone. The levels of prolactin, another hormone, fall immediately after the delivery and rise in the first week after child birth. In some studies postpartum problems are found to be more in such women as do not breastfeed their babies.

2. Personality variables: Psychological factors play an important role in postpartum psychiatric disorders. Some women suffer from deep feelings of inadequacy regarding child-bearing. Many working women suffer from the role conflicts between their job roll and their role as a mother. Those women who have low self-esteem are more prone to developing such problems. In our country women giving repeated births to female children are bound to become victims of the low-esteem syndrome. They also become targets of family and social ridicule — and neglect.

3. Demographic variables: Females belonging to low socio-economic status and having low psycho-social support become more exposed to these psychological problems. Malnutrition and vitamin deficiencies can also add to one's proneness to such sufferings.

4. Obstetric variables: It is commonly observed that young mothers, having a traumatic obstetric experience, are more prone to developing postpartum problems. The mood changes are more marked in patients following caesarian section.

Postpartum problems are more common following the birth of the first baby and when there are very short intervals between pregnancies.

Management:

It is important to know that doctors and the paramedical staff attending to such patients should be sensitive towards the appearance of psychological and behavioural changes after delivery. Fortunately, the problems show a very good response to drugs like anti-anxiety, anti-depression, and anti-psychotic drugs. These medicines have to be used on the basis of the symptomatology and clinical profile of the given case. Severe cases, that turn violent and aggressive or suicidal, may need inpatient care. Such patients require good emotional support and care.

The families of the patients should be cautious since in subsequent deliveries the risk of the re-emergence of the problems increases. It is important for women to be prepared and motivated for the delivery. Delivery is one of the most important milestones in a woman's life. So love, affection and care can make a lot of difference in coming out of the psychological and physical pain of the delivery and some of the negativity associated with it.