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Aversion of post-partum depression for safe motherhood

Dr Suchitra N Pandit, Director, Obstetrics and Gynaecology Department, Surya Hospital, speaks on issues related to motherhood that aren’t spoken about

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Maternal and child health should be high up in the priority list for the short term and long term plans for any country. Healthy mothers are key to birthing an entire generation that is healthy.

The number of women who die during childbirth in India has come down sharply, with more women now delivering children in hospitals. The maternal mortality rate, (according to the sample registration system of Registrar General of India ) has declined to 130 in 2014-16 from 167 in 2011-13 a significant improvement on a parameter widely used by analysts and developmental economists to rate a country’s progress. The 22 per cent reduction in MMR since 2013 means nearly one thousand fewer women now die of pregnancy-related complications each month in India.

The Union health ministry is attributing this improvement mainly to rise in institutional deliveries across the country. The facilities in public hospitals and health centres have also improved and free drugs and diagnostics are among the other incentives to pregnant women that has led to increase in admissions for delivery over the years.

In India, maternal mortality is a huge public health issue. Causes range from excessive blood loss (post-partum haemorrhage), hypertensive diseases in pregnancy abortion-related deaths and infections. Anaemia is highly prevalent in the reproductive age group. India is said to be at number 1 out of the 10 nations adding to the 60 per cent of the world’s premature deliveries.

On National Safe Motherhood Day, there is also a great need to discuss certain issues in relation to motherhood that is not proactively spoken about. The issue of postnatal mental health, especially postpartum depression following childbirth, remains largely ignored and under-recognised. As several surveys point out that Postpartum depression affects one in seven women. There is a need for screening for depression in all pregnant and postpartum women. Screening can help in referring to those at risk to opt for counselling.

Another challenge is to identify women from weaker sections as they are more prone to suffer from postpartum mental illness, but less likely to receive treatment. Not just that, a comprehensive lack of interest in the mental health of a new mother has resulted in creating a large group to go through emotions that are way beyond their mental threshold. Triggers that can lead to PPD is a difficult phase for motherhood, wherein the mother is looking after a newborn, going through hormonal changes, and encountering body-image issues, the mental strength of the mother is at a constant test. Women suffering from postnatal depression usually show similar signs related to common stress and depression such as a feeling of anguish, crying without reason, being petulant, restless, and oversleeping or not sleeping adequately. In some cases, the mother tends to stay distant from friends and family. In critical cases, it can also reach self-harm or even injuries to the child.

Postpartum depression can predispose to chronic or recurrent depression, which may affect the mother-infant relationship and child growth and development. Children of mothers with postpartum depression have greater cognitive, behavioural and interpersonal problems compared with the children of non-depressed mothers.

Postpartum psychiatric disorders can be divided into three categories: postpartum blues; postpartum psychosis and postpartum depression. Postpartum blues, with an incidence of 300‒750 per 1000 mothers globally, may resolve in a few days to a week, has few negative sequelae and usually requires only reassurance. Postpartum psychosis, which has a global prevalence ranging from 0.89 to 2.6 per 1000 births, is a severe disorder that begins within four weeks postpartum and requires hospitalisation Postpartum depression can start soon after childbirth or as a continuation of antenatal depression and needs to be treated. The global prevalence of postpartum depression has been estimated at 100‒150 per 1000 births

Mental health continues to be ignored in India, people tend to refrain from reaching out for professional help. Research shows that there is a sociocultural stigma attached to PPD, which prevents women from seeking help early. One of the common triggers is not giving birth to a male child or having repetitive childbirths. Postnatal depression needs proper attention both medically and at the family level. While psychotherapy may be useful, if the condition proceeds, it is advised to seek professional help. PPD can be treated effectively with medication or an amalgamation of medication and psychotherapy. A mother’s prosperity (or its absence) impacts not only her but also the infant dependent on her, yet another reason why mental health should be discussed in a more transparent fashion and not in confused, hushed tone.

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