Several steps can be taken to diminish psychological stress in the event of a poor obstetrical outcome. For example, following a stillbirth, Gold (2007) encouraged parental contact with the newborn and provision of photographs and other infant memorabilia. Addressing associated sleep disorders also seems reasonable Quulia Paavonen, 2017; Romero, 2014).
• The Puerperium
This is a particularly stressful time for women, and risks for mental illness are increased. Up to 15 percent of women develop a nonpsychotic postpartum depressive disorder within 6 months of delivery (Tam, 2007; Yonkers, 201r1). A few have a psychotic illness following delivery, and half of these manifest a bipolar disorder. Depressive disorders are more likely in women with obstetrical complications such as severe preeclampsia or fetal-growth restriction, especially if associated with early delivery. Houston and coworkers (2015) found that expectations at delivery also increased the risk for postpartum depression.
Importantly, stressors beyond those directly related to the pregnancy can raise perinatal depression rates. T arney and colleagues (2015) identified spouse deployment as a factor for postpartum depression in a study at Womack Army Medical Center. But, among women with a history of bipolar disorder, these elements playra lesser role in the development of mania or depression (Yonkers, 2011).
Also called pospartum blues, this is a time-limited period of heightened emotional reactivity experienced by half of women within the irst week after parturition. Prevalence estimates for the blues range from 26 to S4 percent depending on diagnostic criteria (O'Hara, 2014). his emotional state generally peaks on the fourth or ifth postpartum day and normalizes by day 10 (O'Keane, 2011).
he predominant mood is happiness, but afected mothers are more emotionally labile. hey also may have insomnia, weepiness, depression, anxiety, poor concentration, and irritability. Mothers may be transiently tearful for several hours and then recover completely, only to be tearful again the next day. Supportive treatment is indicated, and afected women are reassured that the dysphoria is transient and most likely due to biochemical changes. They should be monitored for development of depression and other severe psychiatric disturbances.
Both the American College of Obstetricians and Gynecologists (2016a) and the United States Preventative Services Task Force now recommend screening at least once during the perinatal period for depression and anxiety (Siu, 2016). Identiication of psychiatric disorders in pregnancy can be challenging because changes in behavior and mood are often attributed to pregnancy. To diferentiate these, Yonkers (2011) recommends assessment of cognitive symptoms-for example, loss of concentration. Excessive symptoms of anxiety and insomnia-even during periods of infant sleep-can also suggest postpartum depression. Speciic factors for depression are reviewed and include a prior personal or family history of depression.