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Postpartum blues: Awareness and treatment

Maha had just given birth to her first baby. A few weeks had passed and she started withdrawing from society. Her family was being extra nice to her. She hated it. The more they coddled and cared for her, the angrier she became.

This was more than five years ago. Two weeks ago, Maha found out she had suffered from postpartum depression without even being aware of it. Dr. Ahmed Shawky al-Akabawy, professor of clinical psychiatry at Al-Azhar University said 5 percent to 10 percent of mothers in Egypt suffer from the illness.  

A lack of awareness and follow-up care after giving birth makes it difficult to diagnose said Dr. Mohamed Sabry, professor of obstetrics and gynecology at Al-Monofeya University.

“I wished someone had told me what I was going through because I hated it…I kept telling myself I am not crazy I don’t need medication," Maha said.

About 40 days after Maha gave birth she stopped seeing her gynecologist and had no additional follow-up care.

Al-Akabawy said it is important to continue post-natal care because the OBGYN follows up with the patient and asks questions, allowing them to recognize if the patient has any of the symptoms of postpartum depression.

The depression comes in three degrees; the first degree is known as “baby blues” and symptoms include discomfort, loss of appetite and tearfulness. It usually begins 14 to 15 days after giving birth. Al-Akabawy said this form does not require treatment, but the new mother needs increased emotional support.

Dr. Nevine Hassanein, OBGYN Consultant and Public Health Specialist said “we usually deal with the symptoms the first six weeks and then if they persist we refer [the patients] to a psychiatrist.”

The second degree occurs six weeks after the birth and is described as depression. The symptoms include frequent crying, lack of pleasure or interest in activities that the mother normally enjoys, sleep disturbance, weight loss, loss of energy, anxiety, trouble concentrating or making decisions, thoughts of death or suicide, feelings of worthlessness and guilt, fear of rejection, decreased interest in sex and feelings of rejection.

Al-Akabawy said the second phase takes two weeks to treat. The husband is told to show more emotional support and the woman's family is asked to be with her as much as possible. Some anti-depressant and anti-anxiety medicines may also be part of the treatment plan.

The third degree is very rare and occurs in only one out of 1000 new mothers. The symptoms include false beliefs, hallucinations, the patient becomes suicidal and homicidal, possibly desiring to kill herself but feeling guilty for leaving the children. In rare cases, these delusions sometimes prompt the mother to kill her children and then herself. This may be with medication or with electro-convulsive therapy for seven consecutive days.

According to the Mayo Clinic, a nonprofit medical practice and research group in the US, "During ECT, a small amount of electrical current is applied to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of depression, especially when other treatments have failed or when you need immediate results."

From the gynecologists’ point of view, the research and information is limited. According to Sabry, who attended medical school in the late 1980s, “when I was in college, they didn’t mention the issue at all in our text books, now it is at least mentioned.”

Sabry has been working on updating a protocol issued by the Healthy Mother Healthy Child project under the Ministry of Health in collaboration with USAID. The project integrates health care services for mother and child so that whether a mother takes her child to a clinic or a hospital, they can both receive any needed treatment.

The protocol was recently updated to include a small section on postpartum blues, which is caused, according to Sabry, by “a sudden drop of estrogen in the body affects the brain's well-being.”

Hassanein said a lack of support system causes the mother to feel overwhelmed with the responsibility of being in charge of a human being.

She said, “much research is needed on postpartum depression in Egypt. An open forum between community awareness researchers, psychiatrists and OBGYNs is important to create awareness on the issue.“

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