Although delivery is a physiological process that is experienced by all expecting females, there comes with it a considerable change in the biological, psychological and social balance. Sometimes this change is akin to an earthquake in the life of the woman if it is not preceded, accompanied and followed by enough health care - psychological and social. The degrees of that effect on women vary from one person to another. We see that some women pass this time smoothly and simply giving an impression that delivery is a natural physiological change. On the other hand, we also notice the indications of a real crisis which precedes, accompanies or follows the delivery in other cases.

　　It is very important to know the limits and types of postpartum disorder through doctors or even through common people. People who suffer from some of these disorders simply need to be assured, while other disorders require the patient to be admitted to hospital.

　　In this article, Dr. Muhammad Mahdi, a psychiatric consultant, discusses the indications of these disorders.

　　Postpartum Depression

　　This is considered a state of illness and occurs among 50% of the women after delivery. This case begins a few days after delivery and lasts for some days, and is characterized by having a state of depression, a bad mood, frequent crying, feelings of fatigue, worry, angry outbursts and a desire to depend heavily upon others. The severity of these symptoms decreases with time and the mother then goes back to her normal state. This is due to rapid hormonal changes, the pressure of delivery and the woman’s awareness of the increase of her responsibilities which motherhood necessitates. This case requires nothing except assuring the mother and psychologically and socially supporting her until she is over these feelings.

　　Postpartum Psychosis

　　She was a student at the faculty of Law and she knew an engineer whom she insisted on marrying in spite of her family’s refusal due to the social differences and the notoriety of this man. The girl underwent a state of depression during the engagement. The family of the girl attributed this to the problems which accompanied the engagement. This state lasted for about two months and ended with the use of some folk medicine. When the girl married, she found that her husband, whom she had preferred to her family, was treating her very badly. He would leave her alone all the time crying over her misfortune. When he came home, he did not do anything but neglect and insult her. In the meantime, none of her relatives visited her because the tension of the relation between them and the husband. When she became pregnant, she suffered from continuous vomiting, inability to undertake her household chores, loss of appetite, continuous insomnia, and severe deterioration of her health. When she asked him to allow her mother to stay with her for some time until she would get better, he totally refused. Accordingly, she tolerated these conditions unwillingly until she gave birth to her child.

　　Two weeks after the delivery, her mother-in-law noticed that she was in a strange state; she was frequently absent minded. She would sit for long durations of time without moving and then become very worried and nervous without any clear justification. She stopped eating and sleeping at night or day; sometimes she cried and at other times she screamed. There was no one beside her at that time except her mother-in-law for her husband insisted on preventing her family from visiting her. Her husband tried to help her by bringing some folk healers, yet her state became worse. They noticed that she looked angrily at her child throwing him about violently from her arms. At this point, her mother-in-law took the child in order to protect him from his disturbed mother.

　　Her mother-in-law went to the market to buy some things and left the child in a room beside the mother’s room. When the mother-in-law returned from the market, she found that the mother had taken the child to the kitchen and slaughtered him with a knife.

　　I apologize to the reader if this incident was terrifying, but this was a real case which I saw and received at the hospital myself when he was about to die. This mother was arrested after the incident and detained for some days in order to investigate the crime. During these days, everybody was disgusted with her because of her atrocious act. No one can bear seeing someone killing an innocent child and therefore she felt alienated and disgusted among her prison inmates and from many of the supervisors in the prison. She stopped eating and drinking or was perhaps prevented from doing so by others due to them thinking that she was a criminal who did what she did intentionally. She was in a very bad condition and was then moved to a hospital where she received many physical and psychological treatments until she finally got better. This was an example of postpartum psychosis. This disorder requires the attention of gynecologists, a family counselor, psychiatrists and those who need to be around the patient due to the dangerous nature of this case.

　　The occurrence of this disorder ends during the first year, after about two or three weeks after delivery. The longest expected time for this condition is eight weeks after delivery. It is thought that this disorder takes place due to one or all of the following factors:

　　 - Pressure of Delivery

　　There is no doubt that delivery causes psychological pressure; it is not only because of the pain and difficulty of delivery, but the mother also suffers throughout the months of pregnancy and then reaches its climax at the point of delivery. She spends many sleepless and uncomfortable nights. Then, she is surprised to find a child beside her who needs care. She spends the night awake and his needs are endless. These pressures are intensified if she does not have a natural delivery, such as a caesarean or complicated delivery.

　　- Rapid Hormonal Changes

　　After delivery, there is a rapid decrease in the level of estrogen and progesterone and this unbalances the biological state for some time.

　　- Psycho-Social Factors

　　This occurs if the woman lives in a disturbed relation with her husband or his family, undergoes pressure at work or suffers from previous psychological disorders that were not successfully treated. Sometimes, the mother refuses pregnancy and accordingly rejects the child because she does not want to become a mother due to the psychological problems that she has, or due to getting married to someone who she does not feel comfortable with or due to her fear of the responsibilities of motherhood. Some researches have discovered that marital disputes during pregnancy increase the risk of being subjected to postpartum psychosis.

　　- Certain Biological Factors

　　Such as pre-eclampsia or taking certain medications. This illness is preceded by some inceptive symptoms, such as, insomnia, discomfort, restlessness, angry outbursts and inability to concentrate. Then, the symptoms appear, such as severe depression, hypomania, awareness disorders, absence of concentration, disorder of realization, memory and thinking, the appearance of some aberrations such as thinking that she is still a virgin or that she did not give birth and that the child is not her own or that he is a devil. She may also sometimes get hallucinations like hearing a sound telling her that she should kill herself or her child to relieve him from the suffering of the this life, and disorders in moving. These symptoms are mostly accompanied by confusion of consciousness, doubts and obsessions over the well-being and health of the child.

　　This matter should be taken seriously when the case is diagnosed since it is a psychological emergency. It is important to place the patient in a mental hospital if her psychological health deteriorates or if she is inclined to commit suicide or to harm her child. The child should be placed under the care of one of the relatives and the mother should be allowed to see him every now and then under complete supervision so that she does not have a chance to harm her child. These cases can be successfully treated through anti-depressants and lithium; sometimes, the antis of psychosis are added. In severe cases, electroconvulsive therapy (ECT) is used. After the elimination of the severe symptoms, the patient can be helped through psychological treatment where the psychological and social problems are discovered, and then she is psychologically supported and helped to accept her new role as a mother.