A tragic incident has been reported from Balaghat, Madhya Pradesh, where a 24-year-old mother, Dipali Mate, allegedly killed her 3-month-old daughter by strangulation.
Dipali, who lost her husband in November last year, when she was still carrying the child, has since been living with her in-laws.
According to the reports, Dipali informed her mother-in-law that the child was not responding or drinking milk around 1:00 am. Alarmed, the mother-in-law checked on the child and was shocked to find her lifeless. Later, Dipali allegedly admitted to pressing the baby’s neck, resulting in the tragic death.
The heartbreaking incident highlights a grave issue that often goes unnoticed – the fragile state of Maternal Mental health. Losing a spouse while one is still carrying a baby, as seen in Dipali’s case, can lead to immense emotional distress.
No, we are not justifying what she did, but yes, things might have been different if her mental health had been addressed. Dipali’s is one of the many stories and there are hundreds and thousands of women like her who have to navigate the struggles of maternal mental health all by themselves.
Challenges Of Perinatal Mental Health In India
While pregnancy is generally believed to be the most beautiful phase in any woman’s life, for some, it can be quite challenging. According to the Journal Of Psychiatry Spectrum, the most common problems experienced by women during pregnancy include common mental disorders (CMDs) like anxiety and depression. What is important to note is that these problems not only affect the mother but also impact the fetal health and well-being, as well as increase the risks of obstetric complications.
If we talk about the postpartum period, these CMDs can negatively impact breastfeeding practices and the bonding between the mother and the child.
Common Perinatal Mental Health Disorders
Here is a list of some common perinatal mental health disorders that require adequate emotional support, understanding, and, sometimes, even psychological intervention.
Tokophobia
It refers to an extreme psychological fear of pregnancy and childbirth and it is the reason why many pregnant women opt for elective C-sections. Tokophobia is broadly classified into two types – primary tokophobia and secondary tokophobia.
Primary tokophobia is seen in women who have never given birth before or even those who have never been pregnant. The fear may start in adolescence and become prominent during pregnancy. Some women may even postpone their pregnancy due to this fear.
Secondary tokophobia, on the other hand, refers to fear that results from a past pregnancy or childbirth experience. It is often characterized by the emotional incapability to have children in the future.
Perinatal Onset Obsessive Compulsive Disorder
Perinatal onset obsessive-compulsive disorder refers to the development of OCD or worsening of already existing symptoms during the course of pregnancy or after childbirth. It is characterized by the mother’s obsession to keep the baby safe from any potential harm or contamination.
Speaking of obsession, some mothers may have an obsession with cleaning things because they feel that the germs or dirt on it may harm their baby or may always worry about how something they did or did not do may affect their child. Others may have persistent thoughts about harming the baby while some may even have an obsession with being perfect by doing everything the right way.
Some women may also experience the compulsion to do things a certain way, for instance, they may have special washing and cleaning rituals, which they indulge in repetitively, or they may check on their baby every now and then, even at night. Some women may also try to avoid situations or activities that they fear might harm their child, for instance, not letting the baby get close to someone or hiding all the sharp objects at home.
Perinatal Post Traumatic Stress Disorder
According to NIH, “Post-traumatic stress disorder (PTSD) following childbirth is a significant mental health risk for women globally.”
Post-traumatic stress disorder may be defined as a chronic mental condition that is caused by a traumatic factor. The impact can be physical, cognitive, emotional, and behavioural. What makes perinatal post-traumatic stress disorder even more challenging is the fact that it comes at a point when the woman is already undergoing a lot of physical and psychological changes.
“Prenatal depression and anxiety, pre-pregnancy history of psychiatric problems, history of sexual trauma, childhood sexual abuse, intimate partner violence, psychosocial attributes, dread of labor, traumatic birth experiences, complications during pregnancy or childbirth, a lack of support, and dissociation during childbirth are just some of the elements that have been linked to the emergence of postpartum PTSD”
Common symptoms experienced by women suffering from perinatal post-traumatic stress disorder include excessive sweating, nightmares, distressing thoughts, numbness, anxiety, despair, regret, embarrassment, and loneliness.
Postpartum Psychosis
Postpartum psychosis is a serious mental health disorder, which affects women soon after they give birth. It is often mistaken for baby blues, however, one needs to understand that while baby blues are mild and only last for a couple of days, postpartum psychosis is a severe mental condition that requires proper psychological intervention.
Women suffering from postpartum psychosis experience hallucinations (Experiencing things that are not actually there), delusion (Baseless, suspicion, and fears), mania (Being highly overactive or restless), withdrawal, depression, agitation, confusion, and appetite loss.
Postpartum psychosis can also be induced by grief, for instance, the loss of a child or partner during the course of pregnancy as happened in the case of Dipali Mate.
It can be progressive, and if not addressed properly, it can pose a serious threat to the mother’s as well as the child’s safety.
Bipolar Disorder In The Perinatal Period
Bipolar disorder, which was earlier known as a maniac, is a maternal mental health disorder in which the woman is constantly switching between depression and mania. While the underlying cause is not known, it is often believed to be inherited or linked to a stressful experience in the past.
The moments when the mother’s energy levels are significantly low, and then moments when she’s overactive. Bipolar disorder in the perinatal period can drastically impact a woman’s ability to care for her baby and it can even prove to be dangerous for the baby and the mother.
During the depressive phase, the woman will be overwhelmed by the fear and worries of her child’s well-being. It is characterized by symptoms like guilt, hopelessness, fatigue, loss of interest, body pain, aches, suicidal thoughts, or thoughts of harming the baby.
On the contrary, the woman may experience a completely opposite set of symptoms during the manic episode, for instance, she will have increased energy levels, excessive thoughts, increased sex drive, impulsivity, irritability, aggressiveness, and reckless behaviour. Some women may even have hallucinations and delusional thoughts.
Perinatal Depression
Perinatal depression refers to the depression that is seen in women during the course of pregnancy or after childbirth. The latter is commonly referred to as postpartum depression. Just like other common maternal, mental health disorders, perinatal depression, too, calls for the need for proper intervention. Fortunately, it can be treated and the woman can lead a normal life.
The symptoms of perinatal depression can often be mistaken for baby blues, however, these happen to be more intense and can continue for months at a stretch. It is characterized by symptoms like irritability, restlessness, anxiety, and so on. The woman may often find herself crying without any reason.
Other common symptoms include loss of interest in things that she earlier used to love, difficulty in falling asleep, excessive sleeping, fatigue, loss of appetite or increased appetite, suicidal thoughts, guilt, worthlessness, feeling of not being good enough, or fear of harming the baby.
Women suffering from perinatal depression may experience multiple symptoms at the same time, and these may start during the course of pregnancy or within a year following childbirth
If you or someone you know is struggling with mental health during or after pregnancy, please seek professional help. For any queries, you can connect with our experts at Ask Doctor.