Depression after childbirth.

him to prosecute doctors for murder it might be as well to find out what the public thinks about it. That "happy event," the birth of a child, is not always a source of unalloyed joy. About one in six of all births are conceived outside wedlock, and for girls under 20 the figure is seven out of 10.1 The high rate of marital breakdown gives some indication of the strains of establishing and maintaining a lasting relationship, yet the demands on the mother of her adjustment to maternity, especially for her first child, are more complex, more demanding, and subject to inflexible time restraints. Add to this the endocrine and metabolic turmoil of pregnancy and the puerperium, and it is scarcely surprising that the risk of admission to a psychiatric hospital is greater during the 12 months after childbirth than at any other time in a woman's life. For all practical purposes, psychiatric disturbance in the puerperium is affectively based.2 Schizophrenia is largely unaffected by pregnancy, and the risk of its development in the puerperium is no higher than at any other time. Three main types of mood disturbance can be clearly identified. The first, "baby blues," affects more than half of normal women on the third or fourth day after delivery. Weepiness is the outstanding feature, usually accompanied by despondency, lethargy, anxious feelings often related to convictions of maternal incompetence, and subjective impairment of memory and concentration. Many women welcome the contentment of the middle trimester but find the mental fogging of the puerperium distressing and are convinced that they are going mad. No treatment other than reassurance and support is required, for the condition is usually mild and always transitory. Next is the condition best labelled postnatal depression-so long as it is not regarded as an illness which responds to antidepressants alone. Depression of this type usually develops in or after the third week of the puerperium. It varies in intensity and from day to day and is reactive to circumstances, often with a tendency to worsen as the day goes on. Anxiety, often related to the baby, irritability, and fatigue are common and impair the development of maternal competence. Variable insomnia and fluctuations in the appetite add to the difficulties of establishing the new domestic routine. Definite loss of interest in sexual relations and in her personal appearance may contribute to worsening of the woman's relationship …