Postnatal Depression

WHAT IS POSTNATAL DEPRESSION?

Postnatal depression is a type of depression some women experience after having a baby. It can develop within the first six weeks of giving birth, but isn't always apparent until around six months. Postnatal depression is more common then people realise, affecting around 1 in 10 women after giving birth. Any woman can be affected from any walk of life and teenage mothers are particularly at risk. It can sometimes go unnoticed and many are totally unaware they have it, eve if they don't feel quite right.

SIGNS & SYMPTOMS 

There are many symptoms of postnatal depression. They're wide-ranging and can include low mood, poor appetite, difficulty sleeping, loss of libido, irritability and episodes of tearfulness. These are all common after having a baby and are often known as the "baby blues" and usually clear up after a few weeks but if they persist, it could be postnatal depression. Some women don't realise they have it, or choose to ignore their symptoms. They're afraid to be seen as a bad mother but it doesn't mean you don't love or care for your baby. If you think somebody you know is showing any of the symptoms, be supportive and encourage them to see their GP. It's important to understand that postnatal depression is an illness.

The cause of post natal depression is not completely known. Experts think post natal depression is the result of a combination of things.

These may be:

depression during your pregnancy

a difficult deliver of your baby

lack of support at home

relationship worries

money problems

having no close family or friends around you

physical health problems following the birth, such as urinary incontinence, or persistent pain from an episiotomy scar or a forceps delivery

Even if you have none of these problems and you had a straightforward pregnancy or labour, just having a baby can be a stressful and life-changing event that could trigger depression.

People often assume that you will naturally adapt to parenthood overnight. But in fact it can take months before people begin to cope with the pressures of being a new parent. 

Even if this is your 2nd, 3rd or 4th baby, doesn't mean you won't get post natal depression. Some babies are more difficult and more demanding than others, and don't settle so easily. This could lead to exhaustion and stress.

What increases your chance of post natal depression include;a family history of depression or postnatal depression

having experienced depression or postnatal depression previously 

mood disorders such as bipolar disorder.

The most important first step in managing postnatal depression is recognising the problem and taking action to deal with it. The support and understanding of your partner, family and friends plays a big part in your recovery.

Guided self-help

Guided self-help is based on the principle that your GP can "help you to help yourself".

Talking therapies

Talking therapies are where you are encouraged to talk through problems either one-to-one with a counsellor or with a group. You can then discuss ways to approach problems in a more positive manner.

Antidepressants

The use of antidepressants may be recommended if:

You have moderate postnatal depression and a previous history of depression.

You have severe postnatal depression.

You have not responded to counselling or CBT, or would prefer to try tablets first.

A combination of talking therapies and an antidepressant may be recommended.

If it is felt your postnatal depression is so severe you are at risk of harming yourself or your baby, you may be admitted to hospital or referred to a mental health clinic. If you have support available from your partner or family, it may be recommended they care for your baby until you are well enough to return home.

Diagnosis

Your GP should be able to diagnose postnatal depression by asking two questions:

*During the past month, have you often been bothered by feeling down, depressed or hopeless?

*During the past month, have you often been bothered by taking little or no pleasure in doing things that normally make you happy?

If the answer to either of these is yes, then it is possible you have postnatal depression. If the answer is yes to both, postnatal depression is probable.

Some mothers, especially those without a partner or relative to help care for their baby, can be reluctant to provide honest answers to these questions. This is because some worry that a diagnosis of postnatal depression will mean they are seen as a bad mother and that there is a chance their baby will be taken into care. It should be stressed that a baby will only be taken into care in the most exceptional of circumstances. One of the prime goals of treatment of postnatal depression is to help you care for and bond with your baby.

Symphysis Pubis Dysfunction (SPD)

SPD

The symphysis pubis is a stiff joint that connects the two halves of your pelvis. This joint is strengthened by a dense network of tough, flexible tissues. Your body produces a hormone called relaxin, which softens your ligaments in order to help your baby pass through your pelvis. Your pelvic joints move more during and just after pregnancy. This can cause inflammation and pain. 

Symptoms 

Pain in the pubic area and groin are the most common symptoms, though you may also have the following signs: 

Back pain, pelvic girdle pain or hip pain.

A grinding or clicking sensation in your pubic area.

Pain down the inside of your thighs or between your legs. It can be made worse by parting your legs, walking, going up or down stairs or moving around in bed.

Worse pain at night. SPD can prevent you from sleeping well. 

Causes of SPD

SPD is thought to be caused by a combination of hormones that you produce during pregnancy, as well as the way your body moves. If one side of your pelvis moves more than the other when you walk or move around, the area around the symphysis pubis becomes tender. 

The size of the gap in your joint doesn't bear any relation to the amount of pain you may feel. Many women with a normal-sized gap feel a lot of pain. You may be more likely to develop SPD if you started your periods before you were 11, or are overweight.

When does SPD happen?

SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time during the middle of your pregnancy. 

If you have SPD in one pregnancy, it is more likely that you'll have it next time you get pregnant. The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to get pregnant again.

How is SPD diagnosed?

SPD is becoming more widely understood by doctors, physiotherapists and midwives. Your doctor or midwife should refer you to a women's health physiotherapist. Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles.

How is SPD treated?

Exercises, especially focused on your tummy and pelvic floor muscles. These will improve the stability of your pelvis and back. You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes help.

You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan which takes into account your SPD symptoms.

A pelvic support belt will give quick relief.

Pre-Eclampsia

Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.

Symptoms 

swelling of the feet, ankles, face and hands caused by fluid retention 

severe headache

vision problems

pain just below the ribs

Although many cases are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated. 

Who is affected?

Pre-eclampsia affects up to 5% of pregnancies, and severe cases develop in about 1-2% of pregnancies. There are a number of things that can increase your chances of developing pre-eclampsia, such as:

if it is your first pregnancy

if you developed the condition during a previous pregnancy

if you have a family history of the condition

if you are over 40 years old

if you are expecting multiple babies (twins or triplets)

What causes pre-eclampsia?

Although the exact cause of pre-eclampsia is not known, it is thought to occur when there is a problem with the placenta 

Treating pre-eclampsia

If you are diagnosed with pre-eclampsia, you should be referred for an assessment by a specialist. This will usually be in a hospital. While in hospital you will be monitored closely to determine how severe the condition is and whether a hospital stay is needed.

The only way to cure pre-eclampsia is to deliver the baby, so you will usually be monitored regularly until it is possible for your baby to be delivered. This will normally be at around 37-38 weeks of pregnancy, but it may be earlier in more severe cases. At this point, labour may be started or you may have a caesarean section 

Medication may be recommended to lower your blood pressure while you wait for your baby to be delivered.

Prenatal Depression

What is it?

Antenatal depression, also known as Prenatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% percent of pregnant women are affected by this condition.

SIGNS AND SYMPTOMS

Antenatal depression is classified based on a woman's symptoms. During pregnancy, a lot of changes to mood, memory, eating habits, and sleep is common. When these common traits become severe, and begin to alter one's day-to-day life, that is when it is considered to be antenatal depression. Symptoms of Antenatal depression are:

Inability to concentrate.

Difficulty remembering.

Feeling emotionally numb.

Extreme irritability.

Sleep problems that aren't related to pregnancy.

Extreme or unending fatigue

Desire to over eat, or not eat at all.

Weight loss/gain unrelated to pregnancy.

Loss of interest in sex.

A sense of dread about everything, including the pregnancy.

Feelings of failure, or guilt.

Persistent sadness.

Thoughts of suicide, or death.

Other symptoms can include the inability to get excited about the pregnancy, and/or baby, a feeling of disconnection with the baby, and an inability to form/feel a bond with the developing baby.This can drastically effect the relationship between the mother and the baby, and can drastically effect the mother's capacity for self care

CAUSES

Antenatal depression affects about one in every eight women.It's becoming more prevalent as more medical studies are being done. Antenatal depression was once thought to simply be the normal stress associated with any pregnancy, and was waved off as a common aliment. It can be caused by many factors, usually though involving aspects of the mothers personal life such as, family, economic standing, relationship status, etc. It can also be caused be hormonal and physical changes that are associated with pregnancy.

TREATMENT

Treatment for Antenatal depression poses many challenges because the baby is also affected by any treatments given to the mother. It is suggested that the emotional aspects are handled first which includes;

Taking it easy by relaxing when possible.

Spending time with your partner.

Talk about your fears & anxieties involving the pregnancy.

Manage your stress.

Counseling is highly recommended to any woman suffering from antenatal depression. It is a very effective way for the mother to express her feelings and explain in her own words what she is feeling. This is very effective in that it gives the doctors a better insight into the symptoms and their severity. In severe cases Medication can be prescribed. This is usually only done if the symptoms have proven so severe that they interfere with day-to-day life, self care, and ability to sleep.

Gestational Diabetes

What Is It?

Gestational Diabetes means you have a high blood sugar level that happens during pregnancy. The condition usually resolves itself after your baby is born.

Gestational Diabetes begins in your second trimester. If you develop diabets in pregancy it means that either your body isnt releasing enough insulin or your cells arnt responding to it. The result is that your blood sugar remains high, this can have a number of effects on you and your baby.

SIGNS AND SYMPTOMS

Symptoms of Gestational Diabetes are uncommon. This is because the condition is usually diagnosed from screening tests before symptoms develop. However, if diabetes isnt detected or treated you may have the following symptoms :

feeling thirsty more often than usual

needing to urinate more often

having infections which affect your urinary tract

 

These symptoms aren’t always caused by gestational diabetes. If you notice any of these symptoms, see your doctor.

CAUSES

There are a number of factors that can increase your risk of getting Gestational Diabetes. You are more at risk if you:

Are overweight or obese

Have given birth to a baby that wieghed 4.5KG or more

Had Gestational Diabetes in a previous pregnancy

Have a close relative with Diabetes

Have Polycystic overies syndriome

Your ethnic group may also increase your risk of it. The condition is more common in people with a South Asian, Black Carrabian, or a Middle Eastern background.

TREATMENT

If you’re diagnosed with diabetes, you should be offered an appointment with a joint diabetes and antenatal clinic. The doctors and nurses here will be experienced in looking after pregnant women with diabetes. You will have more frequent antenatal appointments than women who don't have gestational diabetes.

Your treatment will be aimed at keeping your blood sugar lowered enough to help prevent complications. You will need to regularly test your blood sugar

Placenta Previa

What Is Placenta Previa?

The placenta is the organ created during pregnancy to nourish the fetus, remove its waste, and produce hormones for your pregnancy. The placenta is attached to the wall of the uterus by blood vessels that supply the fetus with oxygen and nutrition and remove waste from the fetus and transfer it to the mother.

The fetus is attached to the placenta by the umbilical cord. Through the cord, the fetus receives nourishment and oxygen and removes waste. On one side of the placenta, the mother's blood circulates, and on the other side, fetal blood circulates. The mother's blood and fetal blood usually don't mix in the placenta.

The placenta is usually attached to the upper part of the uterus, away from the cervix, the opening which the baby passes through during delivery. On rare occasions, the placenta lies low in the uterus, partly or completely blocking the cervix, a condition called placenta previa.

Placenta previa is frequently seen in pregnancies before the 20th week but usually resolves in most cases, leaving only 10% that persist into later pregnancy. As the uterus grows, the placenta usually moves higher in the uterus, away from the cervix. But if it remains near the cervix as your due date nears, which happens in about 1 in 200 pregnancies, you're at risk for bleeding, especially during labor as the cervix thins and opens. This can cause major blood loss in the mother. For this reason, women with a placenta previa usually deliver their babies before their due date by cesarean delivery.

There are several types of placenta previa:

A low-lying placenta is near the cervical opening but not covering it. It will often move upward in the uterus as your due date approaches.

A partial placenta previa covers part of the cervical opening.

A total placenta previa covers and blocks the cervical opening.

What Causes Placenta Previa?

The cause of placenta previa is usually unknown, although it occurs more commonly among women who are older, smoke, have had children before, are pregnant with more than one baby (twins, triplets, or more) or have had a cesarean section or other surgery on the uterus.

Women with placenta previa,  particularly if they have a placenta previa after having delivered a previous baby by cesarean section, are at increased risk of placenta accreta, placenta increta, or placenta percreta.

In placenta accreta, the placenta is firmly attached to the uterus. In placenta increta, the placenta has grown into the uterus; and in placenta percreta, it has grown through the uterus. These conditions can sometimes be confirmed by ultrasound, CT scan, or MRI. Women with one of these conditions usually require a hysterectomy after delivery of the baby because the placenta does not separate from the uterus.

Symptoms of Placenta Previa

Some women with placenta previa don't have any symptoms. But others may have warning signs such as:

Sudden, painless vaginal bleeding - the blood is usually bright red, and the bleeding can range from light to heavy.

Symptoms of early labor - these include regular contractions and aches or pains in your lower back or belly.

Call your doctor or go to the nearest emergency room right away if you have:

Medium to heavy vaginal bleeding during the first trimester.

Any vaginal bleeding in the second or third trimester.

Treatment of Placenta Previa

Close monitoring throughout your pregnancy - In 90% of cases the placenta moves from infront of the cervical opening before you give birth

If you aren't bleeding, you may not need to be in the hospital. But you will need to be very careful.

Avoid all strenuous activity, such as running or lifting.

Call your doctor and go to the emergency room right away if you have any vaginal bleeding.

In the 10% of cases where this doesn't happen a c section is preformed due to risks involved for Mum & baby. 

If you are bleeding, you may have to stay in the hospital. If you are close to your due date, your baby will be delivered. Doctors always do a C-section when there is a placenta previa at the time of delivery. A vaginal delivery could disturb the placenta and cause severe bleeding.

If your bleeding can be slowed or stopped, your doctor may delay delivery and monitor you and your baby closely. The doctor may do:

Fetal heart monitoring to check your baby's condition.

Amniocentesis to find out if your baby's lungs are fully formed.

You may be given:

A blood transfusion if you've lost a lot of blood.

Steroid medicines if you aren't close to your due date. These medicines help get your baby ready for birth by speeding up lung development.

Tocolytic medicine to slow or stop contractions if you are in early labor.

If your newborn is premature, your baby may be treated in a neonatal intensive care unit, or NICU. Premature babies need to stay in the hospital until they can eat, breathe, and stay warm on their own.

Hyperemesis Gravidarum

What is Hyperemesis Gravidarum?

Hyperemesis gravidarum also known as HG, is a condition that is much more severe than normal  pregnancy sickness.

It can be so severe that a woman becomes dehydrated, lose weight could have to be admitted to hospital and put on a saline drip under specialist care.

Causes of Hyperemesis Gravidarum

It is thought that a lack of vitamin B6 in the diet may be a cause of HG.

You should be able to get enough vitamin B6 through a healthy, balanced diet. It's present in foods including cereals, wholemeal bread, cod, potatoes, milk and bananas. 

Vitamin B6 supplements may ease your symptoms, but don't take them without speaking to your doctor first as it's not clear how safe it is to take vitamin B6 supplements during pregnancy.

Symptoms of Hyperemesis Gravidarum?

The symptoms of HG go far beyond the discomfort of morning sickness and require urgent medical attention. 

They include:

Continued & severe nausea and vomiting

Dehydration caused by the vomiting

Ketosis - raised levels of toxic acidic chemicals in the blood called ketones

Losing weight due to inability to keep food down

Low blood pressure, known as hypotension, especially on standing up

Risk of DVT - deep vein thrombosis (blood clots in a vein) - due to dehydration

In terms of the quality of life, HG can affect a woman’s work, home life and family life due to frequent vomiting.

It’s been described by some women as like having your stomach turned inside out. This lasts for weeks and weeks and weeks. It can last throughout the whole pregnancy for some very unfortunate women.

Treatment of Hyperemesis Gravidarum

Is there anything that pregnant women can do themselves to alleviate the symptoms?

Doctors suggest trying to move less, avoiding tasks such as cleaning the house may help, as any movement may exacerbate the feeling of nausea. 

Rest and relaxation may be recommended as well as avoiding some smells, including food or cooking odours.

In some cases HG needs specialist treatment, and you will need to be admitted to hospital so that doctors can assess your condition and give you the right treatment. This can include intravenous fluids given through a drip to treat the ketosis and treatment to stop the vomiting.

Hyperemesis gravidarum is unpleasant with dramatic symptoms, but the good news is it's unlikely to harm your baby. However, if it causes you to lose weight during pregnancy there is an increased risk that your baby may be born smaller than expected.