The birth of a child is a significant life occasion that brings about radical changes - in routines, sleep patterns as well as roles, relationships, and self-identity. New responsibilities, roles, and expectations of being a parent may be difficult for some. As each baby is unique each new parent's experience is unique, & may range from a brief period of stress to more long-lasting anxiety or even more severe mood or depression (for both genders). Many stages of the early years of parenthood can cause emotions of distress (e.g., weaning, returning to work adapting to childcare, etc.). Therefore, post-natal counseling & care becomes crucial. A consultation with a post-natal counsellor is not an indication that you're not coping, it's an essential aspect of treatment. It is beneficial to have someone listen to you, without offering advice and to talk to someone who you can trust completely.

WHY POST NATAL ONLINE COUNSELING IMPORTANT?

In the postpartum time, approximately 83% of women suffer from an emotional disturbance of some kind. Most of the symptoms, are either minor or temporary, however, between 10 and 15 percent of females suffer more severe symptoms of anxiety or depression. Postpartum disorders are categorised into: (1) postpartum blues (2) postpartum depression, and (3) postpartum psychosis. It is possible to think of these disorders as occurring along the continuum of postpartum blues as the least severe and postpartum psychosis as the most serious form of postpartum mental disorder.

1. Postpartum Blues

It is believed that 50 to 85 percent of women suffer from postpartum blues for those first couple of weeks following the birth. Because the frequency of mental disturbance is in the first few weeks after birth, it might be more appropriate to view the blues as an ordinary occurrence after childbirth, rather than an illness of the psyche. In contrast to feelings of sadness, women suffering from blues are more likely to experience tears, moodiness and irritability, or anxiety. These symptoms are most often seen on the fourth or fifth day following birth and can be present for a few hours or even a few days before easing up completely within two weeks after delivery. Although the symptoms are unstable and frequently uncomfortable, they don't affect a woman's capacity to perform. It is not necessary to seek specific treatment but it must be noted that the blues can signal the beginning of a more serious mood disorder, specifically for women with a background of depression. If depression-related symptoms persist for more than 2 months, then the person must be assessed to identify the possibility of a more serious disorder.

2. Postpartum Depression

PPD is typically noticed in the first two or three months postpartum but can be present at any time after the birth. Women may experience the beginning of more mild depressive symptoms during pregnancy. Postpartum depression can be distinguished clinically from depression that occurs elsewhere in women's lives. The signs of postpartum depression can be seen as:

• Sad or depressed mood

• Tearfulness

• Inattention loss in normal activities

• Feelings of guilt

• Feelings of inadequacy or worthlessness

• Fatigue

• Sleep disturbance

• Change in appetite

• Poor concentration

• Suicidal thoughts

The signs of anxiety can also be present. The general anxiety disorder is quite common but some women may experience panic attacks or hypochondriasis. Postpartum obsessive-compulsive disorder has also been documented, where women have reported obsessive thoughts and disturbing fears of harming their children. 

3. Postpartum Psychosis

Postpartum psychosis can be described as the most severe type of postpartum mental illness. The condition is a rare occurrence that affects 1 to 2 out of 1000 women who have had children. Its symptoms can be abrupt, and the onset of symptoms appears as early as the first 48-72 hours following delivery. The majority of women suffering from puerperal psychosis experience symptoms in the first two weeks postpartum. It is evident that in most instances, postpartum psychosis can be described as bipolar disorder, and the symptoms of puerperal schizophrenia most closely resemble the symptoms of a rapid-changing manic (or mixed) episode. The initial signs include anxiety, restlessness, and sleepiness. Women suffering from this disorder display rapid changes in depressed or elated mood confusion or disorientation, as well as unorganized or erratic behavior. The most common delusions are those that usually focus on the baby. Hearing hallucinations that instruct mothers to harm themselves or their children could also occur. The risk of infanticide, as well as suicide is high in this group.

CHILDBIRTH & CHANGES IN RELATIONSHIP

The arrival of a child can alter relationships. Expectations that are not in sync or assumptions that are made by family or partner members may cause an unexpected conflict or resentment (among numerous other emotions that can be triggered). Existing problems within relationships can become more difficult with the birth of a baby. Best Psychologists in India offer couple counselling (in relation to the adjustment of parenting and parenthood) and family therapy or, if needed can refer families or couples to the best therapists in India who are appropriate in their area of expertise.

It is vital to know that online counselling services are available to spouses (irrespective of how good the mental state of the mother is). If the breadwinner is the primary one, the transition to becoming a parent can be a stressful time, with the added stress of earning money to support the family. This new responsibility may be overwhelming for some parents and can be especially stress-inducing when work isn't going as well or there is an imminent threat to the job.

Post-natal psychologists & online counsellors are skilled in recognizing emotional problems during pregnancy, post-birth as well as during the initial stages of parenting. They can assist women and couples identify whether what they feel is normal, or if it is a more serious disorder like postnatal depression or anxiety. For certain women, when medications or admission to the parent-infant unit is required and the psychologist is working closely with medical practitioners and per-natal psychiatrists to offer the most supportive medical care that is available.

POST NATAL TREATMENT

Postpartum depression can be seen on an arc and the type of treatment is determined based on the degree & nature of the symptoms. Before beginning the treatment for any psychiatric disorders, medical reasons for mood disorders (e.g. thyroid dysfunction, anemia) should be ruled out. Initial assessment should consist of an exhaustive medical history, physical exam, and routine tests in the laboratory.

Postnatal counseling or a non-pharmacological form of treatment can be beneficial in treating postpartum depression. In a randomized research study, it was proven that short-term cognitive behavioral therapy (CBT) was just as efficient as treatment with fluoxetineis an antidepressant of the selective serotonin reuptake inhibitor class prescribed by online psychiatrists for for women suffering from postpartum depression. The therapy known as interpersonal (IPT) has been proven to be successful in treating women suffering from minor to moderate postpartum depression. In addition, women who undergo IPT also experience substantial improvements in their relationships with their loved ones.

These non-pharmacological treatments, such as post-natal counselling could be appealing to patients who are hesitant to utilize psychotropic drugs (e.g. breastfeeding mothers) or patients suffering from milder forms of depression. Women who suffer from more severe postpartum depression could opt to seek out medication from a psychiatrist in consultation with their doctor, either as an alternative or in conjunction with one of these non-pharmacological treatments that include online counselling.

Contribution: Dr (Prof) R K Suri, Clinical Psychologist, life coach & mentor TalktoAngel & Utkarsh Yadav, Psychologist