Perinatal Mental Health Conditions

Postpartum blues, also known as the baby blues (a commonly used term in international medical literature), refers to a short-lived period of low mood occurring within the first 14 days after childbirth. It affects approximately 50–80% of mothers. Symptoms usually begin between the third and fifth day after birth and typically last from a few hours up to several days.

Typical signs of postpartum blues include:

• Fatigue, exhaustion, and lack of energy
• Increased sensitivity and mood swings
• Sadness and frequent crying
• Insomnia and restlessness
• Difficulties with concentration, appetite, and sleep
• Anxiety and irritability

As the baby blues are a common and time-limited experience, they are generally considered a non-clinical response to the physical, hormonal, and emotional changes following childbirth and do not require treatment. However, recognising the baby blues as a normal condition should not lead to them being dismissed. If low mood persists for longer than two weeks, this may be an early indication of postpartum depression and should be taken seriously.

These conditions can develop at any time during pregnancy and within the first two years after birth, most commonly, however, in the first weeks following delivery. The severity can range from mild adjustment difficulties to severe, potentially suicidal forms. In many cases, symptoms develop gradually. Approximately 10–20% of all mothers are affected.

Common signs and symptoms may include:

• Persistent fatigue, exhaustion, lack of energy
• Sadness, frequent crying
• Feelings of guilt
• A sense of inner emptiness
• General loss of interest, absence of sexual desire
• Ambivalent feelings towards the baby
• Difficulties with concentration, appetite, and sleep
• Headaches, dizziness, heart palpitations, and other psychosomatic symptoms
• Anxiety, extreme irritability, panic attacks, obsessive thoughts (recurrent distressing thoughts, images, or ideas that are not acted upon)
• Suicidal thoughts

Perinatal anxiety disorders are considered a distinct category, as anxiety symptoms are predominant. Depressive symptoms may be present but are not necessarily required for diagnosis. These conditions involve severe and recurring anxiety and/or panic. Anxieties and worries may be vague and relate to life or the world in general, or they may arise in specific situations. Commonly, fears and worries focus on the well-being of the baby. Perinatal panic disorders (episodes of intense fear) and perinatal obsessive-compulsive disorders (persistent, intrusive anxiety-related thoughts, images, or fears) represent particularly severe forms of perinatal anxiety responses.

Perinatal psychosis may occasionally develop during pregnancy, but it most commonly occurs within the first two weeks after childbirth. In some cases, it may also emerge from a depressive episode. It is considered the most severe form of a perinatal mental health crisis and affects approximately one to three out of every 1,000 mothers.

Possible signs and symptoms include:

• Markedly increased drive and activity levels
• Motor restlessness (manic phase)
• Loss of drive, reduced movement, and social withdrawal (depressive phase)
• Extreme anxiety
• Confusion, delusions, and hallucinations

The increased drive, which may manifest in a range of unproductive activities, does not indicate an elevated or positive mood. During hallucinations and delusional experiences, affected women may hear voices or see people, animals, or objects that do not exist, or develop delusional beliefs, for example of a religious nature. For the person affected, these experiences feel entirely real.

One of the most common triggers of postpartum psychological distress is a traumatic birth experience. Whether a birth is experienced as traumatic depends entirely on the mother's subjective perception. If she experiences the actions of midwives, physicians, or other healthcare professionals as intrusive or violent, this may lead to post-traumatic stress disorder (PTSD).

Possible symptoms include:

• Flashbacks
• Crying spells
• Being easily startled
• Restlessness and difficulty concentrating
• Persistent, repetitive rumination
• Sleep disturbances
• Panic attacks
• Fear of physical and emotional closeness
• Emotional numbness
• Irritability

To help assess whether a traumatic birth may have resulted in symptoms of post-traumatic stress disorder, the BFAG Self-Assessment Questionnaire for Traumatic Birth can provide an initial indication.

A traumatic birth may be triggered by psychological abuse (for example, being told, “Stop making such a fuss.”), perceived physical violence such as the Kristeller manoeuvre, vacuum-assisted delivery, or being restrained in certain positions. It may also result from procedures carried out without the mother's informed consent, such as medication administered without prior explanation or an unwanted episiotomy. In addition, a long, physically and emotionally exhausting labour may itself be experienced as traumatic.

Feelings of helplessness, loss of control, or not being taken seriously in one's needs and concerns increase the likelihood of a traumatic response. Childbirth may also reactivate memories of previous experiences of abuse or violence, thereby triggering birth-related trauma.

The time around the birth of a child is an emotionally challenging situation for fathers as well, which can be highly stressful. Sometimes, there are clear causes, such as a miscarriage, experiencing violence or a life-threatening situation for the mother or child during delivery.

Strong emotions or emotional numbness can also occur without any obvious reason. In fact, hormonal changes also occur in fathers and many other triggering factors for peripartum mental health disorders are identical between mothers and fathers.

Typical symptoms include:

• Low mood
• Sadness and feeling much less joy than expected
• Feelings of helplessness, being overwhelmed, and anger
• Feelings of guilt
• Isolation and loneliness
• Low self-esteem and self-worth issues
• Anxiety

Many men believe they are not allowed to have these feelings or that they must overcome them on their own, making it difficult for them to talk about this topic or seek help. However, trying to „pull oneself together“ does not lead to improvement; instead, it may worsen their mental health and additionally burden not only themselves but also their partner and child.

An important message for affected fathers: They are not alone with their feelings and experiences! It can also be very helpful and relieving for them to address their thoughts, emotions and experiences, connect with other fathers who have gone through similar experiences or seek professional help.

Schatten & Licht e.V. offers counselling and an online self-help group for fathers.