Why do some mothers reject their babies

Pregnant women and their families expect the postpartum period to be a happy time, characterised by the joyful arrival of a new baby. Unfortunately, women in the postpartum period can be a vulnerable to psychiatric disorders such as postpartum blues, depression and psychosis. Because untreated postpartum psychiatric disorder can have a longterm and serious consequences for both mother and her infants, screening for these disorders must be considered part of standard postpartum care

A postpartum (or postnatal) period is the period just after the birth of a child as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state.The terms puerperium or puerperal period, or immediate postpartum period are commonly used to refer to the first six weeks following childbirth.

There are three clinical syndrome;

1) postpartum blues.
Affects 50-70% of women
It is a transient, self limiting condition most commonly start 3-5 days after delivery and may persist for up to 2 weeks. No specific metabolic or endocrine abnormalities have been detected. But lowered tryptophan level is observed. It suggest altered neurotransmitter function.

Manifestations are:

1. Panic attacts
2. Episodes of low mood of prolonged duration
3. Low self-esteem
4. Guilt or hopelessness
5. Thoughts of self-harm or suicide
6. Any mood changes that disrupt normal social functioning
7. Biological symptoms eg. appetite, early wakening.

Treatment

1. Reassurance and psychological support by the family members.
2. If the condition persist, the patient should be referred for psychiatric evaluation.

2)   Post-natal depression.

This can affect up to 10-20% of mothers. It is more gradual in onset over the first 4-6  months following delivery, abortion or stillbirth.

Present later in postnatal period, most commonly around 6 weeks with a more gradual onset. 

Symptoms include.

1. Early morning wakening
2. Poor appetite
3. Diurnal mood variation
4. Low energy and libido
5. Lack of interest
6. Impaired concentration
7. Tearfulness
8. Feeling of guilt
9. Anxiety
10. Thoughts of self harm
11. Thought of harm to baby.

Risk factors for postnatal depressive illness

1. Past history of psychiatric illiness
2. Depression during pregnancy
3. Social isolation
4. Poor relationships
5. Poor adverse life events
6. Severe pastnatal blues

Management:

Mild to modarate depression may respond to self help strategies and non directive counselling. 

Severe depression will require antidepressants and/or psychotherapy. Fluoxetine or paroxetine (serotonin reuptake inhibitors) is effective and has fewer side effects. It is safe for breastfeeding 

3)  Puerperal psychosis.

This occurs in 1–2 out of 1000 deliveries after delivery. It presents usually in the 5th postpartum day but usually does so before 4 weeks. 

The onset is characteristically abrupt, with a rapidly changing clinical picture. It may recur with each subsequent pregnancy. Is defined as major depression with psychotic  features. 

Symptoms of puerperal psychosis 

1. agitation. 

2. confusion.  

3. Delusions/hallucinations. 

4.  Failure to eat and drink.  

5. Thoughts of self-harm. 

6. Depressive symptoms (guilt, self-worthlessness, hopelessness). 

7. Loss of insight.    

Risk factors for postpartum psychosis

1. Previous history of puerperal psychosis. 

2. Previous history of severe non-postpartum depressive illness. 

3. Family history (first/second-degree  relative)  of  bipolar  disorder/affective psychosis. 

4. Marital problems 

5.  Lack of family support.   

Management: 

1. The patient should be admitted to a regional mother-and-baby unit  with her newborn  where she can receive multidisciplinary care from the specialist medical, nursing and midwifery staff. 

2.  If the condition is severe, the patient will require ( psychotropic medications, antidepressants, antipsychotics, or mood stabilizers) for at least 6  months and, in some cases, electroconvulsive therapy

3.  Most patients make a full recovery, but recerrence rates are high (60–80%) in the long term. 

4.  High-risk patients and those with previous history of puerperal psychosis should be  referred to specialist perinatal mental health service antenatally so that an appropriate care plan can be developed and the use of prophylactic medication can be considered soon after delivery.eg. prophylactic lithium, started on the first postpartum day.  How should her breastfeeding be managed? She should be encouraged to continue breastfeeding but the baby should be monitored for side-effects.

 Note: not all who throws or kills their babies are pyschotic some have their reasons. So education and caring are mandatory to all women before and after giving birth.