This is about a patient whom I consulted during my Psychiatry Post Graduation – Mary (name is fictitious), a 26-year-old married lady. Mary’s mother was the informant. Her husband was also sitting outside the ward. Mary’s mother and husband were crying. But Mary had a blank expression, plainly looking away. No matter how much I asked, there was no answer from Mary, not even a gaze at me. Hence I turned to the mother to know what happened.
She wiped off her tears and started talking.” It’s Mary’s first delivery. After becoming pregnant, she was noticed to be sad mostly and had poor sleep. We never thought of it as a big deal and hence didn’t inform the gynaecologist. After giving birth, she was always sitting like this…no smile, no talk, not even a look. Even if the baby is kept on her lap, she won’t look at the baby. She wouldn’t feed the baby. She would stare at the ceiling, without any sleep, and she would eat only once a day, that too just a handful of rice. (Symptoms of severe perinatal depression).
We didn’t have a clue what was happening. Her husband said that she would improve in a few days. Today was supposed to be the day of the baby’s naming ceremony.
“So why are you in the hospital? What happened?” I asked.
“Yesterday, she suddenly grabbed the baby and jumped into the well. The baby died.” I went numb. Then I looked at Mary’s face. Even then, there was no expression on her face. She was just sitting completely motionless and expressionless, just looking away.
While doing the necessary things to shift her to the psychiatry ward, My mind was preoccupied with the thought “Mary will come out of this in a few days after starting an anti-depressant. But how will she survive the moment when she realizes that she has murdered her child?”
With this incident in mind, when I see cases of perinatal depression, I make maximum effort to help them understand the need for treatment. Such a case came to me lately.
Three months from the start of pregnancy, she started showing symptoms of depression. “This needs proper psychiatric treatment,” I told them. The husband thought for a while and replied, “Oh, I don’t think that’s necessary”. Then I took half an hour trying to make them understand the need for treatment.
“Understood Doctor…but no.. We don’t want any psychiatric treatment”. I realized there was no point in further talking..”Okay, at least don’t leave her alone and go somewhere..always ensure at least one person stays with her. Can you do that ?”. Ah..that can be done”. And they walked out.
Below are the main points of that half an hour long unsuccessful discussion:
Significant hormonal changes occur in all women during childbirth, menstruation, etc. Hence, this is the time when women are most vulnerable to experiencing depression and anxiety. About 20% of women experience peripartum depression, which means one in five pregnant women experience these symptoms.
Untreated perinatal depression is dangerous both for the mother and the baby. The mother may suffer from malnutrition, postpartum hypertension and its complications, premature delivery etc. Studies indicate that the baby is at risk of low birth weight, small head size, growth retardation, lack of attachment to the mother, motor-speech-intellectual impairments, etc. The biggest danger has already been mentioned. The possibility of suicide!! Treatment is antidepressant medication and therapy. Today, Medications are available that are not dangerous to the baby during pregnancy or breastfeeding.
SCIENCE >>> SHAME/ PRIDE OF THE FAMILY !!!
