21 December 2012

Nigeria: Postpartum Psychosis - Rare Challenge in Motherhood


Birthing is a phenomenon normally associated with joy because of the arrival of the new baby. In all cultures across the world the arrival of a new baby is celebrated with fun fare and other joyful and memorable events like baby showers, naming ceremonies, etc. It takes different dimensions but generally one is only happy and grateful to God for the divine gift and the safe delivery of both the mother and child.

Welcome to the world! They come in wailing, ten fingers and toes, no deformity and we are happy. The proud father is happy he has sired a child, the mother now in the elite class of women who have tasted the changes, the pains, the mystery of child birth is now triumphant she has brought a child into the world.

I have always marvelled at Allah's handiwork each time I see a woman with a child, the growth month after month, the intricacies of the baby feeding through the umbilical cord, the expansion of the pelvic bone as the baby descends through the birth canal to come into the world. Just this, is enough to increase ones faith, to know there is a divine being directing all these activities, especially when you consider the number of women who put to bed safely each day. There may be aches and pains here and there but generally all is expected to be well with mother within a few days.

A happy scenario is what one hopes and expects each time our loved ones put to bed. However, I recently came across a kind of psychosis (mental illness) that some women suffer after putting to bed. I then knew why it is said in the Hausa tradition that if a woman puts to bed and you do not congratulate her you should not bother coming to offer condolences when she dies.

Post Partum Psychosis is a severe mental illness that is rare, but affects 1 to 2 women in every thousand births. It appears suddenly in some women within the first 2 postpartum weeks, with or without symptoms. Some of the symptoms are, becoming suspicious of everything and everyone even their loved ones. Seeing and hearing things no one else does. They also sometimes find it difficult to focus or remember things they have always done in their lives. Reading and other simple activities that require intellect become difficult for the sufferers of this illness which is regarded as a mental health emergency.

This illness that touches the mind has been in our societies, but due to the stigma attached to such illnesses it is most times kept secret or left unattended, which in the end result to serious psychiatric disorder. The society has been quiet about it and a lot of people have never even heard of this health condition. Therefore there is no knowledge of/about it. At a time these women need support they are stigmatized as they develop more symptoms of their illness such as violence, disinhibition, confusion, irritability, euphoria and delusions.

It is the dream of every mother to see her daughter grow up, get married and give her a grandchild, but when the process comes with this disorder one cannot help but pity both the Mother and daughter. The sufferer most times does not know what she is doing, may become violent and can even attack the baby or attempt committing suicide. The grandmother a lot of times doesn't know anything about this illness, but has to deal with all that comes with it. A part from caring for the baby since his mother is now indisposed. She bears the burden of keeping the whole affair a secret so that her daughter and all her progeny are not labelled mad. In her confusion she runs helter-skelter and concoctions are now poured down the throat of the sick mother, bathed with some more. The 'Rukiyya' merchants would now have a field day trying to get a non existing jinn causing the "madness" to talk in order to chase him out of the body. Resources are wasted as more and more charlatans take them for a ride.

The hospital is her only safe bet, where doctors know about all the postpartum disorders that can affect a woman be it anxiety, depression or psychosis. They can prescribe medications to get her cured.

Nursing a PPP patient is a herculean task as they need the constant monitoring and round the clock presence of a competent adult. It is the most extreme form of postpartum disorders, in this condition the patient loses control over themselves and with reality. A lot of care, patience, love and understanding must be given to help the new mother recuperate fully. Although lot of doctors feel puerperal psychosis may be due to the hormonal changes that take place in a woman after delivery, it is also certain that stressful life events or dissatisfaction in their marital life may be triggers for this mood disorder that may lead to suicide or infanticide if immediate medical intervention is not recieved.

Earlier in the year I have seen two cases, the more severe of the two cases jumped off the balcony of a storey building after torturing herself with the thought that she had killed her mother. The scenario was so real for her that at that moment she felt she could not live with herself. Luckily she survived the fall, but we all have seen her distress as she sometimes comes through to ask the same mother she thought she had killed, about the bruises and cuts sustained from her fall. She didn't for once ask for her baby, such is PPP she has simply forgotten all about him.

There may be reoccurrence of these episodes with subsequent deliveries thus each time such a victim conceives there's anxiety among family members but with proper medication, understanding and support from them and the society at large the patient will surely pull through.

I sincerely hope that awareneszs will be created perhaps at antenatal classes so that women, their spouses, and family know about this illness and can understand what is happening at onset, so no one suffers any unnecessary hardship and stigmatisation.

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