Birthing depression

The postpartum period is the first six weeks after giving birth to the child. It may appear very obvious that a woman who has conceived through a lot of fertility treatment may be overjoyed and on cloud nine at the arrival of the baby. But that may not always be the case. During the postpartum period, women undergo various physical and psychological changes making them vulnerable to handle the changes and stress. The spectrum of the postpartum period usually begins with baby blues, and eventually, depression. If not treated, it may lead to full-blown postpartum psychosis. The symptoms usually occur within four weeks of birth. It can present as mood swings, extreme tearfulness, and an inability to show love or bonding with the baby. Various trigger factors bring about psychological changes in postpartum mothers. The chemical changes within the body along with the surroundings affect the psychological state and well-being.

Many patients who come for fertility treatment do so under peer or family pressure or to prove their self-worth, and not because they have the urge to have a child. When this aspect of the psyche is not clear, they are completely left perturbed by the newness of the life which comes with a baby. They feel it was not worth it to undergo so much pain and to land up with agitation and psychological disturbances. Changes in hormones like estrogens, progesterone, and thyroid levels cause mood swings, poor sleep, lack of appetite, depression, and anxiety. A lack of support from the family makes the mother feel lonely and unable to handle the newborn if it is her first time giving birth to a child. There are higher rates of caesarean operations as IVF pregnancies are usually considered precious pregnancies. Associated with C-section are pain, time to recovery, and erratic vaginal bleeding that add to the lack of sleep, tiredness, and change in daily patterns. Marital discord or any other difficulty in a relationship, which would have started as a part of an infertility issue adds to the stress. Women also gain weight during pregnancy which may be reversible or may be permanent in some cases. The change in body shape and body image adds to low self-esteem due to social standards of perfection and beauty. The social and self-inflicted pressure disturbs the psychological balance.

A job loss or pay cut because of the pregnancy causes an increased feeling of self-worthlessness especially after undergoing a financial blow following expensive Assisted Reproductive Techniques (ART) treatments.

Postpartum anxiety may be slightly more common in couples who have conceived with ART. Many of the couples who are undergoing ART treatment may be anxious regarding the health of the baby conceived and may overly analyse every test or ultrasonography once they conceive. Usually, couples who are well educated and financially well off come for ART treatments. With increasing online knowledge and increased affordability of advanced investigation, they may end up opting for several unnecessary investigations and increase their stress levels. These are the couples who end up having postpartum anxiety at the drop of a hat. The primary concerns of every pregnant woman would be about congenital abnormality that occurs in the baby, the growth and development of the baby, the IVF treatment, and whether it has caused any abnormality in the baby which is still undetected. These patients may be ensured and counselled that the chances of congenital abnormalities in IVF babies are the same as that of normally conceived babies and there are millions of babies worldwide who are conceived by IVF and are normal and thriving. In IVF pregnancies, the chances of having a twin pregnancy are higher. In India, it is accepted wholeheartedly but worldwide it is considered a complication of IVF. IVF pregnancies that are conceived as multiple pregnancies may show higher chances of postpartum symptoms as the responsibility and stress increase in handling babies. Lower birth weight, premature deliveries, NICU admission that comes with a heavy cost, complications like high blood pressure during pregnancy, and postpartum heavy bleeding in the mother take a toll on the physical and financial health of the couple.

(The author is a consultant in IVF & reproductive medicine)