Psychiatric disorders of childbirth

1. Big picture

Psychiatric disorders of childbirth are mental health disorders occurring during pregnancy, labour, or the postpartum period, especially the puerperium. In obstetrics, they are high-yield because they can endanger both mother and baby, impair bonding and breastfeeding, and may present as a true emergency.

For the exam, think in three levels:

Normal emotional adjustment
        ↓
Postpartum blues
        ↓
Postpartum depression
        ↓
Postpartum psychosis / suicidal or infanticidal risk = emergency

The examiner wants you to recognize:

• Baby blues: common, mild, self-limited.
• Postpartum depression: persistent low mood, impaired function, suicide risk.
• Postpartum psychosis: rare but life-threatening psychiatric emergency.
• Anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, and relapse of pre-existing psychiatric illness may also occur around childbirth.

The golden rule:

Any postpartum woman with suicidal thoughts, thoughts of harming the baby, hallucinations, delusions, confusion, mania, or severe agitation
        ↓
Emergency psychiatric assessment + protect mother and baby

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