Emotional health in the perinatal period
The perinatal period is often viewed as a joyful and privileged state. Pregnant women and new mothers are said to ‘glow’, and are most times treated with extra consideration and even deference. However, contradictory to the belief that pregnancy and early motherhood is a time of special emotional well-being and glowing contentment, women in many parts of the world acknowledge some physical and emotional discomfort associated with such period.
The truth is, up to one-quarter of all women experience a Major Depressive Episode over their life time, with peak incidence occurring during reproductive years, and as such women of childbearing age are more vulnerable to mood swings and depressive symptoms. Understandably, in developing countries such as Nigeria, the focus of health care is on women's medical and obstetrical challenges as well as on the baby's wellbeing. The psychological needs of pregnant and postnatal women are rarely addressed, living women vulnerable to perinatal mood disorders without preventive and/or intervention measures.

Perinatal mood disorders (PMD's) may occur in various forms from mild to moderate to severe.

It may occur mildly in form of the 'Baby Blues' which occurs during the first few weeks after delivery. Between 50-85% of women experience some form of the “baby blues”.Given how common this type of mood disturbance is, it may be more accurate to consider the blues as a normal experience following childbirth rather than a psychiatric illness. Rather than feelings of sadness, women with the blues more commonly report mood lability, tearfulness, anxiety or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery. While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. No specific treatment is required; however, it should be noted that sometimes the blues heralds the development of a more significant mood disorder, particularly in women who have a history of depression. If symptoms of depression persist for longer than two weeks, the patient should be evaluated to rule out a more serious mood disorder.

Postpartum Depression
which is not as mild as the Baby blues and not as severe as pospartum psychosis usually goes undiagnosed and untreated. It usually may occur between delivery date and one year postpartum. Women in this condition may experience:

• Feeling irritable, moody, overwhelmed, sad or hopeless
• Frequent bouts of crying
• Lack of energy or motivation
• Appetite Fluctuations
• Sleep disturbances or changes in sleeping pattern
• Have trouble maintaining focus or being indecisive
• Difficulty remembering things
• Feelings of worthlessness or guilt
• Loss of interest or joy in normal activities
• Withdrawn and somber
• Having frequent headaches, body aches and pains or stomach pain that will not subside

While postpartum depression occurs in women who have recently delivered a baby, it is important to note that women who experience a miscarriage or stillbirth, can also go through postpartum depression.

Finally Postpartum Psychosis may occur in extreme cases. About 2% of women fall victim of this condition.Symptoms include:

• Rapid, manic episodes
• Rapid heartbeat
• Weight loss
• Irritability
• Confusion
• Disorientation
• Insomnia
• Restlessness
• Rapid shift in moods (going from highs to extreme lows)
• Erratic and scattered behavior
• Delusions
• Auditory Hallucinations that drive the mother to harm the infant, are also possible.
• Risk of suicide or infanticide

Other kinds of PMD's include: Postpartum Panic Disorder, Prenatal Anxiety, Postpartum Obsessive-Compulsive Disorder, Postpartum Posttraumatic Stress Disorder

Impact of mental health disorders in the perinatal period
Whether symptoms are mild, moderate or severe, maternal mental health problems are known to have a significant impact on all aspects of a woman’s life, and also affect infants, significant others and families

Impact on the woman

• Postpartum depressive symptoms combined with extreme fatigue and the additional responsibilities of a new baby can create difficulties in the woman’s close relationships and in her capacity to care for her baby

• As well as the suffering associated with compromised mental health, anxiety and depressive disorders are associated with relationship stresses that can lead to a loss of social networks and subsequent isolation if not resolved.

• Although mental health disorders are a leading cause of indirect maternal mortality, the suicide rate in the first postpartum year is lower than at other times. However, among women with a severe disorder, the risk increases at this time.

• In the longer term, depression may also have an impact on a woman’s involvement in the workforce and and even on her personal progress.

Impact on Infant(s)

Parental mental health is universally acknowledged as one of the key determinants for healthy development in infants. It is well-recognized that infant social, psychological, behavioral and cognitive development occurs in the context of a caregiving relationship and that the mother (or primary caregiver) and infant are a unit.
When the relationship is good or ‘good enough’, mother and infant are sensitive, responsive and attuned to each other. Attachment theory has increased understanding of the impact of the quality of this relationship on infant brain development and its contribution to later psychological functioning. During critical periods of brain development, an appropriate caregiving relationship is particularly important.

Effects on the baby during pregnancy — maternal distress during pregnancy influences obstetric and birth outcomes and can adversely affect the developing fetal brain and thus influence infant
behaviour. Maternal anxiety is associated with difficult infant temperament, increased infant cortisol and behavioural difficulties in childhood. Antenatal distress increases risk of attentional deficit/hyperactivity, anxiety, and language delay, and of later mental health problems.

Physical effects on the infant — postpartum maternal mental health disorders have an impact on breastfeeding, infant nutritional status and health and growth rates.

Mother–infant attachment — Having a caregiver who provides consistent, responsive care helps infants to learn to recognise the nature of their own emotions, and to regulate their own behaviour and emotional states. When the mother is experiencing depression, the mother–infant relationship is more likely to experience difficulties and infants are at increased risk of developing insecure attachment and psychopathology. Insecure attachment, role modelling and poorer parenting techniques can lead to poor emotional and behavioural outcomes for children and impaired cognitive development.

Impact on significant others
Most research on the impact of depression in the perinatal period on significant others has focused on male partners. There are similarities in the patterns and correlates of depression after the birth of a child for men and women. The adjustment to parenthood and an increased burden of care may affect men’s ability to assist partners and build resiliency in infants. A partner’s depression and/or anxiety may influence or contribute to maternal distress and mental health disorders. Depression in fathers in the postnatal period is also associated with the later development of mental health disorders in their children, independently of maternal depression.
For either parent, living with a family member with a mental health disorder can affect relationships, work, education and social life, as well as physical and mental health. This complex series of interactions supports the need to consider the full family context and facilitate support for other family members.
While mental health assessment and care for significant others with depression in the perinatal period are not considered in these Guidelines, guidance on family.

Impact on other children in the woman’s care

Other children in the family may also be affected by a woman’s compromised mental health. Younger children may be deprived of parental involvement in play and physical care, while older children may experience a lack of interest in their school progress, social activities and friends. Recurrent maternal depression is associated with increased risk for depression in adolescents, while rates of anxiety disorders in children of mothers depressed postpartum are elevated regardless of subsequent maternal depression.

 Impact on extended family members

Severe depression during pregnancy or after the birth can also have an impact on members of a woman’s