Important Health Advice after giving birth

[NESTLondon]

There are important conditions to be aware of for mothers and babies as many conditions are easier to treat if women realise sooner they are at risk of becoming unwell, so it is vital this information gets to them early

Signs the Royal College of Midwives (RCM) says women should be told to look out for include heavy or persistent vaginal bleeding, fever, a rash, headaches, shortness of breath, pain or swelling in the legs, vulval or perineal areas, and difficulty or pain in passing urine.

In babies, symptoms include a temperature above 38C, a rash, feeding less than usual, floppiness, grunting while breathing and nappies being much drier than usual.

It's useful to be aware of the NICE guidelines of the most severe complications. Hopefully, these will not be relevant for you but forewarned is forearmed.

The relevant pages contained in the NICE guidelines which have advice on life-threatening conditions for mothers and babies start on page 22:

http://www.nice.org.uk/nicemedia/live/10988/30143/30143.pdf

NESTLondon are a local group of specialists in their chosen fields with experience in and a passion for the areas of fertility, pregnancy and parenthood. Check our wesite for further information at: [www.nestlondon.com]

[Saffron]

I'm disappointed to see that in the linked document from NICE under the heading "Common Health Problems", Postpartum Depression doesn't appear even to have its own heading. Instead "Baby Blues" are a listed condition, including the following description, "Action: If [baby blues] symptoms not resolved after 10?14 days, assess for postnatal depression, and if symptoms persist, evaluate further (urgent action)".

This makes it sound as if depression is a possible outcome of baby blues, and not a separate health problem. It also makes it sound like further evaluation and treatment are necessarily delayed 10-14 days whether or not it's depression. This can prevent practitioners and parents from correctly understanding the diagnosis of and treatment strategies for postpartum depression. Depression should be screened and referred for immediate action at the earliest time point. Indeed women should know that they can now take a self-directed online questionnaire. And any women actively seeking medical advice with symptoms that could present as depressive should not be told to come back in 10-14 days. NICE needs to be way more proactive in making women and practitioners aware of postpartum depression, diagnosis, treatment and outcomes.

Also, by grouping postpartum depression under the heading of baby blues instead of its own heading, NICE had failed in this document to mention the need to account for patient history of depression. Where there is a history of depression before, during, or after pregnancy, patients presenting with depressive symptoms should always be screened at the first opportunity and duration of symptoms should be measured in days not weeks.

This NICE document has done a very poor job of clarifying and emphasising these aspects of postpartum depression. Also, I don't see any mention of postpartum psychosis, a serious complication which can endanger the lives of both the mother and child.

Anyone woman who reports concerns over her mental well-being should be taken seriously at the point of access. It's worth noting that the EPDS is a short questionnaire for depression that is readily available for health workers and parents, and can also be accessed online for self-evaluation: http://www.postpartumhealthalliance.org/screen-test.html.

[Dulwich Born And Bred]

Thanks for that as I wasn't told after my labour of any possibilities that I could get an infection. I was given the impression that the labour was the worst part and then it's the babymoon afterwards .

Despite the midwife doing her regular visiting she failed to spot my infection and I ended up in hospital and then the health visitor , GP and midwife failed to spot my child's illness too and he ended up in hospital .

It was a huge shock and it's only afterwards did I realise the risks of certain infections .

No one seems to ever talk about it and I definitely think there should be more education about what to look out for after labour with regards to the health of mother and child.

[NESTLondon]

Saffron, thank you for raising that very useful point about postnatal depression.

I agree that PND goes undiagnosed far too often and that too many mothers suffer in silence, alone and with an unnecessary sense of shame and guilt. It is shocking to me that mental health in general is such a taboo and PND in particular, because having a baby is sold to women like a time when they should be happy and gratified, no matter what.

What I suppose the NICE guidelines are trying to do quite badly is make a distinction between 'baby blues' and PND.

Baby blues tends to develop straight after birth (up to ten days) due to hormonal changes, the need to adjust to a new life phase, the demands of a new baby, an unprecedented amount of tiredness and lack of sleep, etc. It consists of mild symptoms which are manageable and normally go away on their own. It is so common now that is is considered normal. I would say the operational word here is manageable.

PND is instead a mental illness which develops slightly later (up to six weeks) with much more severe symptoms which are unmanageable and just doesn't go away by themselves. It presents itself with the usual signs of depression plus some specific ones like thoughts of harming the baby which can be frightening and incomprehensible, making PND even more of a taboo to talk about.

And as you say, this is when, sometime, undiagnosed and untreated PND can lead to psychosis with grave consequences.

I urge every mother who experiences persistent unmanageable symptoms to talk to their health visitors, midwives, or GP all of whom should have access to the Edinburgh Postnatal Depression Scale questionnaire.

PND is not a sign you have failed in any way or that you are less of a mother. It is a common mental health condition that affects almost a third of all mothers especially if they have a history of previous mental health, abuse, low self esteem and have no support. Seeking help is a sign of strength and care for yourself and your baby. Talking to someone is the first step to feeling better.

Barbara, from NestLondon

[Saffron]

Postpartum depression can develop for some women just days after giving birth, and there is some evidence to suggest that use of synthetic oxytocin in managed labour (including placental delivery) is linked to depression onset in some cases. xx