To better support young mothers who suffer from postpartum depression, a mobile application has been designed by the AP-HP and the Sorbonne University. Called SmartPartum, it is also intended to improve self-diagnosis, detect early signs, and avoid, in the most extreme cases, the worst.
Becoming a mother, giving birth, does not necessarily rhyme with happiness and peace of mind. The birth of a child is not always a happy event. Between 10 and 20% of them are affected by depression postpartum within four weeks of giving birth. For them, 'motherhood is accompanied by a psychic collapse' , specifies the National College of French Obstetrician Gynecologists (CNGOF). In order to help these destitute mothers, who often feel alone and misunderstood in their condition, the AP-HP and the Sorbonne University have developed a mobile application, called SmartPartum . Its primary objective? Better care for women with postpartum depression. For it, SmartPartum will help them self-diagnose and react accordingly if any signs arise . 'It is aimed at all mothers, with advice on baby care, sleep, food, relaxation techniques, self-hypnosis, so that everyone feels good after a birth' , explains psychiatrist Hugo Bottemanne, researcher at the Parisian Brain Institute. The device will be available in early 2023. More generally, in the face of postpartum depression, gynecologists call health professionals and the family is more attentive and vigilant. The consequences are too often overlooked, and can sometimes lead to the worst. Indeed, suicide is the major risk, being the second leading cause of maternal death. . However, with early diagnosis and good management, this disease that is postpartum depression is easily treated. Note that since July 2022, a postnatal interview is now mandatory to detect the first signs.
What difference between the baby blues What about postpartum depression? There is an episode that nearly 80% of mothers go through: approximately three days after birth , they are invaded by a wave of sadness and cry for no reason. These symptoms last a few hours to a few days and go away on their own without any intervention. 'It is then enough for the entourage to be present and understanding “, explains Dr. Jacques Dayan, psychiatrist. It's the famous baby blues, a short and normal phenomenon, intimately linked to fatigue and the sudden drop in hormones. (estrogens and progesterone) which the pregnant woman is bathed in until the childbirth . Even if some symptoms seem similar and if the two are often confused in the collective mind, the baby blues has absolutely nothing to do with postpartum depression . This is serious, long-lasting, deep and can turn out to be very serious if it is not taken care of by a team of professionals. Unlike the baby blues, depression occurs within a year of birth, peaking at 6-8 weeks after childbirth , then between the 9th and the 15th month' , specifies the CNGOF. However, the first symptoms (sadness, fatigue, crying) can be confused. Those around you must therefore remain vigilant, especially since most mothers do not dare to talk about it.
'Postpartum depression can cause a pre-existing psychiatric illness to reappear, not necessarily detected before. Pregnancy and postpartum period thus represent the period most at risk of relapse of bipolar disorders. It can also favor the emergence of psychic disorders, postpartum depression to the rarer, but more serious puerperal psychosis, which affects one in a thousand women', specifies the CNGOF. However, warning signs are present such as mood swings and feelings of vulnerability increased by the mother. But these disorders can also lead to suicide (the risk is 70 times higher in the year following childbirth than at any other time in a woman's life). ' These mental disorders are now the main cause of perinatal maternal mortality, well ahead of bleeding and infections. But the future health of the child is also at stake “, warn gynecologists.
Sure, not every mom with postpartum depression experiences all of these symptoms , but maybe one or more of them, more or less pronounced. As she often tends to want to hide them, you have to be attentive to the slightest change from her usual behavior, without however becoming excessively anxious. It is of course normal to go through a phase of adaptation, especially when it comes to the first child.
|The CNGOF recommends upstream identification , from the early prenatal care , at 4 months gestation. 'All maternity wards in France must provide this space for listening, discussion, to identify weaknesses', specify the gynecologists. Another opportunity to identify depression in young mothers: the postpartum exam , expected 6 weeks postpartum. ' This appointment should be an opportunity to check if the breastfeeding is going well, where are the relations with the companion, and how is the psychic experience of the mother going. But the lack of means does not allow to promote this follow-up, regrets the CNGOF.|
Low self-esteem, stressful life events, social isolation, marital difficulties, physiological upheaval and fatigue related to the arrival of the child are the most common causes . Furthermore, the childbirth stress can play, especially when it gets complicated. Moreover, if there is no typical profile of the depressed mother, several predisposing factors have however been identified. They are in no way triggers of depression and are not essential for its appearance, but they can create favorable ground. And are very similar to the risk factors for 'classic' depression.
Similarly, we have never been able to prove that the hormonal changes related to childbirth have something to do with these post-natal depressions. We know that the sudden drop in hormones on the 3rd day is directly responsible for the baby blues. No other link could be formally demonstrated, even if this hypothesis cannot be ruled out either.
The entourage plays a role that is both essential and extremely difficult with the depressed mother . Initially, very often, he does not understand anything. A birth where everything went well is a happy event. Difficult, therefore, to imagine that the young mother can experience this event in a painful way. In addition, she seems smiling and does everything to hide her dismay. She's tired, sure, but who isn't after giving birth? ' The first good reflex is therefore to accept that postnatal depression exists , insists Dr Dayan. You have to admit that you can get depressed even when there hasn't been a disaster.' Once this state of affairs has been accepted, it is a question of offering an attentive ear. Feeling listened to and surrounded can already be a great comfort for the mother. Just as being able to share his worries and submit them to an outside gaze can help him put them into perspective a little, which should bring him some relief. Make it clear to her that, even if you don't belong to her, you accept that she feels bad and don't judge her. This will help her to feel less guilty about this distraught state in which she finds herself. It is also around feel if the depressed person needs outside help . We must encourage her to take the step, even help her to consult, go with her to a specialist. Otherwise, it is possible that she is reluctant to do so or that she simply does not have the strength to push the door of the doctor's office.
The ideal is to go to a parent-child unit made up of a whole team of professionals (child psychiatrists, psychologists, childcare workers, nurses, etc.). Depending on the situation, the mother can stay there with her baby for the day, in full-time hospitalization or for simple consultations. The advantage is that she receives the appropriate support while remaining with her child. Unfortunately these structures are few in France and therefore overloaded. In an attempt to help as many mothers as possible, some have therefore set up home consultations , which may also present an interesting solution. Another alternative: discuss the subject with the midwife during the postnatal consultation . It is important not to minimize the situation, but on the contrary to clearly specify all the symptoms. She will be able to direct you to the right person and the appropriate solutions.
The attending physician will probably not be able to treat the mother himself but he will be able, in view of her symptoms, to direct her to the service or the professional he considers most suitable. This option is probably preferable to going directly to a psychologist or psychiatrist. Postnatal depression is very special, so it is better to contact a specialist in the matter and not to a 'generalist' psychiatrist or psychologist. All in all, care has improved in recent years, but a lot of work remains to be done, says Nadège Beauvois, from the association Maman blues. ' Professionals are much better trained to deal with this depression. On the other hand, we are still sorely lacking in suitable structures, where mothers can be received with their babies, which nevertheless seems to be an elementary prerequisite. '
The management of postnatal depression is a bit like that of classic depression . The first step is to consult as soon as possible. The less the symptoms are anchored in the mother's daily life, the faster she will recover. In many cases, simple psychological support can be enough to restore the mother's strength and make her see things in a more positive light. It may take a little time, of course, but the results are good. We hesitate more to give psychotropic drugs than in the context of a 'classic' depression. “But antidepressants can be prescribed when the situation is worrying and does not improve quickly with psychotherapy,” says Dr. Dayan. Care must be taken, however, as these medications are generally not compatible with breastfeeding, which is likely to cause additional guilt for the mother.
|In the vast majority of cases, postnatal depression will resolve itself in a few months thanks to appropriate therapy. . Because that's the whole point in the treatment of postnatal depression: to react quickly enough so that the bond between mother and child can still be created quickly. ' It happens that this is not the case immediately, which can pose problems for the continuation of the development of the child' , says child psychiatrist Jacques Dayan.|