Psychiatric disorders of childbirth
Psychiatric complications arising during or immediately after childbirth.
Psychiatric disorders of childbirth are complications that develop during or immediately following labor and delivery, as distinct from those arising in pregnancy or the postpartum period. Despite modern obstetrics and pain control, these disorders—often presenting as delirium, stupor, rage, acts of desperation, or neonaticide—are still observed. Care disparities between wealthier nations and the rest of the world mean that in regions with high birth rates and limited resources, these complications may remain as prevalent as they have been throughout human history.
Quick Facts
- World total annual births
- 135 million
Facts from the source article.
Three settings for childbirth
In nations with state-of-the-art obstetric services, childbirth is usually supervised by a midwife or obstetrician, with pain relief available via nitrous oxide, pethidine, or epidural anesthetic, and complications can be managed by emergency Caesarean section. Even so, at least one third of women find parturition traumatic, and labor may last from hours to days. The complications listed below, though rare, can still occur. "Historic childbirth" refers to births before effective pain relief was introduced in 1847, when psychiatric complications were common even in countries with the best health services. Such conditions persist in nations with high birth rates and a shortage of trained staff; at the beginning of this century only about one third of births in tropical Africa and South-East Asia were attended by doctors or midwives, and about half of births in many nations remain unsupervised by skilled attendants. The third setting is concealed labor, endured by a woman who has dissembled her pregnancy, with no analgesia, skilled attendance, or emotional support, and with her mental state disturbed by anger, fear, shame, or despair. Most neonaticides occur in this setting, and complications are much more common.
Delirium during labor
Parturient delirium is a temporary state of confusion that begins near the end of labor and clears within minutes or hours after delivery, with complete recovery. Symptoms can include rambling speech, mistaking people for others, seeing things that aren't there, odd actions like singing, or not remembering the episode. In a small number of cases, the condition has shown a pattern of shifting between confusion and clarity, lasting into the postpartum period, or returning with a later pregnancy. It was among the earliest recognized childbirth-related psychiatric conditions, with over 50 documented cases, mostly from the time before effective pain relief was available. In countries with modern obstetric care, the disorder has nearly vanished, with only two reports from the early 1900s. Yet in the past decade, 28 countries had fewer than half of births attended by trained professionals, including Nigeria, Pakistan, Ethiopia, and Bangladesh. An estimated 130 to 180 million babies were born without skilled attendance between 2011 and 2015, meaning many women today still face the same risk of labor delirium as women in early 19th-century Europe.
Parturient rage
During the final painful contractions leading to expulsion of the infant, some women have become extremely angry, a phenomenon known historically as parturient rage, furor uterinus, Wut der Gebärenden, or colère d'accouchées. Before effective pain relief was introduced in 1847, obstetricians were familiar with this reaction, and some mothers lost control and attacked their husbands, obstetricians, midwives, or other attendants. It still occurs occasionally under modern obstetric conditions. The infant is at risk, as angry mothers have reached down to haul the baby out or made dangerous assaults on the newborn; for example, a 40-year-old mother at the end of her first pregnancy kicked away the midwife, tore out the infant, and killed it by striking its head against the bedpost. In most neonaticides the infant is killed by suffocation, drowning, or exposure, but significant brutality has been documented. Nowadays this phenomenon would not be regarded as a mental illness, and the only diagnosis could be 'unspecified disorder of adult personality and behavior', though historically in France a mother who stabbed her infant 26 times was acquitted due to mental derangement. There is an insoluble judicial problem because violence is sometimes a feature of delirium, and in a clandestine birth it is impossible to know whether consciousness was clouded.
Complaining reactions
Pathological complaining, or paranoia querulans in the International Classification of Diseases, is a reaction to a severe experience of childbirth in which mothers complain bitterly about perceived mismanagement. Complaints directed at midwives or staff may include lack of pain relief, unnecessary epidural anesthesia, poor condition of the baby, humiliation, excessive use of technology, student examinations, or lack of explanation and sympathy. In response, mothers may harangue midwives repeatedly, write critical letters, and be preoccupied with fantasies of revenge such as beating the midwives to pulp or burning the hospital down. Angry rumination may continue for weeks, months, or more than a year. The frequency is similar to post-traumatic stress disorder, and there is an association between the two. The effect on childcare resembles that of severe depression, but the emotional state is furious anger rather than sadness and despair, and treatment strategy differs; psychotherapy focuses on distracting the mother from her grievances and reinforcing productive child-centered activity, often using a diary as a focus.
More in Pathology of Pregnancy, Childbirth and the Puerperium
Spotted an error? Know more?
Reader corrections go straight into our review queue. Suggest an edit · How this site is sourced