When baby blues lead to murder

Very few new mothers kill their children. But many have to cope with depression. By CARROLL du CHATEAU.

Andrea Yates, the 36-year-old Texan accused of drowning her five children, one by one, in the bath, has focused international attention on a condition affecting one new mother in 10.

But post-natal depression rarely results in the kind of tragedy that stunned Houston last week.

It is a problem that can kick in after the hormones reach a high, then crash like a breaker on the rocks in the days after birth. This surging wave of hormones produces the greatest instability most women will experience.

In the year after giving birth or having a late-onset miscarriage, a woman is 36 times likelier to suffer a psychiatric illness than at any other time. Like many psychiatric conditions, post-partum psychosis and post-natal depression are curable if treated early enough.

But for those who go unsupported and undiagnosed, problems can stretch out to years of near hell - not just for mothers, but for their babies, older children, husbands and families.

What is the difference between post-partum psychosis and post-natal depression?


Post-partum psychosis is severe and easily recognised by a doctor, midwife, nurse, psychiatrist and probably family. It usually erupts within two weeks of giving birth, and often piggybacks on the "normal" post-baby blues that occur in 80 per cent of women about three days after a child is born.

Post-natal depression is far more subtle and insidious. It also occurs within weeks of birth, but its onset is more gradual, starting with depression which, untreated, can spiral lower and lower. Then, for a small number of women with post-natal depression, it can become so severe they develop psychotic symptoms. This is different from post-partum psychosis.

What are the symptoms?

Sufferers of post-partum psychosis can suffer "command hallucinations" when the woman is instructed by a voice in her head to do things like "kill the baby" or delusions that the infant is possessed.

Post-natal depression is more subtle and is marked by sleep disturbance not associated with the baby waking, loss of appetite, anxiety and increased irritability. Other symptoms are crying for no reason and guilt about not being a good mother and being unable to cope.

Dr Sara Weeks, a psychiatrist specialising in birth and hormone-related mood disorders, says "one of the awful things about post-natal depression is that women can think this is what motherhood is like."

How many women are affected? Post-partum psychosis is relatively rare, affecting one woman in 500.

But 10 per cent of all women who give birth will suffer some degree of post-natal depression.

Of the 5000-odd women who give birth in central Auckland every year, roughly 450 are referred to Maternal Mental Health Services. Of these, one-third will get better on their own; one-third will get better with support and psychological assistance; one-third will need continuing anti-depressant medication.

When are women most likely to get sick?

British studies show the peak times for suicide and infanticide (mother killing her child) occur during the first week after birth, at two months, or at five months - especially when a mother has recently left hospital.

Are some people predisposed to the conditions?

All women are. First-time mothers are slightly more susceptible, as are women who have had bipolar disorder (manic depression) or other psychiatric illnesses.

Dr Weeks says "a previous history of post-natal depression makes the likelihood of recurrence one in three in subsequent births." For post-partum psychosis sufferers, the risk after subsequent births is about one in five.

What causes the conditions?

The rocketing round of hormones after the birth of a baby.

Dr Weeks says oestrogen levels rise dramatically during pregnancy, then dive in the days after delivery. Oestrogen levels also remain low during breastfeeding.

Does rest help?

Experts suggest that at-risk women need at least five days - rather than the usual 24-48 hours - in hospital after childbirth.

"If you're in hospital for less than 48 hours, a Sydney study shows your chance of post-natal depression more than doubles," says Dr Weeks.

Which post-natal problem is more serious?

Undiagnosed or untreated depression which becomes psychotic. Generally, depressed people kill themselves because they think they are relieving others of a burden. Similarly, mothers who kill their children believe that they are saving them from a terrible world.

What should you do if you suspect a problem?

Contact the mother's GP or midwife. If the problem is serious, they will refer her to Maternal Mental Health Services at Waitemata, Auckland or South Auckland. Private psychiatrists are also an option.

What treatment is available and how effective is it?
Post-partum psychosis is relatively easily controlled with anti-psychotic, mood-stabilising medication. Severe post-natal depression can be treated with those anti-depressants which do not affect the baby by getting into breastmilk.

Mild post-natal depression is treated with counselling, extra support with the baby and making sure mothers get six hours' unbroken sleep a night, says Sharon Milgrew, coordinator at Maternal Mental Health Services, Waitemata.

"Sleep deprivation is a trigger for many of these illnesses. By making sure they get enough unbroken sleep, mothers with bipolar and psychosis do better and those with mild depression tend to come right."

She says some New Zealand methods, such as a birth plan for at-risk mothers and the sleep deprivation work, are ground-breaking. "We monitor women closely for a minimum of three months after birth."

Dr Weeks suggests prophylactic treatment for high-risk women with a history of severe depression or psychosis. "As soon as the baby is born, we start the drugs again to prevent the illness from taking hold."

Is post-natal depression curable?

People definitely do get better if they get proper treatment and doctors act early. But if it is left untreated, post-natal depression can be a lifetime problem. People need to be educated and receive good psychiatric and social support.

What about residential care for mother and baby?

Unfortunately, unlike Christchurch, Auckland does not have any residential care beds. Instead severely ill mothers must be separated from their babies and the rest of their families.

Says Ms Milgrew: "We desperately need an inpatient unit for women with severe mental illness. Ideally they should come in with their babies until we get them through the acute stage."

What about Andrea Yates?

Her lawyer, George Parnham, says she suffers from a very deep psychosis and he is considering a plea of not guilty on the ground of insanity.

She reportedly said she thought for months of murdering the children because she considered herself a bad mother.

George Dix a law professor at the University of Texas, says insanity defences rarely succeed.

To be found innocent by reasons of insanity, Yates would have to show that she was so mentally impaired she could not see the circumstances for what they were.

If she "believed her children to be devils, she's entitled to acquittal."