Postpartum Depression And How To Manage It

 

It is quiet common for the new mother to feel sad, worried, tired or fatigued. As many as 80 out of 100 mothers go through such feelings for a week or two after the birth of the baby. It is completely normal and they start to feel better and normal after a few weeks..

Postpartum depression is diagnosed when these symptoms are much severe and lasts longer. It can cause severe mood swings, and a mix of physical, emotional and behavioral changes.

The symptoms usually begins within the first few weeks after giving birth but sometimes may even begin earlier while being pregnant or later up to a year after birth. 

Suffering from postpartum depression does not mean that a mother does not love her baby or that she is a bad mother. It is just that she is suffering from a medical condition and needs counselling therapy and treatment. 

Symptoms may vary among different woman but a list of common symptoms include:

- Feeling low

-Lack of interest in daily activities

- Body aches and headache

-Lack of appetite

- Anxiety and irritability

- Not able to think or make proper decisions. 

- Feeling difficult to bond with the baby.

- No interest in friends and family,

What causes Postpartum Depression: Female body produces a lot of hormones during pregnancy but soon after delivery there is a sudden decrease of these hormones which causes changes in the chemical system of the brain leading to depression. 

How To Manage:

Depending on the severity and the type it can be treated with psychotherapy or antidepressant medications. 

It is important to seek medical help if symptoms of depression lasts longer than 2 weeks within 1 year of giving birth. 

-Get Support from friends and family. 

-Be open about your feelings and discuss it with your partner and your family. 

- Join support groups.

-Antidepressants may be prescribed to you by your doctor but they usually take 6-8 weeks to show improvement in symptoms. 

- Psychotherapy helps with more positive thinking approach. 

Tab Duphaston - Uses, Dosing and Other Information

 

Introduction: Tab Duphaston contains dydrogesterone 10mg which is a synthetic orally active progestogen. 

Indications: 

- Treatment of painful menstrual periods that are not managed by over the counter pain killers.
- Treatment of endometriosis.
- Treatment of missed periods.
- Treatment of irregular cycles.
- Treatment of abnormal uterine bleeding.
- Treatment of pre-menstrual syndrome.
- Treatment of threatened abortion, associated with proven progesterone deficiency.
- Treatment of habitual abortion, with history of repeated miscarriages  associated with proven progesterone deficiency.
- Treatment of infertility due to luteal insufficiency.
- Luteal support as part of an Assisted Reproductive Technology (ART) treatment.
- Hormone replacement therapy.

Duphaston should only be taken upon prescription from your doctor. Different indications need different dosing and duration of treatment. 

Dosing: 

For hormone replacement therapy(Usually Given in post menopausal woman): In combination with continuous oestrogen therapy, take one tablet daily for 14 consecutive days of a 28 day cycle.

 Dysmenorrhoea (painful menstruation): Take one tablet twice daily from day 5 to day 25 of the cycle.

Endometriosis (abnormal growth of uterine tissues outside the uterus): Take one tablet two or three times daily from day 5 to day 25 of the cycle or continuously (as prescribed by the doctor).

Dysfunctional bleeding (to stop bleeding): Take one tablet twice daily for five to seven days.

Dysfunctional bleeding (to prevent bleeding): Take one tablet twice daily from day 11 to day 25 of the cycle.

Amenorrhoea (missed periods with a negative pregnancy test): The doctor should prescribe an oestrogen along with Duphaston. Then take the oestrogen once daily from day 1 to day 25 of the cycle, together with one tablet of dydrogesterone twice daily from day 11 to day 25 of the cycle.

Premenstrual syndrome: Take one tablet twice daily from day 11 to day 25 of the cycle.

Irregular cycles: Take one tablet twice daily from day 11 to day 25 of the cycle.

Threatened abortion(history of bleeding or spotting in early pregnancy): Take four tablets at once, then one tablet every eight hours until symptoms subside.

Habitual abortion(history of repeated miscarriages): Take one tablet twice daily until the twentieth week of pregnancy.

Infertility due to luteal (yellow body) insufficiency (Deficiency of natural production of progesterone hormone): Take one tablet daily from day 14 to 25 of the cycle. Continue the treatment for at least six consecutive cycles. In addition, it is advisable to continue treatment for the first few months of pregnancy as described under "Habitual abortion". If the patient is uncertain about how long to continue the treatment, talk to the doctor.

Luteal support as part of an Assisted Reproductive Technology (ART) treatment: Take one tablet three times daily (30mg daily) starting at the day of oocyte retrieval and continuing for 10 weeks if pregnancy is confirmed.

Side Effects: Duphaston is considered one of the safe drugs with minimal side effects. Some adverse effects observed are 

- Headache

- Nausea/Vomiting

- Abdominal Pain

- Breast tenderness.

Contraindicated to be used when any history of allergy to the medicine and should be avoided when breastfeeding. 

Management Of Minor Burns

 

Minor burns can occur anytime while working in the kitchen or accidents can happen with young kids. Immediate first aid management of burns is important to know . 

First degree minor burns are usually not life threatening but are very painful and may even leave a scar if not properly treated.  

The skin is red and painful and there may be some swelling. 

1. First of all remove the victim and move to a safe place to avoid further burning. 

2. Cool the hot burned skin under cool running water or immerse in cool water for sometime , this helps to relieve the pain. 

3. Apply a moisturizing lotion like the one with aleo vera.

4. You can apply petroleum jelly 2-3 times a day. Avoid putting butter, too much of oil or lotions with fragrances which may cause an infection. 

5. Cover the burned skin with a sterile non sticking bandage .

6. If blisters form never pop them up. 

7. Take an over the counter pain killer like paracetamol or ibuprofen.

8. Protect the burned area from sun exposure.

9 If any signs of infection antibiotics may be needed

Positioning A Baby While Breast Feeding

 

Breastfeeding your baby is always encouraged but at times new mothers find it difficult and face a lot of problems which in the end results in giving up and switching to formula.

Proper positioning the baby is very important for breastfeeding and to prevent problems later on.

How to position a baby while breast feeding  depends on the choice and comfort of both mother and baby. No matter which position is used it is important to make sure that

-         The baby’s whole body is supported

-         Baby’s body is facing and is close to the breast

-         Baby’s neck is straight. (not turned or twisted)

-         Baby approaches the breast and nose is in line with the nipple.

While Breast feeding it is very important that

-Mother is comfortable and relaxed.

She should know and learn how to support the breast while feeding. Baby’s lips should be first touched with the nipple and then wait for the baby to widely open the mouth so that nipple along with areola goes in and baby starts sucking.

Five Possible Positions

1.   Cradle Position: The mother cradles the baby in her arm. The baby should be held close to the mother’s body, with the forearm supporting the baby’ head. For mother’s comfort she may want to support the cradling arm with a pillow or her other arm.

2.   Cross Cradle: The mother cradles the baby in her arm. Her hand is supporting the baby’s head and neck.

3.   Football Hold: The mother is sitting or leaning back and the baby is under her arm with feet pointing back. The mother support the baby’s head and neck with her hand and a pillow may be used to support the baby in this position.

4.   Side lying position: Mother is lying on her side and baby lies on its side facing the mother. Mother supports the baby’s head and neck with her hand or a pillow.

5.   Supine Position: The mother is lying on her back with the baby lying face down on the mother’s chest. Mother’s hand supports the baby’s head on her breast. This position is useful immediately after a c section.

Nausea And Vomiting

 

Nausea

Can be simply described as an uncomfortable feeling or a sensation of sickness which may or may not be followed by vomiting.

Vomiting

Is an effortless regurgitation of  stomach contents.

Nausea and vomiting is caused by a wide variety of conditions which stimulate the vomiting receptors in the brain.

Vomiting may lead to dehydration, electrolyte imbalances, aspiration pneumonia.

How to Manage

A detailed history helps to identify the underlying cause.

-         Sudden onset of vomiting without any associated pain may suggest food poisoning, infectious gastroenteritis or use of any dugs

-         Vomiting along with abdominal pain may be caused by acute abdominal conditions like appendicitis, acute gastritis or intestinal obstruction.

-         Early weeks of pregnancy causes nausea, morning sickness and vomiting due to hormonal changes.

-         Migraine headaches are commonly associated with nausea and sometimes vomiting too.

Laboratory tests that should be done include

-         Serum Electrolytes

-         Blood glucose

-         Urea and Creatinine

-         Serum Amylase

-         Liver function tests

-         TSH

-         Pregnancy test

Imaging Studies that can help find out the cause include

-         Flat and upright abdominal X ray

-         Ultrasound of abdomen

-         CT scan abdomen

-         Barium studies

Medications that help includes different antiemetic medicines which are given to control vomiting.

For mild, self limited acute vomiting no treatment is needed , just give clear fluids and soft easily digestible small quantities of food.

In cases of severe vomiting IV fluids are needed to correct and prevent dehydration.