A 16-month-old baby girl was found dead in a Pack-n-Play pen “on a liner soiled with urine and feces with soiled blankets.”

The deep, unconditional love between a mother and her baby is a powerful bond. While most mothers go to great lengths to protect their children, there are instances where this bond doesn’t form as expected, resulting in actions such as harm or abandonment of their own baby. In a heartbreaking incident, On June 6, 2023, Kristel Candelario, a 31-year-old mother from Ohio, USA, left her 16-month-old daughter unattended for 10 days while she went on a vacation to Puerto Rico and Detroit.

In another horrifying incident in Egypt, Hanaa Mohamed Hassan, a 29-year-old mother, decapitated her five-year-old son with a machete and ate part of his head. Hassan confessed to the police that she had eaten part of her son's head because she "wanted him to stay with her forever." The court found her mentally unstable to plead and ordered a more thorough assessment of her mental state.

“How much time will I serve in prison for killing my baby?” was searched on the internet by Meza-Ojeda, a young mother of a preterm baby, as reported by the investigators. According to them, she had borrowed her roommate’s car to meet someone at the store and took her son without his oxygen cylinder. When she removed the baby from the car, the baby was dead, whose body she later disposed of on the side of the road towards Salt Lake City.

The underlying reason behind such cases is not fully understood. They may be influenced by factors like postpartum depression or other complex psychological and environmental factors.

Postpartum depression stands as a frequently undiagnosed condition, silently affecting many mothers during the post-birth period.

The depressive episodes after childbirth can develop at any moment and can continue for a longer period of time [1, 2]. The likelihood of depressive episodes can be twice as high as during other periods of a woman’s life [3], and they usually go undetected and untreated [4].

Postpartum onset is defined to be within 6 weeks after delivery, according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), which describes a depressive episode as follows:

• The patient has a depressed mood with a decrease in activity and energy in mild, moderate, or severe depressive episodes.

• Capacity for enjoyment, interest, and concentration is reduced. Sleep disturbances, feeling of tiredness, guilt, low self-esteem, and low self-confidence are commonly present.

• Somatic symptoms along with psychomotor retardation.

• A depressive episode, depending on the severity of symptoms, can be classified as mild, moderate, or severe.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), postpartum depression is defined as a major depressive episode with the onset of pregnancy or within 4 weeks of delivery. The diagnosis of PPD includes either depression or loss of interest in addition to the five symptoms to be diagnosed.

• Depressed mood.

• Loss of interest or pleasure

• Insomnia or hypersomnia

• Psychomotor retardation or agitation

• Worthlessness or guilt

• Loss of energy or fatigue

• Suicidal tendencies and frequent thoughts of death

• Impaired concentration or indecisiveness

• Change in weight or appetite (weight change of 5% over 1 month)

Postpartum depression can vary significantly from region to region, as well as among different ethnicities and age groups. Various factors, including cultural norms, social support systems, access to healthcare, and individual experiences, contribute to these variations.

Verphy Kudi admitted the manslaughter of her daughter, 20-month-old Asiah Kudi, who was left unattended at her flat as she celebrated her 18th birthday.

Postpartum depression is likely to be more prevalent in teenagers, as teenage mothers may face extra stress related to their age. Lack of support, financial instability, and limited life experiences can increase the occurrence of PPD.

Recently, the U.S. Food and Drug Administration granted approval to the postpartum pill, Zurzuvae. It is to be taken once in 14 days. The pill has shown fewer signs of depression over a period of four to six weeks in postpartum females.

It is essential to consult with a healthcare provider if you or someone you know is experiencing symptoms of postpartum depression, as early intervention and treatment can be highly effective in managing the condition.

References:

1. Crotty F., Sheehan J. Prevalence and detection of postnatal depression in an Irish community sample. Ir J Psychol Med. 2004; 21:117–21.

2. Cooper PJ, Murray L, Wilson A, and Romaniuk H. Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. I. Impact on maternal mood. Br J Psychiatry. 2003; 182:412–9.

3. Cox JL, Murray D, Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry. 1993; 163:27–31.

4. Pearlstein T, Howard M, Salisbury A, Zlotnick C. Postpartum depression. Am J Obstet Gynecol. 2009; 200:357–64.

5. U. S. Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. (2019). Interventions to prevent perinatal depression: US preventive services task force recommendation statement. JAMA 321(6):580–587. https://doi.org/10.1001/jama.2019.0007

   (Rehash/Opinion/Dr. Shelja Chauhan)