Pregnancy and PPD

 Mental illness is an area of practice that is hard for many to understand and cope with. Postpartum depression and psychosis is one area that is not understood by many and still holds a negative stigma for woman. Both of these conditions can have devastating outcomes for the mother and her children if they are not addressed.

Mental illness has always been a difficult subject for many people to discuss. As it refers to postpartum women there are often social stigmas and mores that prevent many people from openly discussing post partum depression (PPD) and postpartum psychosis (PP) despite the fact that PPD and PP affect about 15% of all postpartum women collectively (Doucet et al, 2009). In recent years these disorders have gained in popularity due to events where mothers have killed their children.  The question is should these mothers be tried as murderers?

I believe that there is evidence to support that these women should be tried for manslaughter in such an instance.  According to the website “Life Love and Bipolar” , a support website for individuals suffering from bipolar:

“The law considers bipolar disorder as an EXCUSE, not the reason for the crimes committed by bipolar offenders. The only consideration offered by the legal system in case of this disorder, is a leniency in the charges and the punishment meted out. That means if a bipolar individual commits murder, he may be charged with manslaughter, which is a comparatively lesser charge.”


In their research Doucet et al discovered that PP “represents a variant of bipolar disorder triggered by childbirth” (Doucet et al, 2009).  Bipolar is often triggered by traumatic life event and in the case of PP the onset is often sudden within the first 48 hours to 2 weeks following childbirth.  Issues like family history or mental illness, little social support, low income, advanced birth age, and delivery complications tend to contribute to the incidence of PP and PPD.  I feel that we have an indepth understanding of what contributes to the onset of PPD and PP as well as a strong grasp of treatments for the disorders.  With this understanding I believe that if a mother suffering from PPD of PP murders their child they should be tried for manslaughter as would any individual suffering from a mental illness.  We cannot excuse wrongful death via murder and I feel that trying these people is the appropriate course of action.

The best intervention is always prevention!  As mentioned above we have a good grasp of contributing factors to PPD and PP.  With this knowledge the appropriate action would be to discuss the risk factors with expecting mothers and work trough coping strategies prior to birth.  In women with a family history of bipolar it has been found that prophylactic lithium treatments has reduced the incidence of PP (Doucet et al, 2009).  Many expecting parents, including myself, participate in birthing classes that teach you relaxation and breathing techniques to aid in the birthing process.  These sorts of classes should incorporate discussions of similar techniques to implement in the post partum time to prevent or combat PPD and PP.  Nurses should question mothers and fathers about possible risk factors for PPD and PP and intervene by teaching relaxation techniques, referring to mental health professionals, or providing brief counseling sessions while the mothers are still in the hospital.  Many people have never experience severe depression and are not sure where to go for help.  They need to be made aware of resources and tested to insure they understand that mental health problems do not make you crazy and proper help can improve overall health.


 Many times when a woman becomes pregnant the emphasis and attention is focused on her and the baby and the father is left on the side lines. This can decrease his feelings of being a part and understanding his importance to the family unit. This is especially true in teen pregnancies. As nurses we can sometimes contribute to this problem in the way we interact with the family.

As a stay at home father I can attest to the fact that there are certainly some stigmas in our society regarding parenting.  Although we are a progressing society there are still many expectations for parenting, including a more machoistic approach from men.  Society can influence a male to be more standoffish during the postpartum period and perhaps delay their ability to bond with the child. According to our textbook “culture influences the interactions with the baby, as well as the parents’ . . . caregiving style” (Lowdermilk & Perry, 2006, p 509).  I think the most important role that we can play as nurses would be to let go of our assumptions and attempt to fully include the father. Invite the father to participate in all activities, make eye contact with him, insure that he and the mother feel a part of the teachings, and care of the baby.  As an example of how our society may be overlooking the father there is only one column about the paternal adjustment phase in our book versus 4.5 pages talking about the woman.  I think as we progress as a society and realize that men can be loving and thoughtful caregivers we will aid families in having a more positive adjustment to parenthood.



Bipolar disorder – relation to criminal offenses. (2009). Retrieved from

Lowdermilk, D., & Perry, S. (2006). Maternity nursing. Philadelphia: Elsevier.

Doucet, J., Dennis, C., Letourneau, N., & Blackmore, E. (2009). Differentiation and clinical implications of postpartum depression and postpartum psychosis.JOGNN38, 269-279.