`Maternity Blues'

BRICE PITT
BJP 1973, 122:431-433.
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 Brit.J.Prjchiat. (1973), 122,431—3

‘¿MaternityBlues'
By BRICE PITT

Transitory depression and tearfulness occur having ‘¿the

blues' if they had felt tearful and
ring on one or two days during the early depressed in the puerperium. The day of onset
puerperium (commonly known as ‘¿mother's'or and any factors the patient deemed relevant
‘¿maternityblues', ‘¿third,fourth, or tenth-day were noted, and a ‘¿Blues
Rating' was made on a
blues', or ‘¿thetransitory syndrome') is often score based upon the symptoms described by
mentioned as a normal finding after from 15 Hamilton (1962) and quoted above. Subjects
per cent (Oppenheim, 1962) to nearly 8o per were asked about theirexperiencesofpregnancy,
cent (Robin, 1962) of deliveries. Physicaldis their attitudes towards it and towards the
comfort and psychological difficulty at the onset delivery
of thebaby, theirsuccessor otherwise
of lactation, ‘¿narcissisticloss' before discovery of withbreast-feeding,
and any historyofmenstrual
@ the child (Sciare, perineal soreness and difficulties. Finally, the short form of the
hormonal changes(Railton,1961)have allbeen Maudsley Personality Inventory (Eysenck,
invoked as causes. 1959), measuring Neuroticism and Extra
Moloney (1952) gave fatigue,despondency, version, was administered. Further information
tearfulness and inability to think clearly as the was available in the case-notes.
clinical features. In the Q,,ueenCharlotte's Textbook
of Obstetrics (ig6o) it was reported that 66 per RESULTS
cent of a random sample of 50 women inter Fifty (50 per cent) of the ioo women were
viewed in the maternitywards post-partum had diagnosed as suffering ‘¿theblues'. Of these, 33
a briefspellof depression.Hamilton (1962), (66 per cent) developed this condition within
distilling
theobservationsof 10 district
midwives, four days of parturition, I 3 (26 per cent) on the
listedthe followingsymptoms in order of third day (justifying the alternative term ‘¿third
frequency;fatigue,
crying,anxiety(usuallyover day blues'.)
the baby), confusion, headaches, insomnia,
hypochondriasis and hostility to the husband. SYMPTOMS
Kane cia!.(ig68) assessed137 women on the Most of the women described tearfulness and
third day after delivery; 51 showed diminished despondency,lastingfrom barelyan hour to
mental activity, 49 emotional disturbance, and most of the day, on one to three days; but in
only 50 no change from their usual mental state. seven theirdistress
lastedlonger.
It appears, then, that during the first ten Of the symptoms listed on the ‘¿Blues' Rating

days post-partum many, if not most, women Scale, only Anxiety and Confusion (i.e. poor
suffer‘¿maternity
blues'. concentration, slowness to learn and forgetful
ness)were significantly associatedwith ‘¿the
INVESTIGATIoNs blues' subjects.
It was decided in the course of a prospective In most subjects ‘¿theblues' was a trivial,
study of puerperal depression (Pitt,ig68) to fleetingdisorder,but six went on to develop
look into the incidence, phenomenology and puerperal depression (i.e. a state of prevailing
some associated features of the ‘¿blues'. One despondency lastinga month or more).
hundred women, selected at random from the Fourteen ‘¿blues'
mothers were chiefly worried
lying-inwards of The London Hospital,were
over their babies, g with some justification.
interviewedbetween the seventh and tenth Another 14 were distressedover difficulties
with
days post-partum, and were diagnosed as lactation or feeding their babies; 12 were
43'
 432 ‘¿MATERNITY BLUES'

T4LBLE

Symptoms of ‘¿maternity blues'

number
subjects‘Blues'....50503523II243320I50No .a of

E'.@.El
Iv c54.@ @4•@E l@Total

‘¿blues'....o4i61313202913I50Totals....50545136246@z332100

* p < •¿ooi;@ p < @O5.

homesick; 2 were most troubled by physical The ‘¿confusion',consisting of relatively liii

discomfort. There remained 8 who were unable paired concentration, memory and learning, is
to suggest any such reasons for their transitory similar to the cognitive dysfunction described
distress. The majority of the controls (76 per by Kane ci a!. (i@68) in 37 per cent of the
cent) expressed no such worries. In so far as mothers they interviewed on the third day
the grounds for ‘¿theblues' group's anxieties post-partum. They were unable to find objective
could be checked objectively, only in respect of confirmation by cognitive tests of the patients'
difficulty with breast-feeding did they differ subjective complaints of distractibility, poor
significantly from controls: 15 of 40 ‘¿blues' recent memory and emotional lability, whereas
mothers who breast-fed experienced difficulty Robin (1962) found that psychological testing
in doing so, compared with 7 of 40 breast of 25 normal women interviewed in the early
@ feeding controls 4@OI, 0 @O2<p <0 @O5 for puerperium suggested impairment of conceptual
i d. of f.). In respect of personality (according thought.
to the Maudsley Personality Inventory), men The presence of confusional features and the
strual troubles, parity, attitude to the preg absence of personality predisposition or special
nancy, experience of labour (i.e. as difficult or psychological stresses together suggest that the
painful), the baby's health, and housing or syndrome is organically determined. The lack
money worries, there were no significant of any significantassociationwith infectionor
differences. other obstetriccomplicationsleavesas the most
likelyfactorthe profound endocrinechange
DISCUSSION which follows parturition. The occurrence of
A fewof the 50 womenexperiencinga spellof two-thirds of the cases within four days of
tearfulness and depression in the early puer pasturition, with a peak incidence on the third
perium may have been reactingto ‘¿real' worries day, and the probably significant association
and difficulties (though such stresses were not with lactation problems among breast-feeders,
significantly commoner than in the control suggest that the relevant change might be the
group), while some others were perhaps in the precipitate fallin the progesteroneand oestrogen
early stages of puerperal depression. The levels post-partum. An imbalance between
majority, however, were suffering ‘¿maternity these hormones (Malleson, 1953) could some
blues', a transitory syndrome found to include times be manifest in impaired lactation as well
anxiety and mild confusion as well as depression as the ‘¿Blues'.
and tearfulness. The ‘¿blues'is a trivial, fleeting, common
 BY BRICE PITT 433
place disorder, but perhaps pregnant mothers AcKNowz.anoEM@rs
should be warned to expect it so that they are This work was carried out while I was a Research
not taken by surprise. More importantly, it Assistant to The London Hospital. I wish to thank the
should not be confused with the ‘¿atypical'or Department of Obstetrics for their co-operation, and
Dr. Patrick Tooley, Consultant Psychiatrist, for his
neurotic form of puerperal depression, occurring support and advice.
after delivery in 7 to 10 per cent of mothers
(Dalton, i@@i; Pitt, 1968; Dewi Rees and
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A synopsis of this paper was published in the October 1972 Journal.

Brice Pitt, M.D., M.R.C.PSyCh.,Consultant Psychiatrist, Department of Psychiatty, The London Hospital,
Whitechapel, London, E.i

(Received 26 April 1972)