Foetal abuse.

Pregnancy and motherhood are often presented as natural and unproblematic for women. The fact that there are some women who engage in violent behaviour towards their unborn child suggests that motherhood is not as unproblematic as we are led to believe. This paper presents six previously unpublished cases of foetal abuse that is physical assaults on the foetus by the mothers themselves, and examines how the prevailing myth of the good mother might be further endangering mothers and their unborn children. So far, the research suggests there are some common, possibly co-occurring, features that might be an antecedent to foetal abuse: unplanned pregnancies, prior mental health issues in the mother, trauma, pregnancy denial up to 20 weeks or until birth, and ideation of harm correlated to in utero movements.

Non-reproductive triggers of postpartum psychosis.

Bipolar disorders, and other psychoses, are known to be triggered by a number of agents apart from the reproductive process. In some women, pregnant or recently delivered, psychosis may be due to these alternative triggers. There are substantial numbers of mothers suffering from childbearing psychoses, who have been prescribed bromocriptine or steroids, have had surgical operations or developed thyrotoxicosis. It is best to eliminate these episodes and cases from study samples of puerperal psychosis.

Runge psychoses.

This article describes periodic monthly psychoses that develop during the early months of pregnancy. It is probable that these are a variety of menstrual psychosis.

Recurrent episodes associated with childbearing: a matrix of associations.

A study of several hundred recurrent puerperal psychoses shows that about half of those with known onset recur in the same phase of reproduction, and half have onsets in different phases. Onsets in the same phase are especially a feature of prepartum psychosis and are the strongest indication of a specific trigger operating during pregnancy. Onsets in different phases provide a prima facie case for links between 'puerperal psychosis' and other reproductive onsets. They suggest that the 'picture puzzle' is not just about early onset puerperal psychosis, but a group of related reproductive triggers.

Citation analysis of puerperal and menstrual psychosis.

A citation analysis of more than 2500 works on the childbearing and menstrual psychoses has shown that the average number of citations is 1 % of the literature or less; Anglo-Saxon authors have the lowest standards of scholarship. Many excellent works have received few of no citations. Attention is drawn to citation fraud and the pernicious effect of superficial "reviews."

Late onset postpartum psychoses.

It has been known since the eighteenth century that postpartum psychoses can begin several weeks after childbirth, not during the first fortnight. There are almost 400 non-organic episodes in the literature, starting more than 3 weeks after the birth; some of them are recurrent. The distinction of this disorder from early onset puerperal psychosis is supported by the distribution of onsets (which shows a steep fall after 14-15 days), survey data and the association with later pregnancies, not the first. Marcé believed that these late onsets were related to the resumption of menstruation. This is a hypothesis worth investigating.

Donkin psychosis.

Donkin psychoses are eclamptic psychoses without seizures. As symptomatic psychoses resulting from cerebral endothelial damage, they may explain the lucid intervals that sometimes occur between eclampsia and the eruption of psychosis. They have the same features as eclamptic psychoses, with onset during pregnancy or the early puerperium, especially in first-time mothers, a short duration and full recovery in most. The clinical picture is usually delirium, but mania is also seen, and some patients have retrograde amnesia or other cognitive defects. Donkin psychosis should be considered in the differential diagnosis of childbearing psychoses, and collaborative research is needed to clarify their differences.

Some unusual forms of early onset postpartum psychosis.

In addition to bipolar cycloid episodes, infective delirium and eclamptic psychosis, each of which has characteristic clinical features and course, brief episodes of delirium and stupor are also seen in the immediate aftermath of parturition. Several mothers have had similar episodes developing later in the first 10 days, and some have cyclical disorders with an unusual time base. Bipolar/cycloid disorders can start on day 1 or even earlier.

Relapses of bipolar/cycloid psychosis related to childbearing.

It was observed nearly 200 years ago that mothers with puerperal psychosis may recover, then relapse, sometimes repeatedly. This phenomenon seems to be better recognized in the American and French literature, where it has been reported in a large minority, or even majority, of cases. It offers an opportunity to study the pathogenesis of psychosis.

Suicide and filicide in postpartum psychosis.

This paper reviews the frequency of suicide and filicide in a literature of over 4000, and personal series of 321, childbearing psychoses. Suicide is rare during the acute episode, but the rate is high later in the mother's life and in first degree relatives. The filicide rate is high in depressive psychoses (4.5 %), but lower in episodes without overt depression (less than 1 %), and some of these appear to be accidental, without intent to kill.

An international position paper on mother-infant (perinatal) mental health, with guidelines for clinical practice.

The purpose of this paper is to set out informal, provisional and comprehensive but concise guidelines for mother-infant (perinatal) mental health (psychiatry), as an area of specialisation. It is informal in the sense that the authors are clinicians and researchers from many different nations, who share a common goal and vision, speaking on their own behalf and not with the backing of any authority or society. It is provisional in the expectation that it can be improved by criticism and new research findings. It is a comprehensive summary of the development of the specialty, its core knowledge and recommended investigations and interventions. It is concise (under 6,000 words, taking less than an hour to read) in order to increase readership and facilitate translation. No attempt has been made to parade the evidence for these suggestions, because the document would have been too long to translate, and for many to read. Instead, drafts were circulated for criticism by those included in the authorship, resulting in a consensus (finalised by the three principal authors), providing a framework to guide service provision, clinical practice and research. The full list of authors, from 33 nations, is given in the postscript. They include mother-infant (or parent-infant) and perinatal adult or child psychiatrists and those with a special interest; mother-infant, perinatal and forensic psychologists; psychiatric nurses; the founders of Postpartum Support International and the Association for Postnatal Illness; representatives of social work and obstetrics and the management of these services, and research scientists working in the field.

The Stafford Interview : A comprehensive interview for mother-infant psychiatry.

This article describes an interview exploring the social, psychological and psychiatric events in a single pregnancy and puerperium. It has been in development since 1992 and is now in its 6th edition. It takes approximately 2 h to administer and has 130 compulsory probes and 185 ratings. It is suitable for clinical practice, teaching and research.

Anonymous birth law saves babies--optimization, sustainability and public awareness.

The aims of this study are to assess the impact of Austria's anonymous birth law from the time relevant statistical records are available and to evaluate the use of hatches versus anonymous hospital delivery. This study is a complete census of police-reported neonaticides (1975-2012) as well as anonymous births including baby hatches in Austria during 2002-2012. The time trends of neonaticide rates, anonymous births and baby hatches were analysed by means of Poisson and logistic regression model. Predicted and observed rates were derived and compared using a Bayesian Poisson regression model. Predicted numbers of neonaticides for the period of the active awareness campaign, 2002-2004, were more than three times larger than the observed number (p = 0.0067). Of the 365 women who benefitted from this legislation, only 11.5% chose to put their babies in a baby hatch. Since the law was introduced, a significant decreasing tendency of numbers of anonymous births (p = 047) was observed, while there was significant increase of neonaticide rates (p = 0.0001). The implementation of the anonymous delivery law is associated with a decrease in the number of police-reported neonaticides. The subsequent significantly decreasing numbers of anonymous births with an accompanying increase of neonaticides represents additional evidence for the effectiveness of the measure.

Assessment of psychometric properties of the Postpartum Bonding Questionnaire (PBQ) in Spanish mothers.

The Postpartum Bonding Questionnaire (PBQ) was developed to assess mother-infant bonding disturbances in the postpartum period. The aim of this study was to examine the psychometric properties of the Spanish version of the PBQ in a sample of Spanish postpartum women. Eight hundred forty mothers were recruited in the postpartum visit (4-6 weeks after delivery): 513 from a gynecology unit (forming the general population sample) and 327 mothers from a perinatal psychiatry program (forming the clinical sample). All women were assessed by means of the Edinburgh Postnatal Depression Scale (EPDS) and the PBQ. Neither the original four-factor structure nor alternative structures (Reck et al. 2006; Wittkowski et al. 2010) were replicated by the confirmatory factor analyses. An exploratory factor analysis showed a four-factor solution. The Schmid-Leiman transformation found a general factor that accounted for 61% of the variance of the PBQ. Bonding impairment showed higher associations with depressive symptomatology in both samples. The Spanish version of the PBQ showed adequate psychometric properties for use with clinical and general populations of Spanish postpartum women. The results suggest that the PBQ could be summarized by a general factor and confirm the utility of the use of the total score for detecting bonding impairment.

Emotional Rejection of the Infant: Status of the Concept.

Emotional rejection of the infant is a morbid, clinical phenomenon, central to mother-infant psychiatry. It occurs in about 1% of births in the general population, but much more often in mothers referred to specialist services. It has severe consequences for children, but responds well to treatment. It is now better recognized, but research is required, especially cohort studies and neuroscientific investigations.

Auto-Caesarean section: a review of 22 cases.

The authors have trawled the literature on self-inflicted Caesarean section, assessing circumstances and probable motivation; 19/22 cases had sufficient information. In seven cases, the apparent intention was to kill the child. In four, the action resulted from some form of mental illness. In eight, the woman, in the agony of obstructed labour, took matters into her own hands. We think the third group would be more numerous if there were more publications from Africa and South Asia, where many women give birth without the aid of modern obstetrics. The survival rate among the mothers was surprisingly high.