Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium

129 mothers referred to specialist psychiatric services in Birmingham and Christchurch were interviewed with the Birmingham Interview. Anxiety disorders were more frequent than depression during pregnancy, and equally frequent after delivery. The focus of pre- and post-partum anxiety may be important for psychological treatment. At a severe level, the most common prepartum theme was fear of foetal death; this was associated with a history of reproductive losses or infertility. After delivery the commonest themes were the pathological fear of cot death and fear of the criticism of mothering skills (which was a clue to a disordered mother-infant relationship). Clinicians should be vigilant for obsessional disorders, querulant (complaining) disorders, post-traumatic stress disorder, conjugal jealousy and dysmorphophobic states, which are all quite common. Patients with "postpartum depression" usually had at least one other (co-morbid) disorder, and 27% had two or more. These findings emphasize the diversity of postpartum psychiatric illness.