Treatment for perinatal disturbance

The perinatal period of transition to parenthood is one of heightened passions, which revive the expectant and new parents' own early experiences, and particularly unresolved emotional issues. For many deprived parents close contact with an infant reactivates old grievances at this time of vulnerability, which may manifest in syndromes of self-pity or in fury and vengefulness over past humiliations. Unprocessed dissatisfactions tend to erupt in disruptive or repetitious behaviours, which inevitably affect the baby in their care. In addition, childbearing in societies undergoing transition, like South Africa, may be fraught with extra stresses. These include socio-economic disadvantages and social adversity arising from geographical relocation and breakdown of traditional patterns, and psychological distress due to past or current experiences of physical or emotional trauma and neglect and relationship difficulties which tend to be exacerbated in times of rapid cultural change in the absence of a wider supportive network. It is argued that, in societies with scarce resources, the mental health focus must be on prevention, detection of high-risk groups and early intervention. Two tables are presented - of risk indicators and treatment guidelines, which may be applied during the perinatal period to minimise postnatal disturbance. Health workers with minimal training can be effective in screening and in some cases, delivering prophylactic or postnatal care to people at potential risk. Offering such help may enable resilient people in a state of crisis or transition to marshal their own resources. For others longer-term professional help may be required to shift the chronic effects of cumulative trauma by reworking emotional predicaments in a caring and safe environment.