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إكتئاب ما بعد الولادة.. حالة نفسية بين الحقيقة و الدلع

Photo of Wiam Chermati Wiam Chermati Send an email 16 January 2021
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A Mother and baby child on a bed.
A Mother and baby child on a bed.

هل سمعتم عن إكتئاب ما بعد الولادة ؟ دائما ما يقال للمرأة أن الأمومة أفضل شيء، وأنها ستطير من السعادة بمجرد أن تحمل مولودها بين ذراعيها. لكن لا يقول لها أحد أنها أثناء طيرانها من السعادة، قد تواجه مطبات، تجعل نفسيتها ترتج لفترة من الزمن . هذه المطبات تدعى باكتئاب ما بعد الولادة. هذا الإكتئاب يجعل مشاعر المرأة مثل بندول الساعة تتأرجح يمينا ويسارا بين الحزن والفرح دون ان ترسى على حالة واحدة

إكتئاب ما بعد الولادة
اكتىاب ما بعد الولادة ليس مزحة ولكن حقيقة تعيشها اغلب النساء بعد وضع مولودهن

إكتئاب ما بعد الولادة هو اضطراب في المزاج يصيب نسبة معتبرة من الأمهات بعد ولادة أطفالهن. تبدأ أعراضه في الظهور بعد الولادة بأسبوع إلى شهر. قد يأخذ التعافي منه فترة تتراوح بين أسبوع،شهر،شهرين لكن يمكن أن تمتد الفترة لشهور وحتى إلى سنوات في حال ماكان الاكتئاب شديد.اكتئاب ما بعد الولادة غير انتقائي،قد يصيب المرأة في ولادتها الأولى أو الثانية أو حتى العاشرة، كما يمكن أن يزورها في كل ولاداتها أو لا يعرف لحياتها سبيلا أبدا.

ملامح اكتئاب ما بعد الولادة

إكتئاب ما بعد الولادة يدخل حياة المرأة عنوة. تظن في البداية أنه مجرد إعياء ما بعد الولادة لأنه بارع جدا في فنون التمويه.لكن يمكن أن تستدل عليه من خلال أعراضه المتمثلة في:فقدان الطاقة،الحساسية المفرطة والهياج السريع،الشعور بالذنب والهزال، فقدان القدرة على التركيز أو النسيان،الذعر من إيذاء النفس أو الطفل، أنماط نوم غير منتظمة،فقدان الشهية للطعام،الإنعزال والتوقف عن مخالطة المجتمع،فقدان الإهتمام بالمظهر الخارجي، حالة من عدم المبالاة بما يجري في العالم بأسره… هذه الأعراض ستفشي لك بأنك مصابة باكتئاب ما بعد الولادة.

بعد أن تدرك المرأة إصابتها باكتئاب ما بعد الولادة . تتقافز العديد من الأسئلة إلى ذهنها مثل: لماذا حدث هذا لي؟ لماذا لايحدث للنساء الأخريات؟ أليس من المفروض أن أكون سعيدة؟ لكن اكتئاب مابعد الولادة ليس اضطراب مستجد.

فالنساء في الماضي عايشن هذا الاضطراب.جدات جداتنا كن على علم بكل شاردة وواردة تحدث للمرأة بعد الولادة آخذات كل التدابير اللازمة. كبيرات السن في تركيا مثلا، إلى حد الساعة مازلن يؤمن بأن على الأم الجديدة خلال الأيام الأربعين من ولادتها، أن تبقى برفقة من تحبهم ووسط حفاوتهم.أما إن تركت لوحدها ولو للحظة واحدة، فستكون فريسة هجمات الجن وتغرق ضحية طوفان القلق والمخاوف.لهذا تقوم العائلات التقليدية حتى الآن بتزيين فراش حديثة الولادة بشرائط قرمزية، وينثرن بذور الخشخاش في أرجاء الغرفة لطرد أي روح شريرة تحوم في الهواء. كما أن الإحصائيات تشير إلى أن حوالي 15% من الأمهات يصبن باكتئاب ما بعد الولادة. فحديثات الولادة من كل بلد ودين ومن كل طبقة إجتماعية هن عرضة لإكتئاب ما بعد الولادة دون أي استثناء.

مسببات إكتئاب ما بعد الولادة

يتطفل اكتئاب مابعد الولادة على حياة النساء الحديثات الولادة.لكن لماذا يصيب نساءا ولا يصيب أخريات.فهذا الأمرعائد لمجموعة من الأسباب: أن تكون للمرأة تجربة سابقة مع الإكتئاب، وجود سيرة عائلية للإصابة بالإكتئاب أو مرض عقلي آخر، معايشة المرأة لأحداث صعبة أثناء فترة الحمل مثل موت الزوج أو حدوث مشاكل مالية، غياب الدعم العاطفي من طرف العائلة، حدوث مضاعفات أثناء الولادة أو ولادة طفل يعاني من مشاكل صحية،قلة نوم المرأة نتيجة الإعتناء بالطفل.إضافة إلى أسباب أخرى هي:انخفاض هرمونات الأستروجين والبروجيسترون. وهي هرمونات تناسلية خاصةبالإناث، تزيد عشرة أضعاف خلال فترة الحمل ثم تنخفض بشكل حاد بعد الولادة،مما يؤدي إلى تغيرات في كيمياء المخ ويحفز تذبذب المزاج. ،. غير أن هذه الأسباب هي مجرد ترجيحات ولا يمكن تعميمها على كل الحالات.

وجها لوجه مع اكتئاب ما بعد الولادة

هالة واحدة من النساء اللواتي تقاطعت طرقهن مع إكتئاب ما بعد الولادة، وواحدة من الناجيات منه.تسرد لنا تفاصيل تجربتها التي مر عليها أربعة أعوام،حيث تقول عنها بأنها الأسوء على الإطلاق.قبل ولادتها كانت قد عانت من وعكة صحية عقبتها الولادة القيصرية بآلامها ومضاعفاتها. انتهت الولادة وتخرجت من المستشفى. لكن كان في استقبالها ضيف لم تتوقع حضوره يدعى”اكتئاب مابعد الولادة “. في البداية لم تعلم بوجوده لكن أعراضه كشفت لها أمره حيث عانت من الأرق ولم تعد تنام إلا لسويعات فقط ،أصبحت تدخل في نوبات بكاء طويلة، انسدت شهيتها ولم تعد تولي أهمية لمظهرها إطلاقا وتشعر دوما كأن شيئا يكبس على أنفاسها ويخنقها.

Relaxing with baby

يتبع إكتئاب ما بعد الولادة تكتيكا محددا يستعمله على حديثات الولادة،حيث يقوم باستنزاف كل المشاعر الإيجابية من داخلهن وإعادة شحنهن بالمشاعر السلبية،مثل: مشاعر الوحدة، مشاعر الجفاف العاطفي، فقدان تقدير الذات.هذا بالضبط ماحدث مع هالة التي فقدت إيمانها بأهميتها في الحياة.وتمنت لو خطفها الموت قبل أن تخطفها هذه المشاعر. بعد أن نالت كفايتها من هذه الإضطرابات وذاقت ذرعا منها قررت التوجه إلى مؤسسات خاصة بالدعم النفسي لكنها لم تخرج منها بنتيجة تذكر.لكنها تدريجيا تعلمت كيف تتعايش مع اكتئابها بمساعدة من زوجها الذي كان كلما سقطت يسندها ويأخذ بيدها لتنهض من جديدإلى أن عبرا هذه المرحلة سويا وودعا معا اكتئاب مابعد الولادة.

الثالوث المشؤوم

ينحدر اكتئاب مابعد الولادة من عائلة الإضطرابات النفسية، وظيفته هي التلاعب بمشاعر ونفسية النساء حديثات الولادة بمساعدة شريكيه الإثنين:السيد ذهان مابعد الولادة والسيد اضطراب نفسي عابر.هذا الثلاثي يستهدف نفس الضحية وهي الأم حديثة الولادة لكن لكل واحد منهم استراتيجية خاصة به وهي كالتالي :

الإضطراب النفسي العابر هو عبارة عن تقلبات مزاجية طبيعية تحدث للمرأة بعد الولادة مباشرة. يمكن حصر أعراضه في : الشعور بالسعادة ثم الشعور بالحزن بغتة، البكاء بلا سبب، القلق،الحزن،سريعة الإستفزاز والإنزعاج.تستمر هذه التقلبات لساعات أو لأيام أو لأسبوعين كأقصى تقدير.يمكن تصنيفه في خانة الإضطرابات النفسية الحميدة حيث لا تحتاج فيه المرأة لأي تدخل طبي. حديثها مع شخص مقرب منها سيفي بالغرض ويساعدها على تخطي الحالة.

Pregnant looking ultrasound of their new baby

اكتئاب ما بعد الولادة أو يظهر عند واحدة من بين كل عشرة نساء حديثات الولادة. في العادة، تكون زيارته الأولى بعد أربعة أو ستة أسابيع من الولادة وقد يستمر لأشهر. يبدو في الوهلة الأولى حميدا ومسالملكنه يظهر على حقيقته بالتدريج. تحتاج فيه المرأة إلى استشارة طبيةأو مساعدة لأنه إذا ترك على حاله قد يودي بها إلى أذية نفسها أوطفلها.

ذهان ما بعد الولادة هو الأكثر ضراوة من بينهم.يصيب واحدة من بين كل 1000 سيدة حديثة الولادة. يحط على حياة المرأة أثناء الأشهر الثلاثة الأولى التي تلي الولادة. وهو مرض عقليخطير. تفقد فيه المرأة إتصالها بالواقع وتصاب بهلوسات سمعية وبصرية. النساء اللواتي يعانين من هذه الحالة يحتجن لتدخل طبي سريع، وعادة مايتم حجزهن في المستشفيات.تجنبا من أن يؤذين أنفسهن أو من حولهن.

الدعم النفسي العائلي هو الحل

إكتئاب ما بعد الولادة غير معترف به في العديد من المجتمعات. فالكثير من الأشخاص. رجالا كانوا أو نساءا ينكرون وجوده. يطلقون عليه تسميات أخرى مثل: دلع، دلال، غنج، تذمر.يعرفونه كالآتي: مجموعة من الحركات المائعة التي تقوم بها المرأة. تشير إلى عدم جاهزيتها بعد لتحمل المسؤولية.تريد المرأة من ورائها لفت الإنتباه أو التملص من مسؤولياتها. هذه المعتقدات تدفع المرأة إلى عدم الإفصاح بما تشعر به من تخبطات نفسية. لأنها تدرك تماما أنها لوتفوهت بكلمة ستسمع نفس الأسطوانة: كأنك أول امرأة تلد،نحن كنا نلد اليوم وفي اليوم التالي ننهض لتعزيل المنزل. لقد كنا نعتني بسبعة أطفال في نفس الوقت، نساء آخر زمان. فعوض أن يكونوا دعما لها ، يضعون الملح فوق جروحها..لذا تعمد إلى اخفاء اكتئابها جيدا بعيدا عن عيونهن. وتتقمص دور الأم السعيدة التي لا تواجه أي مشكلة.

Couple hold hands, family psychology support

لكن هذا الكبت للمشاعر لن يكون سوى لصالح الاكتئاب لأنه سيمد من عمره ويؤجج من قوته.على عكسها هي التي ستتأزم حالتها. ويمكن أن تصل بها المواصيل إلى إيذاء نفسها أوطفلها. لذا فالدعم النفسي والجسدي الذي تقدمه العائلة لها مهم جدا.وقد يخلط كل أوراق الاكتئاب. أشياء قد تبدو صغيرة بالنسبة لكم لكنها ستشكل فارقا كبيرا في حالتها. مثل:الإنصات لها وجعلها تبوح بما تشعر به، الاعتناء بالطفل وجعلها تأخذ قسطا من الراحة، زيارتها من حين لآخر وحثها على الخروج للقيام بأشياء تحبها. تأكدوا بأن هذه الأشياء البسيطة التي ستقومون بها من أجلها ستجعل الاكتئاب يحزم أمتعته ويغادر حياتها في أسرع وقت ممكن .

طرق علاج اكتئاب ما بعد الولادة

إكتئاب ما بعد الولادة ليس اضطرابا يستعصى علاجه. على العكس تماما هناك العديد من طرق العلاج المثبتة فعاليتها في التخلص من هذا الاكتئاب.. يأخذ االتعافي من اكتئاب مابع الولادة فترة مابين أسبوعين حتى سنة أو أكثر حسب نوع ودرجة الاكتئاب. كما أن عامل نوع ودرجة الاكتئاب يلعب دورا في تحديد طريقة العلاج المناسبة.

في البداية ، يجدر على الأم عند ملاحظتها لاي اضطرابات تطرأ على مزاجها تنذر بإصابتها  باكتئاب ما بعد الولادة. أن تفصح عما تشعر به للأشخاص المقربين منها وأن لا تكبت تلك المشاعر حتى تتراكم. فالمرأة هي طبيب نفسها. تشخيصها المبكر لحالتها وإقدامها على مشاركة مشاعرها، قد يوجز عليها الطريق ويريحها من عناء المعالجة الدوائية والنفسية. لكن هناك حالات يكون فيها الاكتئاب حاد ولا يجدي التنفيس عن المشاعر لللآخرين وحده نفعا للتعافي منه.

هنا يتم اللجوء إلى أحد الأدوية المضادة للاكتئاب. مثل الأدوية التي من عائلة “مثبطات إعادة امتصاص السيروتونين الإختيارية. تأخذ الأدوية المضادة للاكتئاب عالى الأقل أسبوعين حتى يظهر مفعولها. عيب هذه الأدوية أن معضمها ينتقل مع حليب الأم،مما قد يحرم المرأة من إرضاع طفلها رضاعة طبيعية. غير هذا  فإن الأدوية المضادة للاكتئاب تعد آمنة نسبيا. قد يكون لها بعض الآثار الجانبية مثل:الغثيان، ازدياد حالة القلق،النعاس، الجفاف في الفم،لكنها عادة ماتتتلاشى تدريجيا. ويبقى من المستحسن استشارة طبيبك قبل تناول أي دواء.

Mother and baby playing and smiling. Happy family

علاجات اخرى

من طرق العلاج أيضا، هناك علاج نفسي، يسمى بالعلاج المعرفي السلوكي:هوأحد الطرق العلاجية التي تعتمد على الحديث بين المريض والمعالج يستند على مفهوم: أن الأفكار والمشاعر والتصرفات مترابطة، لذا فإن الأفكار السلبية قد تحفز الإكتئاب.لذا يتم تعليم الأم المكتئبة كيفية إدارة العلاقة بين حالتها الذهنية وأفكارها بطريقة أفضل بهدف ضبط أنماط التفكير لتصبح إيجابية أكثر.

أما إذا كان الاكتئاب حاد وفشلت كل الطرق السابقة في علاجه. تبقى هناك طريقة، لكن لايوصى بها كثيرا إلا بعد نفاذ كل الحلول. وهي طريقة العلاج بالصدمات الكهربائية  . يتم تطبيق هذا العلاج تحت التخدير العام ومع إرخاء العضلات. احتمالات الشفاء بعد تطبيق هذا العلاج مرتفعة، وعادة ماتتماثل المريضة للشفاء في غضون 2-3 أشهر. لكن هناك احتمال كبير من أن يعاود الاكتئاب الظهور في الحمل الثاني. إضافة إلى هذا قد يكون لهذا العلاج آثار جانبية تتمثل في:الصداع،فقدان الذاكرة لفترة وجيزة.

تدابير وقائية من اكتئاب مابعد الولادة

لا يوجد هناك احتياطات تضمن لك عدم إصابتك باكتئاب ما بعد الولادة بنسبة 100%. فهو اضطراب لا يمكن التنبؤ به .لكن لا ضير من أن تتحصني أثناء حملك ببعض السلوكات ،التي قد تقلل من فرص إصابتك به وتكسبك مناعة منه

Pregnant woman practicing yoga exercise at home.
Pregnant woman practicing yoga exercise at home.

١- مارسي الرياضة أو اليوغا إذ أن ممارسة الرياضة تقلل من احتمال الإصابة باكتئاب ما بعد الولادة

٢-اعتني بنفسك جيدا، واتبعي نظاما غذائيا صحيا واشربي كميات كافية من الماء

٣- انظمي إلى مجموعات الدعم والاستشارة

٤- احصلي على قسط كاف من النوم والراحة وابتعدي عن كل ما قد يسبب لك ضغوط نفسية أثناء الحمل

٥- ابقي على تواصل مع طبيبك العام وأعلميه ان كنت قد تعرضت لإكتئاب ما بعد الولادة من قبل

٦- قد يوصى بأخذ الأدوية المضادة للاكتئاب حتى خلال الحمل لتفادي الإصابة به بعد الولادة

بعد ولادة الأم لطفلها ينهال عليها الجميع بأسئلة من نوع: كيف حال الطفل؟ صحته بخير؟ هل يرضع جيدا؟ هل ينام جيدا؟ لمن يشبه؟. لكن لا يخطر على بال أحد أن يسألها إن كانت هي على مايرام. يظنون أن تجاوزها مرحلة الولادة، يعني تجاوزها مرحلة الخطر. دون أن يضعوا في حسبانهم أن نفسية هذه المرأة قد تكون تتآكل من الداخل بفعل اكتئاب مابعد الولادة.فإن كانت تأوهات هذه الأم لا تصل إلى أسماعنا، فهذا لايعني بالضرورة أنها لا تتألم.لأننا لو أنصتنا إليها جيدا  لسمعنا الجلبة التي يحدثها اكتئاب مابعد الولادة داخل روحها. لذا فالطفل ليس هو وحده من له الحق في الرعاية، فالأم كذلك تستحق منا التفاتة اهتمام.لأن الاكتئاب بطبيعته ينفر من مشاعر الحب،الاهتمام،الطمأنينة،الأنسلذا وجودنا معها وبجانبها سيكون مثل خرزة زرقاء تحميها من شر اكتئاب مابعد الولادة.

استبيان ايدنبورغ لإكتئاب ما بعد الولادة

(Edinburgh Postnatal Depression Scale -EPDS)

لقد رزقت بطفل مؤخرا، لذلك نرغب في أن نعرف شعورك الآن.يرجى وضع علامة (×) أمام واحدة من الإجابات التي تعبر عن كيفية شعورك في الأيام السبعة (7) الماضية، وليس شعورك اليوم فحسب.

في الأيام السبعة الماضية

٢- لقد تطلعت إلى الأمور باستمتاع

قدر ماكنت أستمتع من قبل

أقل نوعا ما مما اعتدته

أقل بكثير مما اعتدته

أبدا، لم أستمتع بأي أمر

١- لقد كنت قادرة على الضحك ورؤية الجانب المشرق من الأشياء

نعم، تماما مثل قبل

ليس تماما مثل قبل

قطعا،أقل من قبل

كلا، مطلقا

٤- لقد كنت قلقة ومنزعجة دون سبب وجيه

 كلا، أبدا

نادرا

في بعض الأحيان

نعم، في أحيان كثيرة

٣- لقد لمت نفسي من دون داع عندما سارت الأمور على غير مايرام

نعم،في معظم الأحيان

نعم،في بعض الأحيان

ليس في أحوال كثيرة

كلا، أبدا

٦- تراكمت الأعمال علي ولم أستطع القيام بها كلها

نعم، في معظم الأحيان لم أستطع القيام بها

نعم، في بعض الأحيان لم أستطع القيام بها كالمعتاد

كلا، لقد استطعت القيام بها في بعض الأحيان

كلا، لقد استطعت القيام بها كالمعتاد

٥- لقد شعرت بالخوف والذعر دون سبب وجيه

نعم، في أحيان كثيرة

نعم، في بعض الأحيان

كلا، ليس كثيرا

كلا، أبدا

٨- لقد شعرت بأنني لست سعيدة وبائسة

نعم، في معظم الأحيان

نعم، أكثر الأحيان

كلا، ليس أكثر الأحيان

كلا أبدا

٧- لقد كنت غير سعيدة لدرجة أنه كان لدي صعوبة في النوم

نعم ، في معظم الأحيان

نعم، في بعض الأحيان

ليس كثيرا

كلا، أبدا

١٠- لقد خطرت لي فكرة إلحاق الأذى بنفسي

نعم، أكثر الأحيان

نعم، في بعض الأحيان

نادرا

مطلقا

٩- لقد كنت غير سعيدة وشعرت بألم كبير لدرجة أنني كنت أبكي

نعم، في معظم الأحيان

نعم، أكثر الأحيان

فقط من وقت إلى آخر

كلا، أبدا

النتيجة

مجموع العلامات: 30

إذا كنت قد وضعت علامة (×) في بقية الأسئلة

في الخانة الرابعة أعطي لنفسك نتيجة 0

الثالثة أعطي لنفسك نتيجة 1

الثانية أعطي لنفسك نتيجة 2

الأولى أعطي لنفسك نتيجة

إذا كنت قد وضعت علامة (×) في الأسئلة:1،2 و4

في الخانة الأولى أعطي لنفسك نتيجة 0

الثانية أعطي لنفسك نتيجة 1

الثالثة أعطي لنفسك نتيجة 2

الرابعة أعطي لنفسك نتيجة 3

إذا حصلت على علامة 10 فما فوق فهناك احتمال كبير بأنك مصابة بالاكتئاب. دائما تحققي من إجابتك في السؤال 10 لأنه سيحدد إصابتك من عدمها

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Photo of Wiam Chermati Wiam Chermati Send an email 16 January 2021
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