Ever noticed how in the USA the term “postpartum depression” is used more often than here in Australia, where we mostly use the term “postnatal depression”? In the UK, from my online vantage-point anyway, it seems more mixed – as if the two terms are interchangeable.
What’s the difference? Is it like, “You say potato, I say potato. You say tomato, I say tomato.”?
What about “perinatal mental health” – what’s that all about?
What’s the difference between “prenatal”, “antenatal” and “antinatal”?
What’s “puerperal” – something to do with caterpillars?
Words do matter. Many years ago I made the mistake of asking if the lady I was following-up had delivered. I was very firmly advised by my colleague, a Midwife, that, “Babies are born. Women give birth. Pizzas are delivered.” I was suitably chastened and, although not a midwife myself, I have tried to stay on top of most of the language midwives use.
So, with that spirit of adventure, let’s see if we can get our heads around some key words in today’s perinatal jargon-busting post.
Let’s get started with the basics:
“Natal” = relating to an infant being born
“Partum” = relating to a woman giving birth
“Peri” = around/about
“Perinatal” = around the time of birth, that is: both before and after the baby is born.
How long before and after is where it gets a bit tricky. The World Health Organisation define the perinatal period as from 22 completed weeks of pregnancy to 7 days after birth. The Australian Institute of Health and Welfare differ: they say the perinatal period starts after 20 completed weeks of gestation and ends 28 completed days after birth. The Australian Perinatal Mental Health Clinical Practice Guidelines, issued as part Australia’s National Perinatal Depression Initiative (NPDI), define the perinatal period as pregnancy and the first year after birth. Other organisations, such as the Queensland Centre for Perinatal and Infant Mental Health, define the perinatal period as including preconception, pregnancy, and up to three years after birth.
Generally (not always) in the mental health clinical context, we think of the perinatal period as being over three phases: 1. planning pregnancy; 2. pregnant; 3. new parent.
Just choose your definition of when the perinatal period should begin and end – from what we’ve seen above that’s what everyone else is doing.
“Perry Natal” is on facebook – judging by his profile pic, he seems like a pretty fun guy. As far as I can tell he has no relationship to the perinatal period.
I like to think that Perry Natal gets a lot of enjoyment out of confusing health professionals who work with pregnant women and new mums… “She’s not perinatal! I’m Perry Natal!” Why is that so hard for you to understand? A man can be Perry Natal without there being a perinatal woman!”
“Prenatal” refers to pregnancy. I don’t think it gets used all that much in Australia – not that I’ve noticed, anyway. Semantically, it makes sense to use prenatal, but the usual convention seems to be to use the word “antenatal”.
“Antenatal” gets used all the time to refer to pregnancy. “Ante” = before, so antenatal = before the infant is born.
“Anti Natal” is either a spelling mistake, or an indication that somebody really hates Natal – the capital and largest city of Rio Grande do Norte, a northeastern state in Brazil. It is hard to imagine anyone hating Natal – it looks very pleasant, is considered the safest capital city in Brazil, and is home to the largest cashew tree in the world! Everyone loves cashews, don’t they?
“Antepartum” is not a word I’ve heard used alone as replacement for “antenatal”, although I guess it could be. The word pops-up as a descriptor for a medical emergency that sometimes occurs after 20 weeks gestation: “antepartum haemorrhage” (aka APH). It’s probably used in other contexts too – please feel free to add anything important I’ve overlooked in the comments section below.
Labour and childbirth may attract the descriptors “Intranatal” if it relates to the baby, and ‘intrapartum” as it relates to the woman.
“Postnatal” is after the infant has been born. Literally speaking, everyone can participate in the postnatal period – baby, mum, dad, and whoever is there after the baby is born. Semantically this is why dads can experience postnatal depression.
As with the definition of perinatal, definitions of how long the postnatal period lasts vary a lot. Generally when we’re thinking about postnatal depression we think mostly about the first six or twelve months, but it wouldn’t be unusual to think of any depression that arrives before baby’s third birthday as postnatal depression.
“Postpartum” is after the woman has given birth.
If we get bogged-down in the semantics, I’m pretty sure only a woman who has given birth can experience postpartum depression. Why? Because only the woman is postpartum, the baby and man are postnatal.
That said, it’s also pretty safe to say that hardly anyone gets bogged-down in the semantics. In common usage “postpartum depression” is applied to both women and men, and as with “postnatal depression’ there are varied definitions of how long the postpartum period lasts when it is related to depression. I think obstetricians and midwives have a much more defined, discrete definition on how long the postpartum period is, and sometimes refer to it as the “fourth stage of labor”.
“Puerperal” or “the puerperium” relates to the time from immediately after birth of the placenta to six weeks, with an emphasis on the first two weeks.
In mental health the puerperium is especially noteworthy for two things:
 Something like 80%-90% of first-time mums will experience the baby blues in the puerperium. It’s a transient, self-resolving emotional lability that arrives within a few days of childbirth and goes away within hours or (if you’re a bit unlucky) a few days. More info here.
 Much, much rarer – something that affects one or two women per thousand births – is puerperal psychosis. “Psychosis” = losing touch with reality. To lose touch with reality at any time is pretty scary; to do so when there’s a brand-new baby on the scene even more so. This is nearly always a very frightening time for the woman and the people who love her; specialist mental health support will certainly be required. For more info, there are two great puerperal psychosis resources available via the Helen Mayo House website:
Information on Puerperal Psychosis (March 2010) by Dr Anne Sven Williams and Sue Ellershaw
Puerperal Psychosis: a Carer’s Survival Guide (2011) by Craig Allatt
Which brings me back to where the idea for this post started. Broadly, when people use any of the terms “postnatal psychosis”, “postpartum psychosis” and “puerperal psychosis”, they’re usually talking about the same thing. I would make the distinction that puerperal psychosis is specific to onset of symptoms in the first fortnight or so after birth. Similarly, “postnatal depression” and “postpartum depression” are used pretty-much as interchangeable terms, even though there are semantic differences… same with the abbreviations PND and PPD.
Maybe this picture clears it up:
If the illustrated summary is of any use, there is an easier-to-print PDF version here.
As always, your thoughts/comments/corrections are welcome in the section below.
Paul McNamara, 23rd April 2013
Fun to read………..interesting mental gymnastics there Paul
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PANDA would like to see the term PND become a reference to Perinatal Depression so that we include both antenatal and postnatal depression & anxiety in our discussions and references to mood disorders associated with pregnancy and child birth. It would be great if next year we see it as Perinatal Depression Awareness Week to acknowledge all the parents who struggle through pregnancy too. Tomorrow we plan to publish an infographic to help begin this discussion and hopefully bring a small change to use of the PND acronym.
Such a beautifully presented piece of literature Paul. Such an entertaining, informative read!