For many women, having a baby is the happiest and most important event in their lives.
Yet life with a new baby can have its challenges, as well as its rewards.
Most new mamas experience a brief bout of depression, commonly called the ‘baby blues’, in the first few days or weeks after giving birth.
Each year 800,000 women (1,200 women every day) or approximately 20% of all women who give birth, will experience some degree of postpartum depression. This can interfere with daily life and have a serious impact on families.
Between 1,000 and 2,000 new mothers each year will develop a rare but serious illness called postpartum psychosis.
12 Facts About Postpartum Psychosis
This usually occurs within six weeks of giving birth. It can cause a new mother completely to lose touch with reality, and often involves thoughts of harming herself or her baby.
While postpartum psychosis is rare, it’s important to know the facts about this serious maternal mental health issue, and be aware of the signs.
#1: What Is Postpartum Psyschosis?
Postpartum psychosis is a postpartum disorder which is a hormone-induced state that affects a mother mentally and physically.
During pregnancy and after birth, extreme changes occur in a woman’s hormonal and biochemical make up. These changes can lead to a chemical imbalance in the brain.
#2: What Causes Postpartum Psychosis?
Unfortunately we don’t know what causes this serious mental illness in new mothers. However, women who have experienced the following are at increased risk for developing psychosis:
- A diagnosis of bipolar disorder or schizoaffective disorder
- A family history of mental illness
- A family history of postpartum psychosis (even if there is no history of mental illness)
- A traumatic pregnancy or birth
- Development of postpartum psychosis after a previous pregnancy
#3: What Are The Signs Of Postpartum Psychosis?
In the first weeks after birth, it’s normal for new mamas to feel tired, moody or irritable. Postpartum psychosis, however, causes very distinct changes in a woman’s behaviour.
The early signs of psychosis typically appear from two days to two weeks after giving birth, and include:
- Being full of energy
- Restlessness and irritability
- Feeling invincible, incredibly strong and powerful
- Difficulty in sleeping
- Having irrational beliefs, particularly about someone trying to harm the baby
These signs can emerge as late as three months after giving birth, but this is rare.
If left untreated, over time these symptoms will be followed by a combination of manic, psychotic and depressive symptoms. These can present in different ways:
- Psychotic symptoms: Postpartum psychosis affects the way a mother thinks and how she perceives, which can result in her experiencing visual and auditory hallucinations, and delusions (beliefs not based on reality)
- Manic symptoms: These symptoms include extremely high levels of energy, talking very quickly, and having racing thoughts. They can affect a woman’s ability to concentrate and her moods might change suddenly within a short time.
- Depressive symptoms: These symptoms are the opposite of manic symptoms. A woman might have negative thoughts about herself, about life, and about her ability as a mother. Severe depression can lead to a mother thinking about suicide, self harm, or harming her baby.
#4: It’s Not Your Fault
Even though there is greater awareness about maternal mental health disorders, women who go through this, while pregnant or after giving birth, still feel there is a stigma attached to it. Because of shame or guilt, many women don’t speak about their personal experience of living with mental illness.
It’s important to remember that postpartum psychosis doesn’t happen because of something you or your partner thought or did. Daily stress, relationship problems, unplanned pregnancy, etc. do not cause postpartum psychosis. A chemical imbalance in the brain is not something you can choose to have or not have.
Often, for social or financial reasons, women feel pressured to appear to be coping, even when things are definitely not going well. They fear others will think of them as bad mothers, or perhaps they were brought up not to ask for help. Some women have overbearing family and friends; others are on their own.
You might feel guilty about needing help to care for your baby during the severe stage of postpartum psychosis.
Afterwards, you might also find it difficult to bond with your baby, or to feel confident about caring for her. Be gentle on yourself as you reconnect. And don’t expect everything to snap into place immediately.
#5: Postpartum Psychosis Needs Urgent Treatment
If you, or a new mother you know, is experiencing any of the symptoms of postpartum psychosis, it is important to seek medical help immediately.
Postpartum psychosis is a very serious mental health illness. It places a mother at risk of harming herself, her baby, or other children in her care.
Treatment will almost always require admission to a psychiatric hospital unit. This allows health professionals to closely monitor the woman, and ensure she is in a safe environment.
#6: What Treatment Is Available For Postpartum Psychosis?
Medication is a necessary component of the management and treatment of postpartum psychosis. The medication addresses the chemical imbalance which has led to the extreme symptoms. It also requires ongoing monitoring, to assess any other impact on the mother and baby.
There are three types of medications used to treat the symptoms of postpartum psychosis:
- Mood stabilisers: The most common medication used is lithium, which acts to stabilise mood and reduce the chances of a relapse. Other types of mood stablisers are sodium valporate, carbamazapine, and lamotrigine (all used to treat epilepsy)
- Antidepressants: These treat the depressive symptoms
- Antipsychotics: These medications treat the manic and psychotic symptoms
Medications should be prescribed, changed, or halted only under the direction of a specialist psychiatrist (perinatal psychiatrist) who understands the risks and benefits of treatments for mother and baby.
#7: Will My Baby Stay With Me?
Some hospitals have what are known as mother and baby units (MBU). They allow the baby and mother to stay together while health professionals monitor both.
It also means mothers can remain in close contact with their babies and have support to care for them, while they have the treatment they need.
A five-year study of a mother and baby unit in South Australia found that, if given proper treatment, women with postpartum psychosis made a full recovery and were able to continue to care for their babies after being discharged.
If an MBU is not available where you live, or there are no available beds, you might be admitted to a general psychiatric ward. If that happens, your partner or family member will need to take over the care of your baby.
In the event there is no one to look after your baby, social workers will find a temporary carer. This will be necessary only until an MBU bed becomes available, or you are well enough to care for your baby.
#8: Can I Breastfeed While Being Treated?
If you are breastfeeding, certain medications such as sodium valporate and clozapine aren’t recommended. Lithium should be used with caution, and both mother and baby should be closely monitored for any effects.
In some cases you might not be able to continue with breastfeeding. It could be you are too unwell, or there are no MBU beds available for you and your baby to be admitted together, or the medication you need to take isn’t safe for your baby. Your baby cannot be admitted with you to a psychiatric ward.
You might later feel guilty about not being able to continue breastfeeding. It’s important to remember, however, this is not your fault, and it’s vital for your baby that you have the right treatment.
After you are well, you might wish to consider relactation as an option. Seek the support of an IBCLC to ensure your journey back to breastfeeding is positive.
#9: What Should Partners and Families Do?
Postpartum psychosis is distressing for the mother experiencing it. It is also stressful for her partner, her family, and those who care for her.
When postpartum psychosis symptoms first emerge, it can be shocking and frightening for partners. They might feel confused and worried about the new mother’s behaviour and not understand what’s happening, especially if she doesn’t recognise she is unwell.
If you suspect your partner has postpartum psychosis, or a postpartum disorder, it’s important ask for help when she first has symptoms, especially if she doesn’t acknowledge there is a problem.
Postpartum psychosis is very serious. It puts your partner at risk of harming herself, the baby and any other children, due to the impact of the condition on her thinking and behaviours.
If your partner is hospitalised with your baby it’s likely you will feel very alone and frustrated because you feel you can’t do anything. It’s very important you seek help and support, either from a trusted care provider or an organisation that supports women and families going through postpartum disorders.
If you’re caring for your baby while your partner is in hospital, this can be a very challenging time. Seek support from trusted family members; ask for help with household chores, shopping and meals. You might be inundated with offers to take care of your baby. This can seem helpful but it’s important to remember your baby really needs you during this time.
All newborns seek to make an attachment to a primary caregiver – normally their mothers – for healthy cognitive and physical development. While your partner is being treated, caring for your baby will ensure she feels safe and secure.
Some new parents don’t have family close by, or family members they can rely on for help. If you are in that situation, it could be useful to seek the support of a professional, such as a postnatal doula. A doula can help you to learn baby care, and options for newborn feeding, and will link you to lactation specialists.
When your partner comes home, you can:
- Be patient and listen to her
- Help with daily cleaning and cooking
- Assist with caring for your baby
- Support your partner’s wishes if she wants to continue breastfeeding
- Help your partner get plenty of rest and sleep
- Organise help for things like shopping, meals, and cleaning. A service or postnatal doula is an option if family members aren’t available
- Limit visitors and ensure they don’t overstay their welcome
- Keep your home life as calm and supportive as possible
- Take care of your own emotional and physical wellbeing, by eating well and getting enough rest. Avoid using drugs and alcohol to help you cope.
It can take time for women to recover from postpartum psychosis. If you have any questions or concerns, speak to the perinatal psychiatrist involved in your partner’s care. Some couples seek counselling to help them talk about their experience of postpartum psychosis.
#10: What Happens When I Go Home?
In many cultures, new mothers have what is called a ‘babymoon’, or a postnatal month at home. In an ideal world, all mothers would be granted a month’s rest and support while they recover from birth, bond with their babies and adjust to life as a new mother.
Women who have been treated for postpartum psychosis can benefit from such a postnatal month, after they have been discharged. This involves the new mama getting plenty of rest and sleep, while others take care of the practical details like shopping, cleaning, cooking, and minding other children.
It is important that those recovering from postpartum psychosis have minimal stress. Limiting visitors and reducing their exposure to real world problems and drama is absolutely essential.
Coming home can be daunting if you’ve been separated from your baby, or you’ve had assistance in caring for your baby in hospital. Ask your partner for plenty of help and, if necessary, seek the support of a postnatal doula. Often family and friends genuinely want to help but that might be difficult if you feel you could be overwhelmed with visitors and advice.
It can also be distressing to experience feelings of guilt and sadness about not having been present for your baby in her early days. Some mothers find they don’t bond easily with their babies. Keep talking about how you feel and try not to blame yourself for something you were unable to prevent.
#11: It Takes Time To Recover
The most severe symptoms of postpartum psychosis last between 2 and 12 weeks. However it can take 6-12 months or more to recover fully.
After an episode of postpartum psychosis, most women will experience a period of depression, low social confidence, and anxiety. It takes time to take in what has happened. There is often associated sadness or guilt that you missed out on the early stages of motherhood and bonding with your baby. It takes a while to integrate those feelings into your life. Talk through your feelings with friends and family, speak to others who have been through postpartum psychosis, or seek help from a professional such as a psychologist.
The Action On Postpartum Psychosis Network has advice on practical steps you can take during your recovery.
#12: Will It Happen Again?
About 50% of women who have had postpartum psychosis will experience it again after the birth of their next baby.
Not having more children isn’t a guarantee of avoiding another episode. Over half of women with postpartum psychosis will have another episode unrelated to pregnancy and birth.
However, awareness about the condition will help you and your family be prepared and able to identify a relapse, if it occurs. If you have plans to become pregnant again, it’s strongly recommended you discuss them with a specialist – especially if you’re taking medication.