When motherhood spirals out of control.
Many people are familiar with the concept of postnatal depression, and many health professionals are now specifically trained to be on the lookout for any susceptibility and symptoms.
But more recently there has been greater awareness of another, rarer, emotional consequence of childbirth and motherhood – the rather frighteningly named “postpartum psychosis”.
Table of Contents
What is postpartum psychosis?
At the best of times, none of us would want to be labelled as “psychotic”, least of all when we have just become the primary caregiver of a helpless newborn infant. But in a cruel twist of fate which has no rhyme or reason, this is exactly what happens in ~1 in 1000 births.
Although there are various different forms and severities of postpartum psychosis, with every case being different, it is generally considered to be a psychiatric condition which can occur shortly after giving birth which results in a delusional way of thinking. It often starts quite soon after you get the baby blues (and usually about 3-10 days post-birth), potentially a catalyst for its onset.
It is an illness that can linger for many months. An illness that needs to be treated.
What does it feel like?
One of the important characteristics of postpartum psychosis is that, at the time, you often don’t realize you have it. That is what psychosis does to you. It creates an alternative reality in your mind. One that is irrational, confused, manic, obsessive, and paranoid.
This means that you aren’t even aware that you are in this alternative state of mind.
It is therefore left to those around you to work it out. They need to realize that, on top of the expected emotional changes associated with you being a new mother, this isn’t “the normal you”.
Why does it happen? The possible risk factors.
Although there are still unanswered questions about why postpartum psychosis occurs, scientists do know that, in about half the cases, it is heavily driven by your genetic makeup. Your predisposition to it was likely written into your genes, before you were even born.
There are also some possible risk factors which, in some cases, may potentially make you more or less likely to get it – although the research is often conflicting and unclear about which ones are the most important.
- Bipolar disorder. About half of all mothers who are admitted with postpartum psychosis have had some kind of psychiatric episode on a previous occasion in their lifetime. In addition there is evidence that mothers with a history of bipolar disorder may be more susceptible (1 in 4 likelihood) to getting postpartum psychosis, especially if they show mood instability during pregnancy.
- It’s in the family: Postpartum psychosis is particularly common in women who have a family history of either postpartum psychosis or bipolar disorder. For example, women with bipolar disorder and with a family history of postpartum psychosis are particularly high risk with ~ 1 in 2 mums affected by postpartum psychosis. However, half of all women who develop postpartum psychosis have no family history which may increase their likelihood of getting it.
- Sleep Deprivation: Another risk factor is extreme sleep deprivation, for example if you had a long protracted labour where you were unable to sleep, followed by being “up all night” having to care and feed your baby.
- Postnatal complications. Complications during the birth or immediately after, either for the mother or the baby are a potential risk factor for postpartum psychosis. This could be related to the emotional difficulties or trauma that this experience generates, or due to the potential additional sleep deprivation that can accompany it. In addition, there is some evidence that the immune response which can be activated in mothers after birth-related complications could be a potential risk factor.
- Social support. There is some evidence that the absence of a husband/partner during delivery or reduced social support after the birth from those closest to you might be a partial risk factor, emphasising the importance of getting the right social support in the postnatal period to maintain a healthy and rational state of mind and reduce feeling of depression, and potentially also psychosis.
- Age. The evidence is conflicting suggesting age may not be a key risk factor. Some scientific studies suggest younger mums (under 25) are more likely to get it. Other scientific studies suggest that older mothers(35+) are more likely to get it.
- Sociodemographic factors. Sociodemographic factors such as education, marital status, occupation or family type have no effect on whether you are likely to get the condition.
What are the symptoms?
There are many symptoms of the illness to look out for.
- Having rapid mood changes. Postpartum psychosis is a mix of highs and lows (a bit like bipolar disorder). You will therefore rapidly switch between being happy and manic one minute, to anxious and depressed then next.
- Being highly manic, more talkative and active, and lose your inhibitions. This is the high part. When you are on a high you will think you feel great, you might be very talkative, be really active and be less inhibited in the way you act.
- Being Anxious and irritable. The is the low part. When you may feel teary, on edge. Unable to cope.
- Hardly ever sleeping. One very common symptom, which further worsens the illness is the fact that you often find it nearly impossible to sleep. Although sleep deprivation is expected to some degree with a newborn baby who wakes often during the night, if you are in a normal state of mind then you are usually still able to sleep when you are able to. With postpartum psychosis you often can’t sleep or don’t want to sleep.
- Being paranoid, confused, disoriented and delusional. This is one of the key symptoms which differentiates postpartum psychosis from postnatal depression. You see an altered reality which causes you to interpret actions and events differently and more irrationally compared to if you were in a more normal state of mind.
- Being obsessed about your baby’s wellbeing. One symptom that mothers with postpartum psychosis often mention is having an irrational fear that they will hurt their baby in some way, or that they, or their baby might die. And although the fear of hurting your fragile baby is something that many new mums naturally worry about, they don’t usually obsess or become paranoid about it in the same way as mums with postpartum psychosis do.
How do I get help?
To suffer from postpartum psychosis, you don’t need to show the full collection of all these symptoms. But if you are one of the 1 in 1000 people who has them, then the first and foremost important thing is that you talk to someone about it as soon as possible.
Ideally a health professional of some sort. A doctor. A midwife. A health visitor. Anyone who might be able to give you some advice about how to get help.
Getting help to treat it early on can reduce its duration. Helping you get better sooner. And because, in some instances, the psychosis can be so bad that it interferes with your ability to be the mother that you otherwise want to be, getting treatment early on will minimize the emotional fallout on all sides (it is associated with an increased risk of both suicide and infanticide).
The good news is that the recent high profile media campaigns about postpartum psychosis means that it is no longer an unknown condition.Many more health professionals are familiar with it, look out for it, and know how to deal with it. They know what systems to put in place to get you quickly on the road to recovery.
But it is true to say that seeking help itself has some unpleasant realities that you will likely have to face. Realities which make the decision to seek help even more difficult.
How do I help someone who I think might have postpartum psychosis?
Because postpartum psychosis is associated with a delusional state of mind, where the mother may not even realize that they have it, it is often left to the people who are closest to them to seek help.
But how do you convince someone to get help who might not even think they are ill. Especially if they are paranoid. Especially if it may mean that they are to be admitted to a clinic or separated temporarily from their baby.
The reality is that they may be too scared to speak to anyone about it. That they may categorically refuse to get a medical professional involved. They may even warn you not to talk to anyone yourself.
But should you listen to someone who is maybe in a delusional state of mind? Should you intervene?
It is a difficult decision to make. A heavy responsibility to carry. Even a perceived act of betrayal towards the one you love.
And although the choice of whether to intervene is your own to make, the truth is that sooner a medical professional is aware of the circumstances, the sooner the mother will start to receive treatment. And the sooner they will start to get better from this severe psychiatric attack.
And although you may not be sure about how to tackle this, a health professional should. They will be able to advise you of the options. And then together you can decided how to take it from there.
But remember that you will also be an important ally in the recovery process. Making sure that they take their medication, that both mother and baby are safe, and providing the love and support as they transition back to a sound state of mind and deal with the emotional consequences for many weeks and months to come.
What is the treatment?
Firstly, to get better from postpartum psychosis, in the majority of instances, you will need to be admitted to a hospital clinic. That is how poorly you are. In the best case scenario it will be a mother and baby clinic where baby comes too. But not always. And in an age of austerity where maternity services are often being cut, rather than expanded, it is the reality that you may have to find someone else to care for your baby while you are there. Not easy for any mother, let alone one who has had such a difficult start in establishing a stable emotional bond with their baby.
Secondly, to get better you will need treatment. Usually with drugs. They are given to help stabilize your mood, reduce the psychotic symptoms such as paranoia and help you sleep. If you are a lithium responder, then you will likely be given this as one of your treatments. And although the benefits and risks are evaluated on a case-by-case basis, this may mean that you are not be able to breastfeed your baby. Something that can be a further devastating blow to the way you envisaged nurturing your baby. An alternative approach in some instances in Electroconvulsive therapy, or ECT for short. This is when small electric currents are passed through your brain during general anesthetic which intentionally triggers a form of brain seizure which has been shown to reverse some symptoms of psychosis. The most appropriate treatment regime is decided based on the conversations that you, and those close to you, have with the medical professionals involved.
Thirdly, the social service agencies who are tasked with child protection may become involved. This can be a terrifying prospect. Sparking a fear in your mind that they may want to take your baby away from you, whilst in reality they are simply trying to make sure that your baby is being well cared for and that you are getting better.
Finally, once the dust has settled and your mental reality has returned, you may find yourself wracked with feelings of guilt and shame. These are the most common feelings that people who have suffered from postpartum psychosis find themselves experiencing. But like other emotional traumas that people can experience during their lifetime (for example, post traumatic stress disorder), there are ways to try and deal with these self-destructive feelings which can slowly eat away at you. To rationalize them. To talk through them. To share them with others who may have gone through a similar experience.
What about having another baby?
Another reality of postpartum psychosis is that if you have had it once, you are more likely to have it again with your subsequent children.
But this is where you potentially have the upper hand.
You can be in control.
Because actually knowing that you might suffer from it means that you can plan ahead. You can put the right care plan in place to prepare for, and deal with, the psychosis if and when it arises. You can make sure that your health advisors get to know you before and after the birth, and be on the lookout for any of the telltale symptoms. And you can have family members on standby to help out with looking after the baby when required.
And although the reality of it is just the same. That you might not be able to breastfeed if you need specific types of medication. That you might have to be admitted into a clinic. At least you will know what to expect. And you know that you will have done everything you can to minimize the duration, consequences and disruption of the illness.
And although this is not really much of a comfort when you are completely terrified of going through it all again. It is a small step with coming to terms with it.
And hopefully enough to overcome the fear.
To give you hope.
To realize that having another baby is another option if you wish.
Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood by Veerle Bergink, M.D., Ph.D., Natalie Rasgon, M.D., Ph.D., Katherine L. Wisner, M.D., M.S. The American Journal of Psychiatry.Volume 173, Issue 12, December 01, 2016, pp. 1179-1188