New motherhood: Severe mental illness after childbirth

Postpartum psychosis can have fluctuating symptoms, and early identification is the key

Postpartum psychosis (or puerperal psychosis)  is a severe episode of mental illness that begins all of a sudden, often in the early days or weeks after the baby is born.  

Postpartum psychosis can affect any woman, even someone who has never had mental illness before. It can be a frightening experience for the mother, her spouse and family. Women usually recover fully after an episode of postpartum psychosis.

Note: Postpartum psychosis is a psychiatric emergency, and the mother needs help as quickly as possible. The illness is often dramatic and the mother may have fluctuating symptoms. Families often go to faith healers and use magico-religious treatment because they do not understand the illness and think she may be possessed. This leads to delay in treatment and can have catastrophic results for the mother and the baby. Early treatment is important.

What are the symptoms of postpartum psychosis?

Postpartum psychosis can have varying symptoms including:

  • Rapid changes in mood: feeling ‘high’ or ‘manic’, singing loudly or dancing

  • Being restless and agitated, unable to settle or sit down

  • Irritable, perhaps shouting or scolding others

  • Racing thoughts that present as talking fast and appearing confused

  • Losing one's inhibitions and indulging in behaviour that is out of the ordinary, perhaps talking to people she does not know or being over familiar with friends.

  • Being more talkative, active and sociable than usual

  • Being withdrawn, preoccupied and not talking to people when they talk to her

  • Finding it hard to sleep, or not wanting to sleep even when she is exhausted

  • Feeling paranoid, suspicious, fearful, thinking she may be in danger

  • Delusions: false beliefs that are held firmly and are out of character. For example, the mother may believe that she has inherited a large sum of money or believe that the baby is not hers.

  • Hallucinations: hearing and seeing things that aren’t really there and no one else sees or hears.

These symptoms make it very difficult for the mother to take care of her baby. She may not be able to realize that she is ill. The husband, family or friends will know that something is wrong. It may be hard for the family to understand and come to terms with what is happening; however, it is essential to seek immediate help.

Note: The symptoms of postpartum psychosis can change very quickly from hour to hour and from one day to the next.

What causes postpartum psychosis?

Postpartum psychosis is not the mother's fault. It is also not caused by either relationship problems or stress. Several factors determine whether a woman is likely to develop it, of which genetics is one. The mother is also more likely to have postpartum psychosis if a close relative such as her mother or sister has suffered from the illness. Changes in hormone levels are thought to be associated with this condition. Severe sleep deprivation is a known trigger for this illness

What can women at high risk do to prevent postpartum psychosis?

Women who have had a diagnosis of bipolar disorder, schizophrenia, or another psychotic illness are at a higher risk of becoming ill again after the the baby is born. If a woman has already had an episode of serious illness, she should let her gynecologist and psychiatrist know that she wants to have a baby, and discuss with them any medications she is taking. Their advice will help ensure that she is healthy before she gets pregnant. Some regions employ perinatal psychiatrists, doctors who specialize in the mental health care of women and new mothers with current or previous mental health problems.

If you are pregnant and know you are at increased risk of postpartum psychosis, it is important that you inform your gynecologist and your general physician, who may refer you to a psychiatrist if necessary. This will help them make a plan for your care that includes and respects your mental health care.

Note:If you are taking medicines for serious illnesses such as bipolar disorder or schizophrenia, consult your psychiatrist before you get pregnant. Your doctor may recommend that you continue with the medicines even through the pregnancy to help you stay well.

Getting treated for postpartum psychosis

A mother who is affected with postpartum psychosis needs help immediately, and needs to be treated in hospital. In some areas, there are specialist psychiatric units where mothers with serious mental illness are admitted with their babies. The mother is accompanied by a female carer (usually her mother or her mother-in-law), who will help her care for her baby.

Recovery from postpartum psychosis may take weeks or months. The most severe symptoms tend to last from two to12 weeks. The majority of women with postpartum psychosis will recover fully, but some do have further episodes of illness at a later time. They are especially at risk of becoming ill with a future pregnancy.

Breastfeeding during treatment

Consult your mental health professional and seek advice about breastfeeding. Some drugs are secreted in breast milk, but many others are quite safe. The doctor may advise you to schedule feeding as per your medication plan.

Breastfeeding should be restored whenever possible for infant health, maternal wellbeing and mother-infant bonding. The mother's illness will not pass on to the infant. If a mother is very disturbed, keep the infant away for a while till she is calmer. Always have supervision when the infant is with the mother.

After recovery

Postpartum psychosis is often followed by a period of depression, anxiety, and low social confidence. It can take time to come to terms with what has happened and it is normal to feel some sadness for missing out on early motherhood. It can take time to rebuild confidence in relationships and friendships. Most women get back to feeling like their usual selves again.

Talking emotions through with family and friends can help. However, they may also have their own difficulties to come to terms with. Seek advice and get expert help from a psychologist, psychotherapist or counselor.

with postpartum psychosis

  • For the mother:

It is normal to lack confidence with mothering after postpartum psychosis. Most new mothers, without any illness, also feel the same.

Some mothers have difficulty bonding with their babies after an episode of postpartum psychosis. This can be very distressing, but this feeling is transient. Most women who have had postpartum psychosis go on to bond well with their babies. The mother can speak to her obstetrician / gynecologist or a mental health professional to find ways to interact with and respond to her baby. The family plays a very important role in helping the mother recover from her illness and caring for her baby.

  • For the husband:

If your wife has postpartum psychosis, it can be very distressing for you, and you may be frightened or shocked.  Your wife may not be able to recognize that she is ill, so it is important that you reach out to a professional and  seek help. If your wife is hospitalized with the baby, you may feel alone and frustrated. If she is in the hospital without the baby, you will have extra responsibilities for your wife and family. It is important that you seek help and advice from a counselor or the psychiatrist who is treating your wife. They will be able to offer advice and guide you during this phase.

Once your wife and the baby are home, try to:

  • Be as calm and supportive as you can

  • Take time to listen to your partner

  • Help with housework and cooking

  • Help with baby care, or hire a nurse or help for baby care

  • Your wife may be taking prescribed medicines from the hospital. Support her to continue medication and don't stop or alter the medicines until her doctor tells her to.

  • Help with night time feeds as much as possible. Let your wife get as much rest and sleep as she may be taking medicines that make her feel tired

  • Take help from other family members and friends for household chores. This will give you time to spend with your wife and baby, and also have time for yourself

  • Try not to have too many friends and relatives visiting, this can be very over stimulating for the mother

  • Try to keep your home as calm and quiet as possible.

  • Be patient. It takes time for women to recover from an episode of postpartum psychosis.

  • Ensure you remain healthy by exercising, eating well and getting enough rest. Avoid using drugs or alcohol to cope.

  • In the long term, talking about your experiences may aid recovery

  • Counseling or couple therapy may be helpful for you both.