Postpartum psychosis is a severe mental illness that can affect a woman after she has a baby.
It causes her to have hallucinations and delusional thinking (symptoms of psychosis).
Postpartum psychosis is thought to affect around one in every 1,000 women who give birth. It's sometimes referred to as puerperal psychosis or postnatal psychosis.
Read on to find out:
Most women with postpartum psychosis will experience psychosis (a 'psychotic episode') and other symptoms very soon after giving birth, usually within the first two weeks.
Some women develop symptoms later than this – sometimes at the time they stop breastfeeding, or when their periods restart.
Psychosis causes people to perceive or interpret things differently from those around them. The two main symptoms are:
The combination of hallucinations and delusional thinking can severely disrupt her perception, thinking, emotions and behaviour.
A woman with postpartum psychosis may also behave in a way that is out of character, and may experience:
Her mood may change rapidly. Some affected women experience symptoms of mania and depression at the same time.
Postpartum psychosis is a serious mental illness that should be treated as a medical emergency.
If not treated immediately, the postpartum psychosis can get worse rapidly.
The illness could cause her to neglect or harm her baby or harm herself.
She may not realise she is ill, and it may be up to her partner, family or friends to spot the warning signs and take action – see What should I do if I think someone may have developed postpartum psychosis?'.
The majority of women with postpartum psychosis make a full recovery, and often very quickly provided they receive the right treatment.
Postpartum psychosis is more likely to affect women who:
Once a woman develops postpartum psychosis, there's a high chance she will have another episode following future pregnancies.
Contact your GP immediately if you think someone you know may have developed postnatal psychosis.
If you think there's a danger of imminent harm, call 999 and ask for an ambulance.
If you already have a care plan because you've been assessed to be at high risk, there should be an emergency number you can call to reach a crisis team.
If you don't have a care plan, and think you're having a psychotic episode, see your GP urgently or go to A&E.
Postpartum psychosis is a psychiatric emergency. The woman may need to be admitted to hospital for treatment.
Ideally, she would be admitted with her baby to a specialist psychiatric unit called a mother and baby unit. For some women, this allows them to continue bonding with their baby and gives them confidence in their role as mother.
Typically, a woman with postpartum psychosis would be prescribed one or more of the following drugs:
Doctors will weigh up the effectiveness of these medications with the risk of side effects and the risk of any harmful effects on pregnancy or breastfeeding.
We're not really sure what causes postpartum psychosis. Fluctuations in hormones and sleep patterns could play a role, and there does seem to be a genetic basis, as a woman is more likely to develop the illness if her close relative had it.
There seems to be link between postpartum psychosis and bipolar disorder.
It's important to understand that postpartum psychosis is not caused by anything the woman did, nor is it caused by stress, relationship problems or a baby being unwanted.
A woman's risk of developing postpartum psychosis should be assessed during her antenatal appointments so that if she were to develop the illness after giving birth, the signs would be spotted straight away and there would be a treatment plan to follow.
There are no specific screening tools for postpartum psychosis, but the antenatal care team should be able to identify women who are more likely to develop it and refer them to a psychiatrist for an assessment.
If you've been assessed to be at high risk of developing postpartum psychosis, you may be offered a pre-birth planning meeting at around 32 weeks of pregnancy.
Everyone involved in your care would be invited to this meeting – your partner, family or friends, a mental health professional, midwife, obstetrician, health visitor and GP.
The aim is to make everyone aware of your risk and to agree on a plan for your care.
Studies suggest that taking certain medicines in late pregnancy could help to prevent postpartum psychosis in high-risk women. You may want to discuss this option with your care team. The risks and benefits of medication taken in pregnancy should always be carefully weighed up.
You may also be given advice on what you can do to stay as well as possible during pregnancy – for example, reducing any stress in your life, and getting as much sleep as possible.
You'll get a copy of your written care plan, which should include how you and your family can get help quickly if you were to become ill – see What should I do if I think I'm having an episode?
In the first few weeks after your baby is born, you should be regularly visited by a midwife, health visitor and mental health nurse.
With treatment, the vast majority of women with postpartum psychosis start to feel better very quickly.
Some mothers have difficulty bonding with their baby after an episode of postpartum psychosis, but this doesn't usually last long. With support from family, friends and the mental health team, most women go on to have very good relationship with their child.
About half of women who have postpartum psychosis will go on to have another episode in the future – not necessarily after having another child. In these cases, they should be able to get help quickly. With appropriate treatment, this risk can be reduced.
An episode of postpartum psychosis is sometimes followed by period of depression, anxiety and low confidence. It might take a while to come to terms with what happened.
Women who have experienced or are experiencing postpartum psychosis may find the following charities and forums helpful:
Postpartum psychosis can be stressful and distressing for partners, too. It can be isolating and lonely if both their baby and partner is in hospital.
If you are struggling to cope because your partner is going through an episode of postpartum psychosis or recovering from this, don't be afraid to get help yourself.
Talk to a mental health professional involved in your partner's care, or approach one of the above charities.