Professional Documents
Culture Documents
pregnant women who want to know about mental health problems after childbirth
women with a high risk of postpartum psychosis because of previous mental health
problems
women who have had postpartum psychosis before and are pregnant again
Postpartum psychosis (or puerperal psychosis) affects thousands of women in the UK each year. It is a severe episode of mental illness which begins
suddenly in the days or weeks after having a baby. Symptoms vary and can change rapidly. They can include high mood (mania), depression,
confusion, hallucinations and delusions. Postpartum psychosis is a psychiatric emergency. You should seek help as quickly as possible.
Postpartum psychosis can happen to any woman. It often occurs out of the blue to women who have not been ill before. It can be a frightening
experience for women, their partners, friends and family. Women usually recover fully after an episode of postpartum psychosis.
It is much less common than Baby Blues or Postnatal Depression. It occurs in about 1 in every 1000 women (0.1%) who have a baby.
How do the symptoms of Postpartum Psychosis differ from Postnatal Depression or Baby Blues?
Many women experience mild mood changes after having a baby. It is common to feel many different emotions.
Over half of new mothers will have the 'Baby Blues'. This usually starts 3 to 4 days after birth. You may have mood swings. You may burst into tears
easily. You can feel irritable, low and anxious at times. You may also over-react to things. It usually stops by the time your baby is about 10 days old.
You dont need treatment for Baby Blues.
Postnatal depression affects 10 to 15 in every 100 women after childbirth. The symptoms are similar to those in depression at other times. These
include low mood and other symptoms lasting at least two weeks.
Postpartum psychosis is different from postnatal depression. It is a more severe illness. There are many different ways the illness can start. Women
often have symptoms of depression or mania (see our leaflet on Bipolar Disorder) or a mixture of these. Symptoms can change very quickly from hour
to hour and from one day to the next.
There are many symptoms that occur in postpartum psychosis. These may include:
anxiety or irritability
severe confusion
racing thoughts
delusions: these are odd thoughts or beliefs that are unlikely to be true. For example, you might believe you have won the lottery. You may
think your baby is possessed by the devil. You might think people are out to get you.
hallucinations: this means you see, hear, feel or smell things that arent really there.
You may not be able to look after yourself as well as you would when you are well. Your symptoms may make it very difficult for you to look after your
baby. If you have postpartum psychosis you may not realise you are ill. Your partner, family or friends may recognise that something is wrong and need
to ask for help.
It is important to discuss these with your psychiatrist. This will help you decide what is best for you and your baby.
Some women at high risk of postpartum psychosis may decide to start medication in late pregnancy or after delivery. This may reduce the risk of
becoming ill. There is not enough research evidence to be sure about this. A number of medications are sometimes used in this way. These include
antipsychotics and lithium. You should discuss this with your psychiatrist.
What help is available if I am well but have a high risk of postpartum psychosis?
Preconception (when you are planning a pregnancy)
If possible you should seek specialist advice when you are planning a pregnancy. Your GP can refer you. You should see a perinatal psychiatrist if
there is one in your area. This is a doctor who specialises in the care of pregnant and postnatal women with current or previous mental health
problems. If there is no local perinatal psychiatrist you should see a general psychiatrist for advice. You will be able to discuss:
The type of care you can expect in your local area. For example, how professionals work together with you and your family. Also whether
there is a perinatal mental health service or a specialist midwife
the risks and benefits of medication - they should help you make choices about treatment
who will be involved in your care in pregnancy and after birth of your baby.
Ideally you should have a pre-birth planning meeting at around 32 weeks of pregnancy. This is a meeting involving you and everyone involved in your
care. This includes, your partner, family or friends you choose to bring. It also includes mental health professionals, your midwife, obstetrician, health
visitor and GP. The aim is to make sure that everyone involved in your care knows about your risk of postpartum psychosis. You should all agree on a
plan for your care.
You should get a copy of your written care plan. This should include early warning symptoms and a plan for your care. There should also be details of
how you and your family can get help quickly if you do become unwell.
Urgent help
If you, your partner or family think that you have symptoms of postpartum psychosis, you need to be seen urgently. If you have been told during
pregnancy that you have a high risk of postpartum psychosis, you may have a care plan. This should include emergency contact numbers for your
mental health team or local crisis service.
You may not have this type of plan, or you may not have had any mental illness before. In that case you should see your GP urgently (the same day) or
attend your local A&E department. If you are told you do not have postpartum psychosis but your symptoms worsen, you should make sure you are
seen again.
Most women with postpartum psychosis need to be treated in hospital. Ideally you should be offered a bed in a Mother & Baby Unit (MBU). This is a
specialist psychiatric unit where mothers with mental illness are admitted with their babies. You will be supported in caring for your baby whilst you
have the care and treatment you need.
There are many parts of the country with no Mother and Baby Unit. Even where there are MBUs, there may not be a bed available. You may be
admitted to a general psychiatric ward. If that happens, your partner or family will need to care for your baby. If you have nobody else who can look
after your baby, social workers can find a temporary carer. This will only be until an MBU bed is available, or until you are well enough to care for your
baby yourself. You may choose to be admitted to a general ward if the nearest specialist MBU is far from your home.
Most women with postpartum psychosis need treatment with medication. This is usually anantipsychotic, a mood stabiliser or both.
It is possible to breastfeed whilst taking some medications. Your psychiatrist can discuss the risks and benefits of medications in breastfeeding with
you. You may be unable to breastfeed. There are several reasons for this. You may be too unwell, or you may be admitted to hospital without your
baby. You may need a medication which is not safe in breastfeeding. Some women feel guilty about being unable to breastfeed, but you should not feel
this way. If you have postpartum psychosis, it is not your fault. It is important for your baby that you have the treatment you need so that you get better.
During the severe part of the illness you will probably need help caring for your baby. You are likely to need practical help. You may also need help to
bond with your baby. Mother and Baby Unit (MBU) staff are trained to support you with all aspects of caring for your baby. If you do not go to an MBU,
there are people who can help and support you once you go home. These include health visitors and mental health professionals. There may be a local
perinatal or parent-infant mental health service. In some areas, Childrens Centre staff and/or voluntary organisations can also help.
It is normal to lack confidence with mothering after postpartum psychosis. Remember that most new mothers, who have not had an illness, also feel
like this. You may find it hard to attend mother and baby groups when recovering from postpartum psychosis. Health visitors and community psychiatric
nurses can give you one-to-one advice until you feel up to attending groups with other mothers.
Some mothers have difficulty bonding with their babies after an episode of postpartum psychosis. This can be very distressing. Usually these problems
dont last long. Most women who have had postpartum psychosis go on to have very good relationships with their babies. Talk to your health visitor or
other professionals involved in your care. They can tell you what help is available in your area. Health professionals can support you in learning how to
interact with and respond to your baby. You may find baby massage and other groups for new parents helpful.
Allow your partner, family or friends to help and support you while you get better (see section on partners below).
Usually you will need to have care from a mental health service until you fully recover. This team can advise you about treatment. They can support
you and your family. You may have care from a perinatal or parent-infant mental health service.
These specialist teams do not exist in all areas. In that case your local mental health team, health visitor and GP will continue to support you whilst you
recover.
It is important to ask for advice about contraception. It is a good idea to avoid getting pregnant again too soon after an episode of postpartum
psychosis.
Does everyone with postpartum psychosis need to be referred to Children & Families Social Services?
Some women will be referred to Children & Families Social Services. You may be referred in pregnancy, because of your high risk of postpartum
psychosis. You may be referred if you develop postpartum psychosis. Sometimes women worry that this means that people think they cannot care for
their baby. This is not usually the case. The reason for assessment is to check the support you have from family, friends and professionals. It is also to
make sure there is safe plan for your baby if you are too unwell to care for him/her. If referral is needed, this should be discussed with you (unless you
are too unwell).
Some women and their partners worry that if they seek help for symptoms of mental illness, people may think they cant care for their baby. On the
contrary, seeking help and having treatment means you are doing the best for your baby. This will be seen as positive.
You may need extra help from family members during illness and recovery. If you have no support from family or friends, social services may be able to
help. Social workers can find a temporary carer for your baby if there is no MBU bed.
Although it might take a while, most women recover fully and become good mothers. It is very rare for babies to be removed from women with
postpartum psychosis.
It is important that your life is as stable as possible. Take time for yourself and prepare for when mum and baby return home. Once your partner and
baby are home try to:
let other family members and friends help with shopping, cooking etc. if they can - this will give you more time to spend with your partner
and baby
It can be difficult living with someone recovering from postpartum psychosis. Ensure you remain healthy by exercising, eating well and getting enough
rest. Dont use drugs or alcohol to cope.
Ask to speak to the Perinatal Psychiatrist or the other staff involved in your partners care if you have any concerns or questions. They are usually very
supportive.
Be patient. It takes time for women to recover from an episode of postpartum psychosis.
In the long term being willing to talk about your experiences may aid recovery. Counselling or couple therapy may be helpful for some couples.
Many women who have had postpartum psychosis go on to have more children. There is a high risk of having another episode. About 1 in 2 (50%)
women who have had postpartum psychosis will have this again after the birth of another baby. With the right care, if you have another episode, you
should be able to get help quickly.
Over half of women with postpartum psychosis will have a further episode of illness not related to childbirth. Avoiding having further babies is not a
guarantee of remaining well.