Highlighting signs and symptoms of postpartum psychosis
Women can be affected by a range of mental health problems both during and after pregnancy. Here, one mum shares her experiences of postpartum psychosis which caused terrifying hallucinations
Having a baby is a big life event, and as a society we expect new mums to be happy and excited with their new bundle of joy.
In most cases this isn’t a problem, as save for the normal range of emotions women experience during and after pregnancy, most mums will adapt to motherhood without any issues.
However, up to one in five women will experience a mental health problem during pregnancy, such as antenatal depression, or in the first year after giving birth like post-traumatic stress disorder, obsessive compulsive disorder or postpartum psychosis.
Collectively, these conditions are commonly referred to as perinatal mental health problems.
If left untreated, they can have a devastating impact on women and their families. Suicide is a leading cause of maternal deaths in the UK with mental ill-health being a significant factor in many of these cases.
Perinatal mental health problems can affect anyone, but some groups are at a higher risk than others.
Professor Ian Jones is director at the National Centre for Mental Health and perinatal psychiatrist specialising in bipolar disorder and postpartum psychosis.
He said: “Women with bipolar disorder are at a far greater risk of experiencing an episode of illness in the perinatal period, with up to 50% becoming unwell during this time, with a significant proportion needing inpatient care.
“One of the most serious illnesses we see in psychiatry is postpartum psychosis, which affects around 20% of women with bipolar disorder following childbirth.”
Postpartum psychosis is a severe illness that can occur in the days or weeks following childbirth. There are a wide range of symptoms, but they typically include strange beliefs that could not be true, severe confusion, hearing, seeing, feeling or smelling things that are not there and having a high mood with loss of touch with reality.
“The onset of postpartum psychosis can be sudden, and symptoms can get worse very quickly. With the right treatment women can make a full recovery, but it is important women are treated as soon as possible,” said Prof Jones.
“Highlighting the signs and symptoms to women and their partners, as well as the healthcare professionals likely to be involved in women’s care during pregnancy, will help ensure any problems are identified and treated early.”
Professor Jones runs a pre-conception clinic to help women with bipolar disorder discuss their options and make an informed choice about whether the time is right to have a baby and to develop a plan for pregnancy and the period following childbirth.
“Women with bipolar disorder have some very difficult decisions to make around pregnancy, including stopping, switching or continuing medications, with each option having potential risks and benefits,” added Prof Jones.
“With bipolar disorder affecting thousands of women across the UK and few preconception services available, many have great difficulty in getting the information they need.
“Given the huge impact perinatal mental health problems can have on women and their families, it is imperative that we address this gap.”
To help tackle the issue, the National Centre for Mental Health is launching a new project in partnership with Action on Postpartum Psychosis (APP), a national charity supporting women who have experienced the illness.
The project aims to work with clinicians and women with lived experience of bipolar disorder and postpartum psychosis to develop a collaborative guide to facilitate shared decision making around pregnancy.
It will also help women and their clinical teams to produce individually-tailored plans and strategies covering pre-conception, pregnancy and the postpartum to help prevent and manage potential problems.
“We want to enable women to take an enhanced role in planning their pregnancy and postpartum period,” said Elen Thomas, a PhD student at Cardiff University working on the project.
“Ultimately, we want to support women in making decisions about becoming pregnant, reduce their risk of becoming unwell in the perinatal period and improve their access to care if they experience an episode of illness.”
Sarah Hayes is a qualified nurse and APP’s regional representative for North Wales. She experienced postpartum psychosis after the birth of her son, Alex, in 1995.
She said: “After Alex was born I was over the moon. I had everything in life I could possibly wish for and I couldn’t believe this beautiful baby boy was mine.
“The first six days were the happiest of my life, and although I couldn’t sleep and felt very emotional, I put it down to exhaustion following the birth and assumed it would pass.
“I was discharged from hospital after five days, but I didn’t feel ready to leave. That first night home was scary, trying to do everything, there was no time to sleep. Even when I did have the chance to sleep I couldn’t switch off.
“At 6am I was still awake and decided to go downstairs, make a hot drink and try to relax. When I sat up in bed I could see lights before my eyes, which again I put down to a lack of sleep.
“When I turned on the television I saw myself and my family on the news. The news reader told a story of the girl who won the lottery and didn’t know she’d won. There was a photo of me and my family with my son on the day he was born.
“I called my mum, who was staying for the night, and when she came downstairs I told her to sit down and take a breath as she was going to have a shock.
“I told her we were on the news and had won the lottery, pointing at the TV. She looked at me and then the television and was very confused.
“She went upstairs to get my partner and that’s when I first sensed something was very wrong, so I called an ambulance.
“The paramedics arrived and told my family to call the community
Highlighting the signs and symptoms to women and their partners, as well as the healthcare professionals likely to be involved in women’s care during pregnancy, will help ensure any problems are identified and treated early
The onset of postpartum psychosis can be sudden, and symptoms can get worse very quickly. With the right treatment women can make a full recovery, but it is important to that women are treated as soon as possible
midwife, and when she arrived she immediately knew I was experiencing postpartum psychosis.
“She explained that it was a severe postnatal mental illness, but that I would recover. Even as health professionals, my husband and I had never heard of it.”
Women experiencing postpartum psychosis should be admitted to a mother and baby unit where they can receive specialist care without being separated from their baby.
However, in Sarah’s case, there were no beds available and instead she was admitted to a general psychiatric hospital.
“I spent three terrifying weeks in hospital, where I experienced all kinds of hallucinations and scary beliefs, from thinking the staff were trying to kill me to seeing myself and my family on TV.
“I was convinced everybody could read my mind and see my thoughts. The confusion of not knowing what was real was terrifying.
“The trauma of being sectioned and separated from my baby was the worst mental anguish imaginable, I can only describe it as mental torture.
“When I was discharged I was still very unwell and had severe side effects from the medication I was given.
“I’m very lucky to have had my mum stay with me; she always stayed calm and told me what was real and what wasn’t. I remember her saying ‘trust your mum’. I don’t think I would have got through this experience without her.
“My recovery was very gradual and for a year I struggled with severe highs and lows which had a significant impact on those around me. It put a huge strain on my marriage, which consequently ended.
“I was eventually diagnosed with bipolar disorder and started on lithium medication and my mood stabilised within weeks.
“I worked as a nurse, brought up my son on my own and got my life back. I’m now married again, I have a great relationship with my son and work to raise awareness of postpartum psychosis.
“When I had postpartum psychosis there was very little information available, and the early signs are not always easy to spot, being easily confused with exhaustion after birth and early euphoria.
“These very early warning signs can escalate quickly, so early intervention is so important. I hope this project can give women and their partners, as well as the healthcare professionals involved in their maternity care, the tools and information to put plans in place to help prevent and manage potential problems.
“It could also help identify potential triggers during pregnancy, such as disrupted sleep patterns. I had trouble sleeping throughout my pregnancy because I felt under a lot of pressure at work. I was a newly qualified nurse working on an understaffed ward, so really struggled to switch-off.
“Had I known about postpartum psychosis my partner and I may have been more prepared and recognised the early warning signs. It would also have been less distressing if I understood what it was before-hand, and crucially, that I could get better.”
To learn more about this project visit www.ncmh.info/perinatal-mental-health or get in touch at info@ ncmh.info. For support and further information on postpartum psychosis visit www.app-network.org.