Giving birth drove Katy psychotic in days
Post-natal depression is well known. But some women suffer a far more extreme reaction
Katy ChaChou was in her element as a British airways air hostess, busying herself going from office to office, updating pilots and cabin crew on their new schedules. or so she believed. In fact, Katy had left her job a decade earlier; the ‘pilots’ and ‘crew’ were the health professionals at a mental health clinic who were about to section her — committing her compulsorily to a psychiatric hospital — for the next six months, initially at least without her nine-day-old daughter.
Katy, then aged 32, from Solihull, West Midlands, was suffering from postpartum psychosis, a severe form of mental illness that affects 1,400 women a year.
It comes on suddenly days or weeks after giving birth, and is characterised by symptoms such as non-stop talking, confusion, an inability to sleep, hallucinations, loss of inhibition and paranoia. this psychosis can last from two to 13 weeks, though less severe symptoms may continue for up to a year.
‘the illness is often a complete shock for everyone concerned,’ says Dr Giles Berrisford, a consultant psychiatrist at Birmingham Perinatal Mental health Service and chair of the charity action on Postpartum Psychosis.
‘at what should be the happiest time in her life, a woman can become catastrophically unwell within just a few hours.’
Last month it was reported that alice Gibson-Watt, a 34-year-old jewellery expert who had appeared on the antiques Roadshow, had died following a psychotic episode.
alice, who was married and lived in Fulham in London, had developed postpartum psychosis after the birth of her daughter in october 2012.
Five weeks after giving birth, she’d been taken to hospital by ambulance and reportedly had to be restrained. a post-mortem examination later revealed she had suffered a cardiac arrest and ruptured liver.
It’s not known what causes postpartum psychosis, but fluctuating hormones and a lack of sleep are thought to be involved, as well as genetics. a woman previously diagnosed with bipolar disorder or schizophrenia has an increased risk of up to 50 per cent.
But about half of cases happen out of the blue to women such as Katy with no previous personal or family history of psychiatric illness. ‘I’d never been to hospital before I gave birth and barely had a day’s illness,’ she says.
one in ten new mothers develops perinatal mental illness — mental illness that occurs during pregnancy or the first year of the baby’s life.
Psychosis, however, is the only perinatal psychiatric disorder regarded as a medical emergency.
under guidelines from the National Institute for health and Care Excellence, within four hours of diagnosis women should be seen preferably by a specialist perinatal psychiatrist. ‘Lives can be at risk as women can develop suicidal feelings or very rarely commit infanticide,’ says Dr Berrisford.
the long-term cost of untreated perinatal mental illness — whether psychosis, depression or anxiety — is huge: £8.1 billion each year, according to a 2014 report by the London School of Economics and the Centre for Mental health.
three-quarters of the cost relates to the adverse impact of the mother’s illness on the child’s physical and emotional health. Katy’s experience of postpartum psychosis was typical. She’d returned from hospital tired, but happy to be bringing her baby home.
‘I’d had a difficult 48-hour labour ending in a forceps delivery and then spent three days and nights in a noisy maternity ward as the midwives wanted to get her feeding going before I was discharged.’
yet once at home, Katy couldn’t sleep. She would fuss over the baby, constantly worried that she wasn’t getting enough milk.
‘Every ten minutes, day and night, I’d be trying to get her to feed,’ says Katy. ‘I was obsessed. the longer I went without sleep, the more energy I seemed to have.’
In retrospect, such behaviour may seem to shout ‘mental health issue’, but many — including doctors — overlook unusual behaviour in new mothers.
Partly it’s cultural, suggests Dr Carrie Ladd, Clinical Fellow in Perinatal Mental health at the Royal College of General Practitioners.
‘there’s a deep expectation that women will make a seamless transition to motherhood despite the potential for ill-health.’
Indeed, Katy’s husband, George, 38, a civil servant, recalls how family and friends were insistent that she was well even as her health was deteriorating. ‘I had never heard of postpartum psychosis before Katy was ill, but I knew something was terribly wrong,’ he says.
‘Little things worried me. We were having lots of visits from friends and family and Katy was asking them all to bring fizzy drinks — which just wasn’t her, she never touched the stuff.
‘I was frantic trying to stop her, thinking how sugar highs would make her even more hyper.’
In the middle of his wife’s fourth night at home, he found her sitting in the garage eating chocolate.
‘this time it was too much,’ he says. First thing the next morning, he drove Katy to see their GP, who advised George to take her immediately to the community mental health clinic.
‘It was the most frightening experience I’ve ever had,’ says George. ‘But I was never worried about our daughter. Not for a second did Katy express hostility to the baby as can happen with postpartum psychosis.’
George’s quick-thinking may not be the norm. ‘Dads often tell me they can’t believe they didn’t recognise the illness earlier, assuming that bizarre behaviour is down to tiredness,’ says Dr Berrisford.
In the early stages, doctors can mistake psychosis for extreme anxiety, says Dr Judy Shakespeare, an expert in perinatal mental health at the Royal College of General Practitioners.
Women can also feel uncomfortable seeking help. ‘there’s a terrible stigma surrounding mothers with mental health problems,’ says Dr Shakespeare.
‘Women worry that they will be judged as a bad mother or end up having their child taken away by social services — neither of which is likely.’
EvEN when women confess to dark thoughts, there’s a tendency for doctors to be overly reassuring. Instead GPs should ‘follow through with further compassionate questioning,’ says Dr Ladd.
Postpartum psychosis is treated with medication: a combination of antidepressants, anti-psychotics and a mood-stabilising drug such as lithium.
after spending two weeks on a psychiatric ward, where she was unable to have her baby with her, Katy is ‘forever grateful’ that a bed became available at the motherand-baby psychiatric unit at another hospital, the Queen Elizabeth in Birmingham
yet many women are not so lucky. there are just 122 specialist mother-and-baby beds in 17 units in the uK, with none at all in Wales, Northern Ireland or large swathes of England, including London and most of Scotland: an estimated shortfall of 60 beds at any one time, according to the Maternal Mental health alliance campaign.
Within a month, Katy had recovered and was well enough to be discharged by Christmas 2012.
But she relapsed the following month, suffering severe depression, which can often follow a psychotic episode. It took six months in hospital to get her medication right.
‘the whole experience is like a bad nightmare,’ she says.
Now symptom-free, Katy has started a small manicure business and is confident that both she and her daughter have emerged from the ordeal unscathed.
‘I’m well at the moment, though I can’t be certain it won’t happen again, and I don’t know if I’ll have another child,’ she says. ‘People say: “oh, you’ve only had one?” I think to myself: “If you only knew.” ’
For Action on PostPartum Psychosis, see app-network.org. The Royal College of GPs has produced an online perinatal mental health guide. Go to rcgp.org.uk and search for perinatal mental health toolkit.