Unravelling Postpartum Psychosis

Unravelling Postpartum Psychosis

Postpartum Psychosis (PP) otherwise known as puerperal psychosis is a severe mental illness that normally occurs within the first 2 weeks of birth. It can, however manifest  some weeks later but this is rare. Symptoms of PP can seem similar to postnatal baby blues or depression however, the trajectory of symptoms and treatment of PP is completely different. Moreover, PP has been shown that the biggest cause of suicide in postnatal women. The legacy of PP is extreme trauma a mother, her partner, family and friends. This article will explore PP with a view to helping for easier detection and greater maternal support as unlike other mental conditions, with quick and appropriate treatment patients can expect to have a full recovery.   

1. Lack of Awareness Around Postnatal Psychosis

Brief Overview of Postpartum Mental Health

Many of my postnatal women come to see me because they’re suffering with mental issues. Sadly, they come when they are at their wits because they really don’t know what is wrong with them. Public awareness of PP and is remarkably lacking because it often can get confused with “baby blues” or “postnatal depression”. These conditions are often fobbed and sometimes diminished however, because of the lack of knowledge they might be masking the start of PP. Postpartum Psychosis is a medical emergency as it can lead to suicide and so, why is public awareness so lacking? A some reasons why this could be the case are:

• Society as a whole, have fears around speaking about suicide. There is the assumption that if we name it that it could ‘put ideas’ into a person’s mind. This is not true at all, as evidence suggests that by sensitively asking these difficult questions, it usually creates an opportunity for a mother to open up and get help.
• Generally, there is huge stigma around telling someone that you have suicidal thoughts as it brings with it consequences. Mothers’ tell me that they are terrified they’ll not be seen as fit mothers and so, how can a mother tell anyone these dark thoughts if this is what she is conditioned to think.
• Most mental illnesses are lifetime conditions and so, there is huge fear for a mother that she might not get better. However, the stats shows that with the right help, a full recovery is expected.
• There is a misconception that only women with a history of mental health problems are at risk for PP, as about 50% of PP cases occur spontaneously ‘out of the blue’

Importance of understanding and addressing Postpartum Psychosis (PP)

About 1-2 women in every 1000 women here in the UK will experience PP and although it is uncommon, it is important to remember it the highest contributor of postnatal suicide. When comparing PP to other life-threatening complications we find that PP is much more common than diseases such as sepsis (0.4/1000) and eclampsia (0.5/1000) which have a much lower probability. Given these stats, it is time we started allocating greater resources for its prevention.

2. Postpartum Psychosis

Clinical definition and diagnostic criteria.

Postpartum psychosis, otherwise known as puerperal psychosis, is a severe mental illness that occurs  suddenly in the days, or weeks, after having a baby. Although symptoms vary, the key indicators that someone my have PP are high mood (mania), depression, confusion, hallucinations and delusions. What is noticeable is how labile the symptoms are. What you see is their mental moods rapidly fluctuating to the extremes. So for example, they may be “super happy” one minute and then “down in the dumps” in the next moment. It is a psychiatric emergency and you should seek help immediately. These moods changes can happen literally ‘out of the blue’ even if the person has never been ill before. PP can last for several weeks or even longer however, unlike chronic mental illness the prognosis is good. A full recovery is expected.

How PP differs from other postpartum mood disorders such as postpartum depression and anxiety.

PP has many similarities to Bipolar Disorder (BD) where their moods fluctuate between having bouts of mania, depression and confusion. However their underlying pathological causes are completely different.  Remember PP is a temporary situation where as BD is a long-term condition.

Postpartum Depression is more common that PP and affects about 10-15 in every 100 women after childbirth. Symptoms are similar to depression such as having low mood, lack of energy, negative thoughts, lost of appetite, etc. Treatment will depend on the duration or how severe the depression is.

The ‘Baby Blues’ happens on the 3-4th day in more than half of women giving birth. Women tend to feel a little teary, the euphoria of birth has reduced and there is a drop in mood. They may feel some irritability, frustration or anxiety. It normally recedes and is gone within 10 days after birth. No treatment is needed.

Unless there is a pre-existing anxiety condition anxiety generally, is around the ability to cope as a new mum. Gentle loving support often reduces this.

3. Understanding Postpartum Psychosis

Signs to Watch Out For

Diagnosis and treatment will depend the nature of when and how PP typically manifests itself. In PP the symptoms occur spontaneously and are highly labile. This means that their moods rapidly swinging between high and low moods. So, remember what we are looking for is what is ‘out of character’ for the person. They may be moody naturally but are these swing to the extreme end of what is normal for them. Here are some clues to what you may experience.

• One minute they’re feeling ‘high’, manic or on ‘top of world and the next minute they’re tearful and fell low
• There could be extreme anxiety and irritability.
• Signs of mental distress: Start imagining things that are not there (hallucinations), have extremely odd thoughts or beliefs that seem untrue (delusions) or they may be imagining people are out to get them (paranoia) of just generally confused.
• They may be incredibly restless and agitated. Very talkative, active, social, doing things they wouldn’t ordinarily do and then switching to being withdrawn and fairly uncommunicative.
• Suffer with sleep deprivation. They might be finding it hard to sleep and are so excited or hyped up they don’t want to or feel the need for sleep

The serious nature of PP:

Suicide is the biggest risk that comes with untreated PP. Most of those women that commit suicide do it alone although there are cases when both mum and baby have died. I believe that killing herself it is the last thing a mother would potentially want to consider, especially if she has young children. Often the reason for considering or even attempting suicide comes from a desperation to make their symptoms stop. It is not because they want to it is because the fell they “have to”. In this day and age we should be able to ensure a mother never gets to this level of desperation. The legacy of suicide is far reaching for those that are left behind.

4. Predisposing Causes and Risk Factors

Biological factors:

• Hormonal shifts after childbirth: During pregnancy you have had increasing levels of hormones in your body to support your baby but the moment your baby is delivered those hormones suddenly drop. Progesterone and oxytocin help to keep you calm, centred and connected and without them your body goes into rebound. And because you have got used to these level it make you may make you feel less euphoric and happy.
• Neurological changes: Again the increasing hormonal during pregnancy will have accelerated neural plasticity in your brain. You now have an additional child to look after and love and your brain is been geared to make it so that you will be attuned to your baby and respond. Now depending on how quickly your body is able to stabilise to those new changes and reset to a new normal will mean that there could be a period of unstableness. This normally sorts itself out quickly.

Personal history:

• Previous episodes of PP or other mood disorders: If you have had PP in a previous pregnancy there is a slightly higher risk that you could have PP again. However, this is not cast in stone – every baby is different and you are different with each child.
• Family history of bipolar disorder or psychosis: evidence shows that postnatal women who have been diagnosed with BP1 are the most likely candidates to get PP.

Other potential triggers:

• Sleep deprivation: Sleep deprivation interrupts normal people’s circadian rhythms which can lead to changes in mental and physiological states. So, it makes sense that you not sleeping it will mess with your mind too.
• Birth trauma: Unresolved trauma keeps the body in stress and so, your cortisol levels may be high which could predisposed you to potentially experiencing psychotic like symptoms.  

5. Current Treatment Approaches and Recovery

Immediate medical attention

• Early detection. The quicker you are able to get help the better. Important to normalise the situation so that the  person doesn’t feel rejected or worry that they will loose their mind or their child
• Hospitalization and its importance: It is easier for the person to be in a hospital or a mother and baby unit specialising in mental support. Here they can be supported and taken care of in an environment which is stable and will help to relieve stress and calm the nerves. This is not a psychiatric ward. It is place of temporary harbour and an understanding that a full recovery is expected.
• Medications: Antipsychotics, mood stabilizers, and benzodiazepines are given in the extremes cases. It is more likely that all other aspects of health and wellbeing will be put in place first before medication.
• Electroconvulsive therapy (ECT) in severe cases: The aim is to change the brain chemistry have having the client go though a controlled seizure. This is done by applying a small dose of electrical current through the brain. It is generally a last resort because we are disrupting the brain which is incredibly sensitive.

6. Holistic Approach to Health Care

• Nutrition: The role of a balanced diet and specific nutrients in mental health. Hormones are big molecules and it can be challenging to get rid of them easily, especially if your body is saturated with them. Eating a healthy diet that focuses on gut health is imperative.
• Physical activity: The benefits of exercise and movement for mental well-being. Your body is connected to your mind despite you thinking that it might not be. Thinking is only a small part of the brain the rest of your brain focuses on integrating and co-ordinating all the mind- body process. Physical activity helps your body to detox which also helps to clear your mind.
• Mindfulness and meditation practices: The more “brain muscle” that you have that helps you regulate your emotions the easier it is to get back into balance. Regular intermittent, short burst meditations throughout the day is the best way of doing this. 
• Support groups and community engagement: We are not meant to go through things alone despite what we may have been taught. Humans thrive in communities because we want to belong – period. So try to find a friend or group that van support you.
• Traditional and alternative therapies: Acupuncture, herbal remedies, etc: These all work to bring your body into balance so that you can be rebalance, replenished, restored back to health. Remember your body does the healing and so you must create the environment for healing to happen
• Importance of a personalized approach: Tailoring treatment to the individual is imperative. What works for someone may not work for you. You need to be a co-creator with your therapist, medical personnel or practitioner because ultimately you are responsible for you. So make sure you trust that person and you work with them to make things happen.

Conclusion

The most important take away for this blog is that we need to be acutely aware of the severity of PP and how quickly it can manifest into it most extreme form. Thus, greater awareness of this condition and how it shows up, needs to be given everyone who is dealing with a mum who has PP. Specifically, that they seek immediate intervention as early detection and treatment creates the best recovery results. Moreover, it is imperative that PP understood as a temporary situation. There is so much stigma surrounding mental health and the consequences of having a long term mental illness which can be extremely anxiety provoking. Having the temporary nature reiterated brings hope to an otherwise awful situation. It also means that people supporting someone with PP will be able to do so much more easily.

To Consider….

If this article resonates and you are experiencing pregnancy related challenges maybe I can help. Book yourself in for a FREE introductory chat. In that session we can start exploring what you want and how I can help you you to achieve that outcome. We need to know where are your potential blocks (your biggest gaps) and what is in season to work with right now. Timing is everything and pregnancy is a time when we can do magnificent work together to help you make the biggest difference for you in attaining your outcome.

If you are ready I would love to support you on your journey.

I would also deeply appreciate if you could like and share this article on your social media.

Frequently Asked Questions

1. Question: What is Postpartum Psychosis (PP) and how is it different from the common “baby blues” or postnatal depression?
   • Answer: Postpartum Psychosis (PP) is a severe mental illness that typically manifests within the first two weeks after childbirth. Unlike the “baby blues” which is a brief drop in mood after birth or postnatal depression, which involves prolonged low moods, PP symptoms are intense and can include mania, depression, hallucinations, and rapid mood fluctuations. It’s crucial to differentiate PP from other postpartum conditions, given its severity and potential risk factors.
2. Question: Why is public awareness about Postpartum Psychosis so limited despite its serious nature?
   • Answer: Public awareness about PP is limited due to various factors. Society often hesitates to discuss topics like suicide, fearing it might instigate such thoughts. Additionally, there’s a stigma around admitting to suicidal ideations, with mothers fearing they might be seen as unfit parents. It’s also a misconception that only women with a history of mental health issues are at risk, which isn’t true. Greater understanding and dialogue are essential for early detection and support.
3. Question: Are there certain triggers or risk factors that predispose a woman to develop Postpartum Psychosis?
   • Answer: Yes, several factors can increase the risk of developing PP. Hormonal shifts after childbirth, neurological changes, personal or family history of mood disorders, sleep deprivation, and traumatic birth experiences are among them. However, it’s important to note that about 50% of PP cases can occur spontaneously, even without any prior warning signs or identifiable triggers
4. Question: With the right intervention, what can be expected regarding recovery from Postpartum Psychosis?
   • Answer: The good news is, unlike many chronic mental illnesses, PP is temporary and with timely and appropriate treatment, a full recovery is expected. Personalized care, including medical attention, potential hospitalization, and holistic health care approaches, can ensure a woman recovers completely from PP.
5. Question: How can we support someone who might be exhibiting signs of Postpartum Psychosis?
   • Answer: Early detection and understanding are key. Look for symptoms that seem out of character for the person, such as rapid mood fluctuations. If they exhibit signs of distress, hallucinations, delusions, or extreme mood swings, seek medical help immediately. Remember, opening a dialogue sensitively can create an opportunity for the mother to share her feelings and get the help she needs.

General FAQ

If you have any questions, feedback, or need further assistance, you can easily message me through the contact form on my website. I strive to respond promptly to all inquiries and look forward to connecting with you!

How can I message you?

If you have any questions, feedback, or need further assistance, you can easily message me through the contact form on my website. I strive to respond promptly to all inquiries and look forward to connecting with you!

What services do you offer?

As a Pregnancy and Infertility coach, I specialize in helping professional women to navigate the challenges they experience on their pregnancy journey. I help them reclaim back control by provide them with a safe, non-judgmental space where they can openly express their feelings, fears, frustrations and be empowered to confidently create a safe, nurturing and loving environment for themselves and their unborn child.

My passion lies in empowering women to effect sustainable, positive changes in their lives. To achieve this, I employ a diverse range of transformational tools that help in the release of trauma, PTSD, grief, and loss, particularly those stemming from their primary mother wound. Together, we embark on a journey of growth and healing, inspiring each individual to find solutions that ensure a healthier and more fulfilling pregnancy experience.

Can anyone benefit from your coaching programs?

Absolutely! While my specialization is in tailored to working with professional women who are focused on issues surrounding pregnancy the primary trauma that most women experience is a the collect mother wound. My coaching programs and healing books are designed to benefit any individual, especially women, seeking to overcome trauma, heal deep wounds, and create a positive impact on their lives.

How can I access your trauma healing books?

You can access my trauma healing books, Amazon’s number one best-selling authors, through various platforms, including Amazon Kindle, paperback, and other online bookstores. Additionally, you may find links to these books on my website, making it convenient for you to explore and purchase them.

Using Conscious Pregnancy Approach for Postpartum Psychosis

A holistic approach is always going to be the best approach in treating anyone with ill health. Every decision we make is influenced by our emotions. Emotions are the physical or embodied part of our feeling or thoughts. Our brain tries to make sense of things by giving them labels – Postpartum Psychosis is the category for many of the symptoms it has. We do this because it is a quick way of accessing information. Therefore we need to have our body and mind working together in harmony. This is what I do. Together we create the right physical and mental environment to stabilise your mood. So we will look at regulating your diet, sleep, activities, etc. so that you can experience feeling in control and living more joyously.

Are your coaching programs tailored for specific individuals?

Yes, my coaching programs are personalized to cater to the unique needs and goals of each individual. Whether you a want coaching for reasons such as improving relationships, spiritual connection, optimising health or seeking healing from the Mother Wound, I will work closely with you to design a program that aligns with your desires and aspirations and which will result in personal growth.

How can I stay updated on your offerings and events?

To stay informed about my coaching programs, trauma healing books, and upcoming events, you can subscribe to my newsletter on the website. By joining the mailing list, you’ll receive regular updates, exclusive content, and early access to any new releases or offerings.

Note:

Content and imaging co-created with myself and opensource AI technology