Postpartum psychosis, also called puerperal psychosis, is a severe mental illness that begins suddenly after childbirth. It affects around 1 in 1,000 women, usually within two weeks of birth, and causes delusions, hallucinations, confusion and extreme mood changes. It is a medical emergency, and it is treatable.
Key points
- Postpartum psychosis is a medical emergency affecting around 1 in 1,000 women after birth, and needs same-day assessment.
- Onset is sudden, usually in the first two weeks after birth and often within hours or days.
- Symptoms fluctuate. Seeming well for a few hours does not mean the episode has passed.
- Bipolar disorder or a previous episode means high risk, and specialist care before the birth.
- Inpatient care is usually needed, normally in a mother and baby unit, not a general ward.
- Most women recover fully, though recovery takes months.
Symptoms
- Delusions, including about the baby, such as that the baby is not hers or is in danger; hallucinations.
- Mania: very high mood, overactivity, fast speech, racing thoughts. Or depression: withdrawal, tearfulness, low energy.
- Confusion, not knowing where she is; being unable to sleep even when exhausted; out of character behaviour.
Causes and risk factors
- Bipolar disorder carries at least a 1 in 5 risk of severe recurrence after childbirth.
- A previous episode of postpartum psychosis: more than 1 in 2 later deliveries are affected.
- Family history of severe antenatal or postnatal mental illness; stopping psychiatric medication in pregnancy without medical guidance.
Treatment
- NICE treats this as an emergency: assessment by a secondary mental health service within 4 hours of referral.
- Most women need hospital treatment, normally in a specialist mother and baby unit so mother and baby stay together.
- Antipsychotics, mood stabilisers and antidepressants depending on presentation; ECT is sometimes used where illness is severe.
When to speak to a professional
- Believes things that are clearly untrue, hears or sees things others do not, or is confused or unsure where she is.
- Is unusually high, agitated and not sleeping, or is severely withdrawn or hopeless.
- Contact the perinatal mental health team, GP, NHS 111, or A&E the same day. Call 999 if anyone is in immediate danger, including the baby.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.