What Is Postpartum Psychosis? Signs, Risk Factors, and What to Know

Oct 13

8 min read

In light of recent news, postpartum psychosis has been getting more (very well-deserved) attention. Naturally, people who are pregnant or postpartum may have questions and even anxiety about it. What does postpartum psychosis actually look like? Who is at higher risk? And what should you do if you notice symptoms in yourself or someone you love?

What Is Postpartum Psychosis?

Postpartum psychosis affects around 1-2 in 1,000 people after childbirth. It is a serious psychiatric condition involving a significant disruption in a person's perception of reality. Symptoms often begin within the first two weeks after childbirth. It is considered a medical emergency and requires immediate medical attention.

Someone experiencing postpartum psychosis may:

Experience hallucinations, such as hearing voices or seeing things that other people do not. These experiences can feel completely real to the person experiencing them.
Experience delusions, which are beliefs that feel true but are not based in reality. A person may become convinced, for example, that someone is trying to harm them or their baby, or that something extremely frightening is happening around them.
Become intensely suspicious or paranoid, including becoming afraid of or distrustful toward people they would normally trust.
Become severely confused or disorganized, making it difficult to follow a conversation, understand what is happening around them, or carry out familiar tasks.
Behave in ways that seem very different from their usual selves.
Experience mania, which can involve a dramatic change in energy, sleep, mood, and behavior. Someone may sleep very little without feeling tired, talk much more or much faster than usual, have racing thoughts, feel unusually energized or agitated, or behave in impulsive, grandiose, or uncharacteristic ways.
Experience severe depression, which may involve profound sadness, hopelessness, withdrawing from other people, difficulty caring for themselves, significant changes in sleep or appetite, or thoughts of suicide.

Postpartum psychosis does not look exactly the same in everyone, and symptoms can change quickly. Symptoms can also wax and wane, so there may be periods when someone appears more like themselves, able to care for themselves and their baby, and connected to reality. Postpartum psychosis is still a psychiatric emergency even when symptoms temporarily improve.

What About Scary Thoughts About the Baby?

Because postpartum psychosis can involve frightening thoughts and beliefs about a baby, it's understandable that parents may worry about what their own thoughts mean. But scary thoughts about a baby are very common postpartum, and having them does not, by itself, mean someone is experiencing psychosis. For example, you might suddenly picture a frightening image of your baby getting hurt by accident or of yourself harming your baby. These are examples of intrusive thoughts: unwanted thoughts, images, or impulses that pop into your mind, often about something you would never want to happen.

For many new parents, these thoughts are upsetting precisely because they are unwanted and scary. There is no evidence that having an intrusive thought makes someone more likely to act on it, and they don't make someone a bad parent. Intrusive thoughts can become a problem when they are frequent, difficult to manage, or cause significant distress. Talking with a healthcare provider can help you understand what may be contributing to them and whether treatment would be helpful.

Having an intrusive thought does not automatically mean that someone is experiencing postpartum psychosis. Postpartum psychosis can also involve frightening thoughts about a baby, but the thoughts occur alongside other signs that someone is losing touch with reality. Someone may become convinced that their baby is in danger and that they need to take a particular action to protect or save them. They may hear voices telling them to do something, believe something frightening is happening that other people cannot see, or become so confused or disorganized that they are no longer able to accurately understand what is happening around them.

The distinction is not simply whether someone has a frightening thought. What matters is the larger picture, including whether there are hallucinations, delusions, significant confusion or disorganization, or other signs that the person is losing contact with reality.

Who Is at Higher Risk for Postpartum Psychosis?

Certain factors are associated with a higher risk of postpartum psychosis.

These include:

Bipolar disorder
A previous episode of postpartum psychosis
A previous psychotic episode
Recent discontinuation of mood-stabilizing medication
Significant sleep deprivation
Certain obstetric complications
A family history of bipolar disorder and/or psychosis

Having a risk factor does not mean postpartum psychosis will happen, and some people who develop it have no known psychiatric history or obvious risk factors.

How to Prepare if You Know You're At Risk

Establish Specialized Care

For people at higher risk, having the right support in place before the postpartum period can make it easier to recognize changes and get help quickly if something starts to feel off.

Ideally, that support system should include providers who specialize in treating mental health during pregnancy and the postpartum period. For example, psychiatric medication decisions are best managed by a reproductive psychiatrist, a doctor specifically trained in medication management during pregnancy and postpartum. A perinatal psychotherapist can also be an essential support person during this time to help you manage symptoms, process your experience, and help you recognize when things are changing. While psychiatrists and therapists have different roles, both are highly trained in navigating the unique challenges that arise during pregnancy and postpartum.

If you are trying to conceive, pregnant, or recently postpartum, ask your current providers whether they have experience treating your condition during this time. If they do not, you can ask whether they can refer you to someone who does.

Unfortunately, this kind of specialized care is not equally accessible to everyone. Reproductive psychiatrists can be difficult to find, and specialized treatment may be expensive or poorly covered by insurance. If specialized care is not accessible to you, you can still make a plan with the providers and support people you do have. Let them know about your history and risk factors so they can help you recognize when something may be changing and figure out where to turn if you need additional support.

Protecting Sleep

Sleep disruption is part of life with a newborn, and getting adequate sleep can be difficult.

If you are at higher risk of postpartum psychosis, protecting sleep should be an integral part of your postpartum plan. Before the baby arrives, think realistically about how nighttime care will work.

Who can help with nighttime responsibilities? Who can give you a protected stretch of uninterrupted sleep? Who can take over some of the baby's care if you have had several nights of very little sleep?

If you are breast/chestfeeding, talk with your healthcare providers about how you can protect your sleep while factoring in your feeding goals and values.

Make a Plan and Know When to Get Help

If you know you have risk factors, talk with the people close to you before the baby arrives.

Who knows what you are like when you're doing well?
Who would notice if you suddenly seemed very different?
Who could stay with you if you need to go to the hospital?
Who could take care of the baby while you’re at the hospital?
Which hospital emergency department would you go to?

It can also be helpful to make a list of the healthcare providers involved in your care and keep their contact information somewhere your partner or another trusted person can easily find it. Include your OB-GYN or midwife, psychiatrist or other medication provider, therapist, primary care provider, and any other clinicians involved in your care. If you ever need emergency psychiatric care, you can bring that information with you to give to the hospital staff. Your outpatient providers may be able to provide useful information about your history, medications, and baseline and coordinate with the hospital, as appropriate. Answering these questions and organizing this information ahead of time means you do not have to figure everything out in the middle of a crisis.

You do not need to be certain that someone is experiencing postpartum psychosis before getting help. If something feels significantly different, concerning, or out of character after childbirth, it is okay to err on the side of getting evaluated. Symptoms can change quickly, so it is better to have someone evaluated when you are concerned than to wait and hope things settle on their own.

If you or someone you love is experiencing symptoms of postpartum psychosis, immediate medical attention is needed. Go to the nearest emergency department for evaluation. The person experiencing psychosis should not be left alone with the baby; another trusted adult should care for the baby while help is being obtained. If you cannot safely get to an emergency department or there is an immediate safety concern, call 911.

What If I'm Afraid My Baby Will Be Taken Away?

One of the most terrifying things for a parent to imagine is their child being taken from them. Understandably, this fear can sometimes keep people from telling someone what they are experiencing. People often worry that admitting to hallucinations, unusual beliefs, or frightening thoughts will automatically mean their baby will be taken away.

While postpartum psychosis does require hospitalization, which may mean a temporary separation from your baby, this is very different from losing custody of your child. The purpose of hospitalization is to stabilize you, determine what treatment you need, and keep everyone safe so that you can eventually reunite with your baby when it is safe to do so.

Being separated from your baby during treatment can be painful and frightening, especially during a time when you may already be feeling vulnerable and disoriented. At the same time, hospitalization is an essential part of treatment when you are experiencing postpartum psychosis. It provides a safe setting where you can receive the medical and psychiatric care you need while your baby is cared for by your partner, family, or friends.

What happens with your baby during hospitalization depends on your family's circumstances, the hospital, and the clinical situation. In the United States, most psychiatric hospitals do not allow babies to stay with their hospitalized parent. Some specialized perinatal psychiatric programs offer opportunities for parents to visit with their infants during treatment, but unfortunately, these programs are not common in the US.

If you are hospitalized, you or your family can ask questions about how the hospital can support your relationship with your baby during treatment. Depending on the hospital, this may include asking about infant visitation, lactation or pumping support, postpartum medical care, and opportunities for you to remain involved in your baby's care when it is safe and clinically appropriate. A hospital social worker, patient advocate, or perinatal mental health professional may be able to help you understand what options are available.

Depending on the hospital and the circumstances, you may or may not be able to see your baby during your hospitalization. That separation can be incredibly difficult. But it does not mean you have lost your baby or your place as their parent. Hospitalization creates an opportunity to get the treatment you need so that you can return to caring for and connecting with your baby in the ways that are important to you.

Postpartum Psychosis Is Treatable

Postpartum psychosis is a temporary and treatable medical condition. Recovery can take time, and getting well may involve ongoing care and support beyond the initial treatment. But people can recover from postpartum psychosis, and experiencing it is not a reflection of your ability to parent or your capacity to be the parent you want to be. Knowing what to look for can make it easier to recognize when something isn't right. And knowing what to do next can make all the difference.

Resources

Postpartum Support International (PSI)

Information, support, and referrals for perinatal mental health: 1-800-944-4773 (call or text). PSI's HelpLine is not a crisis service.

National Maternal Mental Health Hotline

Call or text 1-833-852-6262. Free, confidential support available 24/7, with interpreter services in 60 languages.

988 Suicide & Crisis Lifeline

Call or text 988 for 24/7 crisis support.