I first heard about postpartum psychosis (PP) when an acquaintance went from delightedly cuddling her newborn to being committed to a psych ward in a matter of days. Despite no previous mental health issues, a terrifying post-birth mania took hold of her. Barely able to recognize close friends and family, she was hallucinating and gripped by thoughts of self-harm and hurting her baby. She spent her first months of motherhood in a psychiatric unit.
As an illness, postpartum psychosis is rare—affecting one to two in every 1,000 mothers in the US and UK shortly after birth—but its effects can be devastating. Symptoms are quick to set in and can include mania, depression, hallucinations, and delusions. Though treatable, the condition can be difficult to anticipate as its causes are not well understood and around half of sufferers have no prior psychiatric history, says consultant perinatal psychiatrist Dr. Rebecca Moore. However, women with a personal history of bipolar disorder have a one in four chance of developing the condition after childbirth.
Eve Canavan, 36, from London had never heard of the words "postpartum psychosis" before her her first pregnancy in 2010. Despite having no previous mental health issues, she began to feel odd almost immediately after baby Joe was born by cesarean section. "An hour after I had Joe I realized something was wrong," explains Canavan. "My mum said I looked 'glazed over.' I couldn't look at Joe and felt like I suddenly needed to get out of the ward. I found myself looking for windows as I felt breathless and trapped. This intensified until, on our return home, my vision blurred and my hearing became muffled. I felt like I was having an out of body experience. People were talking to me, but I couldn't make out what they were saying."
Though its onset is always swift after birth, sufferers of PP will experience a broad range of symptoms, which can make it even harder to diagnose in its early stages. Canavan's symptoms escalated to anxiety and hallucinations just three days after giving birth.
"I was hysterical and hallucinating," she explains, "thinking the duvet had changed colour or that I was floating in the corner of the room. I would spend ages staring at my mommy wardrobe of leggings and then struggle to put them on because I couldn't remember how to get dressed. I had started to think that death was the only way out of this world I was trapped in." Alarmed by the change in her behavior, Canavan's family began taking her to her general practitioner on a daily basis, but he dismissed her symptoms as a sign of sleep deprivation.
After the family's health visitor (a family nurse who visits new parents in the weeks after birth in the UK) admitted that she had never seen anyone so unwell, Canavan's family took her across the country to Nottingham for a second opinion. As her condition worsened and her suicidal thoughts continued, her husband begged for her to be assessed at a Mother and Baby unit, an NHS medical center that offers specialist mental health support to new mothers. An hour later, she was admitted as an in-patient.
"The unit was wonderful; I went on the meds and I started my recovery," she says. "When finally I could close my bedroom door and sit on my own with Joe—that was the biggest turning point of my illness. But I should have been in that unit from day one."
Dr. Moore explains that women can recover fairly quickly from postpartum psychosis if treated swiftly and appropriately. To do so, they must get rapid access to specialist perinatal mental health services. Most will need in-patient treatment with a combination of medication (including anti-psychotic or mood-stabilizing medication for some), therapy, and emotional support. In the East London borough where Dr. Moore works, there have been seven cases in 2016, and all have required admission to a psychiatric unit.
After being discharged from hospital, women and their families are given advice on self-help strategies such as making sure to have a good night's sleep, daily exercise, eating well, and time spent socializing with friends; over half of PP sufferers will go on to have a further episode of mental illness unrelated to childbirth. According to Dr. Moore, serious consideration around future pregnancies and contraception is needed, as 50 percent of those who suffer from perinatal psychosis in one pregnancy will go on to suffer it in a future pregnancy.
Canavan believes that the delay in her treatment made her recovery long and arduous. "Though I was discharged after three months, and had great support as an outpatient from the Nottingham team, it took about three years to fully recover, and I was left with post traumatic stress disorder, which I had treatment for when when my son was three."
Her poor experience of her local perinatal mental health services is sadly not uncommon. A report in October 2014 found that less than 15 percent of UK localities provide adequate provision in this area.
Jessica Pidsley, 32, also developed postpartum psychosis after the calm home birth of her first child in London in 2014. Thankfully, she was able to access the care she needed in time. "I hadn't slept for more than a few minutes since Albert was born," she recalls, thinking back to her first week at home with her baby before her diagnosis. "The illness was making me fearful of sleeping—it was latching on to ordinary new mom anxieties and vastly distorting them."
In hindsight, she realizes she was already experiencing some of the common symptoms of PP: delusions and mania. "I couldn't stop talking, tweeting, texting, and writing. I was convinced I was having all-consuming, inspiring insights into the soul of humanity. Then I became confused, distressed, and didn't cope well once Albert was re-admitted to hospital with jaundice."
The psychosis would not let me go. It wanted me to die.
Though doctors initially thought she might be suffering from postnatal depression, Pidsley knew better. "I knew it wasn't depression. It was something wholly other. It felt like oblivion." Her behavior became increasingly erratic; her throat was sore from shouting, and her muscles ached from being restrained. "I was terrified of the 'The Thing' outside of the hospital room. The psychosis would not let me go. It wanted me to die. I couldn't eat, sleep, wash, or stop myself ranting, being violent, and switching between fear and ecstasy."
Ten days after Albert's birth, doctors diagnosed her with postpartum psychosis. Crisis nurses rushed to get her admitted as a voluntary patient to a specialist psychiatric unit before her illness took further hold. On the journey to the unit, she became aggressive and began screaming, struggling, and threatening to hit her husband.
They made it to the Margaret Oates Mother and Baby Unit in East London just in time. For the next eight weeks, she underwent intensive talking therapy, "One Flew Over the Cuckoo's Nest quantities of medication," and occupations such as yoga, weaving, and baby massage alongside a highly structured routine. Two years on, Pidsley considers herself fully recovered, but she's aware that things might have been very different without the swift treatment she received.
"Though the vast majority of women with postpartum psychosis fully recover, the condition is serious—and suicide, though very rare, remains a leading cause of maternal death in the UK," explains perinatal psychiatrist Dr. Lucinda Green. "It's vital that women have access to specialist care." The picture in the US is similar, with this 2011 study describing suicide as an important contributing factor to maternal mortality.
To prevent women being diagnosed too late—or not at all—Dr Moore believes that change is needed. "We need to invest in perinatal mental health, full stop. We know that the cost of untreated perinatal illness is £8.1 billion for each one-year cohort of births in the UK. This is equivalent to just under £10,000 for every single birth in the country. Seventy-two percent of this cost relates to adverse impacts on the child rather than the mother." But despite these serious human and financial implications, there is still unequal provision of services across the country. Wales, which is home to three million people, does not have a single mother and baby unit.
Eve Canavan is determined to raise awareness of the condition amongst women. "They need to know they can recover but will need to access medical help. Also, some people try to hide their symptoms, fearing their child will be removed from their care, and they must be told this isn't true." But more than that, she wants healthcare professionals to take the struggles of new moms seriously: "Please listen to women [with postpartum psychosis] when they come to you. It's likely she is terrified, especially if she has experienced hallucinations, intrusive or suicidal thoughts. By listening, you might well save her life."