Postpartum psychosis: signs and getting urgent help

You might say

• “I love you, and I’m not going anywhere.”
• “You haven’t done anything wrong.”
• “Something is making you unwell, and doctors can help.”
• “The baby is safe. Let’s look after you now.”

Try not to take hurtful or strange things she says personally. They come from the illness, not from who she really is.

If there is no immediate danger but something feels very wrong, call her doctor, OB-GYN or midwife and ask for an urgent, same-day assessment. Symptoms can come and go, so a calm hour does not mean she is well.

The National Maternal Mental Health Hotline is free and open 24/7 in the U.S. Call or text 1-833-852-6262 (1-833-TLC-MAMA) to talk through next steps with a counselor. If anyone is in danger, call 911.

Some families fear that asking for help means people will think she can’t care for her baby. In fact, getting help shows you are doing your best for her and the baby. It is very rare for babies to be removed from mothers with postpartum psychosis.

More than half of new mothers get the baby blues. It usually starts 3 to 4 days after birth, with tears, mood swings and feeling on edge. It usually passes by the time the baby is about 10 days old, without treatment.

Postpartum depression affects 10 to 15 in every 100 women after birth. It looks like depression at other times: low mood, poor sleep, low energy and negative thoughts. It needs care, but it is a different illness from postpartum psychosis.

In perinatal OCD, unwanted thoughts about harm feel scary, deeply upsetting and against everything the parent values. In postpartum psychosis, similar thoughts can seem normal or justified to the person. Being alarmed by your thoughts is a sign you are unlikely to act on them.

If there are delusions, hallucinations, a very high mood (mania) or severe confusion, it may be postpartum psychosis. Symptoms can change quickly from hour to hour and day to day.

Finding it hard to sleep, or feeling no need to sleep, is a common sign. One partner described waking in the night to find every light on and his wife wandering, talking to herself.

All new parents are tired. The warning sign is not sleeping when there is a chance to, along with other changes.

This can look like

• Being on the phone a lot or messaging many people
• Big, unusual plans or schemes
• Feeling elated, powerful or “on top of the world”
• Losing inhibitions and acting out of character
• Talking very fast and jumping between topics

Her thoughts may move so fast they feel out of control, linking ideas others can’t follow. She may seem not to know where she is, or feel as if she is in a dream world.

Delusions are strong beliefs that others do not share. She may believe she is being watched or followed, that someone wants to harm her or the baby, that everyday things carry special messages for her, or that the baby has a special spiritual meaning.

Hallucinations are when someone hears, sees, feels or smells things that are not there. Voices can sound kind or cruel.

Some mothers become very low, tearful, withdrawn or silent. Others are anxious, irritable, restless or suspicious. Moods can swing quickly between highs and lows.

Risk is higher with

• A first baby
• A mother or sister who had postpartum psychosis
• Bipolar disorder (especially bipolar I) or schizoaffective disorder
• Having had postpartum psychosis before
• Schizophrenia or another psychotic illness (raised, though less than with bipolar)

Going days without sleep may also play a part.

It often happens “out of the blue”, even to people who have never been unwell before. That is why everyone around a new mother benefits from knowing the signs.

Psychosis can sometimes have physical causes, such as infections, thyroid problems or other medical conditions. Doctors may do blood and urine tests or a brain scan to rule these out.

In the UK, the ideal is a Mother and Baby Unit, a psychiatric unit where mothers are admitted with their babies and supported to care for them. If there is no bed, a general ward may be used, and family or a temporary carer looks after the baby.

In the U.S., Postpartum Support International keeps a list of intensive perinatal treatment programs. Ask the hospital team what options exist near you.

Because the illness affects her sense of what is real, she may not believe she is unwell, or may be afraid of help. When there is a risk to her or others, doctors may admit her to hospital even if she doesn’t agree.

This can feel very scary for everyone. It is done to get her the care she needs as fast as possible, not as a punishment.

Hospital teams use proven treatments for postpartum psychosis. For questions about treatment, side effects or feeding, talk with your clinical provider. It is okay to remind the team that she has a young baby and wants to care for them as much as she can.

Some mothers can’t breastfeed because they are too unwell, are apart from the baby, or need treatment that doesn’t fit with it. It is natural to feel guilty, but this is not her fault, just as the illness is not her fault. Getting well comes first.

An episode is often followed by a period of depression, anxiety and low confidence. Many mums find this low a shock after the worst is over. Ask for help with it early, rather than waiting for the next appointment.

You may feel confused about the birth and the illness. Many women did things that felt very out of character, and feel embarrassed afterwards. These were symptoms of an illness, not a change in who you are.

Things that can help

• Ask your care team for a summary of what happened
• Read other mums’ stories of recovery
• Talk it through with your partner when you feel ready
• Talk with a counselor or a peer supporter who has recovered

Many mums lack confidence after postpartum psychosis, and some find bonding hard at first. This usually doesn’t last. Most go on to bond well with their babies, and there are no known harmful effects of the illness on the baby.

Small steps

• Baby massage or parent groups when you feel ready
• Cuddles and skin-to-skin time
• Doing one care task together with your partner
• Using a sling for walks

Many women feel physically and emotionally drained as they recover. Share night feeds if you can, accept practical help and go easy on yourself.

It is normal to feel sad about missing parts of early motherhood. Many women later say the experience helped them see what matters most, and that they feel stronger now.

Helpful things to do

• Ask one or two trusted people to stay and help
• Do as many night feeds as you can so she can sleep
• Keep noise and screens low
• Keep visitors to a minimum
• Let others cook and shop

Things to find out

• Can you join the doctors’ ward rounds?
• How will her physical recovery from birth be cared for?
• What are the visiting times, and can the baby visit?
• Who is her named nurse?
• What is the ward phone number?

You know her best. Share what she is like when well, and ask staff to explain anything you don’t understand.

Older children may be scared or confused. You can keep it simple: “Mum is poorly in her mind and the doctors are helping her get better. It isn’t anyone’s fault.” Keep their routines as steady as you can.

Try to eat well, rest and move your body, and avoid using alcohol or drugs to cope. Be patient: recovery takes time. Counseling or couples therapy later on can help you both talk through what happened.

Tell your midwife or OB-GYN about your history at your first pregnancy appointment. Everyone in your care, including your mental health team and family doctor, should know about your risk.

UK guidance suggests a planning meeting around 32 weeks of pregnancy with you, your partner or family, and your care team. You should leave with a written plan listing early warning signs and how to get help quickly.

Some people also write, while well, what care they would want if they became unwell. This can guide family and professionals who don’t know you.

Try to get as much rest as you can in late pregnancy and after birth. Ask your partner or family to do some night feeds, and cut down other stress where you can.

Many women who have had postpartum psychosis have more children. The chance of it happening again is about 1 in 2, but with the right care, help can come quickly and the risk can be reduced.

Just over half of women who have had postpartum psychosis have another episode of mental illness at some point not linked to birth. Knowing this helps you keep an eye on your wellbeing over the years.

Ask your care team about timing, since it is a good idea to avoid getting pregnant again too soon after an episode.

Postpartum Support International (postpartum.net) hosts peer support groups for postpartum psychosis survivors and those affected. In the UK, Action on Postpartum Psychosis (app-network.org) offers online chat, peer support and guides written with women who have recovered.

Ways friends and faith or community groups can help

• Bring meals or do a food shop
• Drive the family to appointments or visits
• Help with older children or the school run
• Keep visits short and calm
• Send a kind message with no need to reply

Because a mother may not realise she is unwell, the people around her are often the ones who act. The more families, friends and communities know the signs, the faster mothers get help.

Using kind, plain words, like “she was ill and she got better”, helps reduce shame for mothers and families.

Numbers

• 911: emergencies and danger to life
• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org
• Crisis Text Line: text HOME to 741741
• National Maternal Mental Health Hotline: call or text 1-833-852-6262 (1-833-TLC-MAMA), 24/7, English and Spanish
• PSI HelpLine: 1-800-944-4773 (not a crisis line; a trained volunteer calls or texts you back with support and local resources)

In the UK, call 999 or go to A&E if someone may be in danger, or ask your GP for a same-day assessment. Action on Postpartum Psychosis (app-network.org) offers information and peer support.

Find A Helpline (findahelpline.com) lists free, confidential helplines in many countries.

After hospital, follow-up with a doctor and therapist is important. If anxiety or low mood feel overwhelming, or you worry the illness is returning, ask to be seen early.