From ‘Instagram mothers’ to Postpartum Psychosis

Motherhood is meant to be “Instagram perfect”. Full of smiles, cuddles and cute babies. But there is more to it, sometimes invisible to the naked eye. We all hear about the physical consequences of having a baby, but not about mental illness brought on by having babies.

Motherhood in Real-life

The  Louis Theroux documentary ‘Mothers on the Edge’ was a perfect way to start Mental Health Awareness Week. The film depicted several women and their families with a wide spectrum and complexity of postpartum mental illness, the most severe being postpartum psychosis.

Huge credit to the women in ‘Mothers on the Edge’ as well as those who followed suit in social media sharing their stories to raise awareness and decrease stigma.

Barbara, a first-time mother who was brought into hospital two days earlier, was confused. She told Theroux she believed her husband was her son, which would make him her baby’s brother as well as father.

Her thoughts started racing, she couldn’t sleep and ended up at a train station where she planned to end her life. She had no history of mental illness before this episode. After four weeks on the mother and baby unit, she returned to her ‘normal self’ and was discharged home. ‘Another Christmas miracle’ as described by her treating psychiatrist.

Lisa, a mother of three, with previous episodes of postnatal depression, developed a psychotic episode after this most recent pregnancy. Her husband described an ‘utterly alarming’ decline in two weeks.

Lisa further explained she felt low, did not speak, did not wash for days and believed the house was going to be invaded by killer clowns who would rip them apart and destroy their house. ‘It was graphic what I could see’, said Lisa.

Six months later she still feels that fear, although she no longer believes it will happen. Although she continues to experience symptoms of anxiety, she is now well enough to go back home after a lengthy stay at a mother and baby unit.

Postpartum Psychosis: the facts

Postpartum psychosis is a severe episode of mental illness affecting one to two in every 1,000 births. It constitutes some of the most severe forms of pregnancy-related psychiatric illness and has a clear onset, days or weeks after childbirth.

This can happen in women with no previous psychiatric history, like Barbara, or in around 50% of cases, those with an established history of severe mental illness.

Women with bipolar disorder are at a particularly high risk, with around 1 in 5 women going on to experience an episode of psychosis following childbirth. In other cases, childbirth can trigger further bipolar episodes.

Symptoms during an episode are severe and can change rapidly, within hours or days. They may include high or low mood, confusion, abnormal beliefs, and hearing or seeing things that are not there like the documentary so powerfully illustrated.

Becoming unwell at this time can have a huge impact on the lives of women and their families, disrupting the relationship with the new baby. Tragically, but rarely, episodes of illness may lead to suicide or harm to the baby.

An episode of postpartum psychosis can last weeks to months and despite its severe presentation, with the right treatment most women recover and go on to develop excellent relationships with their children.

Although response to treatment for the acute psychotic phase of illness may be excellent, like we saw with Barbara, it is common for women to experience a more prolonged depressive phase of illness and often a longer phase of recovery, coming to terms with the experiencing a severe mental illness at this time.

Mother and baby units

Episodes of postpartum psychosis are often very severe and usually require admission. The documentary showed two specialist psychiatric units: a mother and baby unit in South London and another in Winchester where mothers live alongside their babies.

While funding has been announced to increase the number of mother and baby units from 17 to 21 in England, there are still no units in Wales or Northern Ireland, and a limited number of beds available.

This means there are still women in the UK facing the difficult decisions of having to travel hours from their homes for the treatment they need or being admitted to a general psychiatry ward and being separated from their baby.

The Maternal Mental Health Alliance is pressing for this issue to be addressed through the Everyone’s Business campaign, which calls for all women to have access to the care they and their families need, wherever and whenever they need it. 

The need for research

In the documentary, the “perfect storm” of events and circumstance that can lead to postpartum psychosis was mentioned: hormones, breastfeeding, sleep changes, obstetric complications, previous history and genetics and adapting to new circumstances among them.

We still know little about what causes postpartum psychosis, how can we predict who is going to have an episode, and more importantly, how can we prevent it.

I am involved in one of a number of projects underway at the University aiming to better understand the causes of postpartum psychosis and mood disorders in pregnancy. We hope that our work will lead to better predictions and improved treatments for women affected by these illnesses.

To help us achieve that goal, we need women who have experienced postpartum psychosis and/or have bipolar disorder to take part in our studies. To find out more about taking part, visit www.ncmh.info/postpartum.