Postpartum Psychosis: Severe mental illness after
About this leaflet
This leaflet is written for:
- pregnant women who want to know about mental health problems
- women with a high risk of postpartum psychosis because of
previous mental health problems
- women who currently have, or are recovering from, postpartum
- women who have had postpartum psychosis before and are pregnant
- women with a family history of postpartum psychosis
- partners, family or friends of these women.
This leaflet will help you learn about:
- what postpartum psychosis is
- care and treatment
- help available during pregnancy and after the birth of a
- how partners and family can help
- risk of future episodes.
What is postpartum psychosis?
Postpartum psychosis (or puerperal psychosis) affects thousands
of women in the UK each year. It is a severe episode of mental
illness which begins suddenly in the days or weeks after having a
baby. Symptoms vary and can change rapidly. They can include high
mood (mania), depression, confusion, hallucinations and delusions.
Postpartum psychosis is a psychiatric emergency. You should seek
help as quickly as possible.
Postpartum psychosis can happen to any woman. It often occurs
‘out of the blue’ to women who have not been ill before. It can be
a frightening experience for women, their partners, friends and
family. Women usually recover fully after an episode of postpartum
It is much less common than Baby Blues or Postnatal Depression.
It occurs in about 1 in every 1000 women (0.1%) who have a
How do the symptoms of Postpartum Psychosis differ from
Postnatal Depression or Baby Blues?
Many women experience mild mood changes after having a baby. It
is common to feel many different emotions.
Over half of new mothers will have the 'Baby Blues'. This
usually starts 3 to 4 days after birth. You may have mood swings.
You may burst into tears easily. You can feel irritable, low and
anxious at times. You may also over-react to things. It usually
stops by the time your baby is about 10 days old. You don’t need
treatment for Baby Blues.
Postnatal depression affects 10
to 15 in every 100 women after childbirth. The symptoms are similar
to those in depression at other times. These include low mood and
other symptoms lasting at least two weeks.
Postpartum psychosis is different from postnatal depression. It
is a more severe illness. There are many different ways the illness
can start. Women often have symptoms of depression or mania (see
our leaflet on Bipolar Disorder) or a mixture of these. Symptoms
can change very quickly from hour to hour and from one day to the
There are many symptoms that occur in postpartum psychosis.
These may include: ·
- feeling ‘high’, ‘manic’ or ‘on top of the world’
- low mood and tearfulness
- anxiety or irritability
- rapid changes in mood
- severe confusion
- being restless and agitated
- racing thoughts
- behaviour that is out of character
- being more talkative, active and sociable than usual
- being very withdrawn and not talking to people
- finding it hard to sleep, or not wanting to sleep
- losing your inhibitions
- feeling paranoid, suspicious, fearful
- feeling as if you’re in a dream world
- delusions: these are odd thoughts or beliefs that are unlikely
to be true. For example, you might believe you have won the
lottery. You may think your baby is possessed by the devil. You
might think people are out to get you.
- hallucinations: this means you see, hear, feel or smell things
that aren’t really there.
You may not be able to look after yourself as well as you would
when you are well. Your symptoms may make it very difficult for you
to look after your baby. If you have postpartum psychosis you may
not realise you are ill. Your partner, family or friends may
recognise that something is wrong and need to ask for help.
When does it happen?
Most commonly these episodes begin in the first two weeks after
birth. Often symptoms begin in the first few days after having a
baby. More rarely, the illness starts later – several weeks after
the baby is born.
Why does it happen?
Postpartum psychosis is not your fault. It is not caused by
anything you or your partner have thought or done. Relationship
problems, stress or the baby being unwanted do not cause postpartum
There are likely to be many factors that lead to an episode of
postpartum psychosis. We know that genetic factors are important.
You are more likely to have postpartum psychosis if a close
relative has had it. Changes in hormone levels and disrupted sleep
patterns may also be involved. More research is needed. To find out
more about helping with research on postpartum psychosis visit
Who is most likely to get postpartum psychosis?
For many women with postpartum psychosis there may be no
warning. For other women it is clear that they have a high risk. If
you have ever had a diagnosis of bipolar disorder or
schizoaffective disorder, your risk of postpartum psychosis is
high. You may also be in this high risk group if you have had a
diagnosis of schizophrenia or another psychotic illness.
If you also have a mother or sister who has had postpartum
psychosis, your risk may be even higher. Women who have had
postpartum psychosis before are also at very high risk. If you are
in one of these high risk groups your chance of having postpartum
psychosis is between 1 in 4 and 1 in 2 (25% to 50%). You should
discuss your individual risk with a psychiatrist.
You may be worried about your risk if a close relative has had
postpartum psychosis. If your mother or sister had postpartum
psychosis but you have not had any mental illness, your risk is
around 3 in 100 (3%). This is higher than the risk in the general
population. It is still much lower than for the very high risk
For women at high risk can anything be done to prevent it?
Ideally let your psychiatrist and GP know that you want to get
pregnant before you start trying for a baby. You can discuss with
them any medications you are taking. They can advise you what you
can do to ensure you are as well as possible before becoming
pregnant. Many pregnancies are not planned. In that case, let
people know as soon as possible.
If you are pregnant it is important to tell everyone involved in
your care about your previous illness. This includes your midwife,
obstetrician, GP and health visitor. Your mental health team and GP
need to know you are pregnant. They all need to know you have a
high risk of postpartum psychosis to make sure you get the care you
need. They should help you to make a plan for your care (see
Paying attention to other factors known to increase the risk of
becoming ill may be important. These could include trying to reduce
other stressful things going on in your life. Try to get as much
sleep and rest as you can in late pregnancy and after the birth.
With a new baby this may difficult. Ask your partner or family to
take on some of the night time feeds if possible. Think about any
factors which usually trigger your episodes of illness. Try to do
whatever you can to reduce the chance of these happening.
Will medication stop me getting ill after the baby is born?
For women taking medication to help keep them well, the decision
to continue or stop medication in pregnancy is very difficult.
There are no right and wrong answers. There are risks involved with
all possible options. The options you can consider include:
- continuing on all or some of your current medication
- switching to other options which may be safer in pregnancy
- coming off all medications.
It is important to discuss these with your psychiatrist. This
will help you decide what is best for you and your baby.
Some women at high risk of postpartum psychosis may decide to
start medication in late pregnancy or after delivery. This may
reduce the risk of becoming ill. There is not enough research
evidence to be sure about this. A number of medications are
sometimes used in this way. These include antipsychotics and
lithium. You should discuss this with your psychiatrist.
What help is available if I am well but have a high risk of
Preconception (when you are planning a
If possible you should seek specialist advice when you are
planning a pregnancy. Your GP can refer you. You should see a
perinatal psychiatrist if there is one in your area. This is a
doctor who specialises in the care of pregnant and postnatal women
with current or previous mental health problems. If there is no
local perinatal psychiatrist you should see a general psychiatrist
for advice. You will be able to discuss:
- Your risk of developing postpartum psychosis
- Risks and benefits of medication in pregnancy and after birth.
This will mean you have the information you need to make decisions
about your treatment.
- The type of care you can expect in your local area. For
example, how professionals work together with you and your family.
Also whether there is a perinatal mental health service or a
Care during pregnancy
If you have a high risk of postpartum psychosis you should have
specialist care in pregnancy. If there is a perinatal psychiatrist
in your area you should be referred when you find out you are
pregnant. Otherwise you should be seen by a general psychiatrist.
Your psychiatrist should discuss with you:
- the risk of you becoming unwell in pregnancy or after
- the risks and benefits of medication - they should help you
make choices about treatment
- who will be involved in your care in pregnancy and after birth
of your baby.
Ideally you should have a pre-birth planning meeting at around
32 weeks of pregnancy. This is a meeting involving you and everyone
involved in your care. This includes, your partner, family or
friends you choose to bring. It also includes mental health
professionals, your midwife, obstetrician, health visitor and GP.
The aim is to make sure that everyone involved in your care knows
about your risk of postpartum psychosis. You should all agree on a
plan for your care.
You should get a copy of your written care plan. This should
include early warning symptoms and a plan for your care. There
should also be details of how you and your family can get help
quickly if you do become unwell.
Care on the maternity unit
Your maternity care in labour will depend on what you and your
baby need. The midwives will support you with feeding and caring
for your baby.
If you have any symptoms of mental illness, a psychiatrist will
see you when you are in hospital. The care you have will depend on
how unwell you are.
In some maternity units, you may see a psychiatrist or mental
health nurse before you leave hospital, even if you are well. This
is to check that you are well at the time you go home. They should
also check the plan made at your pre-birth planning meeting. They
can make sure you have any medication you need.
Care when you go home from hospital with your baby
Your mental health should be closely monitored. Your midwives,
health visitor and mental health nurse should visit you regularly
in the first few weeks after your baby is born. If you become
unwell, this can be picked up quickly so you get treatment
You and your family should have emergency contact numbers for
local crisis services. You can use these, see your GP or go to
A&E if you, or your partner or family, think you are becoming
If you think you are becoming unwell don’t wait. It is better to
be seen quickly as symptoms can worsen rapidly.
What help is available if I develop postpartum psychosis?
If you, your partner or family think that you have symptoms of
postpartum psychosis, you need to be seen urgently. If you have
been told during pregnancy that you have a high risk of postpartum
psychosis, you may have a care plan. This should include emergency
contact numbers for your mental health team or local crisis
You may not have this type of plan, or you may not have had any
mental illness before. In that case you should see your GP urgently
(the same day) or attend your local A&E department. If you are
told you do not have postpartum psychosis but your symptoms worsen,
you should make sure you are seen again.
Most women with postpartum psychosis need to be treated in
hospital. Ideally you should be offered a bed in a Mother &
Baby Unit (MBU). This is a specialist psychiatric unit where
mothers with mental illness are admitted with their babies. You
will be supported in caring for your baby whilst you have the care
and treatment you need.
There are many parts of the country with no Mother and Baby
Unit. Even where there are MBUs, there may not be a bed available.
You may be admitted to a general psychiatric ward. If that happens,
your partner or family will need to care for your baby. If you have
nobody else who can look after your baby, social workers can find a
temporary carer. This will only be until an MBU bed is available,
or until you are well enough to care for your baby yourself. You
may choose to be admitted to a general ward if the nearest
specialist MBU is far from your home.
- Medication and breastfeeding
Most women with postpartum psychosis need treatment with
medication. This is usually an antipsychotic, a mood stabiliser or both.
It is possible to breastfeed whilst taking some medications.
Your psychiatrist can discuss the risks and benefits of medications
in breastfeeding with you. You may be unable to breastfeed. There
are several reasons for this. You may be too unwell, or you may be
admitted to hospital without your baby. You may need a medication
which is not safe in breastfeeding. Some women feel guilty about
being unable to breastfeed, but you should not feel this way. If
you have postpartum psychosis, it is not your fault. It is
important for your baby that you have the treatment you need so
that you get better.
- Help in caring for my baby
During the severe part of the illness you will probably need
help caring for your baby. You are likely to need practical help.
You may also need help to bond with your baby. Mother and Baby Unit
(MBU) staff are trained to support you with all aspects of caring
for your baby. If you do not go to an MBU, there are people who can
help and support you once you go home. These include health
visitors and mental health professionals. There may be a local
perinatal or parent-infant mental health service. In some areas,
Children’s Centre staff and/or voluntary organisations can also
It is normal to lack confidence with mothering after postpartum
psychosis. Remember that most new mothers, who have not had an
illness, also feel like this. You may find it hard to attend mother
and baby groups when recovering from postpartum psychosis. Health
visitors and community psychiatric nurses can give you one-to-one
advice until you feel up to attending groups with other
Some mothers have difficulty bonding with their babies after an
episode of postpartum psychosis. This can be very distressing.
Usually these problems don’t last long. Most women who have had
postpartum psychosis go on to have very good relationships with
their babies. Talk to your health visitor or other professionals
involved in your care. They can tell you what help is available in
your area. Health professionals can support you in learning how to
interact with and respond to your baby. You may find baby massage
and other groups for new parents helpful.
- Care and support for you during recovery
Allow your partner, family or friends to help and support you
while you get better (see section on partners below).
Usually you will need to have care from a mental health service
until you fully recover. This team can advise you about treatment.
They can support you and your family. You may have care from a
perinatal or parent-infant mental health service.
These specialist teams do not exist in all areas. In that case
your local mental health team, health
visitor and GP will continue to support you whilst you recover.
It is important to ask for advice about contraception. It is a
good idea to avoid getting pregnant again too soon after an episode
of postpartum psychosis.
Does everyone with postpartum psychosis need to be referred to
Children & Families Social Services?
Some women will be referred to Children & Families Social
Services. You may be referred in pregnancy, because of your high
risk of postpartum psychosis. You may be referred if you develop
postpartum psychosis. Sometimes women worry that this means that
people think they cannot care for their baby. This is not usually
the case. The reason for assessment is to check the support you
have from family, friends and professionals. It is also to make
sure there is safe plan for your baby if you are too unwell to care
for him/her. If referral is needed, this should be discussed with
you (unless you are too unwell).
Some women and their partners worry that if they seek help for
symptoms of mental illness, people may think they can’t care for
their baby. On the contrary, seeking help and having treatment
means you are doing the best for your baby. This will be seen as
You may need extra help from family members during illness and
recovery. If you have no support from family or friends, social
services may be able to help. Social workers can find a temporary
carer for your baby if there is no MBU bed.
Although it might take a while, most women recover fully and
become good mothers. It is very rare for babies to be removed from
women with postpartum psychosis.
What about partners?
If your partner has postpartum psychosis, it can be very
distressing for you. At first you may be frightened or shocked. It
is important that you ask for help when your partner first has
symptoms. This is particularly important if she does not recognise
that she is ill. If your partner is hospitalised with the baby, you
may feel very alone and isolated. You may feel frustrated that
there is little you can do to help. It is important that you seek
help too, if you feel you need it. There are organisations you can
talk to. They can support you through this very worrying time (see
list at the end of this leaflet).
It is important that your life is as stable as possible. Take
time for yourself and prepare for when mum and baby return home.
Once your partner and baby are home try to:
- be as calm and supportive as you can
- take time to listen to your partner
- help with housework and cooking
- help with baby care
- help with night time feeds as much as possible
- let your partner get as much rest and sleep as possible
- let other family members and friends help with shopping,
cooking etc. if they can - this will give you more time to spend
with your partner and baby
- try not to have too many friends and relatives visiting
- try to keep your home as calm and quiet as possible.
It can be difficult living with someone recovering from
postpartum psychosis. Ensure you remain healthy by exercising,
eating well and getting enough rest. Don’t use drugs or alcohol to
Ask to speak to the Perinatal Psychiatrist or the other staff
involved in your partner’s care if you have any concerns or
questions. They are usually very supportive.
Be patient. It takes time for women to recover from an episode
of postpartum psychosis.
In the long term being willing to talk about your experiences
may aid recovery. Counselling or couple therapy may be helpful for
When will I get better?
It can take 6 -12 months or more to recover from postpartum
psychosis. The most severe symptoms tend to last 2 to12 weeks. The
vast majority of women will recover fully. You may have further
episodes of illness at a later time.
Postpartum psychosis is often followed by a period of
depression, anxiety, and low social confidence. It can take time to
come to terms with what has happened to you. It’s normal to feel
some sadness for missing out on early motherhood. It can take time
to rebuild confidence in relationships and friendships. Most women
get back to feeling like their usual selves again.
Talking emotions through with family and friends can help. Seek
advice about getting expert help from a psychologist,
psychotherapist or counsellor. For advice on practical steps that
can be taken during recovery, see the recovery guide produced by
How likely is it to happen again?
- Will I get postpartum psychosis again after a future
Many women who have had postpartum psychosis go on to have more
children. There is a high risk of having another episode. About 1
in 2 (50%) women who have had postpartum psychosis will have this
again after the birth of another baby. With the right care, if you
have another episode, you should be able to get help quickly.
- Am I likely to have an episode of psychiatric illness
at other times?
Over half of women with postpartum psychosis will have a further
episode of illness not related to childbirth. Avoiding having
further babies is not a guarantee of remaining well.
Where can I get further information and help?
A network of women across the UK who have experienced postpartum
psychosis. They aim to increase public awareness and promote
research into the condition. Run by a team made up of academics,
health professionals and women who have recovered from postpartum
The Association for Postnatal
Tel: 020 7386 0868 Telephone helpline and information leaflets
for women with postnatal mental illness. Also a network of
volunteers (telephone and postal) who have experienced postnatal
An organistion that helps individuals and their families with
pre- and postnatal depression advice and support. They also
offer support to families in the antenatal period. Helpline
(open 9am to 8pm) 0843 2898401.
Widely read blog about postnatal mental illness
Bipolar Education Programme
Information about pregnancy and childbirth for women with
bipolar disorder, including an online interactive module.
The following are personal accounts of postpartum psychosis
which some women may find helpful:
Eyes without Sparkle by Elaine Hanzak
Saving Grace: My journey & survival through postnatal
depression by Grace Sharrock
Out of me: the story of a Postnatal Breakdown by Fiona
Understanding Postpartum Psychosis: A Temporary Madness
by Teresa Twomey
Hillbilly Gothic: A Memoir of Madness and Motherhood by
and postnatal mental health: clinical management and service
guidance. NICE Clinical Guideline 45. (2012) National Institute for
Health and Clinical Excellence: London.
Doucet S, Jones I, Letourneau N et al. (2011). Interventions for
the prevention and treatment of postpartum psychosis: a systematic
review. Archives of Women's Mental Health. 14(2): 89-98.
Jones I and Smith S (2009) Puerperal Psychosis: Identifying and
caring for women at risk. Advances in Psychiatric Treatment. 15:
Sit D, Rothschild AJ and Wisner KL (2006). A Review of
Postpartum Psychosis. Journal of Women’s Health. 15(4):
Series Editor: Dr Philip Timms
Expert review: Lucinda Green, Jess Heron and Ian Jones.
User and Carer input: Nicola Muckelroy, the APP network
Ilustration by Lo Cole: www.locole.co.uk
This leaflet reflects the best
available evidence at the time of writing.
For a catalogue of public education materials or copies of our
leaflets please contact:
The Royal College of Psychiatrists,
21 Prescot Street, London E1 8BB. Tel: 020 3701
Charity registration number (England and Wales) 228636 and in
© April 2014. Due for review: April 2016. Royal
College of Psychiatrists. This leaflet may be downloaded,
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