Sarah West says in the days after the birth of her son in 2012, she felt the emotions many new mothers describe – a mixture of joy combined with anxiety about breastfeeding and whether she was doing everything right.
But around one week after the birth, West’s new-mum anxiety went into overdrive. Despite the exhaustion that comes with being a new parent, she was unable to sleep when her baby slept. Her thoughts raced.
Her doctor diagnosed her with postpartum depression and prescribed West antidepressants. But her symptoms worsened and she began experiencing delusions and hallucinations.
She was experiencing postpartum psychosis, a severe, rare and little-understood condition that can place both mothers and their children in serious danger. It is markedly different to postpartum depression, because mothers experience symptoms such as loss of reality, delusions and hallucinations. This can be accompanied by either mania or depression.
The temporary condition is debilitating, yet research into it is scarce, especially in Australia.
But new research being presented at the annual congress of the Royal Australian and New Zealand College of Psychiatrists on Thursday found that if properly recognised and treated, women experiencing postpartum psychosis could make a full recovery within weeks and successfully bond with and care for their babies at home.
This is critical because left untreated or misdiagnosed, the consequences of postpartum psychosis can be fatal. In a small number of cases mothers may harm or kill themselves or their baby due the condition, which is beyond their control. The condition nearly always requires hospitalisation to protect the mother and her baby.
The study examined women admitted with postpartum psychosis to a mother-baby unit, Helen Mayo House, in South Australia, over a five-year period from 2012 to 2016.
It found the women often required one-on-one nursing care, and all patients received antipsychotic medication. A few also required lithium, a mood stabiliser.
This treatment saw almost all of the women make a complete recovery and able to return home to care for their babies after an average stay of four weeks, similar to the average stay for other mental health conditions. A key finding was the treatment saw 77% of the women still breastfeeding at the time of their discharge.
West received treatment after a friend told her she was not behaving like her usual self and called the National Perinatal Anxiety and Depression Helpline [Panda]. They advised that West should be taken to hospital immediately for psychiatric care, and West is now a strong advocate for the helpline.
After a four-week hospital stay which included being taken off antidepressants and prescribed antipsychotics, and visits from her baby for bonding, West was able to return home and care for her baby.
Her time in hospital and her period of postpartum psychosis remains a blur, and West says she is still not ready for her family to fill in the gaps for her.
“People can mistakenly describe what women like me go through as ‘baby blues’ or ‘depression’, but I was definitely not depressed,” West says.
“My anxiety went into overdrive, I was experiencing delusions and hallucinations, and really irrational thinking. But so few people know about the condition, and my obstetrician said I was only the second case of postpartum psychosis he had ever seen.
“I think all of the gaps in my memory is my body’s way of protecting me.”
As well as taking medication, West made changes to her lifestyle and learned to recognise when she needed time to de-stress. She has fully recovered and she and her son are now doing well. But West is still fearful of reactions when she shares her story, given the lack of understanding and empathy from some towards mothers who experience the condition.
Postpartum psychosis occurs in about one to two of every 1,000 births, and there is a 50% chance of recurrence in subsequent pregnancies. West wants other women who have experienced it to know there is support and treatment available. She also wants people around new mothers, including healthcare professionals, to be more aware of the symptoms so they can make an accurate diagnosis.
“I know women who are so traumatised from experiencing this that they won’t have another child because they’re terrified,” West says.
“I have to speak up because I don’t like the thought of other families going through what we did. This has to change and to do that we need better recognition of the condition.”
Dr Rebecca Hill from the Women’s and Children’s Health Network in Adelaide led the Helen Mayo House study, and says she believes a key part of the treatment of her patients’ was that the unit accommodated both mothers and their babies.
“While we didn’t specifically study this, my intuition is that it’s better for the mother and the baby to avoid separation because the attachment relationship is vulnerable to trauma when separation occurs,” Hill says.
“It’s distressing to think some mothers may be separated from their babies longer than necessary because they could not access proper treatment. Even a few days’ delay in treatment can expose them to substantial risk.”
But not all states have mother-baby units. In New South Wales for example, there is only one mother-baby unit, and it is only available to private hospital patients who are admitted to hospital voluntarily. Most patients Hill sees with postpartum psychosis are involuntarily admitted, and even Helen Mayo House only has six mother-baby beds.
West, who lives in NSW, agrees more mother-baby units are needed. She believes they may be able to help mothers with bonding and would see women receive more specialised treatment from clinicians familiar with the condition. She says general mental health wards cannot always provide the specialised care postpartum psychosis patients require.
The president of the Royal Australian and New Zealand College of Psychiatrists, Professor Malcolm Hopwood, says the study shows the importance of identification and early intervention for women with postpartum psychosis.
“The good news for these women is that with the right care they can bond with their babies and care for them like any other new mother,” he says.
Hill says the causes of postpartum psychosis are unknown, with most of those experiencing it having never shown psychiatric symptoms before. It usually presents within the first six weeks after birth. Some research is under way into genetic causes, but this is in its early stages. An accurate diagnosis also means early intervention and monitoring measures can be put in place for any subsequent pregnancies, Hill says.
“For the vast majority of women they will only have susceptibility to this at the postpartum period,” Hill says. “Something at this time makes them exquisitely vulnerable. But the key is that once postpartum psychosis is identified, it is so, so treatable.”
- PANDA National Helpline, Mon to Fri, 10am-5pm AEDT, 1300 726 306
- Lifeline, 24 hours, 13 11 14
Contact the author at melissa.davey@theguardian.com
Postpartum psychosis: research reveals full recovery possible within weeks
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