Postpartum psychosis (PPP) is one of the most serious psychological crises after pregnancy. Fortunately, this illness is also the rarest. Out of 1,000 mothers, a maximum of three women are affected. In comparison, a Postpartum depression much more common: around 100 to 200 women out of 1,000 mothers develop the disease.
So even though comparatively few women suffer from postpartum psychosis, I would like to bring this serious illness into focus. This is because it is possible that the affected mother may then put herself or her baby in danger.
First of all, however, very important: Postpartum psychosis is a form of psychosis that is characterised by Completely uncaused Illness! It simply happens and is then a medical emergency. No mother who has just given birth is really protected from it - and no woman is "to blame" if she is hit by postpartum psychosis. A guilty conscience would therefore be totally out of place.
The causes
The causes that can lead to this disease have not yet been conclusively researched. However, it is already known that a severe untreated postpartum depression can also develop into postpartum psychosis. Scientists also suspect that there are various triggering factors that can interact and reinforce each other. In any case, it is assumed that the sudden change in hormone levels after the birth plays an important role, as oestrogen and progesterone, for example, then drop rapidly. A traumatising birth process cannot be ruled out as a trigger for postpartum psychosis. Social and mental distress could also be involved, such as a highly stressful life situation, enormous stress in the family or partnership, extremely overwhelming self-expectations or the attitude towards the child.
Women with a history of depression or manic-depressive disorder (also known as bipolar disorder) are particularly at risk of developing postpartum psychosis.
The clinical picture of postpartum psychosis
Postpartum psychosis does not develop slowly and insidiously, but usually attacks the affected mother suddenly within the first two weeks after the birth. The disorder can also occur up to around four weeks after the birth.
It is not easy to recognise whether it is actually a case of postpartum psychosis, either for the relatives of the sick mother or for the mother herself. Symptoms such as sleep disorders, loss of appetite or difficulty concentrating can also occur in the case of temporary baby blues directly after the birth or in the case of postpartum depression.
Even more serious signs of postpartum psychosis are sometimes dismissed ("Oh, it's just the hormones") or are difficult for those around them to recognise because the affected person hides them from themselves and others out of shame or fear of being considered "crazy". In addition, the symptoms often occur in rapid succession, so that a sick mother can also appear healthy in between.
Postpartum psychosis is often characterised by a loss of reality and a lack of insight into the illness on the part of the affected mother. Specifically, the following disorders can occur individually or in combination, usually in rapid succession and with varying degrees of intensity:
- Frequent mood swings, anxiety, euphoria, despair, aggression, hopelessness. Manic phases, in which an exaggerated feeling of elation, exuberant ideas, urge to talk, strong restlessness, irritability and restless activities can occur, alternate with depressive phases. These can be accompanied by paralysing listlessness, great apathy, deep melancholy, lack of interest, indifference, lack of emotion and even recurring thoughts of death.
- The thinking abilities of those affected change. Their thoughts are often disorganised and disjointed, and the next moment they are racing again or very slowed down and often illogical and incoherent.
- Perceptual abilities are disturbed. The environment, including the family, partners and friends, are perceived by the mother as strange. This varying degrees of loss of reality is a typical feature of postpartum psychosis. Some sufferers also see things that are not there, hear voices or have hallucinations (including in their sense of smell and taste).
- Various delusions can also occur (e.g. feeling watched or persecuted, morbid jealousy, imagined illness or the conviction of being poisoned).
Consequences of postpartum psychosis for the child
Many of these symptoms of postpartum psychosis endanger not only the mother, but also the baby: a woman suffering from postpartum psychosis is usually unable to care for her child appropriately or respond adequately to the newborn's needs. Responsible for this are, among other things, the mother's excessive worry and fear for the child, her paralysing feelings of listlessness, indifference or failure, the often enormous loss of reality and delusions.
It can become very dangerous if the sick mother develops obsessive thoughts of harming herself and/or her baby. For example, because her inner voices "tell" her to do so. Or because she sinks into complete hopelessness. Or because she can no longer bear the delusion of seeing herself and/or her child acutely threatened. As a result, the suicidal thoughts may not only focus on the person's own wish to die, but may also make the patient believe that she must not leave the child alone in the world (extended suicide).
It is true that not every sick woman who has given birth automatically harbours suicidal thoughts or endangers the life and limb of her child - but this risk does exist. In any case, the affected mother's bond with her child is permanently disturbed by the postpartum psychosis and its effects.
Organising help with postpartum psychosis
Postpartum psychosis also puts an enormous strain on the affected woman's relationship with her partner, her older children and other relatives. Ultimately, the whole family is affected by the illness and faces huge challenges.
To make matters worse, the sick mother is hardly or not at all open to reasonable arguments. Her relatives should therefore not even try to discuss her delusional ideas and beliefs with her. Instead, help is needed quickly. This must be aimed at both the mother and, if necessary, the protection and care of the child.
To put it bluntly: Postpartum psychosis is a medical emergency that requires immediate specialist treatment.
Relatives should therefore speak very quickly with the midwife who is caring for the mother in the postpartum period if the mother's behaviour is conspicuous or there are clear changes in her behaviour. The midwife will probably have already noticed the changes. In any case, she can initiate immediate help.
In many cases, however, relatives also contact other organisations that offer or arrange help. These can be, for example
- the gynaecologist or general practitioner
- the maternity clinic
- the local social psychiatric service
- a psychiatric clinic
The website of the initiative "Shadow and Light e.V"., which is dedicated to peripartum mental illness, offers initial orientation, advice and specific points of contact.
The treatment of postpartum psychosis
The sick mother should be examined and treated by a trained expert in perinatal psychiatry. The chances of recovery are good, even if the duration of recovery varies from person to person.
A woman affected by postpartum psychosis is usually hospitalised in an appropriate clinic, especially if the illness is severe. There she receives appropriate medication such as antidepressants and neuroleptics as well as psychotherapeutic treatment (e.g. counselling therapy). In some cases, treatment can also take place on an outpatient basis, but this is only possible following a medical assessment and diagnosis and under favourable conditions.
During an inpatient stay, we try to avoid separating the mother and her baby as much as possible. However, it is often necessary to separate the mother and baby temporarily to protect both of them. Unfortunately, not all specialist clinics offer a mother-child ward where the woman can be reunited with her baby once her condition has stabilised. This puts additional strain on the mother-child relationship.
This is why follow-up care after hospitalisation is so important. In many cases, further psychotherapeutic counselling is useful for the mothers concerned. Above all, it is important to gently rebuild a relationship with the child without overburdening the mother. In this phase, it is good for her to have conversations with a professional counterpart in which she can recognise, express and process all of her feelings - often including subsequent feelings of guilt and failure.
In addition, once the acute postpartum psychosis has been overcome, initially closer support from the midwife, but also the understanding, trust and help of the family are valuable at home.
If the cured woman becomes pregnant again, there is an increased risk that she will suffer from postpartum psychosis again after the next birth. It is therefore particularly important that she receives reliable support from a midwife during the pregnancy and immediately after the birth. In this way, an early and timely response can be made as soon as the first symptoms appear.
The most important self-help measure is to remain active and accept professional advice.
