When it's not just the baby blues
Why postpartum psychosis needs more awareness
I haven’t given birth, so you might think this is a strange topic for me to write about. I have, however, been working with the fabulous and invaluable national charity, Action on Postpartum Psychosis (APP), for about four years now. And one thing I’ve learned is that maternal mental health is everybody’s business.
That’s why, in the run up to maternal mental health awareness week I thought I’d use my platform to add another voice to the campaign - to make sure that as many people as possible are aware of the signs of postpartum psychosis - a severe but highly treatable maternal mental illness.
It’s not just the baby blues
Before I talk about APP and postpartum psychosis (PP) specifically, there’s one thing that’s really struck me during the time I’ve been interviewing the many women who have experienced PP (it affects around 1,200 women each year in the UK. Of course I haven’t interviewed them all!) The thing that’s really stood out to me is how many have been told that their concerns, thoughts and behaviours were simply a sign of the ‘baby blues’.
I think this is a really important point, because not only is a missed or delayed diagnosis of PP incredibly dangerous (we’ve seen too many suicides linked to PP), but it also, in my mind anyway, indicates how women are far too often given catch all labels to explain away the many difficult health challenges they face.
And once lumped with that label - they’re expected to just crack on!
Period pain’s normal.
Mood swings are normal.
Feeling like it’s the end of the world is…normal.
But everything’s on a spectrum. Crippling period pain could be endometriosis. Mood swings could be postnatal depression or postpartum psychosis. Feeling like it’s the end of the world could indicate suicidal ideation.
Surely, by now, women should be trusted to know when something’s not normal. I mean, women are hardly weak and feeble little creatures. Women give birth, bleed profusely each month and undergo major hormonal shifts that affect every part of their body. So when a woman expresses a deep concern about her mental health - especially after giving birth - surely she should be listened to. And surely those concerns should be taken seriously.
I’m not suggesting that the baby blues couldn’t be upsetting enough to deal with. Every day life can feel overwhelming - and I imagine that giving birth must be incredibly overwhelming (I’m in awe of every woman who does it). And maybe, in those instances where it could be considered normal, being heard and supported might just be enough.
But if a woman is deeply concerned about her wellbeing, and/or if her partner is voicing concerns too, then maybe there’s more going on. And, more worryingly, when it comes to PP, the person experiencing it doesn’t always know there’s something medically wrong themselves as their sense of reality has shifted. Which is why it’s key for partners, friends, family and colleagues to be aware of the signs. In these instances, over enthusiastically implying ‘the baby blues’ - particularly by health professionals - could even risk a life.
What is postpartum psychosis?
Postpartum psychosis, or PP, is a severe but treatable maternal mental illness that should always be treated as an emergency. If you don’t know anyone who's experienced it, you might have come across it in TV shows, films or books. The most famous TV storyline is probably Stacey Slater’s in EastEnders. We’ve also seen characters in Hollyoaks and Casualty experience PP (both programmes I worked on, alongside the wider APP team, to support programme makers with accurate representations).
All of these programmes did a fantastic job of portraying the symptoms and behaviours associated with PP, which are:
Rapid/extreme mood swings (e.g. euphoria/mania)
An inability to sleep / feeling like you don’t need to sleep
Delusions (e.g. strong beliefs that other do not share, for example, paranoia that you are being followed)
Hallucinations (seeing or hearing things that others can’t)
Confusion
Irritability
These symptoms can come on rapidly in the hours, days, weeks or, occasionally, months after giving birth (and sometimes after baby loss, too).
To put it simply, as APP does in its straight talking campaign, if a new mum seems strange - if her behaviour or beliefs seem kind of bizarre - it could be a sign that she is struggling with PP.
It’s also important to note that, while women who have been diagnosed with bipolar disorder or experienced mental illness with psychotic features in the past are more vulnerable to PP, it can also occur completely out of the blue, in women with no prior experience of mental illness (in fact, around half of cases present in this way).
What to do if you suspect PP
PP should always be treated as a medical emergency, and the best course of care is access to a Mother and Baby Unit - where new mums are treated with specialist care and support without being separated from their baby.
GPs and health visitors are usually a first port of call, but the APP website can also serve as an invaluable resource - as can the APP peer support community. All of this information and support is provided completely free of charge.
Speaking out and asking for help is key
Many women I’ve spoken to, if indeed they were able to identify that they were becoming unwell, said they were too scared to tell health professionals, friends or family about their PP symptoms because they thought they would be deemed crazy, perhaps locked up and have their child taken away from them. However, this couldn’t be further from the truth - as most women with PP go on to make a full recovery when they receive the right treatment. But getting that treatment - and getting it fast - is key.
Indeed, many women told me that being open and honest about what was going on inside their mind was a real turning point for them - because it was only then that they were able to access the correct treatment and medication.
What can you do as a member of the public?
We will all know someone - be it a friend, loved one, colleague or neighbour - who is at some point expecting a baby. And just being aware that PP exists, knowing the basic signs and symptoms and being able to reassure the woman or family affected that help is out there and recovery is possible could make a huge difference.
So many families have been in the midst of a PP episode without ever having heard of it - and that is far more frightening than being able to put a name to what’s happening and knowing that it can be treated.
Whenever I interview any woman or family member who has experienced PP I always ask what they would say to anyone else going through what they did and, overwhelmingly, the response is always along the lines of - ask for help. You can get better. It doesn’t make you a bad mum. And there is hope.
For more information about APP and postpartum psychosis (including many stories of recovery) visit www.app-network.org
If you’ve experienced PP in the past, it doesn’t matter how long ago, the peer support community is always open to you. For more information, click here.
If you think you, or someone you know, is experiencing PP, get urgent help now. Read APP’s guide on where to turn.