What Is Puerperal Psychosis?

Having a new baby can be a wonderful thing, but sometimes it can have a profound effect on a new mom’s mental health. After all, childbirth is a major life event, with physical and emotion ramifications. While most mothers experience just a few bumps in the road when it comes to their postpartum mental health, other mothers experience challenging postpartum mood disorders.

You have likely heard of postpartum depression, but that’s not the only mental health condition that a new mom might experience. Though much rarer than postpartum depression, puerperal psychosis, or postpartum psychosis, is a postpartum mood disorder that every new mom and her loved ones should become aware of.

Puerperal psychosis doesn’t happen very often, but when it does, it’s very serious, and requires immediate medical attention. Luckily, puerperal psychosis can be treated and the majority of mothers who experience it go on to have healthy, fulfilling experiences of motherhood.

What Is Puerperal Psychosis?

Puerperal psychosis is a rare, and very severe postpartum mood disorder commonly referred to as postpartum psychosis. Symptoms usually present within a few days of giving birth, and resemble symptoms of bipolar disorder and schizophrenia.

Mothers who have puerperal psychosis may have intense mood swings, hear voices, experience hallucinations, feel confused, and have disturbing thoughts. They may be a harm to themselves and their baby.

How Common Is Puerperal Psychosis?

Unlike other postpartum mood disorders, puerperal psychosis is not very common. Whereas postpartum depression affects as many as 1 in 8 new mothers, puerperal psychosis affects about 1 to 2 of every 1,000 postpartum moms. Some mothers experience symptoms within 48-72 hours of giving birth, and most will experience symptoms within the first two weeks after childbirth.

Puerperal Psychosis and Other Postpartum Mood Disorders

It’s common for mothers to experience many heightened emotions after they have a baby. Some of this is normal and expected.

Even some intense emotions can be normal, as long as they are manageable and don’t interfere with your ability to care for your baby and yourself. But sometimes your mental health can suffer greatly during the postpartum period.

You may be wondering what postpartum experiences are considered normal, and how to distinguish between more serious postpartum mood disorders such as postpartum depression and puerperal psychosis. 

The Baby Blues

The “baby blues” are something that almost all mothers experience to some extent. Triggered by  shifting hormones, sleep deprivation, and the stress that comes with shifting into the new role of mother, the “baby blues” are characterized by feelings of heightened emotion, feeling “weepy,” anxious, and generally irritable. 50-85% of new mothers experience the “baby blues.” As long as they pass after the first two weeks of giving birth and don’t interfere with your ability to function on a day-to-day basis, the “baby blues” are nothing to worry about.

Postpartum Depression

Postpartum depression is different from the “baby blues” because it lasts beyond the first two weeks postpartum, is characterized by more intensive emotions, and can make it difficult to function and care for yourself or your baby.

Postpartum depression is common—up to 1 in 8 moms experience it. Its main symptoms include depression, anxiety, insomnia, racing thoughts, feelings of guilt, feelings of numbness, and feeling as though you are a bad mom or won’t be able to care for your baby.

Difference Between Postpartum Depression and Puerperal Psychosis

Both postpartum depression and puerperal psychosis are considered serious mental health issues. Postpartum depression can include suicidal ideation and thoughts of harming your baby—moms who are experiencing these things need to seek emergency medical care.

However, postpartum depression, unlike puerperal psychosis, isn’t always considered an emergency. While treatment is necessary for moms who experience postpartum depression, most cases can be managed on an out-patient basis.

On the other hand, puerperal psychosis is characterized by mania and delusions. A mother who experiences puerperal psychosis is experiencing a medical emergency because she may be a danger to herself or her baby. Moms who experience puerperal psychosis aren’t to blame for what is happening to them, but their cases need to be taken seriously and they must receive immediate care.

What Are the Symptoms of Puerperal Psychosis?

The symptoms of puerperal psychosis usually come on suddenly and may be disturbing to both the mother who is experiencing them and to her loved ones. Usually the symptoms of puerperal psychosis appear within the first two weeks after giving birth, and may appear within the first few days.

Callout: Early signs of puerperal psychosis may simply include feeling restless and not being able to sleep. Soon, symptoms similar to bipolar show up: intense mood swings, hallucinations, delusions, and erratic behavior.

Mothers who have puerperal psychosis may also experience suicidal thoughts and thoughts of infanticide. If untreated, a mother suffering from puerperal psychosis may carry out these acts, which is partly why puerperal psychosis is considered a medical emergency.

Signs and Symptoms of Puerperal Psychosis

  • Feeling elated, “high,” or intensely happy
  • Experiencing periods of very low moods, including depressive feelings and frequent crying
  • Anxious feelings
  • Feeling moody and irritable
  • Swinging quickly from one mood to another
  • Feeling easily set off and agitated
  • Feeling restless
  • Feeling confused
  • Seeming extra “chatty”
  • Having periods of seeming more social than normal, followed by periods of social withdrawal
  • Insomnia
  • Sleeplessness that may drag on for days
  • Paranoia
  • Loss of inhibitions
  • Delusions: You may believe things that make no sense or aren’t true
  • Hallucinations: You may see things that aren’t there, and you may hear voices
  • Inability to care for yourself or your baby

Part of what makes puerperal psychosis symptoms so concerning is that often the person who is experiencing them doesn’t realize that they are problematic. That’s why it’s important for anyone who cares for a mother who is exhibiting these symptoms to take them seriously and to seek medical care.

What Are the Risk Factors for Puerperal Psychosis?

If you or your loved one is experiencing puerperal psychosis, you may wonder how this came to be, what caused it, and how it can be prevented in future pregnancies.

First of all, it’s very important to note that if you have puerperal psychosis or had it previously, you did nothing wrong. Stress in pregnancy doesn’t cause puerperal psychosis. Neither does something you ate or a relationship issue you had.

You did not cause this: it was something unfortunate that happened to you, and you should not feel guilty. Unfortunately, many mental health conditions are cloaked in shame, especially ones as serious as puerperal psychosis.

That said, it can be very helpful to understand why some mothers may be more prone to puerperal psychosis than others. Like many mental health conditions, experts agree that the causes of puerperal psychosis are multifactoral, meaning that there is usually more than one cause at the same time that causes the condition to be triggered.

Here are the most common risk factors for puerperal psychosis:

  • History of bipolar disorder or schizophrenia
  • Previous experience of puerperal psychosis
  • A close relative who had puerperal psychosis

Other factors that might influence your risk of puerperal psychosis may include genetic factors, your family history, hormonal imbalances, and sleep deprivation.

Is There Any Way to Prevent Puerperal Psychosis in the Future?

Given that a previous bout with puerperal psychosis means that you are more likely to experience it in the future, you may be wondering what you can do to ensure that you don’t experience it with subsequent pregnancies.

First of all, just thinking about this is a step in the right direction! After that, you need to make a plan with your healthcare providers and therapists/psychiatrists. Usually, talking about this prenatally or during pregnancy is your best bet. Your providers can discuss appropriate medication, what your puerperal psychosis triggers might be and how to avoid them, as well as getting your whole team involved in monitoring your symptoms.

How Is Puerperal Psychosis Treated?

Being treated for puerperal psychosis can be a very difficult situation. You may be rushed to the emergency room without much time to prepare. You might be separated from your baby for some time. You might be given tests and scary diagnoses.

Callout: The experience of being treated for puerperal psychosis may feel traumatic, but it’s important to understand that the staff and medical professionals who are caring for you want to help you. They want to treat you and protect you so that you can be well and be a good mom to your baby.

Being diagnosed with puerperal psychosis can be extremely distressing, but you should know that treatments are usually very successful.

Puerperal Psychosis Treatments

Most, but not all, women who experience puerperal psychosis require hospitalization. They need to be stabilized so that they will not be a danger to themselves or their baby. Hospital stays can vary in length, depending on your situation and its severity. Sometimes you will be allowed to room-in with your baby; at other times, you may not.

Whether you are hospitalized or not, you will need to receive a psychological evaluation, and a treatment plan that involves medication. The main kind medication used to treat puerperal psychosis are antipsychotic medications. Electroconvulsive therapy (ECT) is another treatment that is sometimes used in puerperal psychosis treatment.

If you are a breastfeeding mother, you may be concerned about using medication and being able to continue to breastfeed. Some medications used to treat puerperal psychosis may be compatible with breastfeeding and some may not.

You should always discuss your desire to continue nursing with your doctor and ask for breastfeeding friendly medication when possible. You can consult a lactation consultant for more information or check the LactMed database to learn more about whether a particular medication is safe for breastfeeding.

While you are receiving hospital or in-patient treatment for puerperal psychosis, you will need help caring for your baby. You may also need continued help with baby care after you leave the hospital, as it may take several weeks for you to be fully functional and well.

After your condition stabilizes and you are ready to leave the hospital, you will receive a discharge plan, which will include information about the medication you need to take as well as plans for follow-up care and regular appointments with your psychiatric team. Some mothers may need daily psychiatric care for several weeks or more.

Puerperal Psychosis Outlook

The outlook for puerperal psychosis is promising. With proper care, most mothers are able to recover from the most severe symptoms of puerperal psychosis within 2-12 weeks after starting treatment. However, it can take a full 6-12 months to fully recover from puerperal psychosis.

Unfortunately, the rate of having a repeated episode of puerperal psychosis is high, with as many as 31% of moms at risk of this happening. This is why taking proactive steps during future pregnancies is important; stay in touch with your healthcare providers for a care plan.

A Word From Verywell

After you experience puerperal psychosis, you may be prone to feeling of depression and anxiety. After all, what you experienced was upsetting and traumatic in ways. You may also feel upset and down on yourself because this was not how you wanted new motherhood to go! Make sure to give yourself time to grieve for what happened, but also remember that none of it was your fault.

If you are the spouse, friend, or family member of a mother who experienced puerperal psychosis, you may be unsure of what you can do to help. First of all, when symptoms first present, your top priority will be getting your loved one safely to emergency medical care.

After that, you can help by offering care for the baby, as well as care for the mom. Meals and housekeeping will be much appreciated.

But maybe more than anything, be a good, non-judgmental listener. Experiencing puerperal depression is going to be an extremely challenging experience for your loved one—they will remember what happened for the rest of their lives and may live with a lot of guilt about it. Helping them to understand that what happened is not their fault, that their upset feelings are valid—and most of all, that they are strong enough to overcome this—may be the greatest gift you can give them.

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