What Is Puerperal Psychosis?

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

You have likely heard of postpartum depression, but that’s not the only mental health condition that a new parent might experience. Though much rarer than postpartum depression, puerperal psychosis, also called postpartum psychosis, is a postpartum mood disorder that every new parent and their 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 people who experience it go on to have healthy, fulfilling experiences of parenthood.

What Is Puerperal Psychosis?

Puerperal psychosis is a rare, and very severe postpartum mood disorder commonly referred to as postpartum psychosis. Symptoms appear suddenly within the first couple of weeks of giving birth. While the condition may resemble symptoms of bipolar disorder and schizophrenia, puerperal psychosis has its own unique symptoms that set it apart from other mental health conditions.

People who have puerperal psychosis may have intense mood swings, feel suspicious, experience hallucinations, feel confused, and have delusions. They may be a harm to themselves and their baby.

How Common Is Puerperal Psychosis?

Unlike postpartum depression, which is relatively common, puerperal psychosis is rare. It affects about 1 to 2 of every 1,000 postpartum gestational parents. Some experience symptoms within 48-72 hours of giving birth, and most will experience symptoms within the first two weeks after childbirth.

Puerperal Psychosis vs Other Postpartum Mood Disorders

It’s common for parents 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

Almost all new parents experience the “baby blues” to some extent. Triggered by shifting hormones, sleep deprivation, and the stress that comes with shifting into a new parenting role, the baby blues are characterized by feelings of heightened emotion, feeling weepy, anxious, and generally irritable.

The baby blues are very common, affecting up to 80% of new parents who have recently given birth. 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. However, if your symptoms persist or if they are severe, you should talk to your doctor right away.

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, affecting as many as 1 in 8 new parents who have recently given birth. Its main symptoms include crying, anger, withdrawal from family and social circles, fear of hurting your baby, feelings of numbness, and feeling as though you are a bad parent, or that you won’t be able to care for your baby.

Postpartum Depression vs 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. People 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 those 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 person who experiences puerperal psychosis is experiencing a medical emergency because they may be a danger to themselves or their baby. People 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.

Symptoms

The symptoms of puerperal psychosis usually come on suddenly and may be disturbing to both the person who is experiencing them and to their 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.

Early signs of puerperal psychosis may simply include anxiety, mood fluctuation, and not being able to sleep. Soon, more symptoms like intense mood swings, hallucinations, delusions, and mania show up.

People who have puerperal psychosis may also experience suicidal thoughts and thoughts of infanticide. If untreated, a person experiencing puerperal psychosis may carry out these acts, which is 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
  • Feeling moody and irritable
  • Swinging quickly from one mood to another
  • Feeling fearful and suspicious
  • Feeling restless
  • Feeling confused
  • Seeming extra “chatty”
  • Insomnia
  • 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

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 someone who is exhibiting these symptoms to take them seriously and to seek medical care.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

Risk Factors

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 after future pregnancies.

If you have puerperal psychosis or had it previously, you did nothing wrong. Nothing you did or didn't do could have caused puerperal psychosis.

Even though you did not cause this, it is common for people to feel guilty when they have been diagnosed with puerperal psychosis. 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 people 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:

  • Personal or family history of bipolar disorder
  • Previous experience of puerperal psychosis
  • First pregnancy and birth
  • Sleep loss

Puerperal psychosis used to be associated with pregnancy complications. However, more recent research has not shown conclusive evidence that conditions of pregnancy place people at greater risk for developing puerperal psychosis.

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.

If you have a history with puerperal psychosis, you may want to make a plan with your healthcare providers and mental health professionals. 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.

Treatment

Puerperal psychosis is a medical emergency. If you suspect you may have puerperal psychosis, you should call 911 and go to the emergency room.

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 parent to your baby.

Being diagnosed with puerperal psychosis can be extremely distressing, but you should know that treatments are usually very successful. There are a number of common treatment methods that have proven to be successful.

Hospitalization

Most, but not all who experience puerperal psychosis require hospitalization. Some will 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.

While you are receiving 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 your medication as well as plans for follow-up care and regular appointments with your psychiatric team.

Medication

Whether you are hospitalized or not, you will need to receive a psychological evaluation, and a treatment plan that involves medication. Medications used to treat puerperal psychosis include mood stabilizers, antipsychotics, and antiepileptic drugs.

Common medications used include:

  • Benzodiazepines
  • Carbamazepine
  • Lamotrigine
  • Lithium
  • Olanzapine
  • Quetiapine
  • Sodium valproate

Breastfeeding and Medications

If you are breastfeeding, be sure to discuss with your doctor which medications are compatible with breastfeeding. Some medications may not be compatible with breastfeeding.

Non-Pharmacological Treatment

Electroconvulsive therapy (ECV) and psychotherapy are both effective treatments for a wide range of psychiatric disorders, including puerperal psychosis. ECV can be used safely alongside or without psychiatric medications. Psychotherapy may be utilized to compliment other treatment modalities.

Outlook

The outlook for puerperal psychosis is promising. With proper care, most people are able to stabilize quickly. Research has shown that at nine months postpartum, the majority of people with puerperal psychosis have a good, functional recovery.

Unfortunately, the rate of having a repeated episode of puerperal psychosis is high. Research shows that those who have had it following a prior pregnancy, may be up to 31% increased risk of developing it again in the future. 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 feelings of depression and anxiety. After all, what you experienced was upsetting and traumatic. You may also feel upset and down on yourself because this was not how you wanted new parenthood 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 someone who experienced puerperal psychosis, you may be unsure of what you can do to help. 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 to care for the baby, preparing meals, and helping out with housekeeping.

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 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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7 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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