Having a baby can evoke a whole range of strong emotions and reactions – from sheer joy and unconditional love, to overwhelming exhaustion and anxiousness as you adjust to life with a newborn. In most cases, the exhaustion and anxiousness eventually improve as your baby begins to settle and your parenting confidence grows.
However, for some, the period immediately after giving birth can be a frightening and even dangerous time.
In a recent case that sent shockwaves throughout the world, Melissa Arbuckle placed herself and her three-month-old baby girl in the path of an approaching train. She survived the impact but tragically her baby suffered fatal injuries. Arbuckle was found to be suffering from severe postpartum depression and anxiety at the time of the incident. While this tragedy represents an extreme case of this illness, Arbuckle is not alone. Around one in six women and one in 10 men will experience depression and anxiety after the birth of a baby.
One to two per thousand women will develop something potentially even more serious – postpartum psychosis.
Dating back to antiquity
Also known as postnatal psychosis, postpartum psychosis was noted in medical literature as far back as 400 BC. Hippocrates described the first known case, noting that his patient “was delusional, confused and insomniac, within six days of a twin birth”. In 1858 French psychiatrist Louis Victor Marcé published his Treatise on the Madness of Women who are Pregnant, Recently Delivered, or Nursing. With his patients who had recently delivered and were nursing their babies, he observed symptoms of confusion and delusional thinking. This led Dr Marcé to explore the link between the massive changes that occur to a woman’s reproductive hormones immediately after birth and the serious mental illness he observed in some.
Postpartum depression and anxiety, on the other hand, have only been properly researched in the last 30 years, but this condition is now widely recognised as a potentially serious but treatable mental illness. Postpartum psychosis typically develops within days of giving birth, but the risk remains the highest during the first six weeks after having a baby.
In fact, current research suggests the perinatal period – the time between becoming pregnant and six weeks postpartum – is the time when women are at the highest overall risk of developing a psychiatric illness of any sort.
For most women, however, postpartum psychosis can be their first experience with mental illness, making it even more frightening and bewildering.
Different to depression
Associate Professor Anne Sved-Williams has been working in the field of maternal mental health since the mid-1980s. She is a consultant psychiatrist at Helen Mayo House in South Australia, which is a specialist health unit providing inpatient services for mothers experiencing significant mental health problems in the postnatal period. Associate Professor Sved-Williams says that “although postpartum depression and postpartum psychosis are two different illnesses, women who suffer a major depression can demonstrate psychotic behaviour, so the two conditions can be similar.” While postnatal psychosis presents in the first days or weeks after childbirth, depression and anxiety can happen at any time after birth and during the first few months at home with a new baby.
It’s quite common for new mothers to feel teary in the first few days after giving birth – something known as ‘the blues’ – but this should not be confused with postpartum depression.
“The blues is hormonally related tearfulness that tends to happen between days three to five after birth, but it usually goes away within days and women just need reassurance and support rather than rushing for instance to medication,” explains Associate Professor Sved-Williams.
However, depression can set in within weeks or months later when new mothers are chronically sleep deprived, their partners may have gone back to work and they’re struggling to adjust to a completely different life with a newborn. According to Associate Professor Sved-Williams, serious postpartum psychosis is probably a genetic condition that can run in families. Sometimes a woman suffering from this illness learns that her mother also suffered the same thing after childbirth but it was never discussed.
In some cases, postpartum depression may also have some genetic links.
Why does it happen?
As Dr Marcé observed back in 1858, the massive hormonal changes that occur once the placenta is delivered trigger something genetic in the brain, making postpartum psychosis the only illness in psychiatry where doctors are able to predict the onset.
While genetics do play a role, according to Associate Professor Sved-Williams there are actually multiple risk factors to be aware of, including: past trauma; previous birth losses; lack of support from a partner; financial stress or caring for a child with special needs.
Postpartum psychosis affects about 600 women each year in Australia. According to research carried out in New Zealand, ethnicity also represents a risk factor, with women from non-European backgrounds more likely to suffer from antenatal and postnatal depression, specifically Māori, Asian and Pacific Islander people. In both New Zealand and Australia, suicide is also the leading cause of maternal death.
With social media flooded with pictures of seemingly perfect mothers and babies, the quest for perfectionism is also considered another risk factor. Associate Professor Sved-Williams says that it’s important to “give mothers who tend to be perfectionists, permission to feel ‘good enough’, especially around their relationship with their baby.”
Gabrielle’s story
For psychologist and mother of two Gabrielle Micallef, learning she was expecting her first child was a joyous time in her life. She had a dream pregnancy and easy birth and it was not until she brought her baby boy home that the reality of caring for a newborn became apparent. Her baby would not settle and she was sleep-deprived, feeling increasingly anxious and emotional.
For Micallef, this turned out to be far more serious than the normal hormonal fluctuations and exhaustion new mothers commonly experience.
She started to experience disturbing feelings of paranoia, mistrusting her husband and thinking there were hidden cameras in her home that were spying on her. Micallef, who had no past experience of mental illness, was spiralling into a dangerous and frightening form of psychosis. She began to withdraw from her friends and family and was unable to explain to her husband what was going on inside her head.
She got to the stage where she wasn’t able to shower or dress herself, let alone care for or bond with her new baby.
Fortunately for Micallef, a friend who also happened to be a doctor saw what was happening and urged her to seek help. A mental health crisis assessment and treatment team was sent to Micallef’s home and she was diagnosed with postpartum psychosis. Although Micallef received psychiatric treatment relatively quickly, she describes her recovery as being painfully slow. Even though the worst symptoms started to subside with medication, she continued to suffer ongoing symptoms of depression and anxiety.
How is postpartum psychosis treated?
In the case of psychosis, it’s vitally important new mothers get the right kind of care immediately – because of their level of distress and confusion they may not be able to care for their baby properly. In more severe cases there is a risk they’ll develop ideas around their baby that may endanger the child’s health or life.
The good news is that, if treated promptly and effectively, the rates of recovery are very good.
According to Associate Professor Sved-Williams, the first treatment is standard antipsychotic medications: the same you would use in treating conditions such as schizophrenia or bipolar mood disorder. Therapeutic support through seeing a psychiatrist or psychologist, combined with community-based support programs and group therapy, can also be helpful for some.
Practical lifestyle changes and self-care, such as trying to get enough sleep and exercise, eating well and practising mindfulness can help with recovery overall. Getting help from partners, available family and friends can also be vital. According to Associate Professor Sved-Williams, if you have suffered postnatal psychosis before your chances of getting it again are very high.
When Micallef learned she was pregnant with her second child she thought she would be prepared for what lay ahead. However, despite taking all precautions she fell ill with psychosis again and ended up in a psychiatric ward.
Micallef describes this period in her life as an extremely frightening time, made even worse because she was separated from her newborn son.
Fortunately, if your doctor is aware of your past history with postnatal illness, receiving appropriate medication, either in late pregnancy or in the delivery room, so that it gets into the system quickly, can prevent the psychosis from developing.
Role of partners & family
According to Julie Borninkhof, CEO of Perinatal Anxiety & Depression Australia, “because a person suffering from postnatal psychosis may not realise they are unwell, partners and family should be aware of the warning signs.”
These warning signs may include everything from sleeping problems, a lack of energy and simply not coping to disorientation, severe anxiety about their own wellbeing or their baby’s safety, as well as expressing suicidal thoughts.
Now fully recovered, Micallef looks back on her experience with postnatal psychosis as something positive. Although it was a frightening time in her life, she knows the illness is treatable and that there is hope. She now counsels other new parents who are dealing with peri and postnatal mental health issues.
“It’s important partners and family are not afraid to check in with new mums and ask them, in a kind, respectful and loving way, if they are okay,” she says.
“Just listen and support them by taking a step in connecting with relevant local services and supports.”
For further information and support contact a PlunketLine nurse 24 hours a day free from any phone on 0800 933 922.
