Postpartum Psychosis: The other side of giving birth

I sat in my room reading articles on abortion rights in India when suddenly a case came up which talked about a woman being denied the right to abortion by a judge because of postpartum psychosis. What was that? I thought to myself. I had heard of postpartum depression but hadn’t heard anything about psychosis. It’s funny how women themselves are rarely ever educated on topics like female sexuality, mental health and physical health. Many new and old mothers, under those same articles, shared their stories about how they never even knew what it was. Many of them were mothers who had given birth to their babies and experienced these symptoms. Still, it was either downplayed or they didn’t even know what was happening to them and realised too late about this condition. Some of them learned that their mothers had it too but they either had no help in their time or never shared it with anyone.

Postpartum Psychosis is a very serious mental condition and one of the 6 prenatal mood disorders, which affects at least 1 in 1000 mothers after delivery. Many women experience mild mood changes otherwise known as “baby blues” but this condition is serious and should be treated like a medical emergency. It is also known as puerperal psychosis or postnatal psychosis.

The symptoms usually start within the first 2 weeks after giving birth, sometimes within hours or days of giving birth. Symptoms include hallucinations which are seeing, smelling or feeling things that are not real, like a woman reported seeing her mother’s face morphed into her own and her grandmother’s face in place of her baby’s face. Delusions which include suspicions, fears, thoughts or beliefs that are unlikely to be true are felt by the mother for eg. they are a danger to their kids or their kids are chronically unsafe regardless of reasons. Mania which is the feeling very “high” or overactive eg. talking or thinking too fast. A low mood such as showing signs of depression, withdrawal, low, gloomy, anxiety, agitation, trouble sleeping etc. These women will doubt if they’re fit to be a mother or just a failure, or if they’ll ever recover from these feelings.

Sadly, these symptoms are often overlooked because many new mothers remain silent or are silenced. Due to the fear of being called “crazy” or “unsafe to be around their babies” they maintain silence. Seldomly, if they share their feelings they are silenced by their husbands or other family members to just “ignore these thoughts”.  There is so much shame, blame and stigma surrounding mental health conditions, especially concerning prenatal care because traditionally women are supposed to be grateful and should be great mothers who are always happy. Because of this, many women go through this illness completely alone out of fear of criticism or judgement or the negative consequences.

Who is at risk for this condition? Women who have a history of bipolar disorder are very susceptible to it but more than 50% of women who experience this illness have no psychiatric history. Trauma is a major risk factor, especially for people who experienced childhood trauma like sexual or physical abuse. Insomnia can also cause a psychotic break, severe sleep deprivation can be a trigger for this psychosis. Postpartum psychosis is treatable. Treatment includes medications, counselling, Electroconvulsive therapy and sleep aides.

What happens if the patients do not seek medical help? Suicide is the leading cause of maternal death up to one year postpartum. In postpartum women, 5% commit suicide. Infanticide is also a very severe consequence of not treating this condition. A third of women hospitalized for postpartum psychosis expressed delusions about their infants and tragically, 4% kill their child. In the height of a manic PPP episode, a woman may also commit other acts that cause them to end up in mental hospitals or even in prisons. 

Our society expects that the only acceptable feeling after giving birth is overwhelming happiness and love and while this is the case for most women for many women it is not. The mother has just pushed a human being weighing 2.8-3.2 kgs out of her body after carrying it for nine months! Nothing is going to be rainbows and sunshine. Nobody, except the mother, knows what she’s going through and so nobody except the mother has the right to talk for her. Women should be allowed to openly speak about postpartum without shame and should be reassured that it happens to a lot of other women without judgement. Moreover, they should be guided to the resources to heal and provide hope. If we as family members, community members and as a society work to recognise and acknowledge the pain and vulnerability that bringing a child into this world can create then we can foster healthy and happy mothers. Every woman needs to know the reality of prenatal anxiety and mood disorders. Women are already in the dark regarding so many female body-related diseases, hygiene and sexual health. In a country where it is okay to sexualize and objectify women and produce kids after kids but little girls are not even educated about basic menstrual health, I suppose we expect too much. 

Jazbia Junaid is a student pursuing English honours from Jamia Millia Islamia.

Edited by: Ayesha Alim