Postpartum Psychosis: the ‘Silent’ Postpartum Disorder

You’ve probably heard of the ‘baby blues’. You might know that some mothers can develop postpartum depression or anxiety. But you’ve probably not heard of a little-known and rare condition that occurs in 1 to 2% of births: postpartum psychosis. 

In August 2018, singer and songwriter Adele brought attention to postpartum psychosis when she shared a photo with her friend, Laura Dockrill, who was diagnosed with the condition. Adele wrote:

“This is my best friend … She has written the most intimate, witty, heartbreaking and articulate piece about her experience of becoming a new mum and being diagnosed with postpartum psychosis. Mamas talk about how you’re feeling because in some cases it could save yours or someone else’s life.” 

The piece is a powerful personal account of Laura’s experience with this debilitating postpartum disorder.

Although rare compared to postpartum depression or anxiety, postpartum psychosis is a recognized condition. It is included in the latest edition of the World Health Organization’s International Classification of Diseases (ICD-11). It’s also included in the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here, it is listed as a specifier – “with postpartum onset” – to the “brief psychotic disorder” diagnosis.

Symptoms of postpartum psychosis include rapid mood swings, hyperactivity, strange beliefs and delusion, hallucinations and paranoia. Although a rare temporary and treatable illness, it can be potentially dangerous and life-threatening.

Postpartum psychosis has a 5% rate of suicide and a 4% rate of infanticide.

The challenge with the condition, as with mental illness in general, is that there isn’t a single predictor of whether a mother will develop it. Risk factors include a history of bipolar disorder, previous psychotic episodes, obstetrical complications, sleep deprivation and lack of partner support. In Laura’s case, there was no history of mental illness or psychotic episodes. Treatment can include medications such as antidepressants and antipsychotics and psychotherapy such as cognitive-behavioural therapy (CBT). 

Laura’s story exemplifies the silence surrounding postpartum psychosis. She said herself that she had never heard of postpartum psychosis until she experienced it firsthand.

Lack of awareness is particularly problematic as having social support can be crucial to a quick identification and treatment of the condition – and this can save lives. 

Laura shared she was healing with the help and support of her family and psychiatrist, and through medication and psychotherapy. To other mothers struggling with postpartum psychosis and other postpartum mental health conditions, Laura said: “You don’t have to brave it alone. You don’t have to act like a hero, you already are one.”

If you or someone you know is struggling with suicidal thoughts, please reach out for help immediately. In the United States, call 1-800-273-TALK (8255) or text TWT to 741741. For a list of international suicide hotlines, visit www.buddy-project.org/hotlines.

Opinions and experiences published on girlsglobe.org are not medical advice. If you are struggling with your mental health, please seek help from a doctor or mental health professional.

The Vulnerabilities of Being Pregnant

Women face unique challenges throughout their lives. For some, one such challenge can be pregnancy. It is an exciting and beautiful time, but it can also be a major test on the strength of a woman’s body and mind.

Did you know a woman’s socioeconomic status has a surprising amount of influence, not just on her baby, but also on how her pregnancy goes? Childbirth outcomes are heavily tied to socioeconomics, with women in more impoverished regions experiencing a wide range of additional challenges.

While some of these challenges are health-related, others are not. Many factors combine for a successful pregnancy and birth, and an individual’s financial situation has a huge impact. Of course, most people can’t just change their financial standing quickly, and so we need to examine ways we can change the culture around pregnancy.

In countries that lack universal health care, financial status has a significant impact on prenatal outcomes. Merely being able to afford regular medical checkups, prenatal vitamins and any additional medications can significantly increase the chances of a healthy pregnancy and baby. It’s impossible to understate how important prenatal care is.

Access to medical care goes beyond prenatal care, though. Women in lower socioeconomic classes tend to be less likely to be able to access health care before becoming pregnant, which also contributes to the health outcomes of the child. Even with socialized health care, the risks remain, because money affects every aspect of our lives.

Women can also suffer in countries without socialized health care. One U.S. case, for example, shows how insurance companies took advantage of pregnant women who qualified for government-funded Medicaid. The companies claimed to give the women coverage, then denied their claims while still collecting the money from the government. This is just one case that demonstrates how willing people and companies can be to take advantage of those in ‘vulnerable’ positions.

There are many countries where access to quality prenatal care should not be an issue. Universal health care should eliminate the barrier, but it doesn’t stop women from having problems. As some studies have demonstrated, even with socialized health care, pregnant women in lower income brackets tend to have more challenging pregnancies, including problems like preeclampsia, premature birth and obstetrical hemorrhage.

Lower incomes make women more vulnerable to things like stress, domestic violence, poor personal health choices and drug use. It has been shown that stress is one of the precursors to birth issues like premature birth and low birth weight.

Studies also show that women experiencing poverty are more likely to experience abuse from their partner. This abuse often occurs alongside other issues, like financial dependence on the abuser and isolation from a support network. The stress, isolation and risk of hospitalization all take a serious toll. Women who are pregnant and have been in the relationship for a while may see violence escalate during their pregnancy.

The problems related to having a new baby don’t just impact the mom and baby. They’re a serious issue for everyone in society as well. Pregnant women are certainly in a place of high vulnerability, but they are not weak links. Women make up half of the population, so we need to address the gendered issues at play.

Addressing the reasons behind the systemic problems that women and new moms face will undeniably lead us to a better and healthier tomorrow for everyone.

U.S. Opposes Global Breastfeeding Resolution

If it seems like the world is crying over spilled milk right now, I promise it’s much more than that. In May this year, a global breastfeeding resolution was passed at the World Health Assembly in Geneva, but not without a fight.

What Happened?

As recently reported by the New York Times, the proposed World Health Organization (WHO) resolution aimed to limit the marketing of breastmilk alternatives, and to “protect, promote and support breastfeeding”. An American delegation attempted to block the resolution, and made threats of trade measures and cuts to military aid to countries planning to introduce the measure. This, naturally, made other nations hesitant to support the resolution.

Ultimately, Russia proposed the final resolution, though U.S. delegates successfully had language removed stating the WHO would support nations discouraging misleading promotion by formula companies.

Why It Matters

The American Academy of Pediatrics recommends breastfeeding as the optimal source of nutrition through a baby’s first year of life. Breastfeeding provides benefits for both baby and mother. In fact, breastmilk could lead to lowered risk of asthma, type 2 diabetes, and obesity in babies and lowered risk of breast and ovarian cancers in moms.

A joint investigation by the Guardian and Save the Children in poorer regions of the Philippines found four large formula companies (Nestlé, Abbott, Mead Johnson and Wyeth) to be enticing health workers to promote formula in addition to distributing pamphlets disguised as medical advice to mothers. Although this is an explicit violation of the WHO’s international code, formula promotion persists in poorer countries where mothers are less informed about breastfeeding benefits.

Soon after transitioning in 2017, the new American administration re-enacted the global gag rule, prohibiting international non-profits receiving U.S. government funding from sharing abortion service information. Now the U.S. is supporting pro-formula companies over policies promoting global childhood nutrition.

This is not just another example of prioritizing private profit over public health, but rather, yet another infringement upon women’s rights.

While there are, of course, circumstances where choosing formula over breastmilk may be the best option for mother and child, every mother deserves to make her own informed decision, and country delegations should support that globally.

CDC’s Infographic and the Double Standard of Behavior

 

A man has a beer and is featured in TV commercials. He’s cool, he’s “one of the guys.” But time and time again, women are called out, shamed, and even blamed for the behavior of others for doing the same thing.

In 2013, Hong Kong Security Secretary Lai Tung-kwok appealed to young ladies to stop drinking too much because of the increase in rape cases. The Missoula Montana Police Department has a history of blaming rape victims for alcohol use, and Crimewatch creator Nick Ross suggested that “not all rape is rape” when the victim is drunk. Now, the U.S. Center for Disease Control (CDC) has released this infographic in their monthly Vital Signs report.

The CDC infographic intends to prevent fetal alcohol spectrum disorders (FASDs). As the CDC states, “alcohol use during pregnancy, even within the first few weeks and before a woman knows she is pregnant, can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime.”

Understanding the harmful effects of alcohol during pregnancy and even the time in which you are trying to get pregnant is important, but, to me, the infographic suggested even more.

It warned women that “drinking too much” can lead to violence, illnesses, STIs, and unplanned pregnancies. Can men not also experience violence, illnesses, STIs, and unplanned pregnancies if they drink too much? Where is the caution poster that reads: Drinking too much can have many risks for men? This is a clear double standard where women are warned for a behavior that also causes harm to men.

While I respect the good intentions in seeking to prevent FASDs, I am outraged by the suggestion, yet again, that women are responsible for the actions of others. Rather than emphasizing that the decreased control alcohol induces could potentially lead to negative outcomes, this poster implies that because women drink, they get pregnant or experience violence – forgetting the other individuals involved, who may also have been drinking.

This infographic lends itself to a wide collection of victim-blaming propaganda that suggest women should not dress “provocatively” or walk alone at night, or blame women for the violence and sexual assault they experience. Women should not be told their actions are the reason someone else acted upon them.

We should not have to tell women to be more careful, but we do, and in doing so we put the burden on them to not be assaulted – because if they are, it’s somehow their fault. Perhaps instead of cautioning women rather than perpetrators, this infographic should be added to a growing collection of measures we take to highlight how prevalent violence against women is and how everyone – men and women alike – can end and prevent violence against women.

Next time, CDC, I highly suggest creating two campaigns – one about the negative relationship between drinking and pregnancy and another that warns all people about the potential harmful effects of drinking. To warn women about a harmful behavior without similarly warning men is a ridiculous and unacceptable double standard.

How Ebola Impedes Women’s Empowerment in West Africa

Originally published on Huffington Post.

On November 17, 2014, at a women’s health event called “Better by Half”, Barbara Bush and Melinda Gates voiced concerns about women’s health in Ebola-affected countries. Arguing that “women’s health is becoming a casualty of the Ebola outbreak,” Bush and Gates reignited calls to take concerted action to address the Ebola crisis.

As I read Lucy Westcott’s Newsweek piece “Barbara Bush on the Impact of Ebola on Women’s Health”, I couldn’t agree more with Bush’s remark on the conversation about Ebola. Speaking to Newsweek, Bush remarked: “One thing that has been missed out of the dialogue around Ebola is, we talk about it as a health issue and it is a health issue, but there’s so many other repercussions from it.” Hoping to learn more about the the effects of Ebola on women’s and girls’ empowerment in West Africa, I found out that the outbreak does indeed extend beyond the purview of women’s health. Worryingly, the Ebola outbreak has directly and indirectly spilled over into other areas concerning women’s empowerment; it is patently clear that Ebola is injurious not just to women’s physical health, but to their education, safety, and economic well-being.

EBOLA’S IMPACT ON MATERNAL HEALTH

The Ebola outbreak in West Africa has had deleterious consequences on maternal health. Although the Ebola-affected countries – namely Guinea, Liberia, and Sierra Leone – had some of the highest maternal mortality rates globally before the Ebola outbreak, these maternal mortality rates were declining as women “were more likely to go to a health facility to give birth and be delivered by a skilled health worker or midwife.” Yet, because health facilities are deluged with Ebola patients, medical professionals at these health facilities have developed an exclusive focus on treating Ebola, at the expense of caring for expectant mothers. Compounding this problem, pregnant women also fear visiting hospitals and clinics due to the stigma attached to the Ebola virus, resultantly reducing their chances of having valuable antenatal checkups and health advice. Skilled health attendants and midwives also fear contact with bodily fluids, which transmit the Ebola virus, and thus are unwilling to deliver babies.

Since the Ebola outbreak, women have given birth on the streets and in other low-resource settings bereft of protective and sanitation supplies. In the absence of skilled care during childbirth, women are more likely to experience life-threatening complications including obstructed labor and infections. Aid charities posit that “one in seven women risk dying in childbirth in Ebola-hit countries,” and in the wake of the Ebola outbreak, the maternal mortality rate is projected to skyrocket to 15% – a 20-fold increase in the current rate.

EBOLA’S IMPACT ON GIRLS’ EDUCATION

Additionally, the Ebola crisis barricades girls’ access to education in West Africa, causing “major setbacks to the progress that’s been made,” according to Laurent Duvillier, a communication specialist at UNICEF. Despite the fact that Ebola-affected countries have had flagrant gender inequalities in education, major progress has been made to improve girls’ access to education in recent years. However, since the Ebola epidemic, girls have dropped out of school because their families feel incentivized to keep them at home. When girls are at home, they undertake the role of default caretaker, to help out with family burdens, particularly taking care of family members who have contracted Ebola.

EBOLA’S IMPACT ON SEXUAL VIOLENCE AGAINST WOMEN

Reports from Ebola-affected regions heighten concerns about sexual violence against women and girls by male Ebola survivors. With schools shut down, girls run a higher risk of child marriage and early pregnancy as a result of sexual exploitation within marriage. Another noteworthy point is that because the Ebola virus suffers in the male semen for approximately three months (or 100 days) after recovery, male Ebola survivors are likely to return home post-treatment and infect their wives and sexual partners through intercourse. In addition, the culture of violence against women in these West African countries raises fears about men transmitting the Ebola virus through rape.

EBOLA’S IMPACT ON WOMEN’S ENTREPRENEURSHIP

The effects of the Ebola crisis go beyond the ambit of physical well-being – the outbreak has adversely impacted women’s economic empowerment and security. Because travel between Ebola-affected regions has been restricted, women have been unable to access resources crucial to the maintaining of their businesses, and their business activity has decreased significantly. Moreover, the looming threat of Ebola has caused a shutdown of vital market centers. Women entrepreneurs across West Africa have experienced plummeting sales, major losses, and being forced out of businesses.

Furthermore, travel restrictions have occasioned soaring transport fares, which are reported to be 70% higher than they used to be. For women engaged in internal trade, problems with agricultural goods perishing due to travel delays have also posed salient risks not just for the sustaining of their small businesses, but to the health of their customers. Women entrepreneurs who take loans from financial institutions are also reporting being charged alarmingly high interest rates.

More Than a Number

This week, the international aid world will convene in New York City during the United Nations General Assembly to discuss data, procedures, progress or perhaps lack thereof. But it’s important to remember that behind all of these facts and figures are women like Shefali*.

At age 20, Shefali was a happy wife and mother of a beautiful son. Like most women, when she became pregnant with her second child she was excited about expanding her family. She went into labor at home alone, without access to a skilled birth attendant, as do more than two thirds of women in Bangladesh. After enduring a day of excruciating labor she felt that something was wrong. She knew that her baby had already died inside her womb. Her husband took her to the hospital where the stillborn baby removed, but this was just the beginning of Shefali’s suffering.

Not long after, Shefali began to leak urine: days of obstructed labor had caused an obstetric fistula, an injury that caused her to become incontinent.

Photo Credit: HOPE Foundation for Women & Children of Bangladesh
Photo Credit: HOPE Foundation for Women & Children of Bangladesh

Obstetric fistula is a terrible injury happening to some of the poorest women in the world. As in Shefali’s case, it occurs when a woman’s labor becomes obstructed and constant pressure from the fetus causes tissue to die. As a result, a small hole is created that causes the woman to become incontinent. The smell of her incontinence often spurs a woman’s husband to leave and community to abandon her – and even worse, she often thinks it’s her fault, believing she’s cursed. Her child usually does not survive.

The most shocking part? The surgery that can completely transform a woman’s life costs as little as $450 and often takes less than an hour to complete. Yet there are women like Shefali with fistula today who have lived with this condition for decades because they do not know treatment is available or because they cannot afford to access it.

Recently, Shefali heard about the free obstetric fistula repair services offered by HOPE Hospital for Women and Children of Bangladesh, a Fistula Foundation partner. She arrived at the hospital in Cox’s Bazar for treatment, eager for the surgery that would finally cure her and allow her to once again walk with pride through her village, free from the burden of obstetric fistula.

Obstetric fistula used to be common in the developed world until the early part of the 20th century – in fact, a fistula hospital once stood on the site of today’s Waldorf Astoria Hotel in New York – but thanks to the widespread availability of emergency obstetric care and emergency interventions like C-sections, fistula is now extremely rare in the U.S. and other industrialized nations. But, in places like rural Bangladesh, where Shefali gave birth, there is too often no medical help available if something goes wrong during labor.

Today, Shefali is 40 years old. She suffered with obstetric fistula for 20 years, without any idea that her devastating childbirth injury could be treated through surgery. We know there are at least one million more women like her, who suffer from untreated fistula, and too many of those women have suffered for years.

Shefali’s life was transformed because true partners worked together: Fistula Foundation’s generous donors paid for the surgery she received through skilled hands from our trusted partners at HOPE Hospital. This week, as we all reflect on achievements made and significant work that remains to be done, let us pause for a moment and think about the individuals behind these spreadsheets and data points, and about the collaboration and partnership required of all of us to treat the one million women just like her who are still in need of help.

This post is written by Kate Grant, CEO of Fistula Foundation, a nonprofit that works to treat the childbirth injury obstetric fistula by funding treatment, surgeon training, and equipment that enables providers to give the very best quality of care to women who are suffering. To learn more, visit www.fistulafoundation.org or join the organization on Facebook or @Fistula_Fdtn on Twitter.

*Name changed to protect patient privacy.