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

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

Motherhood in Conflict: Colleen’s Story

In northern Uganda, many mothers have lived through armed conflict. Some gave birth in a time when murder, abduction, mutilation and rape were common practices. It was a time when child soldiers were forced to kill loved ones. What would it be like to become and be a mother in this context?

Colleen* is one of the women I grew very close to during my time volunteering in a counselling centre in Northern Uganda. Like Achola, she told me about her experiences of motherhood during and after the war.

Becoming a Mother in a Conflict Zone

I visited Colleen at her home in rural Ngetta, close to the city of Lira in the northern part of Uganda. The region has been badly affected by the Lord’s Resistance Army (LRA) insurgency. There were great consequences for all, and especially for pregnant women and mothers.

Colleen told me that she was abducted by rebels from the LRA when she was only 15. She escaped them by hiding in the open stem of a bush. Colleen told me that she became a mother at the same time as losing both of her parents, who were killed by the rebels. She spoke about how hard it was to flee from the rebels night after night, while ensuring the safety of her siblings and her baby.

Colleen’s experiences of the war have been debilitating, and she is still recovering. Though the war ended more than a decade ago, Colleen continues to be in emotional and physical pain. She tells me:

“When I was with my baby hiding in the bush, somebody stepped on my waist. It affected my waist so much up to date. Whenever I laugh, I could just fall unconscious for some minutes. It is still painful.”

What is very striking about Colleen’s story is that it demonstrates that life after war can still be filled with terror. For Colleen, the days of violence are not over.

‘Post-Conflict’ Motherhood

Just after Colleen had been abducted by the rebels, she was married at 16 to her current husband. The day I spoke with her, he was out working on nearby land. Colleen leaned towards me and whispered in my ear:

“I never wanted to marry him, my brothers forced me to marry him cause they needed money and animals [bride price] so that they can marry their wives.”

The practice of bride price is one of many practices that highlight the negative effects of poverty and patriarchy on women’s wellbeing.

The women I worked with told me that in their communities, girls are usually seen as a commodity by both their natal family and their new husband. As soon as a girl is born, she is a source of income for her family. This puts girls and young women at great risk of being forced into early or childhood marriage. This is exactly what happened to Colleen.

Colleen is now in an unhappy and abusive marriage. The years of grabbing her children and running into the bush have not been forgotten. These days, however, when she runs with her children it is not to escape the rebels, but the violence of her husband.

For Colleen, instead of a safe place, her home is a place of terror.

The end of the conflict with the Lord’s Resistance Army was supposedly meant to be time of peace. For many women, however, peace-time violence continues to disrupt and negatively influence their well-being.

Colleen’s Way Forward

Though Colleen’s daily life is characterized by the violent relationship with her husband, it does not define her. Colleen experiences a lot of joy in the relationship with her children, and with her female friends who she meets in her neighbourhood and in the local counselling centre. The women often sing and dance together:

“During the rebel time there was no music, now there is music and we can dance and feel better. I dance! … I always dance and listen [to music] because it is telling me about peace, if it is gospel it is counselling me also. There are songs which you listen to and it teaches you about peace.”

Community groups, the church, gospel songs and the local counselling centre are all crucial for Colleen’s recovery. We need to acknowledge the importance of creativity and body work in psycho-social and mental health support. For Colleen, dancing and singing is not only simply enjoyable, it also offers a way of healing.  

*Colleen is a pseudonym. The image accompanying this article does not depict the woman who told this story.

Motherhood in Conflict: Achola’s Story

“Women, in short, lack essential support for leading lives that are fully human. This lack of support is frequently caused by their being women.”
– Martha Nussbaum

Across the globe, mothers face difficulties in relation to their experiences of motherhood and well-being. Many of these are recognizable across countries and cultures.

Becoming and being a mother in the context of a conflict lasting over two decades, however, is different. For these women, their highly dangerous situation means daily care of her children becomes a matter of life and death. This was, and arguably still is, the case for many of the women in northern Uganda.

Before I went to volunteer in a women’s counselling centre in Uganda in 2018, I had prepared myself appropriately. Or so I thought. I watched documentaries on the government’s conflict with the Lord’s Resistance Army. I read loads of newspaper interviews, academic articles and NGO reports, and I spoke with professionals in the field.

All of my preparation, however, still came nowhere near to a full picture of what womanhood, and particularly motherhood, during and after war looks like.

Becoming a Mother in a Conflict Zone

During times of war, stories of motherhood – and female experience in general – have been excluded and unexplored. It is time this silence, often resulting from gender blindness, is broken.

To understand maternal well-being in a post-war context, we must realize what women had to deal with specific to their role as a mother.

The following story was told to me by Achola*. Achola is a 54 year old widow, with 8 children. I visited her home in rural Ngetta, close to the city of Lira in the northern part of Uganda. This region has been badly affected by the Lord’s Resistance Army insurgency, which had great consequences for all, and especially for pregnant women and mothers.

Pregnancy can be a challenging time for women anywhere in the world, and especially for women in impoverished regions.

The challenges Achola faced just became bigger and bigger after giving birth. Only two days post-birth, she had to run to a nearby mountain to find safety from the rebels. Her husband ran in a different direction and so she sat alone with their new-born baby.

“We were sleeping in the hut when the rebels came in 2002. I had a baby child and heard a gunshot. I came out and ran into the bush. The child was only two days old. We were hiding at a swamp and throughout it all the body was shaking.”

With no clean toilets, nothing to withhold the bleeding, no painkillers, no food, no emotional support, fear overtook Achola. At this point, she thought about killing her new-born baby.

“I felt like killing the baby I have so that I am left alone. Because I felt I was going to die, the rebel was going to kill me. There were no merits, that was just the sadness showing. I was full of sadness, and the feeling came from fear. Fear was the one thing making me think that … It was so painful, it was so painful in my heart.”

Like all the other families in the area, Achola had to run away from home every few nights for months in a row.

Hiding in the bush, however, came with great dangers and consequences – 5 tombs next to Achola’s hut are a painful and visual reminder of this.

“Those are the bodies of the children … I cannot recall when those children died. I gave birth to thirteen children, now there are eight … they could not even sit, they could not even crawl.

It happened as a result of running to the bush with these children, the mosquitos bit us in the bush and gave them malaria, then that child dies later on like that.”

Achola’s Way Forward

Achola suffered tremendous losses during the war. She tells me that she “cried and cried and cried for many years.” Today, however, she says: “I am feeling better and better slowly, it is not like in the past. I can laugh.

The community counselling centre, run by Ugandan psychologist and trauma specialist Sister Florence, has helped a lot: “I am now recovering from these problems and this pain … I am now getting energy and feeling better.”

Reconnecting with her body has helped Achola in overcoming some of her struggles. Besides the counselling centre, the church is a major source of social support for her. The word of God, according to Achola, is a form of counselling: “I am always counselled from there [church] by the word of God. When I’m in problem and I hear the word of God I always feel better.”

By sharing this story and trying to understand the complexity of post-conflict issues, we can move on from merely reading narratives of pain and loss.

Instead, we can focus on what helps women live more fulfilling lives after conflict – and how we can support them in their journey.

*Achola is a pseudonym. The image accompanying this article does not depict the woman who told this story.

The personal reason this superwoman has dedicated her life to Indigenous midwifery

This blog post was originally posted on as part of a project with Girls’ Globe, Upworthy and Johnson & Johnson.

Claire Dion Fletcher was taking a class in Women’s Studies as part of her undergraduate program when she first realized she wanted to become a midwife.

She was writing a paper on the decline of midwifery and the medicalization of birth in Ontario, when she started thinking about whether or not midwifery was even practiced anymore. It didn’t take long before Claire found that the answer was ‘yes’ along with a lot more information on the subject from the Association of Ontario Midwives and the Ryerson Midwifery Education programme.

The more she read, the more confident she became about wanting to become a midwife herself. She had always been interested in health care, and especially women taking an active role in their health, so midwifery seemed like the perfect fit.

But it wasn’t just an academic interest — Claire also had a personal connection to health care and midwifery.

Claire is Potawatomi-Lenape, and she wanted to help Indigenous women like herself take an active role in their health care. She thinks that Indigenous women should have access to an Indigenous midwife if they want, because their Aboriginal identity is something that “cannot be replicated or taught”.

Despite the differences in experiences of Indigenous people, Claire explains that they share an ongoing experience of assimilation. Indigenous people also typically don’t have access to as comprehensive health care as other groups in Canada.

But one of the biggest challenges Indigenous people face is that “[they] have the poorest health outcomes compared to any other group in Canada”, Claire explains.

And there are studies to support Claire’s claim. In a report by the National Collaboration for Aboriginal Health, health indicators show a higher burden of disease or health disparities among Indigenous people than among non-Aboriginal Canadians. And there isn’t just a gap in health outcomes, there is also a gap in data which makes it more difficult to address the situation.

What’s more, women often get the shortest end of the proverbial stick, “due to the intersecting effects of colonization, race, sex and gender,” notes Claire.

This is why people like her are so important — Claire recognizes that there’s a lot about the state of maternal health that needs to change.

“Our families deserve Indigenous midwifery care that meets all their health needs, our people deserve access to health care in a place where they feel safe and respected, where they will be listened to and their concerns taken seriously.”

Thankfully, Claire found a way to actively work towards that change – she became a registered midwife who specifically caters to Indigenous women.

Claire Dion-Fletcher receiving the Iewirokwas Cape Award for Midwifery Heroes from the Toronto Birth Centre on February 16. Photo via Ryerson University.

But she does much more than deliver babies.Claire holds several other positions that help propel her mission forward.

She sits on the core leadership of the National Aboriginal Council of Midwives, where she works on several projects to expand Indigenous midwifery and enhance midwifery education. She also supports increased access to culturally safe educational opportunities through her role as an Aboriginal student coordinator at the Ryerson Midwifery Education Program, which is also where she got her midwifery certificate.

And Claire’s constantly researching decolonized health care and Indigenous midwifery, too. One of her most interesting findings so far is the unique approach that Indigenous midwives bring to health care.

“Indigenous midwifery provides clinically excellent care that incorporates an Indigenous understanding of health and world view,” writes Claire.

Ultimately her mission is to recover Indigenous practices while trying to improve overall health and wellbeing of Indigenous people and fight against the ongoing impacts of colonization and assimilation.

Photo by Claire Dion Fletcher @cgdionfletch

And Claire and the National Aboriginal Council of Midwives share another important goal — to have at least one Aboriginal midwife in each Aboriginal community.

That’s why she lobbies for the expansion of Indigenous content in university programs and the growth of Indigenous midwifery in Ontario.

“I see all of these as a part of Indigenous midwifery and part of our responsibility as Indigenous midwives to serve our communities,” she notes.

Since she’s involved  with so many projects, it’s impressive that Claire finds the energy to keep up her work, but the strength and resiliency of her Indigenous clients help her stay motivated.

And her goal for the future of Indigenous health care in Canada is a powerful motivator as well.

She wants to help build a health care system that is focused on the clients, in order to meet the needs of the people actually using the system. She also wants to make Indigenous midwifery is more accessible, and make it easier for Indigenous people to become midwives themselves.

To achieve this, she will keep lobbying for a fairer health care system and increased recognition for Indigenous midwifery. She hopes her research will also provide her with more tools to improve the situation and spread information about the most pressing issues associated with Indigenous health today.

There’s still a long way to go before we see the necessary changes in place, but with people like Claire in the mix, the chances are good that they’ll happen a lot sooner.

Tilde Holm co-authored this post with Ally Hirschlag.

What Can I Tell You About Uganda?

What do you know about Uganda? I asked myself while booking my flight to Entebbe. That was two months ago.

I have been working for the Swedish Organization for Global Health for almost 2 years now and involved in the evaluation of our project on maternal and newborn health in Uganda (Mama & Family Project) for more than year. I should know a lot.

But, knowing a place based on paper, other people’s experience, and Google is not really knowing a place. The only way to truly know about a country and its culture is to experience them for yourself.

As my plane took off, ideas and images swirled in my head, some based on pictures I had seen and some creations of my imagination. I was excited and open to the challenge of truly discovering the country and the work. I had a smile on my face when I landed. Ready to learn! I thought to myself.

Geographically, Uganda is located on the Central East part of the African continent. It is surrounded by many countries, Kenya, Tanzania, South Sudan, Rwanda and Democratic Republic of Congo. Though not located on a coast, Uganda has a great source of water, Late Victoria – the biggest tropical lake on earth. However, this is information that you could easily find on Google. What can I tell you about Uganda that you cannot find out yourself on the internet?

I can tell you about ‘You’re Welcome!’ – the phrase I heard the most during my time in Iganga, a small city located around 3 hours east of Entebbe. ‘You’re welcome!’, not as a response to my ‘thank you’, but as ‘Hello, we are happy to have you here’. I immediately felt at home in a place I had never been before with people I had never met. This is what Uganda felt to me: welcoming.

Scientists, who didn’t know me at all, welcomed me at their amazing research facility of infectious diseases in Entebbe. The UDHA team welcomed me when I arrived at the office the next day. Fancy, a midwife of the Mama & Family Project, welcomed me at the Maina Clinic. The women in the villages I visited welcomed my excited soul and shy presence. 

SOGH Mama & Family Team. Photo Credit: SOGH

What else is Uganda (at least for me)? Uganda is red sand, everywhere. The sand gets into your shoes, into the tiny space between your glasses lenses and frame, even into your ears. But that color… That color just captured me. I was in love, I am in love with it. The warm feeling of the sun on the skin, a warm hug, that was, is, the red sand for me.

What would I miss the most about this place? You’re welcome, the red sand and for sure the people… Moses, Jarius, Sumaya, Fariba, John, Sulaiman, Tabisa, Rose, Zainabu, Olivia, Fancy, Sarah, Betty, the waitress at Smile and Dine, the nurse at the hospital, Joffrey, and many more. All the people I had met contributed to our work, not just by telling me about menstrual health in Uganda but also by giving me the opportunity to understand the culture and their country.

Menstrual health is a social issue because it doesn’t concern just health, but also education, infrastructures, culture and beliefs. Menstrual health is the kind of topic that needs cultural insight for true understanding.

What else is Iganga? Iganga is animals running around everywhere, chips from a street vendor, houses painted with coca cola commercials, music from a local band, water bottles, slow internet, car rides, ‘jumping’ roads, great driving skills, kids’ ‘hello, bye’, kids, kids and kids, walks, old men and checkers, becoming a ‘latrine pro’, slow pace, smiles and high dreams, collaboration, community and women, communities of women.

All bright and beautiful? No. Uganda is a low-middle income country. There is poverty, garbage piles, issues with sanitation, a high maternal and child mortality, malaria and other infectious diseases. However, many people already know about these issues. So, yes difficulties are there, but there is much more beyond those difficulties. Uganda is not the difficulties it faces, but the communities of people who rise up against them. Uganda is the community spirit of ‘going ahead, all together’.

Together we rise.

You’re welcome.

See you very soon, Uganda!

Sex Doesn’t Stop During Emergencies

So where’s the sexual and reproductive health in emergency response?

Millions of people around the world have been displaced from their homes this year. They are running from natural disasters – hurricanes, mudslides, floods, wildfires, drought – and some that are at least partially man-made – violence, famine, epidemics. As these crises continue to increase in frequency and severity, we must be prepared.

When an emergency occurs, aid agencies spring into action, providing clean water, food, and temporary shelter to those who are affected. Some may also provide urgent medical care, treating physical injuries caused by the disaster. These efforts are obviously critical, and must continue – but they are not enough.

After an earthquake levelled villages and caused an avalanche on Mount Everest in Nepal, killing nearly 9,000 people and injuring more than 20,000, CARE was one of the agencies to respond. Our team found that most of the health clinics in the area had been destroyed, and pregnant women had no choice but to give birth out in the open without sanitary equipment, qualified birth attendants, or private facilities. This was dangerous and distressing to everyone involved, and it could have been prevented.

The United Nations Population Fund (UNFPA) has shared many stories illustrating the horrific circumstances currently facing women and girls – especially pregnant ones – in emergency settings, from Nepal to Nigeria to the Democratic Republic of Congo. We know that over two-thirds of preventable maternal deaths happen in fragile and conflict-affected countries. We also know that sex happens every day, everywhere, and that incidents of gender-based violence tend to increase after disasters and during armed conflict.

We know that family planning saves lives, and if everyone who wanted to use contraception could do so, an estimated 104,000 maternal deaths could be averted each year. So, if we know all of this, why isn’t more being done to prioritize sexual and reproductive health during emergencies?  

Fortunately, the tide is turning. The Inter-Agency Working Group on Reproductive Health in Crises (IAWG) has been working to expand access to quality sexual and reproductive health services for people affected by conflict and natural disaster. CARE and other members of IAWG helped to develop the Minimum Initial Service Package (MISP) – a set of priority activities for first-responders to help protect women and girls at the onset of a humanitarian emergency – including basic sexual and reproductive health services, comprehensive family planning, gender-based violence response, and HIV/AIDS treatment.

At this year’s Family Planning 2020 Summit in London, governments of the UK, Canada, Netherlands, Denmark, and Australia committed to put resources toward improving sexual and reproductive health services in crisis settings. These are exciting developments, and we know they will make a big difference in the lives of women and girls living in these difficult circumstances.

At CARE, we have seen the need firsthand. Through our Supporting Access to Family Planning and Post Abortion Care (SAFPAC) program, we have helped more than a quarter of a million women in crisis-affected countries to prevent unwanted pregnancies and deaths from unsafe abortion. We provide assistance, training, and medical supplies to health facilities and partner with governments to ensure implementation of MISP activities in established communities and camp settings. We also help to create opportunities where community members (including adolescents and young people) and health providers can discuss challenges and generate mutually-acceptable solutions.

The impact of these efforts is meaningful – contraceptive use in SAFPAC regions of Chad (Moyen Chari and Logone Oriental) has risen to over twice the rates of the rest of the country (11% vs. 5%). In Djibouti, the government was so impressed by the increase in family planning use in two SAFPAC-served refugee camps that they adopted the approach in health facilities around the country.

The need is vast, but fortunately feasible solutions have already been developed. Sex does not stop in emergencies, and neither does pregnancy. Women and girls must have access to comprehensive sexual and reproductive health services, including family planning, wherever they are. When these services aren’t available during a humanitarian emergency, vulnerable people face increased risks with fewer lifelines, too often with deadly consequences.

For more on this issue, visit the UNFPA website. For more on CARE’s SAFPAC program, visit