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.

Marianna’s Birth Story: respect and unconditional love

This is a story about feeling respected and secure. It is a birth story about having a supportive partner and about loving your child unconditionally. In this episode Marianna shares her very positive and empowering story about giving birth despite it being prolonged and an infection complicating things.

“Oh my goodness you are so ugly. He looked so swollen!”


The Positive Birth Story Podcast features empowering & positive stories about birth. Swedish midwife Åsa Holstein shares her in-depth knowledge of birth and speaks to brave women who share their personal stories. This is a podcast with women for women about the super power that resides in all of us. Find all episodes of The Positive Birth Story Podcast here.

The Venezuelan Babies Being Born Stateless in Colombia

In 2016 alone, Venezuela’s infant mortality rose by 30% and maternal mortality by 65%. Back then, the situation in Venezuela wasn’t as dire as it is now. Because of the current economic crisis, women in Venezuela don’t have access to the healthcare or supplies they need to give birth safely and raise their babies.

Hospitals are running low on doctors and medicine. For example, the Jose Manuel de los Rios Children’s Hospital in Caracas lost 20% of its medical staff in just two years as 68 of its doctors fled the country between 2016 and 2018. Many women don’t have access to diapers, milk and formula. In some cases women are also too malnourished to breastfeed their babies.

Knowing this, it’s not surprising that many pregnant women are leaving the country to give birth. So far, the UN Refugee Agency estimates that 2.4 million Venezuelans have left their country for other Latin American nations. Their most common destinations are Colombia, Peru, Ecuador, Argentina, Chile and Brazil, in that order. While the latter countries grant citizenship to everyone born in their territories; the situation in Colombia is different.

In Cúcuta, Colombia, a city located near the border between Colombia and Venezuela, medical authorities indicate that there are now more Venezuelan women giving birth than Colombian women. Out of the 554 babies born in medical institutions in Cúcuta in September 2018, 353 (64%) have Venezuelan mothers.

Colombian legislation states that children, even when born in Colombia, cannot have Colombian nationality if their parents aren’t Colombian or don’t have a legal migrant status in the country. This applies to the babies being born of Venezuelan women who don’t have official refugee status yet.

Venezuelan citizens are currently struggling to acquire passports, which leads to impediments and difficulties to process a visa or asylum request. The lack of documentation also presents an obstacle for these mothers to register their babies as Venezuelan citizens in the Venezuelan consulates in Colombia because they can’t prove their own nationality.

These babies are stuck being stateless until their parents can register them in a Venezuelan consulate.

Not having a national identity and legal attachment to a country means having no government protection, and no access to certain benefits and rights.

The Colombian government is looking for solutions to this problem, but in the meantime there is a risk of having an ‘invisible generation’ of Venezuelans who do not legally exist in any country.

This is one of the many consequences of the Venezuelan refugee crisis that countries in Latin America need to address to reduce the vulnerability of Venezuelans.

Mothers are leaving their country to ensure their babies are born somewhere they can live safely, but without a nationality they are stuck in migration limbo.

Teenage Girls in Argentina Deserve Better

As multilateral organizations continue to research sexual and reproductive rights in Latin America, I’ve been learning many sad truths about my country.

This year, we learned that Argentina’s teenage pregnancy rates are the highest in the Southern Cone (Brazil, Argentina, Chile, and Uruguay). It’s estimated that 109,000 teenagers and 3,000 girls under 15 years old give birth to a child every year. These numbers make up 15% of annual births in the country.

Most of these pregnancies are unplanned and unwanted. UNFPA’s latest study, The Power of Choice, shows that Argentina’s maternal mortality rates are also much higher than in the rest of this region. For every 100,000 births per country, 52 mothers die in Argentina, 44 in Brazil, 22 in Chile and 15 in Uruguay.

The results of this study have strengthened the call for inclusive sexual education, accessible contraceptives and the decriminalization of abortion in Argentina. 

Adolescent maternity rates are higher in communities living in poverty, where girls are also less likely to go to school or have access to healthcare and contraceptives. When a girl gets pregnant at an early age, she’s very unlikely to continue her studies, which perpetuates a circle of poverty for the girl and her family. She’s also less likely to survive the pregnancy and the birth.

Earlier this month, a 13-year-old girl had a baby in the Chaco province in northeast Argentina, where poverty and early maternity rates are among the highest in the country (according to UNICEF more than half of children under 17 years old in Chaco were living in poverty in 2016).

Her name has been kept secret, but her living conditions have shocked the country. She was malnourished, anaemic and had pneumonia, yet never received treatment for any of these conditions. She was living with an older man, her boyfriend, and wasn’t going to school.

When her 20-year-old aunt took her to the hospital for a fever, they discovered she was 28 weeks pregnant. The fact that this girl was pregnant for 7 months without knowing it…it’s hard to imagine how neglected she was. She had to have a C-section because of her extremely weak condition. The baby lived only a few hours, and the girl died less than a week later.

So many things went wrong for her.

The health system in the province went beyond failing her, because it didn’t even know she existed until it was too late. She didn’t have family to take care of her and the system did nothing. Her health was gravely deteriorating and the system did nothing. She was in an abusive situation and the system did nothing.

Her story breaks my heart. And it hurts me even more to know that she’s not the only one living like this and won’t be the last to end up like this. She deserved better. All of them deserve better. 

Forget the ‘Mommy Wars’ – Breastfeeding Inequality is the Real Issue

Too many heated words and firey tweets are being spent on the breastfeeding ‘mommy war’. It needs to stop.

Whether or not a well-educated and well-off mother chooses to breastfeed is not the big issue. The real problem – one impacting tens of thousands of lives – is breastfeeding inequality. Too many mothers are NOT getting equal opportunity to breastfeed.

Did you know that in the US, breastfeeding rates vary wildly from state to state? In Louisiana, 57% of infants are ever breastfed. In California, it’s 93%. That’s a huge difference.

It’s no surprise that Louisiana is one of the poorest states while California is one of the wealthiest. In fact, socioeconomic forces drastically affect breastfeeding rates. This visual guide by WeTheParents brings the shocking reality of breastfeeding inequality into focus.

Women born into socioeconomic hardship tend to have lower family income, lower level of education, and lower breastfeeding rates.

It’s not fair for the baby or the mother.

Some of the reasons for reduced breastfeeding are:

  • Less access to paid maternity leave
  • Lower paid jobs that are less likely to allow for pumping breaks
  • Inadequate maternity and lactation support in hospital
  • Less effective family and community support
  • A culture that doesn’t treat breastfeeding as a desirable status symbol (in contrast to the ‘crunchy mommies’).

The problem is intensified because babies born into conditions of hardship are less likely to receive adequate healthcare, parental involvement, and nutritious supplementary food once weaning begins.

This means that the babies who would benefit most from breastmilk are the ones least likely to get it.

Mothers Unite

This week is World Breastfeeding Week organized by World Alliance for Breastfeeding Action (WABA). It is the perfect opportunity to begin reframing the debate.

The mommy wars are a distraction. Let’s not waste valuable energy debating whether or not a well-off, middle-class mother is right to breastfeed her child. Yes, breast is best, but it’s likely her child will get a good start in life either way.

Mothers, let’s all come together and fight for breastfeeding equality. Surely we can all agree, that if a woman wants to breastfeed, she should be given the best possible chance to do so. The fact that less well-off mothers often don’t have the same knowledge or opportunities to breastfeed their babies is simply not right.

Instead of dividing along tribal lines, let’s unite and push for all mothers to have the same access to breastfeeding information, support, and workplace lactation programmes. It’s this that will really drive up breastfeeding rates and improve health outcomes for mothers and babies.

And so, the next time you find yourself caught up in breastfeeding guerrilla warfare taking place within the comments section of some blog, remember the real issue: breastfeeding inequality.

Neve is a mother of two, writer and breastfeeding advocate. You can find her trying to simplify parenting and empower new moms to meet their breastfeeding goals over at her blog WeTheParents.

 

The Amazing Reason Mothers in India are Giving their Babies Wearable Medical Records

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

When Ruchit Nagar’s parents moved to Houston, Texas, in the late 1980s, they had no idea their son would grow up to save children’s lives in their home country of India.

Then again, it wasn’t exactly a total surprise, though, as their son had been interested in global health from a young age. Nagar had loved biology in high school, so he volunteered in American hospitals to learn more about the healthcare system. Later, he went on global health mission trips to Honduras and Ecuador, where he spent time working in a research laboratory at a government-run hospital.

But it was while he was in college, studying at the Yale Center for Engineering Innovation and Design, that he learned a startling truth. 1.5 million children die from vaccine-preventable diseases every year and an estimated 9.5 million infants worldwide still don’t have routine immunization services. Despite how critical these vaccines are, this “vaccination gap” still exists.

Nagar quickly realized that it wasn’t just an issue of access, either. Poor record keeping was making the problem much worse.

An agricultural community in Udaipur, India. Photo credit: Wikimedia Commons/TeshTesh

Maintaining immunization data in developing countries is a difficult task. Healthcare workers usually collect and store the information manually in paper log books, which means searching through all that data by hand. Couple that with how often families lose their medical documents and you can see what obstacles providers are up against.

That’s why, after Nagar’s professors asked the question: “What can you do to address the world’s vaccination gap?”, he and a group of other students came up with a business plan that could help address the vaccination gap, while helping healthcare workers too.

This led them to launch a nonprofit called Khushi Baby to help monitor the health care of mothers and children in India.

Khushi Baby (which translates to “Happy Baby” in Hindi) created a culturally-symbolic necklace that also happens to contain their full medical history.It’s a digital, battery-free, waterproof data storage device. In other words, it allows people to literally wear their medical records.

In order to access those medical files, healthcare workers in rural villages just need to scan the necklace with the help of the smartphone Khushi Baby app.

Photo credit: Khushi Baby

So, in a way, this invention is like a child’s medical passport, as well as a visual reminder for mothers to get their babies vaccinated on time.

The team hopes that when mothers and their babies wear their Khushi Baby pendant in the village, it might also start a conversation among mothers who may not be attending health camps regularly. And since Khushi Baby services include voice call reminders in the local dialect, the team is also hopeful that more mothers will plan checkups and vaccinations ahead of time.

Hopefully, this easy-to-use technology will help bridge the healthcare gap that exists between developing nations and the rest of the world.

“I have a reason to get out of bed every morning because I truly believe that what we are doing has the potential to make a difference to improve maternal and child healthcare for those who may otherwise be forgotten,” says Ruchit.

Digitizing vaccination data makes treating patients much easier, and, since the technology is relatively low-cost, it’s accessible even in low-income areas.

But Khushi Baby is about more than access to vaccines. It’s also about giving health workers the data they need to improve their treatment programs.

The technology empowers healthcare providers by allowing them to make better decisions faster. The app’s checkup summary page helps them consolidate patient info from busy health camps, which then helps them make appropriate recommendations and offer the right kind of care.

The Khushi Baby team at work developing technology. Photo credit: Khushi Baby

“Many of our early interactions with mothers and frontline nurses in rural Udaipur [India] showed us that there was an opportunity to do things better,” says Nagar.

Monitoring data is crucial in helping countries prioritize and tailor vaccination strategies for each region. The app also comes in handy for medically-focused nonprofits because it helps them monitor the impact of their work, ensuring the success of their immunization programs.

Of course, for the Khushi Baby app to work, people have to actually use it. That’s why Nagar chose to make it a necklace.

He tapped into a cultural norm in India to get locals interested in wearing his smart device. The black thread around the necklace is traditionally worn across India to ward off buri nazar, or evil eye. It’s said to bring good health and fortune.

“By observing that children were wearing jewelry in rural Udaipur, we realized that we could slot our technology into something that was already culturally-symbolic and accepted by the communities. In doing so, it made our wearable less likely to be lost or forgotten,” he explains.

A woman in India wearing the Khushi Baby necklace. Photo credit: Khushi Baby.

So far, the Khushi Baby app is operating in over 350 villages and tracking the health of over 15,000 mothers and their babies.

And they’re not stopping there.

Khushi Baby aims to scale its impact to over 1000+ villages with a team of over 250 health workers. They hope to track the health of over 80,000 beneficiaries in the future.

Photo credit: Khushi Baby

“Closing the vaccination gap will require national and multinational resources and efforts,” says Nagar. “Our goal is to track the health of the entire district of Udaipur by 2020 and lay down the blueprint for other districts across India (and elsewhere) to replicate and scale-up.”

It’s no surprise Khushi Baby was named as one of the finalists of the GenH Challenge, which acknowledges and awards innovative solutions to worldwide health issues.

Khushi baby is on the verge of transforming lives for the better in areas that desperately need the help.

It all started with a simple but powerful idea — that everyone, no matter where they are in the world, deserves the chance to thrive. Thanks to innovators like Nagar, that possibility is closer than ever.

And with technology like this leading the way, we might someday live in a world where no mother or child is left behind.

Preeti Shakya co-authored this post with Maisha Z. Johnson.