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.

Breaking the Taboo: Sex During Pregnancy

Phew, maybe you’re thinking…this girl gets straight to the point! And it’s true, because in this blog I want to talk about sexuality both during pregnancy and afterwards once the baby arrives. I have noticed that sex is kind of an awkward subject for women to talk about during appointments with their midwife. But why is that?

We all know how people get pregnant, so why can’t we talk about it? After all, research shows us that many women experience problems with sex during and after pregnancy.

At the moment I am a first year midwifery student in Rotterdam, in the Netherlands. My first year of study is all about the physiology of pregnancy. I believe my studies and future job as a midwife are privileges, and I think that it’s an honour to be a part of such life changing events for women, and to be able to offer them support.

To continue on the subject of sexuality, maybe you’re thinking to yourself – what kind of problems could there be? The most common problems during pregnancy are generally a belly which is in the way, back pain or other pain in the body, feeling unattractive or feeling scared of hurting the baby. After delivery, women can struggle with the healing after a rupture, vaginal dryness, low sex drive and tiredness – because with a newborn baby you’re awake a lot during the night! And sometimes, with so many changes taking place in their bodies, women can feel unattractive or worry that their partners don’t find them as attractive as they did before.

The main message I have for any women who are worried is that it’s okay to have sex during pregnancy! You can try different positions and find what works and feels best for you at different stages of your pregnancy. There are only some specific circumstances when it’s not smart to have sex or an orgasm, for example, if you’re experiencing blood loss or suffer from severe varicose veins. It’s also not a good idea when your water breaks, as it could threaten premature birth, or when the placenta is located before the exit of the uterus.

Finally! Your little baby is there. What happens now? My advice here would be to take the time your body needs to heal! It has just accomplished an incredible thing, and will need to recover. The first time you have sex after giving birth can be exciting. Start carefully, take your time and consider using lubricant to make things easier.

Of course, if you experience regular or intense pain during sex at any point of pregnancy or after childbirth, make an appointment to talk to your midwife or doctor. They will be able to help you, give you tips and hopefully put your mind at ease. And if that is a too big step for you, try researching using reliable websites online until you feel more ready to talk to someone in person.

10 Things That Happened to Me After Childbirth

Warning: this post contains lots of details around bleeding, toilet visits and sex after childbirth. 

The postpartum period (the time after childbirth) is a time that is often described as a baby-bubble – where all the focus is on cosying up with your new little human as the rest of the world kind of disappears. Throughout my first pregnancy, I didn’t think too much about the time after birth – with only one session with my midwife and one parental class to prepare for breastfeeding. I was not fully prepared for what was going to come – and perhaps I could never be prepared enough – but there were a few things that happened to me, my body and my baby that I wish I had known before giving birth. I am not writing this post to ‘scare’ you, but to help prepare you, at least a bit, for what can happen in those first few days and months after birth.

1. You can’t plan your childbirth

I had written up a birth plan and really thought through what I did and didn’t want during childbirth. I had read about different methods of pain relief and had opted for a natural birth. I was looking forward to handling the pain with a warm bath, using gravity to speed up labor and get into a zen zone during birth. However, despite my greatest efforts to avoid medication and medical intervention, I ended up with morphine in a hospital bed and a room full of midwives and doctors when my daughter was born with the help of a vacuum. You can read my full story here.

Although you may not be able to plan your childbirth, you can prepare by reading up on your options and thinking through different scenarios. It’s important to keep an open mind and to have an environment where you feel safe. If things don’t go as you had hoped or expected, demand to talk to your midwife or doctor about it.

2. Postpartum breastfeeding pain – not in your breasts!

After birth your uterus needs to start contracting again to pull together and stop bleeding. Breastfeeding is a natural way to help speed up a woman’s recovery after childbirth – which is fantastic! However, the pain of postpartum uterine contractions during those first latches at the hospital and during the first few days, was not expected. I needed pain relief during my first breastfeeding sessions in the first week after childbirth.

3. Your first toilet visits can be a nightmare

After popping out a baby from your vagina, having to pee or poop can be very scary. The only thing you don’t want to do is to put any more pressure on your open wound and it may feel like you are on the verge of turning inside out! Holding a pad to relieve the pressure can help you as you relieve yourself. This does pass, quicker than you may think when you’re sitting on the toilet seat in fear after delivery.

4. You bleed, and you may bleed a LOT

I bled a lot – although not more than what’s ‘normal’. At the hospital I was given unrestricted access to huge pads that barely fit in a pair of regular panties, and despite the size of these diaper-like beauties, I still left stains in the hospital bed 30 hours after birth. The bleeding escalates during those postpartum uterine contractions, so when you get up after breastfeeding those first times, be ready for the flood. However, this too does decline and eventually turns into a brownish mucus in the weeks after birth, to end at around 5-6 weeks postpartum.

One week after giving birth I was beginning to feel better. My blood pressure had been incredibly low and my energy levels limited my movement to staying inside for the most part (although I did walk home from the hospital… what on earth was I thinking?!). However, on that Thursday I called the hospital in a state of worry after a bathroom visit when my vagina had just handed me a ball of thick blood – the size of a golf ball. “Oh, that’s just coagulated blood. That’s completely normal,” the midwife on the other end of the phone told me. So, how come I was not aware of any of this normalcy?

5. You may wake up in a huge puddle of breastmilk

I was ready for my breasts to swell up and to become hard as stone in that third or fourth day after birth when the milk starts it’s high-level production. The body is amazing. I was not ready to wake up in the morning with aching and leaking breasts and notice that I was soaked in breastmilk. Neither was I ready for the power of my breasts to squirt a TV-screen from 1,5 meters away when my newborn stopped latching. There were several other lessons that I learned about breastfeeding, but this was definitely one of the most surprising.

Want to know more about the difficulties of breastfeeding? This is a great article on The Guardian.

6. You still can’t wear your pre-pregnancy clothes

Although this may be a small problem, it was a major concern for me. I was looking forward to getting into my pre-pregnancy wardrobe and pampering myself with a bigger range of clothes to wear, to feel fresh and comfortable in my new life as a mother. I hadn’t thought so much about how everything I was going to wear had to be breastfeeding friendly. You need clothes that can zip up, button down, or be lifted up to reveal your nipples for your little one to nurse. Also, you may still not fit into those favorite jeans, and may need to continue wearing maternity tights to comfortably sit and breastfeed your baby. When you’re in a hormonal haze and sleep deprived there are little things that make a big difference, so prepare yourself with some items that make YOU feel like YOU.

7. Getting “back” to your pre-pregnancy body may never happen

While we are on that subject, your baby-belly doesn’t just disappear and your body changes in ways you wouldn’t expect. I was incredibly comfortable in my body when I was pregnant – I felt gorgeous. I had not expected that it would be so difficult to embrace my post-pregnancy self – which isn’t so strange given that women’s bodies are constantly objectified everywhere we look. With time I am accepting my stretch-marks and my saggy skin and now that I’m in my second pregnancy, I’m just utterly in awe of my body and what it can do! I believe that that feeling will continue into this second postpartum period, as I am more prepared of what awaits me. Expect your body to change and be grateful for it.

8. Sex can hurt

After pregnancy and childbirth sex might be the last thing on you mind, but eventually intimacy with your loved one is something that you miss – as there is a baby sucking out most of the energy from you. And once you feel ready to have sex again it will most probably not feel the same, especially if you have scarred tissue. Thankfully there are many ways to be intimate. Take your time and talk about it with your partner. If you have prolonged problems speak to your midwife about it! This too should pass.

9. You may lose your hair – lots of it

After about 4 months postpartum I started losing hair. My fluffy pregnancy hair suddenly disappeared and I was afraid I was balding for good. Not only did my hair fall out in clumps, the texture of my hair definitely changed. And come to think of it – my skin also changed. I’ve never ever had as dry skin as I had that winter after birth, trying to remedy my body with coconut oil with no result.

10. Not all babies get into a routine

My baby was a great sleeper in the first 3 months, then became a mega-eater and non-sleeper at 4 months. Just when I felt that we were getting the hang of things, my baby changed and so did her mood. I found out about The Wonder Weeks (which deserves it’s own blog post!), which helped me understand her development and be humble to the changes in her little life.

There are several other realities about the time after childbirth which I was fortunately spared from. For the most part you just don’t know what may happen and it is good to be aware of what can take place to prepare as much as possible and be aware of any serious symptoms. The good thing is that these things too shall pass and here I am in my third trimester with my second baby trying to prepare again for childbirth and the upcoming baby bubble.

Read more posts on Girls’ Globe about the postpartum period: