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22 May 2019
Motherhood is meant to be “Instagram perfect”. Full of
smiles, cuddles and cute babies. But there is more to it, sometimes invisible
to the naked eye. We all hear about the physical consequences of having a baby,
but not about mental illness brought on by having babies.
Motherhood in Real-life
The Louis
Theroux documentary ‘Mothers on the Edge’ was a perfect way to start
Mental Health Awareness Week. The film depicted several women and their
families with a wide spectrum and complexity of postpartum mental illness, the
most severe being postpartum psychosis.
Huge credit to the women in ‘Mothers on the Edge’ as well as
those who followed suit in social media sharing their stories to raise
awareness and decrease stigma.
Barbara, a first-time mother who was brought into hospital
two days earlier, was confused. She told Theroux she believed her husband was
her son, which would make him her baby’s brother as well as father.
Her thoughts started racing, she couldn’t sleep and ended up
at a train station where she planned to end her life. She had no history of
mental illness before this episode. After four weeks on the mother and baby
unit, she returned to her ‘normal self’ and was discharged home. ‘Another
Christmas miracle’ as described by her treating psychiatrist.
Lisa, a mother of three, with previous episodes of postnatal
depression, developed a psychotic episode after this most recent pregnancy. Her
husband described an ‘utterly alarming’ decline in two weeks.
Lisa further explained she felt low, did not speak, did not
wash for days and believed the house was going to be invaded by killer clowns
who would rip them apart and destroy their house. ‘It was graphic what I could
see’, said Lisa.
Six months later she still feels that fear, although she no
longer believes it will happen. Although she continues to experience symptoms
of anxiety, she is now well enough to go back home after a lengthy stay at a
mother and baby unit.
Postpartum Psychosis:
the facts
Postpartum psychosis is a severe episode of mental illness
affecting one to two in every 1,000 births. It constitutes some of the most
severe forms of pregnancy-related psychiatric illness and has a clear onset,
days or weeks after childbirth.
This can happen in women with no previous psychiatric
history, like Barbara, or in around 50% of cases, those with an established
history of severe mental illness.
Women with bipolar disorder are at a particularly high risk,
with around 1 in 5 women going on to experience an episode of psychosis
following childbirth. In other cases, childbirth can trigger further bipolar
episodes.
Symptoms
during an episode are severe and can change rapidly, within hours or days. They
may include high or low mood, confusion, abnormal beliefs, and hearing or
seeing things that are not there like the documentary so powerfully illustrated.
Becoming
unwell at this time can have a huge impact on the lives of women and their
families, disrupting the relationship with the new baby. Tragically, but
rarely, episodes of illness may lead to suicide or harm to the baby.
An
episode of postpartum psychosis can last weeks to months and despite its severe
presentation, with the right treatment most women recover and go on to develop
excellent relationships with their children.
Although
response to treatment for the acute psychotic phase of illness may be
excellent, like we saw with Barbara, it is common for women to experience a more
prolonged depressive phase of illness and often a longer phase of recovery,
coming to terms with the experiencing a severe mental illness at this time.
Mother and baby units
Episodes of postpartum psychosis are often very severe and
usually require admission. The documentary showed two specialist psychiatric
units: a mother and baby unit in South London and another in Winchester where
mothers live alongside their babies.
While funding has been announced to increase the number of
mother and baby units from 17 to 21 in England, there are still no units in
Wales or Northern Ireland, and a limited number of beds available.
This means there are still women in the UK facing the
difficult decisions of having to travel hours from their homes for the
treatment they need or being admitted to a general psychiatry ward and being
separated from their baby.
The Maternal Mental Health Alliance is pressing for this
issue to be addressed through the Everyone’s Business
campaign, which calls for all women to have access to the care they
and their families need, wherever and whenever they need it.
The need for research
In the documentary, the “perfect storm” of events and
circumstance that can lead to postpartum psychosis was mentioned: hormones,
breastfeeding, sleep changes, obstetric complications, previous history and
genetics and adapting to new circumstances among them.
We still know little about what causes postpartum psychosis,
how can we predict who is going to have an episode, and more importantly, how
can we prevent it.
I am involved in one of a number of projects underway at the
University aiming to better understand the causes of postpartum psychosis and
mood disorders in pregnancy. We hope that our work will lead to better
predictions and improved treatments for women affected by these illnesses.
To help us achieve that goal, we need women who have
experienced postpartum psychosis and/or have bipolar disorder to take part in
our studies. To find out more about taking part, visit www.ncmh.info/postpartum.
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