Women recovering from the rare and most severe form of postnatal illness known as postpartum psychosis (PP) must receive enough help after being discharged from psychiatric hospital if maternal suicide rates are to improve, according to researchers from the University of Birmingham.
Postpartum psychosis is a severe and debilitating psychiatric illness which starts suddenly in the days following childbirth. Regarded by health professionals as a psychiatric emergency, symptoms include hallucinations, delusions, mania, bizarre behaviour, confusion, elation and depression. Often, it occurs ‘out of the blue’ to women with no previous psychiatric history but women with a history of bipolar disorder are at particular risk with PP episodes following around 25 per cent of deliveries.
Most women who develop PP need in-patient treatment. Without proper care and management risks include maternal accident and suicide, accidental harm to the baby and, in very rare and tragic cases, infanticide. Although the clinical prognosis is generally good, women find it can take 12 months or longer to feel fully recovered.
The recovery process itself can be long and difficult. This study, in collaboration with the University of Cardiff, aimed to gain an understanding of the difficulties that recovering women face and to help to improve information and support services.
Little is known about women’s experiences of the recovery process from postpartum psychosis. The researchers conducted in-depth interviews with women who had been treated for episodes of PP and were members of the support network known as Action on Postpartum Psychosis.
Shock and bewilderment were common among women recovering with PP, the study found. ‘The event did not make sense and was not consistent with their sense of self.’ Some women had considered the possibility of the baby blues or fatigue but had no idea it was possible to mania or psychosis following childbirth.
During recovery, women reported periods of lost time, confusion, jumbled experiences, emotions and images, for example: ‘I didn’t want anyone to be close to me….you know…which is quite wrong, cause (sic) if they could have helped me, it would have helped me to get better.’
The results, published in Archives of Women’s Mental Health, revealed that PP is a life-changing experiences that challenges women’s sense of personal and social identity. Recovery included ruminating and rationalising, rebuilding social confidence, having health service support and help with family functioning, finding out information and understanding that recovery takes time.
Women suggested they would have benefited from one to one contact with fellow sufferers and that ‘health professionals must be encouraged to consider the particular needs of new mothers, their infants and the critical timing in the relationship’ Women admitted to units without their baby reported distress and anger about the separation and low confidence about taking over the mothering role on discharge, the authors reported.
Lead author Dr Jessica Heron, Research Fellow in Maternal Mental Health at the University of Birmingham, comments: ‘Postpartum Psychosis can devastate families. Information about how to recover – or even that full recovery is possible - has been hard to come by. This research – conducted by women who have themselves experienced the illness - will help health professionals better understand the condition and support women in their recovery. We hope that information will help women feel less isolated by the experience and realise that there are others out there who have recovered fully and have a happy normal family life.
‘We are extremely fortunate in Birmingham to have an excellent Mother & Baby Unit, specialising in treating women with such severe forms of postnatal mental illness. Many other areas of the country are not so lucky and women can be admitted without their babies to general psychiatric wards – which can be either single or mixed sex. We know from this study and others that we have conducted – that this separation in the early weeks of new motherhood can be incredibly distressing have a devastating impact for the speed of women’s recovery.
‘This situation needs addressing urgently as suicide is still one of the leading causes of maternal death in the UK.’
* Information and support needs during recovery from Postpartum Psychosis
For more information, please contact Jenni Ameghino, University of Birmingham Press Office, 0121 415 8134. Mobile: 07768924156.
Notes to editors
- National Mental Health Awareness Week runs from May 21-27, 2012
The journal article is free for all to access during mental health awareness week
- Dr Jessica Heron is available for interview. Please contact the press office to arrange.
- Naomi & Andrea are women who have experienced PP and are available for interview.
- Action on Postpartum Psychosis (APP) is a network of over 500 women throughout the UK who have experienced PP. Set up by Dr Jessica Heron & Dr Ian Jones, it is run by academics from the Universities of Birmingham and Cardiff and by sufferers themselves.
- APP has received a big lottery grant this year to create a central information resource for women with this severe frm of postnatal illness and set up a peer support network so that women who have recovered can support recovering women.