As a reproductive psychiatrist, one of the most heartbreaking and misunderstood conditions I see is postpartum psychosis. When high-profile cases make headlines, it can create a lot of fear and confusion for everyone, including new and expectant parents. But here's the thing: postpartum psychosis is rare, temporary, and highly treatable with the right care. The problem is, that care can be really hard to access, unreliable and misinformed. This highlights the need for reproductive or perinatal psychiatrists to guide the treatment of this condition and how we can work together to change the landscape of psychiatric care for mothers.
First, let's be clear about what postpartum psychosis is and isn't. Postpartum psychosis IS a psychiatric emergency. This is one of the most important things I want you to know from reading this article. If someone you know is experiencing concerning symptoms it needs to be addressed immediately. Postpartum psychosis involves a break from reality and most commonly will show up shortly after childbirth. It's characterized by delusions (irrational beliefs), hallucinations (seeing or hearing things that aren't there), and rapid mood swings. It also can have a “waxing and waning course” where the person experiencing psychosis can be “normal” at certain times or in some aspects like making meals but still be deeply disconnected from reality. Postpartum psychosis is unique in this way and this can lead to many people being missed, misdiagnosed, or dismissed.
Postpartum psychosis is different from the "baby blues," which are mild, common, and resolves on it’s own within two weeks. It's also different from postpartum depression, which involves prolonged sadness, exhaustion, or a parents difficulty being able to manage caring for themselves or baby.
And crucially, it's different from postpartum OCD, which can involve terrifying intrusive thoughts but does NOT involve a break from reality. In fact, people with postpartum OCD are usually horrified by their thoughts precisely because they know they aren't rational.
Postpartum psychosis is being discussed in the media as “rare,” but in reality calling something that occurs in about 1 to 2 out of every 1,000 births “rare” doesn’t sit quite right with me. With the number of deliveries that occur this can be thousands of people each year.
While over 40% of cases happen in people with no prior mental health history, there are some key risk factors:
Symptoms of postpartum psychosis usually emerge within the first two weeks after delivery and can change rapidly from hour to hour. Key warning signs include:
Here's the good news: postpartum psychosis is temporary and treatable. Because it's a medical emergency, immediate evaluation and usually hospitalization is necessary. Treatment typically involves antipsychotic medication and mood stabilizers, along with a lot of support for the family.
With proper care, the vast majority of people with postpartum psychosis recover completely.
So if postpartum psychosis is treatable, why aren't more people getting the care they need? There are a few key barriers:
Lack of screening. The traditional postpartum care model involves one check-up at six weeks. But postpartum psychosis usually emerges much earlier, within the first two weeks. We're missing that critical window. Even at the 6 week checkup this should be included and I don’t know that it is. I remember at my postpartum visit many years ago my screening consisted of my doctor asking me “you’re not depressed, are you?” So I know first hand exactly how inconsistently this recommendation is being applied.
Stigma and fear. The fear of being judged or even losing custody of their baby can prevent parents from speaking up when they start to notice warning signs. In an ideal world psychiatric care would be treated without stigma and moms would be taken seriously.
Shortage of specialized care. We have a nationwide shortage of reproductive psychiatrists and inpatient mother-baby units equipped to handle postpartum psychiatric emergencies. This shortage is due to many systemic issues.These systemic issues have real consequences. Untreated perinatal mood and anxiety disorders are estimated to cost the U.S. $14 billion per birth cohort due to lost productivity, health complications, and delayed care.
If you or someone you know is showing signs of postpartum psychosis, it's crucial to act fast:
Postpartum psychosis is scary and should be treated like an emergency. However, with the right care, full recovery is possible. The bigger issue is making sure that care is accessible to every parent who needs it and each person feels they can be taken seriously and treated with kindness, respect and dignity as they seek treatment.
As a society, we need to do better. We need universal postpartum depression, anxiety and psychosis screening. We need more reproductive psychiatrists and more inpatient mother-baby psychiatric units. We need policies that support families and break down barriers to care. We need to address systemic issues that prevent people from wanting to seek care.
But most of all, we need to talk about it. We need to normalize these conversations so that no parent feels alone or afraid to ask for help.
If you're struggling, please know that you're not alone and it's not your fault. Reach out. There is help and there is hope.
Ready to talk to someone? I'm here to listen without judgment and help you get the care you need. Call Reproductive Psychiatry and Counseling at (512) 982-4116 or visit rpcaustin.com to schedule an appointment. We see patients in-person in Austin or virtually throughout Texas.
Written By: Grace Rao, LMSW If you carry the burden of perfectionism in parenting, know that you are not alone, but in the company of caregivers trying their best all over the world. Fortunately, science shows that parenting mistakes are not only inevitable, but actually helpful and necessary in building a strong parent-child connection and resilient kids!
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