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Postpartum Psychosis: What to Watch For

At 37, Erin turned to in vitro fertilization to become pregnant with her second child. Her son was nearly a teenager by this time, and Erin desperately wanted to have another baby before she turned 40. Everything - pregnancy, delivery, breastfeeding, etc. - had gone smoothly with her son, and despite being over 35, Erin’s second pregnancy had gone smoothly as well. A baby girl was born without complications and she was healthy and beautiful. She took to breastfeeding just fine and everything seemed right with the world.

But very soon, things began to change for Erin. She began to feel extremely anxious; worried something would happen to the baby. Although most new parents check on their sleeping babies with concern, Erin attempted to rearrange everyone’s sleep schedule so that someone could be awake at all hours to stand over the baby and ensure that she was breathing. When this failed, she refused to sleep, watching over her baby like a guard or a hawk. She paced to stay awake and her thoughts began to race. She soon imagined that her milk was somehow poisonous for her new infant. Although her loved ones tried to reassure her that this was untrue, she became obsessed with the idea, and weaned her nursing baby after only three weeks.

Soon, the baby’s crying became too much for Erin, and she began to disconnect. It occurred to her that her child’s suffering was her fault and the only way to remedy the pain was to end her baby’s life. She believed that if she did this, she’d have to end her own life too, because what mother could live with herself after killing her baby? And if she killed herself and the baby, she’d have to also kill her son because she could not leave him to suffer the pain of her suicide and the death of his baby sister; it would be too cruel.

This was the illogic of Erin’s psychosis - postpartum psychosis. Although no one around her understood it at the time, certainly not Erin.

Prevalence and Connection to Bipolar Disorder

Postpartum psychosis (PPP) occurs approximately one or two times in every 1,000 births. This rate becomes 100 times higher in women with bipolar disorder or with a previous history of PPP. Those women who have family members with bipolar disorder also experience a heightened risk, as well as those with schizophrenia or family members with schizophrenia, although to a lesser extent than with bipolar illness.


The majority of women who experience postpartum psychosis are unaware of the symptoms leading to the condition beforehand, or may simply become too ill, too quickly to help themselves. This is why it is very important that all adult members of expecting families - immediate and otherwise - know what the signs are so that they may be prepared to act in the event that postpartum psychosis arises in a new mother.

From mild to severe the symptoms are:

  • Inability to sleep
  • Depressed mood or irritability
  • Confusion
  • Mania
  • Paranoia
  • Delusions or hallucinations

Hallucinations involve seeing things that aren’t there. Delusions include bizarre beliefs that only the individual can understand and are frequently religious in nature; a new mother with postpartum psychosis may believe that her child is bound for hell and that she must save him, or that God has a special plan for her child that may include bizarre details.

It is not uncommon for women experiencing PPP to have delusions of harming their babies or themselves. This does not indicate that these women are bad people; they are very sick. But there is treatment. Postpartum psychosis, like its mates - postpartum depression and postpartum anxiety - waxes and wanes. A woman experiencing serious delusions may become alternately clear-minded and seek help. Other women may be too ashamed or simply too sick to seek help. Agreeing to a family plan of action in the event of PPP while still expecting is a good idea.


A new mother experiencing PPP will need a medical and psychological evaluation to rule out possible other causes of her condition. Once this happens and a diagnosis of postpartum psychosis has been established, medications combined with therapy is generally the most efficacious strategy of response. Cognitive behavioral therapy, or talk therapy, may be suggested as well as check-in visits from clinical professionals. There are support groups, both in person and online which may be beneficial to new mothers experiencing the pain of PPP symptoms.

When a new baby is first expected, family and friends would do well to know the signs and symptoms of postpartum psychosis. Recognizing that the diagnosis is separate from the mother who may have it is also important; she is still the woman you knew before her delivery. Reaching out and speaking up is key. You may be wrong, but it would be better to make an uncomfortable mistake than to risk saying nothing when the life of a child and mother may be at stake.

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