Postpartum Psychosis: What New Parents Need to Know

Our whole lives, we’re told that having a baby is supposed to be a magical and wonderful experience. But what if you’re not delighted to be with your new baby? What if you’re actually a bit miserable and feel like you could be losing your mind, as you struggle through wild, intrusive thoughts, and a rollercoaster of emotions that have you questioning your capacity to care for yourself or your new baby?

First of all, you’re not alone. Postpartum mood disturbances are the most common issues that people encounter after having a baby, impacting up to 85% of birthing people. In the first few months, when you're navigating sleep deprivation, hormonal adjustments, relationship changes, and devoting every last bit of physical and emotional energy to keeping a tiny human alive, it’s understandable that you may feel kind of miserable. However, when volatile emotions and distressing thoughts about self-harm or harm to your baby begin to emerge, it can feel especially alarming.

Understanding the various symptoms of perinatal and postpartum mental health conditions can feel overwhelming, especially when you have concerns about postpartum psychosis. If you or your family members have any concerns about your mental health, it's best to speak with a qualified healthcare professional to discuss your concerns. In the meantime, this guide to postpartum psychosis can give you a better idea of the nature of this condition and when not to worry.

Perinatal Mental Health & Intrusive thoughts

Perinatal mental health disorders describe a group of mental health conditions that can impact anyone during pregnancy and postpartum, up to a year after giving birth. As a group, they are very common, impacting 1 in 5 people after birth. That said, some individual conditions, like postpartum psychosis, occur very rarely.

Perinatal mental health conditions include:

• Postpartum Depression (PPD)
• Postpartum Anxiety (PPA)
• Postpartum Obsessive Compulsive Disorder (PPOCD)
• Postpartum Post-Traumatic Stress Disorder (PPTSD)
• Bipolar Disorder
• Postpartum Psychosis (PPP)

While conditions like depression or anxiety can occur at any point in a person’s life, circumstances during pregnancy and postpartum make this a particularly vulnerable time for them to develop or worsen.

Symptoms of perinatal mental health disorders include:

• Feelings of sadness or depression
• Irritability and anger
• Difficulty bonding with your baby
• Anxiety and worry
• Difficulties eating or sleeping
• Upsetting and unwanted thoughts
• Feelings of “craziness” or being “out of control”
• Regret over becoming a parent

Perinatal mood and anxiety disorders present with a variety of distressing feelings and concerns, with symptoms ranging from mild to severe, and often including intrusive thoughts.

Intrusive thoughts are disturbing and unwanted thoughts that can include imagining harmful things happening to your baby — or situations in which you harm your baby. These thoughts are common, impacting around a half of all new birthing parents, and can understandably leave you wondering if something is "seriously wrong" with you. In the vast majority of cases, the answer is a reassuring "no."

Do intrusive thoughts mean I am psychotic?

Dr. Sarah Oreck, a reproductive psychiatrist and medical advisor for Origin who’s worked with countless postpartum birthing parents assures her patients that it’s very common for birthing parents to visualize harming their babies, sometimes in incredibly violent ways, like drowning them in the bathtub or even stabbing them. “We all experience intrusive thoughts”, Dr. Oreck explains. “When we’re in our baseline and doing well, we can easily discard those as like ‘Oh that was a weird thought, but that’s not who I am.’ Intrusive thoughts actually go against everything we believe in and want for ourselves and our loved ones. Your thoughts are not who you are.”

Intrusive thoughts go against everything we believe in and want for ourselves and our loved ones. Your thoughts are not who you are.

Oreck goes on to explain that after giving birth, the brain’s “alarm system” – the amygdala – is particularly sensitive. The hormonal shifts that happen postpartum can really leave you at risk for developing postpartum mood and anxiety disorders, and when you add extreme sleep deprivation and an overly sensitive amygdala, you can become extremely vulnerable to having these intense and concerning thoughts.

Some birthing parents, especially those that had anxiety disorders before giving birth, can develop extreme fear-based beliefs, like the belief that their baby will die if they’re not with them or that something is trying to hurt their baby. Some birthing parents even think that they’re seeing or hearing things that aren’t there. So, even if your thoughts and feelings have you questioning your sanity after giving birth, it’s very likely that you’re dealing with intrusive thoughts. That being said, there are very rare cases where birthing parents actually do experience a psychotic break after giving birth.

What is postpartum psychosis (PPP)?

One of the more extreme and rare psychiatric conditions that can be experienced in the postpartum period is known as Postpartum Psychosis (PPP). Occurring in one or two cases for every 1,000 live births, people with PPP can become delusional to the point where they lose touch with reality.

Dr. Oreck stresses that PPP goes way beyond the intrusive thoughts that many birthing parents have after giving birth. Though these intrusive thoughts can be disturbing, the very fact that the birthing parent is shocked by them means they know these thoughts aren’t in line with reality, and won’t act on them. People with PPP can’t make this distinction — they won’t feel the same sense of shock — because they’ve lost touch with reality.

“People with postpartum psychosis unfortunately are negotiating this whole different reality,” says Dr. Oreck. “So it’s not about obviously intrusive thoughts disrupting their normal thinking pattern — the whole pattern, or system is altered.”

Though people with certain psychiatric conditions, specifically schizophrenia and bipolar disorders, are at higher risk for PPP, the condition can impact any birthing parent, even those who have no history of mental health issues. Symptoms of PPP often start suddenly, usually within the first couple of months after childbirth, and can come and go. A birthing parent may seem fine one day and delusional the next. The delusions, which are often centered on a narrative about their newborn, can be accompanied by extreme paranoia, and sometimes auditory or visual hallucinations.

In addition to delusions, hallucinations, and paranoia, common symptoms of PPP include:

• Mania
• Insomnia
• Depression
• Irritability
• Extreme and/or frequent mood swings
• Extreme confusion
• Disorientation
• Depersonalization – feeling like they’re not real or they’re watching themselves from outside their bodies
• Fading in and out of consciousness

Dr. Oreck emphasized that the vast majority of people with PPP do not harm their children or themselves. That being said, the birthing parent’s delusions and alternate reality can put their babies, and other children, in danger. PPP is always a psychiatric emergency, even if the birthing parent doesn’t seem like a danger to themselves or others. The course of the condition is highly unpredictable, and early treatment is essential to the safety of parent and baby.

Understanding the symptoms of postpartum psychosis

When it comes to postpartum psychosis, the intensity of the common symptoms can be what sets this condition apart. For example, birthing parents with PPA may experience periods of mania where they feel intensely energetic, productive, and like they don’t need sleep, but a birthing parent with PPP might experience mania so intense that they feel like a literal god. Someone with PPD may feel sad, empty, or hopeless and have some intrusive thoughts about self harm and/or suicide, but someone with PPP may believe that their depression is caused by demonic possession and that killing themselves is the only solution. All new parents are irritable and have pretty big mood swings, but people with PPP may rapidly cycle through emotions and lash out at others for no apparent reason.

One of the biggest warning signs for PPP that doesn’t happen with other postpartum mood disorders is what Dr. Oreck calls “fluctuating consciousness”. “Often these patients look confused, sometimes don’t know exactly where they are or what’s going on,” Dr. Oreck explained. “Or at one point are very alert and then kind of look a little drowsy.”

If a birthing parent starts to say strange things, especially about their baby, it could be a sign that they’re struggling with PPP.

Partners, family members, and friends also need to pay close attention to what birthing parents are saying in the first few weeks postpartum. Though some birthing parents will keep their delusions to themselves for a period of time, most will eventually share their beliefs with their most trusted people. If a birthing parent starts to say strange things, especially about their baby, it could be a sign that they’re struggling with PPP.

Dr. Oreck stressed that when people with PPP share their delusions, it’s incredibly important for partners, family members, and friends to approach them with curiosity and empathy rather than dismissing their delusions or trying to convince them their delusions aren’t real. For them, the delusions are very real, and being told the opposite can feed into the delusional system and increase paranoia. Dr. Oreck suggested encouraging them to talk about their delusions with gentle questions.

When and how to get help for postpartum psychosis

Postpartum psychosis is a severe and potentially dangerous psychiatric condition, and should always be handled as a psychiatric emergency. If a birthing parent is showing signs of PPP, it’s crucial that they receive treatment as soon as possible. Here are a few things to consider:

If the birthing parents’ symptoms aren’t currently a crisis:

Dr. Oreck suggests scheduling an appointment with your obstetrician or primary care provider. Since they know you well and are familiar with your medical history, they are well-equipped to evaluate you for postpartum conditions.

One thing to understand is that many primary care providers and obstetricians aren’t very familiar with PPP. They’re trained to screen for PPD and PPA, and they know the signs and symptoms of these conditions very well. Because of this, many birthing parents with PPP get misdiagnosed as having severe PPD or PPA and are treated as if they have those diagnoses. The problem is, the medications and treatments for PPD and PPA are unlikely to work for those who have PPP. Because of this, it is important for a partner, family member, or friend to attend the appointment and explain exactly why they’re concerned about PPP rather than PPD or PPA.

If the birthing parents’ symptoms are severe:

This may look like aggression, attempts to harm themselves or someone else, or they’re talking about harming themselves or someone else – Dr. Oreck stressed that it’s important to get them to an emergency department as soon as possible.

For some people, calling a crisis hotline or an ambulance is the best bet. However, these resources may not be safe for some people, especially those who have marginalized identities. Crisis hotline workers often contact the police, who aren’t well trained to handle people undergoing mental health crises. Sometimes police will also accompany the ambulance, creating the same problematic scenario. If this is your concern, make sure the baby is safe, and drive the birthing parent to the local emergency department as soon as possible, and stay with them through the intake process.

Recovering from postpartum psychosis

Experts still aren’t sure exactly what causes PPP, but they do know that it is a serious medical condition that involves observable changes in the brain, and those affected deserve compassion and care. It’s not a sign that someone is an unfit parent or that they don’t love their baby. It’s a condition that needs immediate medical treatment, from which people can, and often do, fully recover.

In the vast majority of cases, PPP responds extremely well to treatment. “If you get the right treatment and you stay safe and your family stays safe, there is a really good chance of recovery in six months to a year,” Dr. Oreck said.

Treatment usually involves a combination of medication and intensive therapy. Mood stabilizers like Lithium, antipsychotic medications, and benzodiazepines are the most common medications prescribed for PPP. Electroconvulsive shock therapy is also effective for treating PPP, but it’s typically only used when people don’t respond to other treatments.

Many people with PPP need treatment at an inpatient facility. This can be traumatizing for a new birthing parent, especially because the U.S. doesn’t have inpatient facilities that accommodate infants as well as their sick parents. “You’re often separated from your baby, which can be really difficult,” Dr. Oreck acknowledged. “Because even those birthing parents and those new moms who have psychotic disorders in the postpartum, still feel in these moments, really attached to their baby and want to be with their baby. That separation, I have to say, even though it can be lifesaving, it can be traumatic. But what you get with those hospitalizations is safety and stabilization. Once people are out, we really see great recovery.”

Dr. Oreck added that support from family and friends is crucial during recovery from PPP, especially as the birthing parents return to their baseline. Many people who go through an episode of PPP struggle to grasp what happened, how it happened, and what it means about who they are as a person and a parent. Family and friends can help immensely by actively listening, offering kind and nonjudgmental feedback, and grounding the person in their sense of self.