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Tuesday, December 6, 2011

Childbirth and Postpartum Psychosis



Having a baby is supposed to be one of the happiest times of your life. But for some women, childbirth can be the trigger that causes them to temporarily 'lose their minds'.
Every year, about 1,000 women in the UK suffer from what is called postpartum psychosis. Most of them will need several weeks in hospital to help them recover but, because of the stigma of mental illness, it is not often talked about.
When I gave birth to my baby daughter Ettie, I was absolutely elated. But this elation soon turned into a form of mania - non-stop talking, an inability to sleep, an exhausting energy - all of which were unnatural and unsustainable.
I became very irritable, suffering from extreme mood swings and hallucinations. I was admitted to a psychiatric hospital for several weeks.
That period in my life was not one I discussed readily with anyone. It was so far from most people's experience of new motherhood and because of the stigma of mental illness that exists in our society, I felt slightly ashamed.
Would people want to associate with a "crazy person"? Might they think I was "a bad mother"?
It took me a few years to get over that feeling and it is only recently that I have had the opportunity to meet other women who have also suffered from postpartum or puerperal psychosis.
Sharing stories was a liberating experience and prompted us to become involved in a Wellcome-funded project to publicise the illness and tackle the stigma that hinders recovery.
The project is called Unravelling Eve. It was conceived by artist Joan Molloy, an artist and mother of two whose work has focused on themes of family, memory and time.
I helped to run a workshop where Joan met a group of women who had all had postpartum psychosis, to hear what the experience had been like for them.
For the first time, these women were able to talk about the terrible impact of the illness.
Tracy spoke of her terrifying hallucinations: "I thought I'd given birth to the anti-Christ and my child, I believed, had little devils living inside his stomach which would come out at night and dance around my kitchen floor."
Some spoke of suicidal thoughts and being convinced that their babies would be better off without them.
For some it also took a long while to get better. "I felt like a zombie for at least a year or two", says Ceri. "I can't remember how long I was on anti-psychotics for - obviously the drugs saved my life, but my goodness they take a while to recover from."
With treatment each of these women recovered, but it was a life-changing experience for them all.
So why does it happen to some new mothers?
Joan and I went to see Dr Ian Jones of Cardiff University, a perinatal psychiatrist and expert on the condition.
He explained: "When we're talking about postpartum psychosis, we're talking about some of the most severe episodes of illness we see in psychiatry."
"These are women who very quickly after childbirth have an episode triggered that may involve lots of different mood symptoms.
"They often have psychotic symptoms, delusions, believing things that aren't true, or hallucinations... seeing things or hearing things when nothing's there."
Tragically, if the symptoms are not recognised in time, in rare cases this can result in suicide or, very rarely, infanticide.
The causes of postpartum psychosis are unclear, though we do know that genetic factors are important. You are more likely to have postpartum psychosis if a close relative has had it.
Changes in hormone levels and disrupted sleep patterns may also be involved.
More research is needed, so we have set up a new charity called Action on Postpartum Psychosis (APP) to raise awareness and support women and their partners who feel isolated.
For many women with postpartum psychosis there is no warning, but if you have bipolar disorder you are at considerably greater risk, so it is wise to find out about postpartum psychosis and prepare yourself just in case.
Due to a shortage of specialist beds, many women will have to be admitted to a general psychiatric hospital, usually without their baby.
But some parts of the country are lucky enough to have specialist mother and baby units where women can keep their newborns with them for the weeks or months it takes to recover.
We visited the oldest of these, the Channi Kumar Unit at the Bethlem Royal Hospital, south London.
They support the mother in developing a relationship with her infant in order to reduce the impact of the illness on the child.
Mothers and babies can stay together or the mothers can stay on their own with a gradual reintroduction to their babies on the ward.
The average length of inpatient treatment is eight to 12 weeks, and staff encourage the involvement of fathers or partners in the treatment process.
Perinatal psychiatrist Dr Trudi Seneviratne says their aim is to prepare mothers for a lasting return to the community.
"One of the joys of working in a unit like this is that women do get better", she says. BBC.