Like many moms-to-be, Julie Shapiro was excited and happy when pregnant with her first daughter. The pregnancy and delivery went smoothly. After birth, Shapiro struggled with breastfeeding but talked to lactation consultants and kept trying. Still, she never figured it out and was overwhelmed — she felt like she was failing her daughter.
“It was incredibly stressful and disappointing,” Shapiro, 48, of Long Island, New York, told TODAY. “We’re all, in this day and age, conditioned to breastfeed and I was under the impression … this was what was best for my baby.”
Then Shapiro started experiences disturbing flashes of her infant daughter’s lifeless body and she worried that giving her daughter formula was poisoning her. Soon, Shapiro felt scared by her thoughts
“I was so worried somebody would take her from me or that I wouldn’t be able to care for her and something would happen to her,” she said. “I eventually started having these visions of her limp body crumbled up on the floor or hanging over the side of the chair.”
Shapiro later learned she had something called postpartum psychosis, a rare postpartum mental health condition. While it’s uncommon, postpartum psychosis represents a real mental health emergency for those experiencing it.
As awareness of postpartum depression has increased, experts started understanding that people can experience a variety of postpartum mental health conditions, including psychosis, anxiety or obsessive-compulsive disorder, for example. While postpartum psychosis symptoms can come on quickly and feel terrifying, it affects fewer people, occurring in 1 in every 1,000 new mothers, according to the Massachusetts General Hospital Center for Women’s Mental Health.
“It’s not as well-known because it’s more rare,” Dr. Stephanie McNally, an OB-GYN at Northwell Katz Institute for Women’s Health, told TODAY. “A very small percentage of women will not only have mood changes, but do have potential delusions, hallucinations and real changes, which can vary.”
- Delusions, “where that woman believes something is true, but it’s not.”
- Hallucinations, “hearing, seeing, feeling, smelling” things that are not there.
- Mania, “where their moods are so high or so, so low.”
“One of those four components really helps transition of how we’re looking for someone who (may) become psychotic,” McNally said.
Risk factors include:
- Having an underlying mood disorder, such as depression or anxiety.
- Having bipolar disorder or schizophrenia.
- Not regularly taking medications for mood disorder as prescribed.
- Having substance use issues.
While women undergo screening at various points after having a baby, there isn’t a tool that looks specifically for psychosis. The measures for depression and anxiety, including the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9, might weed out people experiencing psychosis. But in some ways postpartum psychosis can be harder to detect.
“Some of the symptoms of delusion, hallucination and mania can be very acute so you have to be very in tune,” McNally said.
Receiving treatment for postpartum psychosis remains important for both mom and baby’s well-being and to prevent people dying from suicide. According to the Centers for Disease Control and Prevention, “mental health conditions” remain a leading cause of death for women in the postpartum period. The data indicate that deaths related to mental health causes can be from suicide, overdose or poisoning. Psychosis generally requires specialized treatment, including medication and therapy.
“A lot of times they may need inpatient hospitalization and very, very close monitoring,” McNally said. “You have to do a full assessment for risk of homicide and suicide.”
McNally — who heads Northwell Health’s fourth trimester efforts to increase awareness of everything mothers face after birth — says that screening for postpartum mood disorders need to occur more often, for longer and include more than just depression. The good news? People with postpartum psychosis can find relief.
“You will get better with the appropriate treatments,” McNally said. “The more we can empower providers on that front end to identify (postpartum mood disorders) and then get appropriate treatments we can potentially help more women.”
When Shapiro started experiencing the twice-daily images of her daughter, she assumed it was postpartum depression. After three weeks of symptoms, she talked to her husband and they reached out to her doctor who connected her with a psychiatrist, who prescribed a medication.
“The doctor made me feel so much better. (He said) ‘It’s not uncommon. You’re going to be OK. Your baby is going to be OK,’” Shapiro recalled. “Knowing that someone else was in charge started the process of me becoming better. And once the medication kicked in, I was fine and able to enjoy again.”
Shapiro felt surprised that she experienced a postpartum mood disorder as she had not previously experienced depression or anxiety. After six months of the medication, she started feeling better and the psychiatrist helped wean her off of it. Shapiro had a second child without experiencing postpartum psychosis. Her daughter is now 17 and Shapiro feels grateful she received treatment and recovered. She shared her story so that others feel less alone and to offer hope.
“Our society tries to make becoming a mother so easy and beautiful and women feel like they’re failing when it doesn’t look the way they think it’s supposed to. It’s really important that women know there’s all kinds of experiences,” she said. “It’s important to know what could happen and it’s important to know if it does happen it’s going to be OK.”
This article discusses postpartum mental health. If you or someone you know is experiencing worsened mental health please call the Postpartum Support International help line at 800-944-4773 or visit https://www.postpartum.net. If crisis intervention is needed for you or someone you know at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or go to SpeakingOfSuicide.com/resources for additional resources.