Postpartum Psychosis Care Staff Guide: Recognising an Emergency

Postpartum psychosis is a serious mental illness that can start soon after a woman gives birth. It is rare, but it is a medical emergency, and it can develop very quickly. Anyone who works in health, social care, supported housing or community services may meet a new mother who is showing early signs, and knowing what to look for, and what to do, can protect both mother and baby.

This guide summarises NHS information on postpartum psychosis and explains how care staff can recognise it, escalate quickly and support recovery. It does not replace the advice of a GP, midwife, health visitor or perinatal mental health team.

What is postpartum psychosis?

The NHS describes postpartum psychosis, also called puerperal or postnatal psychosis, as a serious mental illness that affects around 1 in 1,000 mothers. It is very different from the "baby blues", which are mild mood changes after birth. Symptoms usually begin suddenly, often within hours or days of the birth and almost always within the first two weeks, although in rare cases they appear several weeks later.

Symptoms to recognise

According to the NHS, symptoms can include:

• Hallucinations: seeing, hearing, smelling or feeling things that are not there.
• Delusions: fixed beliefs or suspicions that are unlikely to be true.
• Mania: feeling overactive, talking or thinking very fast, or losing normal inhibitions.
• Low mood: depression, withdrawal, tearfulness, low energy, loss of appetite, anxiety, agitation or sleep problems.
• Mixed or rapidly changing moods.
• Marked confusion.

The person may not realise she is ill. That is why partners, family, friends and professionals sometimes need to act on her behalf. If you notice any of these signs in a woman who has recently had a baby, treat it as urgent. For general background on the condition, see our guide to psychosis and schizophrenia.

Who is at higher risk?

The NHS lists these higher-risk groups: women with an existing diagnosis of bipolar disorder or schizophrenia, women with a family history of mental illness (especially postpartum psychosis), and women who have had postpartum psychosis after a previous pregnancy. Our guide to bipolar disorder explains one of the conditions that raises risk. Women in these groups should have a plan in place during pregnancy, so if you support someone who is expecting and has one of these histories, check that a plan exists and that the right professionals know.

Why it is an emergency

The NHS states that postpartum psychosis can worsen quickly and may put the mother and baby at risk. Early action matters. The NHS advises:

• See a GP immediately and ask for an urgent, same-day assessment.
• Call NHS 111 if you cannot reach a GP or do not know what to do.
• Contact the midwife or health visitor, who can help arrange care.
• If the woman already has a care plan because she is assessed as high risk, call her crisis team.
• Go to A&E or call 999 if she or anyone else may be in imminent danger.

If you are worried about thoughts of suicide or harm to the baby, follow your organisation's emergency and safeguarding procedures at once. Our guide to suicide and self-harm awareness explains how to respond.

Treatment

The NHS explains that treatment usually takes place in hospital, ideally in a mother and baby unit so that the baby can stay with the mother. If no such unit is available, a general psychiatric ward may be used. Medicines may include antipsychotics, mood stabilisers such as lithium, and antidepressants. Electroconvulsive therapy may be recommended if other treatments have failed or the situation is life-threatening. Cognitive behavioural therapy may help later in recovery, and peer support from people with lived experience can be valuable.

Recovery

The NHS says the most severe symptoms usually last between two and twelve weeks, and that full recovery can take six to twelve months or longer. Most women make a full recovery with the right treatment. Depression, anxiety, low confidence or difficulty bonding with the baby can follow an episode, so ongoing emotional support matters. The NHS notes that many women go on to have more children; there is about a 1 in 2 chance of another episode after a future pregnancy, but early help and planned interventions can reduce the risk.

Supporting families and partners

The NHS suggests that family and partners be calm, supportive and good listeners, help with housework, cooking, shopping and childcare including night feeds, help the mother get as much sleep as possible, keep the home calm and quiet, and limit visitors. Partners and relatives need support too, and the charity Action on Postpartum Psychosis provides it for dads, co-parents and grandparents. If you work with families, signpost them and treat them with respect. Avoid blame; postpartum psychosis is an illness, not a failing.

Good practice for care staff

• Know the early warning signs and treat sudden changes in a new mother as urgent.
• Record exactly what you saw and heard, with dates and times, and share it with the clinicians involved.
• Use calm, clear, non-judgemental language, and do not argue with delusional beliefs.
• Think about the baby's safety as well as the mother's, and follow safeguarding procedures.
• Keep information confidential, sharing only what is needed with the right professionals.

Training and professional development

Recognising rare but urgent conditions is part of safe practice. Record what you learn in your CPD log, reflect on scenarios with your supervisor, and explore our CPD resources for care staff for more.

Frequently asked questions

How is postpartum psychosis different from postnatal depression?

Postnatal depression is a depressive illness; postpartum psychosis involves symptoms such as hallucinations, delusions, mania or confusion and usually begins suddenly within days of birth. The NHS treats it as an emergency.

Can a woman with postpartum psychosis stay with her baby?

The NHS says treatment is ideally in a mother and baby unit so the baby can stay with the mother.

Will it happen again?

The NHS says there is about a 1 in 2 chance of another episode after a future pregnancy, but early help and planned interventions can reduce the risk.

This article draws on the NHS postpartum psychosis page (last reviewed October 2023).