“This campaign is a direct response to the voices of the thousands of families APP have supported in the aftermath of postpartum psychosis. These families know that antenatal education will prevent others going through the trauma they have all experienced due to lack of knowledge about postpartum psychosis and how to ask for help.” - Naomi, Campaigns and Policy Coordinator
Covered in this toolkit:
Why is it important for antenatal educators to talk about PP?
- Seeking help for PP quickly can save lives
Postpartum psychosis is a severe postnatal mental illness with symptoms that often escalate very quickly. Parents who do not know about PP may not feel comfortable talking to health professionals about their concerns, and delay seeking help. Delays in accessing urgent care can lead to suicide and (in extremely rare cases) harm to a baby or other family members. Shockingly, suicide is still the leading cause of maternal death in the UK in the first year after birth. Whilst loss of life due to postpartum psychosis in the UK has decreased since APP was founded, there are still too many foreseeable and preventable deaths with a devastating impact on families.
“Postpartum psychosis isn’t a term commonly found in the first-time dad handbook – I’d never heard of it, anyway… I had no idea that it was what Laura was going through until she was acutely unwell and suicidal.” - Hugo, APP ambassador
- PP is not as rare as you might think
While it’s not as common as the baby blues or postnatal depression, PP affects 1-2 women per 1000 deliveries. This is more common than other life-threatening complications such as sepsis (0.4/1000 deliveries) and eclampsia (0.5/1000 deliveries). An average sized maternity hospital would see around 8 cases of PP each year - 1400 across the UK. There can be a misconception that only women with a history of significant mental health problems are at risk of PP, but in fact about 50% of cases of PP happen ‘out of the blue’.
- PP can affect anyone
PP can affect anyone regardless of ethnicity, social support or physical health. It is not possible to know which women will be affected by PP - half of those who develop PP have no history of mental health difficulties. As an antenatal educator, you can reassure expectant parents that PP is uncommon, but arm them with the vital information they need if they see early symptoms - in the same way as you would discuss the warning signs of sepsis or eclampsia.
- The majority of expectant parents have no knowledge of PP
Most families who use APP’s services had never heard of PP before they experienced it. PP often causes women to lose insight into unusual behaviour they may be exhibiting, meaning that their partner or family members may be the first to notice that something doesn’t seem right. If families don’t know about the early signs of PP, or that urgent treatment is needed they may hope that symptoms will go away on their own, misinterpret symptoms as ‘baby blues’ or minimise their concerns when speaking to health professionals due to stigma or fear that their baby could be taken away.
“I am a qualified midwife and I had postpartum psychosis after my fifth baby. I knew the signs and symptoms but being unwell myself, I could not be responsible for getting care as I was so unwell. However my husband did not know the signs, symptoms or even what PP was. To think that I could have been supported and helped a lot sooner if more information was available is heartbreaking given my experience.” - Emily
New parents Jade and Naumaan share their powerful stories of the difference antenatal education on PP would have made to them.
Why don’t we talk about PP?
Many physical health problems are discussed at antenatal classes, but when it comes to perinatal mental health, we often only talk about postnatal depression and the ‘baby blues’.
- I have limited time.
- I don’t feel that I know enough to talk about the topic.
- I don’t want to scare people.
- Those at risk will already be in specialist perinatal services.
- I have never thought about mentioning it.
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What do expectant parents need to know?
“We need PP to be mentioned in antenatal classes. We went to all of them and not a whisper. Then I had my son, spent 6 weeks with mania and was admitted to a Mother and Baby Unit, terrified. Husband terrified. It doesn't need to be discussed in detail, but five minutes dedicated to it would be wonderful.” - Eve
Talking about PP doesn't have to be scary
We know that thinking about any complications of pregnancy and birth can worry expectant parents. However, the message we always hear from families who have experienced PP is that they just wish they had known it could happen. Often the word ‘psychosis’ itself can carry a lot of stigma and misperception, and many people do not know that psychosis is different from depression. Families we support tell us that a short overview of symptoms in understandable language, where to get urgent help, and reassurance that there are effective treatments enabling full recovery would be all they needed.
“It can literally take as little as 5 mins to facilitate and should be built into the wider discussions around PND, partner mental health, birth trauma and signposting. I always included it in my antenatal sessions.” - Midwife
Below are 5 key facts for a brief 3-5 minute conversation about postpartum psychosis:
1. Postpartum psychosis is an emergency - don’t be afraid to seek help immediately if you are at all concerned.
2. PP is not a common postnatal mental illness - but it can happen to anyone. (There is a higher risk for women with a diagnosis of bipolar disorder, or who have had PP before).
3. Symptoms are noticeably different from postnatal depression or the ‘baby blues’ and usually develop quickly in the first 2-3 weeks after birth. Look out for:
- Feeling unusually high or energetic
- Difficulty sleeping
- Confusion
- Intense anxiety, withdrawal from others or feeling paranoid
- Strange beliefs
- Hallucinations (seeing, hearing, feeling or smelling things that are not there)
- Behaviour that seems out of character
You can also signpost expectant parents to our detailed information on symptoms of PP.
4. PP is often a very frightening experience but with the right treatment you can fully recover. The best place to have treatment is in a specialist hospital called a Mother & Baby Unit (MBU). In an MBU, partners and other children can visit throughout the day, spend time as a family and support with baby care.
5. To get help, contact any health professional immediately. Call your midwife, health visitor, GP, NHS mental health crisis line or NHS 111 straight away - tell them that you are concerned that a new mother may have postpartum psychosis and you need an urgent assessment. It’s OK to say to the health professional that postpartum psychosis can get worse very quickly and can be dangerous if they do not offer a same-day assessment. If you think there is imminent danger, call 999.
Midwife Marley shares how to talk to expectant parents about Postpartum Psychosis in this helpful two minute video.
You can find out more about the illness and get support by visiting app-network.org
Free resources to download
We’ve created some resources here that you can print out and use - just click on the image or title to be taken through to the full PDF.
To find out more about APP’s training offer, click here.
| Flyers for expectant parents | Information for antenatal educators |
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Postpartum psychosis signs and symptoms
- free printed A4 posters available
Our postpartum psychosis signs and symptoms graphic is available as an A4 printed or downloadable poster.
If you could display one in your maternity hospital, GP surgery, mother and baby group, Mother and Baby Unit, or perinatal mental health clinic, please get in touch.
We can send you up to 10 posters free but if you feel you could support us to cover the cost of postage you can donate here.
Thanks
This resource has been developed by Action on Postpartum Psychosis (Dr Jessica Heron, Dr Sally Wilson, Naomi Gilbert, Jessie Hunt, Felicity Lambert and Lucy Nichol.)
The campaign is is supported by fundraising in memory of Alex Baish. APP would like to thank Richard Baish, his friends and family for their bravery, commitment and energy supporting this campaign – and for lending their voice to help us show the importance of this campaign.