This toolkit is a draft for antenatal educators and is for public and professional consultation. Please send feedback and comments to: antenatal@app-network.org.
Please check back regularly for updates and final resources.

“This campaign is a response to the voices of lived experience - the pleas that parents and their families have made - "if only I had known something... I would have been able to call for help sooner" or "I wouldn't have been so afraid of what was happening to my partner / daughter / sister / friend..."  Naomi, peer supporter

Covered in this toolkit:

 

In this toolkit we discuss the reasons we don’t often talk about PP and look at some of the reasons we should. We outline the things that women & families wished they’d known about PP before it happened, and share ideas from women, partners and antenatal educators about how we can talk to expectant parents about PP in a balanced and non-scary way.

Why talk about PP with expectant parents

“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 5 minutes dedicated to it would be wonderful.” Eve

  • Suicide is the LEADING cause of maternal death in the UK

The UK government has committed to halving maternal deaths by 2030. To make this a reality, we must do more to prevent mental health related deaths.

  • PP is not as ‘rare’ as you think

While it’s not as common as the baby blues or postnatal depression, as far as serious, life-threatening complications of childbirth go, PP is one of the most common. PP affects 1-2 in every 1000 deliveries – an average size maternity hospital would see around 8 cases each year.

  • Expectant couples don’t know about PP

Most women and partners who use APP’s services had not heard of PP before they developed it. This delayed help-seeking and contributed to their shock, denial and the trauma experienced.

  • PP can affect ANYONE

Some women are at risk due to previous bipolar or PP – for these women careful management plans can be put in place. BUT… PP affects women from all backgrounds, classes and cultures equally. Around half of women who develop PP have no history of mental illness.

  • Seeking help fast saves lives

Delayed care risks the safety of mother and baby. Delays cause longer, more severe and difficult to treat episodes, causing greater trauma. Due to the nature of the illness, partners are best placed to identify symptoms early – but few partners know what to look out for.

  • Talking about PP doesn’t have to be scary

Whilst the idea of any pregnancy complication is concerning, we should not pretend these don’t happen. Arming expectant couples with information about the chances, risk factors, signs to look out for, and the help available could be life-saving. Some of the fear surrounding the illness comes from the stigma. Presenting the facts, talking about the help now available in the UK, and sharing the knowledge that people recover helps to address this stigma.

  • Women and partners wished they’d known about PP

Women and partners say that if only they’d known about PP, they could have identified symptoms quicker, sought help faster, and been spared some of the trauma they experienced.

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’.

A 2021 YouGov survey for APP found that only 6% of expectant parents were given information about postpartum psychosis at their antenatal class.

Plus, in 2022, we surveyed midwives and antenatal education providers about whether they talk about PP. Whilst 88% felt PP should be covered in antenatal classes, only 48% said they regularly covered it.

This needs to change. We know that rapid access to care reduces the risks of PP for mother and baby and can be life-saving.

We asked what the barriers might be to talking openly about PP in antenatal classes. This is what midwives and antenatal educator providers say - in order of importance:

  • I have limited time.
  • I don’t feel that I know enough to talk about the topic.
  • I don’t want to scare people.
  • I have never thought about mentioning it
What do expectant parents need to know?

“I am a qualified midwife and I had postpartum psychosis after my 5th 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

Women, partners and professionals suggest all that is needed is a 3-5 minute conversation covering:

  • What PP is
  • How likely it is
  • What symptoms to look out for
  • Who is at risk
  • How to get help
  • You will recover

Below are all the facts you need for this quick, potentially life-saving, conversation:

  • Postpartum psychosis (PP) is an emergency. Women normally need admission to a Mother and Baby Unit (MBU) for specialist care – ideally ‘same day’ care within 4 hours of identifying symptoms.
  • Postpartum psychosis is treatable. It can be a frightening experience, but women recover.
  • PP is rare, unless you have bipolar or had a previous episode of PP, affecting 1-2 in every 1000 births – but it can happen to anyone.
  • Symptoms can include elation (high mood) or depression, difficulty sleeping, confusion, anxiety, strange beliefs, hallucinations (seeing, hearing, feeling or smelling things that are not there) and unusual behaviour.
  • Symptoms usually begin in the 2 weeks after birth, and can get worse very quickly or escalate gradually.
  • To get help, contact your GP, midwife, mental health crisis service, or NHS 111 urgently, stating that you are concerned you/your partner is developing postpartum psychosis. If you think there is imminent danger, call 999.
  • You can find out more about the illness and get support by visiting app-network.org

“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

Downloadable resources

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

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 funded by The Baish Memorial Fund, in memory of Alex Baish. APP would like to thank Richard, 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.