A Psychologist Explains The Scary Link Between Pregnancy And Psychosis

Pregnancy is a life-changing experience for most women, radically affecting both their bodies and minds. During this time, mothers face a bombardment of rapid and extreme physical changes, coupled with immense hormonal transformations. While some women breeze through the process—glowing and basking in the glory of impending motherhood—for others, pregnancy can be a grueling ordeal.

Very sadly, for some mothers, the horrors of pregnancy do not end after the 40 weeks of gestation. The postpartum period is a precarious time for women, marked by a significant risk of decline in mental well-being. While many people are familiar with mental postpartum complications—such as postpartum depression, anxiety or even rage—there is a small percentage of mothers who experience something far worse: postpartum psychosis.

What Is “Postpartum Psychosis”?

According to a 2018 study from the Eastern Journal of Medicine, the postpartum period is an incredibly risky time for mothers, during which they are 22 times more likely to experience psychotic or manic breakdowns. The authors define postpartum psychosis as an exceptionally rare and severe postpartum psychiatric disorder, affecting between 0.1–0.2% of new mothers.

Several aspects of pregnancy and the postpartum period are hypothesized to contribute to the onset of postpartum psychosis. These risk factors include:

• Primiparity. Being a first-time mother.
• Puerperal hormone changes. Significant hormonal fluctuations after childbirth.
• Sleep deprivation. Severe lack of sleep, which can exacerbate mental health issues.
• Pregnancy/postpartum complications. These include factors like environmental stress, complications during delivery (e.g. traumatic birth, miscarriage, stillbirth, etc.) or congenital malformations of the baby.
• Comorbidities with other psychiatric disorders. For example, the presence of bipolar disorder increases the likelihood of developing postpartum psychosis from 25–50%. Similarly, the onset of postpartum psychosis has been linked to 40–80% of mothers consequently developing bipolar disorder.

The experience of postpartum psychosis can vary greatly from one mother to the next, but there are several common symptoms that have been identified. These include insomnia, mood changes, as well as obsessive, uncontrollable and often irrational thoughts centered around their baby’s well-being. However, after the manifestation of these symptoms, more severe symptoms may emerge:

• Delusions. Strongly held false beliefs, often of a paranoid nature.
• Hallucinations. Seeing, hearing or feeling things that are not present.
• Disorganized behavior. Inability to organize thoughts or actions coherently.
• Psychomotor agitation. Increased physical movement and activity driven by mental tension.
• Food rejection. Refusal to eat, often due to delusions or severe anxiety.
• Delirium. Acute confusion and impaired awareness.
• Severe mood changes. Extreme fluctuations in mood, ranging from euphoria or mania to severe depression—or mixed episodes.
• Catatonia. A state of unresponsiveness or unusual physical rigidity.

By ignoring, downplaying or failing to recognize any combination of these symptoms, mothers can quickly become a great risk to both their babies and themselves.

What Does “Postpartum Psychosis” Look Like?

To visualize the extremity and dangers of unbridled postpartum psychosis, consider a case study posed in the journal of Treatment in Psychiatry. It depicts Mrs. A, a 34-year-old mother, three weeks after giving birth to her son, B. Living with her husband and their 5-year-old daughter, Mrs. A had a planned and healthy pregnancy, although she experienced some depression at 28 weeks’ gestation. Her delivery was normal, and she began breastfeeding immediately.

From postpartum days 2 through 11, Mrs. A’s depression worsened. She struggled with severe insomnia, found it difficult to get out of bed and could not attend to her hygiene. She became increasingly suspicious and fearful that her husband might harm their baby. On day 2, she began having distressing and intrusive thoughts about throwing her baby out of the window, and that her breast milk was harming him too. She was met with reassurance from her pediatrician.

By day 12, her mental state had deteriorated further. She contemplated harming herself and her baby, and eventually attempted suicide by overdose. Although she survived, she did not inform anyone about her attempt. As her condition worsened, she became disorganized and confused, particularly about feeding B. She was severely agitated, and she sought constant reassurance from friends regarding formula, bottles and diapers.

On day 15, Mrs. A attempted to smother B, but stopped herself upon hearing her husband arriving home. She claimed that she did not feel compelled to harm B after that evening, but her mental state remained fragile. Despite her husband noticing she was not herself, he did not realize the severity of her condition. She did not seek nor receive treatment following this event.

Tragically, on day 20, Mrs. A experienced a severe psychotic episode. She felt as though she was in a daze, describing it as being “taken over” by an uncontrollable force. In this state, she suffocated B, ultimately killing him. Thereafter, she attempted to end her own life, but her attempt was unsuccessful. After her episode and the death of her baby, Mrs. A was later charged with homicide and incarcerated.

The Bottom Line

The postpartum period is a critical time for mothers, who are both immensely at-risk and often overlooked. Despite the immense challenges they face, women are often told from a young age that hardship—whether it be suffering through caregiving, menstruation, pregnancy or postpartum difficulties—is simply part of “what it means to be a woman.” This egregious myth leads many women to internalize their complications and concerns, no matter how severe.

This dangerous mindset, combined with recent findings highlighting women’s significant dissatisfaction with available postpartum professional services, can have dire consequences for both mothers and their families. Without a support system, early intervention or healthcare professionals who take women’s experiences seriously, helpless mothers can tragically become criminals in the blink of an eye—when in reality, they’re simply victims of circumstances beyond their control.

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