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With the Supreme Court hearing a petition by a married woman for a medical termination of her 26-week pregnancy (MTP) on grounds of her postpartum psychosis, questions have arisen about this condition. The woman said she had been going through postpartum psychosis since October last year, shortly after her second pregnancy, and the medicines she was having to treat her illness were not conducive for her third pregnancy. Healthwise, does this condition disqualify a mother from bringing another life into the world and make her unfit as a care-giver and nurturer?
According to Mimansa Singh Tanwar, Clinical Psychologist, Head, School Mental Health Programme at Fortis National Mental Health Programme, postpartum psychosis happens after delivery when the mother experiences a phase of sudden disconnection with reality and may develop hallucinations or delusions. Usually, such patients have underlying mental health conditions, which pregnancy might bring to the fore.
What is postpartum psychosis and what causes it?
Postpartum psychosis is a mental health condition that can affect a woman in the first few weeks after giving birth. The symptoms can appear suddenly whereby they lose their sense of reality and may experience hallucination, delusion, mood swings and behaviour changes. It may affect the woman’s ability to get into child care immediately after pregnancy.
Any mother is at high risk of developing it if she has an underlying mental health issue or bipolar disorder but they can get into this trough even if they don’t have any history of mental illness. Sometimes, the reasons are entirely biological with pregnancy-induced hormonal changes affecting the patterns of neurotransmitters.
It is different from the more common condition called postpartum depression and the patient needs a psychiatrist and medication to see her through.
What happens in postpartum psychosis?
The patient undergoes a severe guilt syndrome. Sometimes there are extreme mood swings. Patients go through sleeplessness, become aggressive, violent or agitated and sometimes speak in a disordered or nonsensical way. They find it hard to concentrate, become paranoid and have irrational or delusional thoughts or beliefs. They usually demonstrate changes in sense perception (like smelling, hearing or seeing things that are not there) and are prone to self-harm.
Is a woman more prone to developing it after multiple pregnancies?
I don’t think there is a lot of evidence to say that but in some cases, we have seen mothers experiencing it after their second pregnancy too.
What is the line of treatment?
As a clinical psychologist, I would suggest cognitive behaviour therapy so that the patient is able to manage thoughts and moods, deal with self-blame and emotions around child care. I would work on reversing negative thought processes and restore the woman’s confidence to care for her new-born. The first phase of treatment can take weeks or months, depending on your symptoms.
Medications include antidepressants, mood stabilisers and antipsychotic medicines. In extreme cases, one would have to resort to ectroconvulsive therapy (a process that stimulates brain neurons with an electric current to treat mania, psychosis and severe depression).
What is the role of family here?
Giving the kind of support the woman requires, diverting her attention and having multiple hands to take care of the child. Symptoms of postpartum psychosis usually start to show in the first week or two after birth. But sometimes, they may take up to 12 weeks to appear. So consult a doctor the moment you see something going off the rails.
