Over the past two months, I’ve seen a surprisingly high rate of postpartum psychosis among my patients – 6%, which is almost six times the rate reported in medical studies. I’ve never encountered such a concentration of cases. Sadly, many people only learn about postpartum psychosis when they read about a tragic event in the news. We need to start talking about how to prevent these tragedies, both through better medical care and by changing laws, before it’s too late.
About half of women who experience postpartum psychosis have never had a mental health condition before. This rare condition affects less than 1% of new mothers and has been linked to a roughly 4% risk of harming their baby and a 5% risk of suicide. While still uncommon, a recent large study showed an increase in diagnoses between 2016 and 2019.
For a long time, postpartum psychosis has been primarily associated with bipolar disorder. However, recent research indicates that other mental health conditions, like anxiety, may also increase the risk. As Medical Director of a program supporting mothers’ mental health across Massachusetts, I’m seeing more healthcare providers express concerns about psychosis or mania in pregnant and postpartum patients, which aligns with these findings.
Severe sleep loss is a significant danger – it’s no coincidence that depriving someone of sleep has historically been used as torture. I once worked with a mother who was so incredibly tired and stressed that, during a Zoom session, she accidentally tried to feed her baby’s bottle into his ear. She would also wake up repeatedly checking if her baby was still breathing. By the time she needed hospital care, her mental state had been declining for weeks, but it wasn’t always obvious. Often, the early signs of serious problems can seem surprisingly normal.
Psychosis involves a loss of touch with reality, and its symptoms can come and go. This is particularly concerning in mothers because they might seem perfectly fine – happy, capable, and functioning normally – which can mask the severity of their condition. A mother experiencing psychosis may have rapidly changing thoughts and feelings, even within a single hour. She could believe others would intervene if they knew she was considering harming herself or her baby, yet still be compelled to act on harmful thoughts driven by internal voices, sometimes while feeling unable to ask for help. Sadly, we often only learn about these situations after something tragic has already happened, usually through media reports.
Thinking about my own experience as a mother of three children born close together helps me understand what my patients go through. Even with a lot of support from my husband, family, and friends, the extreme tiredness after childbirth was incredibly challenging. The difference between my experience and my patients’ wasn’t a lack of effort or love, but rather a complex mix of biological, emotional, and societal factors that we’re still learning about.
As a movie buff, I always think about timing, and when it comes to mental health around having a baby, the timing is way off. It’s shocking to learn that most issues – about two-thirds – actually start before the baby arrives. A third happen even before someone is trying to get pregnant, another third during pregnancy, and only the last third after birth. That means waiting until the standard six-week checkup is often too late to really help. What we should be doing is identifying women who might be at risk – looking at their history with mental health and family history, planning for medication if needed, and emphasizing the importance of sleep – all before delivery. Ideally, we’d connect with them even when they’re thinking about starting a family. There are three key ways to make this happen, and we really need to focus on them.
Healthcare providers who work with new moms – like pediatricians, doulas, and therapists – are in a unique position to identify early challenges because they see mothers frequently during the first month after birth, even more so than OB/GYNs. To help them effectively support these mothers, we need to give them standardized screening methods and clear procedures for connecting patients with needed resources, rather than simply raising awareness.
It really does take a community to help someone struggling with their mental health. Family, friends, and neighbors are usually the first to recognize when something isn’t right. They need clear, simple information about the early signs of psychosis – things like increased irritability, confusion, or paranoia, especially when combined with a lack of sleep – and they need to know exactly who to contact for help.
It’s time for a nationwide campaign to raise awareness about issues like postpartum depression. Kriti Lodha, who has personally experienced this, explained that her family wasn’t prepared for her postpartum psychosis and felt let down by the system – just as she did. She emphasized that quick treatment is crucial to prevent lasting harm, and we need to ensure all healthcare professionals and caregivers are properly equipped to help.
As a huge movie buff, I’m always fascinated by how effective programs can be scaled up – and it’s really encouraging to see that happening with mental healthcare! There are these access programs designed to strengthen psychiatric care resources, and the Massachusetts Child Psychiatry Access Program (MCPAP) is kind of the gold standard. It was even highlighted in a White House report on maternal health back in 2022, and now they’re using it as a template in almost thirty other states. That’s fantastic news for getting moms the mental health support they deserve.
I’ve collaborated with senators, lawmakers, and advocates – inspired by groups like the Massachusetts Mind the Gap Coalition – to push for changes in Massachusetts law. The goal is to treat postpartum psychosis as a medical issue instead of a criminal one. Punishment should be for those who commit crimes, not individuals struggling with illness. Postpartum psychosis fundamentally affects a mother’s understanding of reality, and we need other states to adopt similar approaches.
Postpartum psychosis can affect any new mother, no matter her background. While we understand the condition and are learning more about who might be vulnerable, and have the resources to help, a critical sense of urgency is missing – and these mothers need immediate support.
2026-07-21 13:06