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ARTICLEPREGNANCY

What Happens in Postpartum Psychosis and Who’s at Risk

By Erica Patino
Reviewed by Susan Ko, Ph.D.
March 29, 2023

In the first two weeks after giving birth, it’s common for people to experience “baby blues,” or a shift in their mood. They may feel anxious, have trouble sleeping, cry a lot, or have other big emotions.

For 1 in 7 birthing parents, these feelings extend past the first few weeks, which means they may be experiencing postpartum anxiety or depression. Even fewer may have a more severe mental health concern called postpartum psychosis.

Postpartum psychosis is relatively rare. It occurs in approximately 1 to 2 out of every 1,000 births, or about 0.1-0.2%, according to Postpartum Support International (PSI). But it’s important to be aware of, since it's considered a mental health emergency.

“Of all the perinatal mood and anxiety disorders, postpartum psychosis carries the biggest risk for suicide and infanticide, making awareness and support a vital part of postpartum care,” says Kelli Cavaliere, a psychotherapist in New York City, who specializes in treating postpartum mood issues. Perinatal means symptoms can happen during or after pregnancy.

What Is Postpartum Psychosis?

Postpartum psychosis is a condition that can affect one’s sense of reality. It usually starts suddenly, within the first two weeks after giving birth, but can develop any time in the first year postpartum. “While there are many symptoms that can show up, there is a general break from reality that includes hallucinations and delusions,” says Cavaliere.

Hallucinations are when people hear, see, or smell things that aren’t actually there. A delusion can mean believing something that isn’t true or real. “For example, a possible delusion is believing the baby is possessed,” adds Cavaliere.

Who’s at Higher Risk?

Postpartum psychosis can be closely tied to another mental health condition, bipolar disorder. “Someone who has experienced one episode of postpartum psychosis has a 50% to 80% chance of experiencing another severe psychiatric episode, usually within the bipolar spectrum,” says Diane Solomon, Ph.D., a psychiatric nurse practitioner and certified nurse-midwife in Portland, Oregon.

This is because psychotic symptoms, such as hallucinations and delusions, can occur in mania and severe depression, primary symptoms of the bipolar spectrum. For a person who is already predisposed to bipolar disorder, the combination of lack of sleep, hormonal shifts, and massive life change of becoming a parent can trigger a bipolar episode.

What Are the Signs of Postpartum Psychosis?

Irrational beliefs, hallucinations, and delusions set postpartum psychosis apart from other postpartum mood issues.

Other signs of postpartum psychosis can be:

  • Restlessness
  • Insomnia
  • Extreme irritability
  • Rapidly shifting mood, such as mania
  • Erratic behavior
  • Disorientation or confusion
  • Thoughts of hurting yourself or others
  • Feeling deeply depressed
  • Difficulty communicating at times

What Should I Do If I Notice Any of These Signs?

One of the most recognizable signs may be insomnia. “It’s normal to have disrupted sleep if that baby is waking up every two to three hours to feed, but the parent should be able to sleep when given the opportunity,” says Caveliere.

While mood swings are also expected—they’re only expected to a point. Notice how high the highs are and how low the lows are.

If they’re extreme, last longer than the first two weeks after birth, or interfere with your ability to function, you should contact your doctor or a mental health professional.

It can be hard to notice your own mental health when you’re dealing with the demands of a newborn. So make sure the people in your life are aware of the signs and ask them to check in with you about them.

Have people in your life ask you about how you’re sleeping and how you’ve been able to manage your mood.

“People should also ask if the parent is hearing or seeing things that aren’t actually there or having strange thoughts, thoughts of hurting themselves or the baby,” Cavaliere says. If any of these symptoms are occurring, consider this a mental health emergency. Immediately contact your doctor, and ask someone to be with you and your baby while that’s happening. People in the United States can call 988, the Suicide & Crisis Lifeline, or 911, or go to the nearest hospital.

What Are Some Other Reasons I Should Seek Help?

You should reach out to your doctor or a mental health professional any time you think you might need support for your mental health. Having a baby is a big life change that’s often intense, and a therapist can be part of your support system.

Also, reach out if you’re just feeling off or aren’t sure if your feelings are considered typical or worrisome. You should also reach out if someone in your life says you don’t seem like yourself. This could be a different type of perinatal or postpartum mood disorder.

Postpartum Support International has a provider directory where you can find a therapist trained in mental health concerns during and after pregnancy. It also has a helpline, support groups, and other resources.

The good news is that all postpartum mental health concerns are highly treatable. “Get treated early, and stay treated,” says Solomon.

For more on postpartum psychosis, visit:

“Recovery is possible when you’re connected to the right care,” says Cavaliere.

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