Postpartum Psychosis

What is it?

In this presentation I will analyse the effects postpartum psychosis has on the mother and her family and critique the effectiveness of the local care provisions in meeting the women's needs. I will also discuss the factors, signs and pathophysiology, evaluate prevention and management and discuss support available.

Intro &

statistics

Postpartum psychoisis is a serious psychotic illness that requires immediate psychiatric intervention and expert support (Macdonald and Johnson, 2017).

Signs of this illness are rapid onset and can include hallucinations, mood swings, loss of contact with relaity and intursive thoughts (Macdonald and Johnson, 2017)

Harmful behaviours can be major signs of onset piostpartum psychosis, for example, thoughts of suicide, child neglect and abuse, or even in some rare and extreme cases killing their child (Essali et al, 2013).

(RCOG, 2017)

Predisposing Factors

Hormonal changes- A clinical explanation for Postpartum Psychosis is the drop in oestrogen and progesterone levels, most commonly between day 3 and day 7 post-partum. This has an effect on the dopamine system and can cause a wide range of symptoms e.g. fatigue, depression and more commonly in psychosis, hallucinations. (Marshall and Raynor, 2014). Aswell as the drop in these hormones, other hormones produced by the thyroid gland can decline sharply resulting in symptoms such as fatigue, anxiety and depression. (Macdonald and Johnson, 2017)

PTSD- Postnatal post-traumatic stress disorder is a type of anxiety disorder. It is also known as birth trauma and can be triggered by any event the women deems traumatic during labour (Mind, 2020). PTSD can trigger postpartum psychosis through trauma flashbacks, hallucinations, and dissociation. (Tull, 2020) For example, women who have had major obstetric problems during their labour e.g. emergency caesarean section under general anaesthetic. This obstetric trauma can result in nightmares, intrusive thoughts of killing themselves or their baby and physical symptoms such as sweating and trembling (Mind, 2020)

Factors &

Symptoms

Effects

Psychological

Sociological

Emotional

Psychosis often causes a great strain on marriages and family relationships, since individuals may reach very different conclusions about how to handle the situation.

Creates psychological obstacles to love, such as diminished trust toward herself and her partner

(Budziszewska, Babiuch-Hall and Wielebska, 2020)

The more productive and more socially integrated a person is when they develop a psychotic illness, the greater the deline in social inclusion.

A long term effect is experiencing practical difficulties in creating and sustaining relationships e.g. a job and this can lead to poverty

(Killaspy et al., 2014)

Effects

Accoring to a study done by the BMC, partners typically described the support neglected their needs and instead, they identified that they struggled to ask for help and felt isolated and overwhelmed whilst their partners were getting treatment (BMC, 2018)

Some women suffering with postpartum psychosis are so distrubed, distractable and their concentraion so impaired that they are not aware of their newbron baby therefore leading to issues with bonding and attchment. (Marshall and Raynor, 2014).

Management and Treatment

Due to the severity of the presenting symptoms, medication in the form of antipsychotics, antidepressants or mood stabilisers are usually considered as the first-line treatment options. Electroconvulsive therapy (ECT) is also believed to be effective in treating puerperal psychosis, particularly for women with signs of depression and anxiety (Chaudron,2003).

The National Institute for Health and care Excellence (NICE) is a national guideline for healthcare professionals, this alongside other government guidelines create a working standard of care amongst midwives. The NICE guidelines provide evidence-based research on treatment and management of postpartum psychosis and are always up to date to be referred back to during practice. It contains the most recent care pathways and medication management ( NICE, 2020).

Mange-

ment

Postpartum psychosis requires immediate treatment. Due to this condition being rare, midwives have a lower chance of encountering it in practice therefore their knowledge of treatment and symptoms may be reduced resulting in a late diagnosis. This means that there is an increased need for them to familiarise themselves with the condition, or they may not recognise it in its early stages (Korteland et al., 2019). This will result in women not receiving the best and most effective forms of care and educational interventions as part of the recovery process.

Role of the midwife

Clinical Role

All midwives require skills in understanding

perinatal mental health issues, promoting positive mental health, discussing mental health difficulties with women and helping women to access appropriate care and support when needed (PNMH network Scotland, 2020).

Support, advise and communicate effectively with women with, or at risk of perinatal mental illness, and their families, to help them recognise signs of ill health and to make informed decisions about their mental health care

Advocate for, and work alongside women with perinatal mental illness to ensure they receive the mental health care they need

Provide additional mental health assessment, care planning and care delivery for women with mental health difficulties, those at risk of mental ill health and those with complex disadvantage

(PNMH Network Scotland, 2020)

Role of the Midwife

• Advocate for the individual woman
• Telephone support
• Stress management/relaxation techniques/birth trauma/non-directive counselling/support.
• Further referral to other services e.g. outpatient clinics
• Liase with GPs, community mental health team, clinical psychologist and health visitors to provide a person centred approach to care plan (RCM, 2018))

Local Care

Provisions

The UK government launched an initiative in 2016 named the ‘Five year forward view for mental health’. The goal of this initiative was that 30,000 more new and expectant mothers should be supported through maternal mental health services by 2020-21. (House of Commons, 2021)

However even with the government backing and the funding, mother and baby unit beds are still very scarce within Scotland. Awareness was made in both 2018 and 2019 through the MBRACCE report but there is still a lack of knowledge surrounding perinatal mental health.

Local care provisions

Most woman with postpartum psychosis will be admitted to hospital, likley a mother and baby unit, depending on the number of beds available. This is the only hospital setting that is equipped with the adequate staff to care for the physical and emotional needs of the mother (Marshall and Raynor, 2014).

There are two regional 6-bed mother and baby units (MBUs), at St John’s Hospital, Livingston and Leverndale Hospital, Glasgow, giving a total of 12 beds for Scotland (Scottish Goverment, 2019)

Throughout Scotland between 2019-2020 11,000 mothers suffered perinatal mental health issues and of this number, 2,250 women were diagnosed with the most severe mental health illness such as postnatal depression, postpartum psychosis and anxiety (Scottish Government, 2021)

Support

The Birth Trauma Assosciation is a charity that supports women that suffer any type of birth trauma- including psychosis. They offer support for post trauamtic stress after birth.

This charity is evidence based and their research is done alongisde NICE guidelines and offers counselling, a support line open daily and CBT (Birth Trauma Assosciation, 2021)

Support Groups

(Unsplashed, 2020)

The Assosciation for postnatal illness is a charity that supports women with perinatal mental health issues. They offer a 24 hour support line for women who are struggling and need help. This charity offers support in the form of education and counselling. They have links to mother nad baby units throughout the United Kingdom and also with Samaritans helpline charity (APNI, 2021)

References