Roughly half of women who develop postpartum psychosis have no prior psychiatric history. Postpartum psychosis has historically affected fewer than 1% of new mothers, carrying an estimated 4% risk of infanticide and 5% risk of suicide. Rates remain low, but a national study of over 12 million deliveries found diagnoses rose between 2016 and 2019.
Intense and sudden sleep deprivation is a major risk factor. There is a reason that sleep deprivation has been used as a form of torture. One mother I treated over Zoom—exhausted and anxious—was so depleted she didn’t realize she was feeding a bottle into her baby’s ear. She woke repeatedly through the night to press her finger beneath his nostrils, terrified he’d stopped breathing. By the time she was hospitalized, the psychosis had been building for weeks in plain sight. Sometimes, the warning signs can look deceptively ordinary.
I think about this when I come home to my own three children, all born within four years. I know the intensity of postpartum sleep deprivation, even with the most hands-on husband, parents, sisters, and friends. What separated my experience from my patients’ was not effort or love—it was a combination of biological, psychological, and social factors we still don’t fully understand.
First, pediatricians, doulas and therapists are our earliest warning systems, and we aren’t equipping them. They see mothers during the highest-risk window, the first month postpartum, more often than obstetricians do. Pediatricians and doulas need standardized screening tools and clear referral pathways, not just awareness.
A national awareness campaign, like the one we built around postpartum depression, is overdue. As Kriti Lodha, an advocate with lived experience of the condition, told me: “My family was blindsided by postpartum psychosis—the system failed them as much as it failed me. Timely treatment can prevent trauma or tragedy: we must equip all caregivers and frontline providers.”
Due to organizations like the Massachusetts Mind the Gap Coalition, I have worked alongside senators, legislators and advocates so Massachusetts can move towards decriminalization legislation so a postpartum psychosis diagnosis can be addressed as the illness it is rather than a crime. Punishment should be reserved for the guilty, not the sick, and postpartum psychosis, by definition, impairs a mother’s ability to process reality. Other states should follow.
Postpartum psychosis can happen to any mother, regardless of race, ethnicity, or income. We know what it looks like. We increasingly know who is at risk. We have the clinical infrastructure to act. What we lack is urgency—and these mothers cannot wait for us to find it.
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