Postpartum psychosis: the signs, and what to do right away
Postpartum psychosis is rare, serious and treatable. The early signs, who is at higher risk, what to do in the moment, and what recovery looks like.
AI-assisted educational guide based on the public sources below. Not clinically reviewed. Your family's care team should guide medical decisions. How we write and check our guides.
Postpartum psychosis is a rare but serious illness that can start suddenly after birth. It happens after about one to two in every thousand births. It is a medical emergency, and it is also treatable: with fast care, most people recover.
Early signs
- Not sleeping, or feeling no need to sleep, for days.
- Seeming very high, energetic, talkative or restless, or very low and withdrawn, sometimes swinging between the two.
- Confusion, or seeming "not like herself" in a way the family finds hard to put into words.
- Seeing or hearing things that aren't there.
- Strong beliefs that aren't true, such as that the baby is in danger from someone, is not really hers, or has special powers.
- Paranoia or suspicion of the people closest to her.
When it happens, and who is at higher risk
- It usually starts in the first two weeks after birth, and occasionally later in the first year.
- Risk is higher with bipolar disorder, a previous episode of postpartum psychosis, or a close family member who has had either.
- It can also happen with no history at all.
- If you're at higher risk, tell your OB or midwife during pregnancy so there's a plan, including protected sleep after the birth.
What to do right away
- Call 911 or go to the nearest emergency department. Say she gave birth recently and describe what you're seeing.
- Don't leave her alone, and don't leave her alone with the baby, until she's been seen.
- Stay calm and kind. Arguing with beliefs that aren't true rarely helps; focus on getting her to care.
- If you're not sure whether it's an emergency, treat it as one. The National Maternal Mental Health Hotline (1-833-852-6262) can help you think through next steps, but it isn't a substitute for emergency care.
- If she talks about suicide or harming the baby, call 911. For thoughts of suicide, and for family members who need support, 988 (call or text) is there any time, but when psychosis is suspected, 911 comes first.
How it's different from intrusive thoughts
Many new parents have unwanted, upsetting thoughts about harm coming to the baby. Those thoughts feel wrong and frightening to the person having them, and they are common in postpartum anxiety and OCD. In psychosis, the person may lose touch with reality: the beliefs feel true and make sense to them. Both deserve care; only psychosis is an emergency.
Treatment and recovery
Treatment usually starts in a hospital, often with medication and protected sleep, followed by outpatient care. With treatment, most people recover fully, usually over weeks to months; some need ongoing care, especially if they also have bipolar disorder. Afterwards, many families find it helps to talk with others who've been through it; Postpartum Support International has resources and peer support for families after postpartum psychosis. If she wants more children later, planning with her care team beforehand lowers the risk of it happening again.
Common questions
What are the first signs of postpartum psychosis?
Early signs include not sleeping or feeling no need to sleep, being unusually high or restless or very low, confusion, seeming not like herself, seeing or hearing things that aren't there, and strong beliefs that aren't true. It is an emergency: call 911 or go to an emergency department.
How common is postpartum psychosis?
It is rare, happening after about one to two in every thousand births. It is more likely with bipolar disorder or a previous episode, but it can happen with no history.
When does postpartum psychosis start?
It usually starts suddenly in the first two weeks after birth, and occasionally later in the first year.
Can you recover from postpartum psychosis?
It is treatable, and with prompt care most people recover fully, usually over weeks to months, with hospital treatment followed by outpatient care. Some need ongoing care, especially if they also have bipolar disorder.
Is postpartum psychosis the same as intrusive thoughts?
No. Intrusive thoughts are unwanted and upsetting to the person having them, and are common in postpartum anxiety and OCD. In psychosis, the person may lose touch with reality and the beliefs feel true. Psychosis is an emergency.
Sources and further help
Educational only; not medical advice. If something here worries you, talk to your care team.
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