Critical Values Based Practice Network

C-VBP-N

Psychosis in Early Motherhood

Written by Amanda Campbell on . Posted in Clinical Psychology Bite-Size

Psychosis in Early Motherhood

Issue 24 – September 2010

Author: Amanda Campbell (c/o jenny.poole@nottshc.nhs.uk)

Key points

  • Women are particularly at risk of mental health problems in the time after childbirth
  • Psychosis in this time is predominantly understood as caused by biological and hormonal changes but could also be understood as driven by the significant life changes and experiences that occur prior to, during and after childbirth
  • Childbirth is a time of many social expectations and pressures, with the expectation of being a time of fulfilment, joy and development of the bond between mother and child.
  • Mental health problems do not fit the social ideal of motherhood as a time of fulfilment  

Implications for practice

  • It seems important to develop an empowering environment for women at this time, acknowledging the social expectations and reducing isolation by putting people in contact with others with similar experiences
  • This might provide a space for women to form their own understanding of their mental health problems in the context of their life experiences
  • Supervision can be used as a space for staff to reflect on their own assumptions about motherhood and how this can affect their clinical practice 

Risk of mental health problems in early motherhood

In the time after childbirth (postpartum) women are more at risk of mental health problems than at any other time in their life1. After childbirth mental health problems can range from mild ‘blues’ to more severe and distressing unusual experiences including those diagnosed as postpartum psychosis. Onset of unusual experiences (psychosis) after childbirth is often sudden and women may describe unusual and often anxiety-provoking beliefs involving their infant, for example, fear that their baby is the devil2.

Models of understanding of distress in the postpartum

The medical model is currently the dominant way to understand unusual experience following childbirth. This model suggests that hormone levels, notably oestrogen, dramatically drop after childbirth causing psychotic symptoms3. This has led to the use of a range of pharmacological interventions, from hormone replacement to atypical antipsychotics. However, as yet there is limited evidence supporting biological causes of psychosis after childbirth2 and many women state preferences for non-pharmacological interventions4. Despite the acknowledged role of social context in other mental health problems, these are often less considered for women after childbirth despite the obvious and significant life stressors at this time. Pregnancy and childbirth may reactivate previous traumatic experiences, such as abuse or neglect and prompt re-evaluation of the mother’s own parents and childhood. The demand on new parents to care for, and develop a relationship with their infant is often stressful5. Further, whilst attempting to meet this new challenge, childbirth also means established relationships with partners, family, friends and colleagues are being altered and tested5.

Social Roles and Expectations

Women’s experiences during pregnancy and childbirth are strongly influenced by the social expectations of women’s roles6. In general, mothers are the preferred caretakers of infants and are expected to be intensively devoted to the care of their children, whilst fathers are expected to provide financially. Motherhood continues to be a highly valued role in society with contemporary mothers expected to fulfil ever increasing social roles whilst meeting increasingly high standards of good mothering. These expectations can lead to mothers feeling social pressure for childbirth to be a time of joy and fulfilment of a valued social role. This can make it particularly difficult for mothers to report mental health difficulties or experiences which do not fit this norm. If mothers do report emotional difficulties they may encounter stigma and negative reactions from others in society and possibly their own families. These reactions can create or contribute to a disempowering environment where women who have mental health problems are assumed unlikely to be fit mothers7. This may inadvertently be reinforced through attachment theory which implies that to be a ‘good mother’ mothers should be emotionally available and completely attuned to their infant8. These expected social roles may also affect how women see themselves and have long-term effects on identity, self-esteem and social isolation. 

Clinical Implications

It seems important for services to offer a balanced perspective which acknowledges the contribution of women’s life experiences and social world to their mental health around the time of childbirth. The role families and staff play in women’s experiences at this time can be profoundly influential in promoting recovery through an empowering environment. This might provide opportunities for women to make their own sense of their experiences9 and understand the social expectations acting upon them10. Women and their families may additionally benefit from the chance to meet and share their experiences with others in similar situations. Staff working in this context should be allowed the opportunity to reflect on their own assumptions about the social role of motherhood and how this affects them personally and their clinical practice. 

REFERENCES

  1. Kisa, C., Aydemir, C., Kurt, A., Gulen, S. & Goka, E. (2007). Long term follow-up of patients with postpartum psychosis. Turkish Journal of Psychiatry, 18, 3, 1-7.
  2. Kumar, R., Marks, M., Platz, C. & Yoshida, K. (1995). Clinical Survey of a psychiatric mother and baby unit: Characteristics of 100 consecutive admissions. Journal of Affective Disorders, 33, 11–22.
  3. Kulkarni, J., de Castella, A., Smith, D., Taffe, J., Keks, N. & Copolov, D. (1996). A clinical trial of the effects of oestrogen in acutely psychotic women. Schizophrenia Research, 20, 247–252.
  4. Dennis, C.-L., & Chung-Lee, L. (2006). Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth, 33, 323-331.
  5. Frayne, J., Nguyen, T. & Allen, S. (2009). Motherhood and mental illness. Part 1 – towards a general understanding. Australian Family Physician, 38, 8, 594-598.
  6. Soares, M.V.B. & Carvalho, A.M.P. (2009). Women with mental disorders and motherhood. Revista Latino-Americana de Emfermagem, 17, 5, 632-638.
  7. Diaz-Caneja, A. & Johnson, S. (2004). The views and experiences of severely mentally ill mothers: A qualitative study. Society of Psychiatry and Psychiatric Epidemiology, 39, 472-482.
  8. Medina, S. & Magnuson, S. (2009). Motherhood in the 21st century: Implications for counsellors. Journal of Counseling and Development, 87, 90-96.
  9. Bryne, L., Hearle, J., Plant, K., Barkla, J., Jenner, L., & McGrath, J. (2000). Working with parents with a serious mental illness: what do service providers think? Australian Social Work, 53, 21–26.
  10. Davies, B. & Allen, D. (2007). Integrating ‘mental illness’ and ‘motherhood’: The positive use of surveillance by health professionals: A qualitative study. International Journal of Nursing Studies, 44, 365-376.
 

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