Australian women with postpartum psychosis are “falling through the cracks”, with some contacting health services dozens of times before getting care.
A new report by researchers at Flinders University found women were seeking help an average of seven times before receiving it.
The peer-reviewed report, published today in the Australian Journal of Advanced Nursing, interviewed 15 women diagnosed with postpartum psychosis.
Pregnancy psychosis ’emergency’
The condition, which affects one to two in 1,000 mothers, is considered a psychiatric emergency, developing suddenly in the days or weeks after birth.
But many of the women interviewed said their symptoms were not met with urgent concern, lead author and provisional psychologist Donna McMahon said.
“One of the stand-out findings of the research for me was that all the women we interviewed recognised something felt wrong to them,” she told the ABC.
“They all describe having this feeling soon after childbirth, but before other and more overt psychotic symptoms developed.
“None of the women thought to be disingenuous or hide their symptoms, they were actively seeking help.
“[But] they described feeling like their symptoms were going unheard and minimised when they were asking for help.”
Women report a sense ‘something was not right’
More than half of the 15 women interviewed by researchers had never been diagnosed with a mental health condition prior to developing postpartum psychosis.
The lowest number of contacts with the Australian healthcare system when seeking help was four times.
The highest number was 27.
Women often had recognised a “vague, yet persistent sense that something was not right soon after childbirth”, the report said.
Many said they had requested to be taken to the hospital, identifying they needed “urgent” support.
“I can remember thinking I’ve got to get to the bottom of this,” one woman told researchers.
“Like … I’m going to get everyone together. I need my doctor. I need my psychiatrist. I need to … work out what’s going on.”
But the process of getting help, according to the report, was “fragmented”.
Many women found the healthcare professionals they spoke to were unfamiliar with postpartum psychosis, often underestimating or overlooking symptoms.
They found their symptoms were “invisible” until they deteriorated further.
“It was sort of determined that it was probably a bit of baby blues,” one woman said.
“I had lost touch with reality in that next 24 hours.”More follow-up needed from healthcare staff
The report identified a “critical period” for detecting postpartum psychosis early in its onset.
Failure to get help when they first noticed something was not right, according to the women interviewed, left many of them experiencing worsened outcomes.
“We are very lucky to have a health system like we do in Australia … but just like any system there is room for improvements,” Ms McMahon said.
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“From our research, one of those areas is [that] we need to actively and carefully listen to women and families when they are presenting time and again, saying something isn’t right.
“We found the women felt that healthcare professionals weren’t asking enough follow-up questions or probing questions that could help [the women] articulate what this feeling was.
“One way that the system can improve on their detection of this disorder is by improving the awareness and knowledge of what postpartum psychosis is, how it may present.”
The report noted some limitations, including that its small sample size had been recruited via social media support groups.
This, according to the report, may mean the women were “more engaged with services and willing to share their experiences”.
“However the sample reflects the target population relevant to the study and provides a realistic snapshot of the help-seeking experiences of women within the Australian healthcare system,” the report said.
The localised sample size also meant the findings were more specific to Australia, and should not be used to draw global conclusions.
Concerns among women put down as ‘part of new motherhood’
Asked about the report, psychologist Ariane Beeston said having localised research was vital.
Ms Beeston was diagnosed with postpartum psychosis after the birth of her son, Henry, in 2011.
‘His little face turned into a dragon’: One mother’s experience of postnatal psychosis
She has since written a book about her experience and now works for the Centre of Perinatal Excellence (COPE), Australia’s peak perinatal mental health body.
“[Postpartum psychosis] has definitely been an under-researched area, so while the findings aren’t surprising, it’s so important ot have them documented,” she said.
“One thing that stood out to me was just the fact [that] when we’re at our most vulnerable, we’re left navigating this really confusing, fragmented system that’s often ill-equipped to meet our needs.
“The other thing [was] concerns being dismissed and minimised, or put down as simply being part of new motherhood.”
She said the number of women in the report who had actively sought help had surprised her.
“[I] and other women found it really difficult to speak up and ask for help, and certainly were fighting [or] downplaying symptoms,” she said.
“I think while there are women who are very proactive and presenting to health professionals … there’s still a lot of stigma and shame around this condition.
“It’s not the case that everyone feels comfortable enough to seek help.”