My Fourth Trimester Psychosis Recovery

Updated: Dec 18, 2019

By Katrina


At 27 years old, I was happily married to my high school sweetheart who had known me better than anyone for 13 years. We had waited until the time was right in our lives to try for our first child. God quickly blessed us, and I think we were both a little shocked but very thankful and excited. We both wanted children, but I especially was over the moon to be a mom. We prepared for our first baby with all the love and support from family and friends. We were so excited and felt fully prepared to be new parents, but we had no idea postpartum psychosis would write a very different story for us than we had imagined. No one had educated us about postpartum mood disorders. We both thought “postpartum” was only depression. My husband knew something was very different about me only five days after giving birth, noticing I was worrying at home about things I had never worried about before, such as becoming really skinny because of breastfeeding.


I have no previous history of mental illness. My first pregnancy was mostly uneventful and healthy other than having gestational diabetes, which was not very well controlled and required insulin around 34 weeks. Looking back, I was in a very stressful job situation that didn’t allow me to take very good care of myself, and I was exhausted. Fortunately, my labor and delivery were uneventful, and we welcomed a healthy baby boy at 37 weeks. We stayed two nights in the hospital, and I noticed I wasn’t able to fully fall asleep. One of my good friends was our nurse, so she would take our baby to the nursery often to give us rest, and I would try to fall asleep, but I always felt like I was in a daze and still half-awake hearing everything around me. I didn’t feel tired so I didn’t worry about it too much, letting my husband know but also remembering how everyone tells you, “You will never sleep again like you did before.” I thought this must be a new normal. My symptoms of mania were just beginning these two days after delivery, but unfortunately, we were uneducated about these symptoms and clueless about what would follow.


I should add that I’m a perfectionist - I learned later this can be a personality trait associated with risk of postpartum mood disorders. We had lots of visitors, and my mom, even more of a perfectionist than myself, stayed with us the first week we were home since my husband had to go back to work. I now realize I was very overwhelmed by my mom’s stay and all the visitors. As a perfectionist, having my mom living with us, and having frequent visitors, I felt that the house chores couldn’t wait. I didn’t take time to sleep when the baby slept. I couldn’t fall asleep. I didn’t fall asleep for 5-6 days. I would lay down between feedings at night but never fall asleep before the next feeding.


I didn’t feel tired, so I didn’t worry about it, and I mentioned it to my husband, who was exhausted. This started to make him wonder. I was thankful I wasn’t exhausted. We had no education to recognize I was manic and needed medical attention. I was successfully breastfeeding and very happy about this, feeding on a 3-hour schedule after reading a sleep training book and starting to obsess over my baby having a sleep routine like the book suggested. I wish I never would have read that book and that someone would have discussed feed-on-demand with me and told me, “You are the only expert when it comes to your baby.”


Five days after delivery, I recognized symptoms of a UTI at home. I called my OB office and started antibiotics that afternoon after staying awake again all-night obsessing over being able to void so my UTI didn’t get worse. I began to notice my legs starting to feel numb and tingle throughout the day, and I wasn’t able to void when going to the bathroom. I began obsessing over something being seriously wrong with me. My husband noticed I had increased energy, inability to sleep or desire to sleep, extreme happiness then irritability, racing thoughts, fast/pressured speech, anxiety about things I never would have worried about in the past, and difficulty focusing on tasks as simple as eating a meal. I started to become paranoid that our house would catch on fire in the night and that we wouldn’t get our baby out of the house since he was in his own room. I even called the electric company to come to our house and check to make sure our house wasn’t having an energy surge. I also felt like there could be a dangerous presence in our house that was out to get our baby and discussed this with my husband. We called our OB office after hours, and they suggested I may have postpartum symptoms and needed to come in to see my OB the following day.


I started to call my OB after-hours number often and suggested to all three doctors I talked to that something was seriously wrong with me. They directed me to the ER several times. I had one visit with my OB, but I didn’t want to take the anxiety medication she suggested because I would have to stop breastfeeding. She suggested I go home and sleep, but I couldn’t. I had a total of four ER visits. I had unusually high blood pressure, and they sent me home with a catheter because I couldn’t void. I later learned not voiding was a symptom of my anxiety. My last ER visit lasted over 10 hours and ended with a psych evaluation and involuntary hospitalization in a mental hospital 3 hours away. My husband and I have faced a lot of challenges together, but nothing like what we were about to face.

I spent 14 days in an inpatient psychiatric unit. The second morning there, I woke up and felt something was very different. I suddenly did not feel like myself. Before then, I felt like I was myself, but that others just didn’t understand me. I believe this morning was when the worst of my psychosis began, and I’m so thankful my husband pushed for answers for me. As hard as it had to be for him to agree to hospitalize me, I’m so thankful I wasn’t at home during this experience. I did not see my son by choice because I was too scared to have him in a car with anyone. My husband visited every day, but we were only allowed visitors for one hour in the evenings. I was not well during a lot of these visits and sometimes didn’t visit him because I felt like my presence could harm him. My mind even told me that one of the patients in the hospital with me was God, and he would help me get better. I was scared to be there and felt so alone and abandoned. I felt a strong God/Devil presence in the hospital. I was hallucinating, seeing sparks come out of the electrical outlets and feeling like I had powers to unlock doors and to understand what God was trying to tell me through other patients. I saw things that weren’t real. I heard things that weren’t there. It was an out-of-body experience - like truly living in a nightmare, wondering when you would wake up to tell someone about this crazy dream. I struggled to get better in the hospital and didn’t understand why I was there in the first place. I felt like my husband and family wanted me to be kept away from my son on purpose. I was crushed. No one at the hospital explained postpartum psychosis to me or my family. It would have been so helpful to hear that I would get better eventually and be able to go home to my family. I believe it would have helped me recover faster.


I was involuntarily committed to the hospital for 13 days by a judge who I appeared in front of 2 days after being taken to the hospital in the back of a police car. My dad and husband were able to take me home after a 14-day stay. I was so thankful to come home to my son and family, but we struggled with postpartum psychosis for the first year of my son’s life. The first couple months after coming home were really hard. I still struggled at night with obsessing over my son not waking up or feeling an evil presence at times. I had a lot of flashbacks from the hospital, which I still have sometimes even three years later.


It was a struggle to get access to care, and I didn’t see a psychiatrist for 19 days after coming home. My baby was now on formula, and I was thankful for being able to sleep and him being well. I took antipsychotic medication for six months and anxiety medication for at least a year. During these six months, my husband was amazing and held down a job while taking all the night feedings so I could sleep all night long because my antipsychotic medication was sedating me when I would take it at night. It was really hard for me to complete basic tasks, always feeling overwhelmed and interrupted. I went back to work after a 14-week maternity leave. Realizing my work environment was triggering a lot of my residual anxiety, I quit work and started staying home with my son when he turned 18 months. This is when I noticed a huge change in being able to take care of myself and my family, and I gained some relief from feeling overwhelmed and anxious. After my son turned a year old, my anxiety and overall mood improved, but I don’t know why. For about a year, I didn’t enjoy life events and being around others the way I used to. This eventually improved and went back to normal over time.


Unfortunately, postpartum mood disorders and caring for mom, dad, and baby in the “fourth trimester” are rarely discussed. Hoping to change this, to educate others, and to encourage health care professionals to be the first to educate and evaluate, I’m sharing my story of surviving postpartum psychosis. We are expecting our second child soon, and in three years have survived postpartum psychosis and built what we believe is a strong team of professionals to help us have a much more positive postpartum experience this second time around. Although I know I am high risk for relapse, I have faith that God, my husband, and the support team and action plan we have built together will result in a more positive postpartum experience this time around. I have a perinatal psychiatrist, a psychologist who specializes in postpartum mood disorders, a urologist, and many other professionals who have helped us design a plan. We will be formula feeding so I can have 6-8 hours of uninterrupted sleep and take whatever medications I need to stay healthy. I will take antipsychotic medication after delivery for at least six months and anxiety medication as needed. I have been under the care of my psychiatrist and psychologist during this prenatal period and will continue care for at least a year after delivery.


It’s my hope that in the future all parents watch a video about postpartum mood disorders before being dismissed from the hospital after delivery. Screening and educational information should be incorporated into prenatal visits. Formula feeding should be equally accepted and encouraged to keep mom and baby healthy if breastfeeding isn’t the healthiest option. We need to look at the big picture to educate and encourage moms and dads to be healthy during the fourth trimester by discussing what a healthy fourth trimester looks like and when to seek professional help. Knowledge is power. My advice is to ask at prenatal visits about postpartum mood and anxiety disorders and to let your provider know you want to learn as much as you can about fourth trimester, then passing your knowledge on to your postpartum support team. It’s important to take the postpartum period one day at a time, sometimes hour by hour, and know there is no right or wrong way to go about learning your new normal. There are help and resources out there even if you have to search hard to find them. If it’s overwhelming to have someone stay with you, only ask for help when you feel you truly need it, and don’t be afraid to ask.


Awareness is everything! It took at least six months if not a year before my husband and I felt like we understood postpartum psychosis with the help of my psychologist. Overall, I wish we would have been educated during our prenatal period about postpartum mood and anxiety disorders. My husband and I are both health care professionals ourselves, but because we do not interact closely with those who suffer with mental health disorders, we were shocked at the stigma and lack of access to care once we found ourselves in this battle. I hope awareness continues to spread and results in healthcare professionals doing their best to gain and give as much knowledge as they can to provide early education and early diagnosis of postpartum mood and anxiety disorders. I hope my story can help those suffering with these disorders to know that education is crucial and recovery is possible.

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©2018 by Massachusetts General Hospital Postpartum Psychosis Project (MGHP3).