Psychosis is a break from reality. It waxes and wanes, so a mother can appear happy, intact, and even functional, which is what makes it so dangerous. Her clinical picture can shift hour to hour. A psychotic mother may believe others would stop her if they knew her plan to harm herself or her baby, but the voices in her head are still telling her to act—and sometimes telling her to tell no one. Too often, it’s only after the psychotic break that we hear about it—in the news.
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.
Approximately two-thirds of perinatal mental-health conditions begin before birth: a third in preconception, a third during pregnancy. Only the last third occurs in the postpartum period. Waiting for the six-week postpartum checkup with an obstetrician is too late. Early screening for psychiatric and family history, medication planning, and protecting uninterrupted sleep can serve as prevention, but only if we connect at-risk patients to care well before delivery and ideally during the family-planning phase. There are three ways to do this.Â
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