Post-partum psychosis - a mother's account.

Post-partum psychosis (PP) is one of the most severe and frightening conditions among a wide spectrum of post-natal mental health problems.

While post-natal depression affects around one in 10 women, around one-in-500 to a 1,000 women develop PP, which includes severe psychotic symptoms, believing things that are not true and marked mood swings.

According to National Centre for Mental Health director, professor of psychiatry at Cardiff University, Ian Jones, a world expert in PP, the onset of the condition can be sudden.

He says that some women can go from being perfectly well to being ill enough to require psychiatric care in a matter of hours while for others the change is slower and less obvious.

For around 50 per cent of women who suffer PP, the condition is their first bout of psychiatric illness. Women with bi-polar disorder have a 20 per cent chance of developing PP while those who have suffered previous PP episodes have a 50-60 per cent chance of reoccurrence.

There are many hypotheses as to what causes PP, including big hormonal changes, sleep disruption or immunological changes. The impact of genetic factors is part of continuing research into the condition.

University lecturer, Sally Wilson, suffered from PP after the birth of her daughter, Ella, in March 2015, and has spoken about her traumatic experiences with the condition.

Sally, who married her husband Jamie in 2013, says: “My labour was painful but, as the hours went by, things began to deteriorate. I became terribly confused. I had difficulty grasping the notion of time. I barely slept and felt feverish.

“The medics ramped up hormones for induction and I was given gas and air and pethidine. Ella's heart rate kept dropping and she was in distress. She was born early in the morning by Caesarean section.

“As I came round from the anaesthetic, something very sinister was unfolding. My confusion was off the scale. I kept saying I didn't understand what was going on, asking why there were doctors in the room. A brain scan for a suspected stroke and blood tests came back negative.

“At one point, I remember my eyes rolling back in my head and I slumped onto the bed. At night I pleaded with the nurses to sit with me as I was so scared. I was also paranoid that the midwives were talking about me.

“By now I was very panicky, convinced I was doing something wrong and would get upset. A few days later my condition got a lot worse. I got up to go to the toilet and collapsed. I was sobbing and refused to get up.

“In my mind, there was a strange realisation that I'd died. I could see everyone who was there, including the midwives and Jamie, behind me. I saw a midwife take Ella away. I believed they were taking her to be resuscitated because I'd harmed her.

“I now know that I was having a psychotic episode. My reality had shifted, I believed I had died and was living in an afterlife. I began to hallucinate.

“The sound of babies crying was deafening, the whirr of the air conditioning unit overwhelming and the canteen trolleys sounded like trains crashing through the ward; lights being switched were like explosions and I could see shadows on the wall.

“I was convinced that, because I'd hurt my baby, I had died and was now living in the 'after life', a kind of hell. The most terrifying nightmare imaginable was now my reality.

“The nurses brought Ella to see me, to reassure me she was ok. I was convinced they'd swapped her. This wasn't my baby. My baby was dead. I had killed her.

"What's wrong with Jamie? Why's he crying?" He's not crying Sally, look he's fine. "Who are those people outside the door in white coats?" There's no one outside the door Sally. "Yes, there are. They've come to get me and take me to prison. Oh God… how could I have harmed my baby?"

Sally was transferred to a psychiatric ward and prescribed anti-psychotic and anti-anxiety medication. Jamie was told she was suffering from PP.

Sally adds: “All I can recall is being led into a terrifying maze where I'd see people pacing around as grotesquely exaggerated caricatures.

“I would refuse to have bloods taken, convinced there was a conspiracy against me.

Jamie and my parents would visit with Ella and I'd hold her but couldn't understand that she was mine. I felt no connection.

“We went to the café and she needed her nappy changed. The toilets were near to the labour ward and I became really stressed and upset, as I didn't want to go anywhere near there. I thought I couldn't be trusted on the labour ward as I was convinced I'd hurt my own baby.

“A week later I had a review with the consultant and I told him things were better than they were just to be allowed out of there.

”A home treatment team was arranged to visit me every day but things didn't improve much. I'd manage to help meet Ella's basic needs, change and feed her but I was going through the motions.

“I still 100 pet cent believed that I'd killed my baby. I hit an extreme low, a bleak depression punctuated with psychotic symptoms. I read a news article about a murder at a caravan park that had happened on the day I had the psychotic episode in hospital. In my mind I'd committed the murder.

“The sound of birds was really loud, particularly crows. I then discovered the collective noun for crows is 'murder'. I interpreted meaning to that, of what I'd done in the hospital.

“I had an obsession with a certain number bus which always seemed to pass when I left the house. This was part of the conspiracy and had a hidden meaning. Over-powering, intrusive images constantly flashed into my mind of walking out into the sea near our home and ending it all.

“Ten months after coming home, I told Jamie that I couldn't go on. My husband, who'd done so much to help me, was distraught. Determined to help, Jamie did a literature review on PP treatments. Electro-convulsive therapy (ECT) came up a lot.”

Sally’s psychiatrist contacted professor of psychiatry at Cardiff University, Ian Jones, who agreed that ECT might help her.

Sally adds: “You immediately think it's a barbaric, horrible treatment, involving being strapped to a chair and electrocuted. It's fairly dramatic. You are anaesthetised and electrical currents are passed through your brain to trigger a seizure.

“Half way through the 10 sessions, there was a shift in my thinking. Something terrible was being lifted from me. It saved my life.

“Gradually I've grown stronger and bonded with Ella. It's sad to think about what I've missed out on but now I look at her and get excited that everything's ok, we're here, happy and healthy.

“I can't say I'm the same person. But I'm back at work a few days a week and I'm pre-occupied with the everyday challenges of parenting.

“Once you've suffered from PP there's a very high chance of it recurring with subsequent pregnancies. It's a very personal choice, but even if there was only a slight risk of going through that again, for us, it's just not worth it.

“But it's very important to me to give hope to others going through the horrors of PP. You'll be convinced it will never, ever end. I was convinced too. But this is a day I thought would never come when life feels good once again.”