Postpartum Mental Health Deserves More Than an Afterthought

By Dr. Tara Chalakani, Chief Executive Officer, Preferred Behavioral Health Group

It is no secret that the nuances of women’s health have been sorely under researched, under treated, and often dismissed. Until as recently as 2019, according to the Association of American Medical Colleges, women still did not make up even half of the participants in the medical research that affects them most: cancer, cardiovascular disease, and psychiatric disorders.

With a growing awareness of mental health disorders, it seems timelier than ever to prioritize and understand the mental health needs of women. Nowhere is that need more visible, or more consistently overlooked, than in the months following childbirth.

A Gap in Public Understanding

Public attention has turned recently to postpartum psychosis, a diagnosis most people had never heard of, following the case of Lindsay Clancy, a former labor and delivery nurse in Massachusetts. That case is before a jury as I write this, and it is not my place to comment on it. What it has revealed is how little is commonly understood about a condition that occurs, according to Postpartum Support International, in one to two out of every thousand deliveries.

Consider what that number means. The likelihood of experiencing psychosis postpartum is roughly the same as the likelihood of developing a blood clot postpartum, which published clinical reviews place at about one in every thousand women after delivery. Every new mother in this country is counseled about blood clots. She is told what to watch for, when to call, and when to go to the emergency room. Almost none are told anything at all about psychosis.

That is not a failure of any one mother, or any one clinician. It is a gap in how we have chosen to define postpartum care.

What Happens After Birth

The hormonal fluctuations that occur postpartum are dramatically severe. Estrogen and progesterone, elevated throughout pregnancy, fall sharply within days of delivery. The mental impact of these dramatic shifts can cause what we commonly call baby blues, along with anxiety and brain fog. Clinical reviews published through the National Library of Medicine estimate that between half and three quarters of new mothers experience baby blues, which typically resolves within about two weeks.

For many women, it does not resolve. The Policy Center for Maternal Mental Health reports that postpartum depression and anxiety affect roughly one in five women who give birth. And in severe instances, these shifts can contribute to psychosis, which presents as confusion, insomnia, mania, hallucinations and delusional thinking.

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What to Watch For

Because public awareness is low, families are often the last to recognize what they are seeing. The following are worth knowing for any woman who is pregnant or recently postpartum, and for anyone who loves her.

1. The timeline is short and the onset is sudden.

   Postpartum Support International reports that onset is typically within the first two weeks after delivery, though it can emerge later in the first year. A woman who seemed like herself one day can be unwell within days.

2. Sleep is the earliest signal.

   Exhaustion is expected after a birth. A mother who cannot sleep even when the baby is sleeping and someone else is covering the night is a different matter. Prolonged sleep loss is both a warning sign and a contributing factor.

3. The early signs are quieter than the ones people picture.

   Hallucinations are what most people associate with psychosis, but they are rarely the first symptom. Drawing on descriptions from the American Psychiatric Association and PSI, earlier indicators include:

   • Confusion or difficulty following a conversation
   • Paranoia, or new suspicion of trusted people
   • Irritability or agitation that is out of character
   • Racing thoughts, pressured speech, or unusual energy
   • Beliefs that do not match reality
   • Behavior that appears disorganized

   Symptoms fluctuate. A period of apparent clarity does not mean the episode has passed.

4. A history of bipolar disorder carries the greatest risk.

   PSI and the Policy Center for Maternal Mental Health identify a personal or family history of bipolar disorder, or a previous psychotic episode, as the strongest risk factors. Risk also rises with a prior episode of postpartum psychosis and with discontinuation of psychiatric medication during pregnancy.

   One caveat is essential. A substantial share of women who experience postpartum psychosis have no prior psychiatric history at all. The absence of risk factors is not the absence of risk.

5. This is a medical emergency.

   It is not a concern to raise at a six week checkup. PSI classifies active postpartum psychosis as an emergency requiring immediate care. Contact her obstetrician or psychiatrist, call a crisis line, or go to the emergency department.

6. Asking directly does no harm.

   Families often hesitate to ask a new mother whether she is having frightening thoughts. That hesitation is understandable and it is misplaced. Asking plainly is one of the most useful things a family member can do.

7. Postpartum psychosis is treatable.

   This must be said as clearly as the warnings. PSI is explicit that the majority of women who experience postpartum psychosis do not harm themselves or anyone else, and that with prompt treatment most recover fully. A woman who fears that disclosing her symptoms will cost her her children will not disclose them. Accuracy here is not reassurance. It is what makes treatment possible.

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What Needs to Change

It is estimated that at least 20 percent of postpartum women suffer with a mental health disorder, but less than half receive treatment. This is unacceptable.

Psychiatric care is not a standard component of postpartum care in this country. Screening exists in some settings and not in others. Where screening does occur, it frequently is not connected to anything. A positive result on a questionnaire is not care. These are solvable problems, and several of them have already been identified by the professionals who deliver this care.

1. Screen more than once, and beyond six weeks.

   The American College of Obstetricians and Gynecologists has called for postpartum care to become an ongoing process rather than a single encounter. Symptoms that emerge at four months are not less serious than symptoms that emerge at four weeks.

2. Screen for bipolar disorder, not only for depression.

   A history of bipolar disorder is the strongest known risk factor for postpartum psychosis, and standard depression screening instruments are not designed to detect it. Identifying this history during pregnancy allows a monitoring plan to be built before delivery rather than after a crisis.

3. Connect a positive screen to an actual appointment.

   A referral is not a treatment plan. A warm handoff, meaning a direct connection to a provider with an appointment attached, is the difference between identifying a problem and addressing one.

4. Educate families, not only patients.

   A woman experiencing psychosis often cannot assess her own condition. The people around her can. Partners and family members should receive the same discharge education about psychiatric warning signs that they receive about hemorrhage and infection.

5. Train the clinicians who see her first.

   Obstetric, pediatric, and emergency department staff frequently encounter a new mother before any behavioral health provider does. Recognition training at those points of contact would identify cases that are currently missed entirely.

6. Treat coverage as part of the clinical picture.

   Screening requirements without corresponding treatment capacity and reimbursement produce documentation rather than care. The commitment has to extend through the point at which a woman is actually seen.

None of this requires a discovery. It requires deciding that the months following a birth are part of medical care rather than a footnote to it. Women deserve to receive care that is attentive and tailored to their unique needs. No woman should have to reach a crisis before her symptoms are taken seriously.

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References

Every source below is also linked inline where its finding appears in the text.

1. Association of American Medical Colleges. Why we know so little about women’s health. 2024.
2. Carlson K, et al. Perinatal Depression. StatPearls, National Library of Medicine, 2025.
3. Policy Center for Maternal Mental Health. About Maternal Mental Health Disorders.
4. Postpartum Support International. Perinatal and Postpartum Psychosis.
5. American Psychiatric Association. What is Perinatal Depression.
6. Blondon M, et al. Preventing Postpartum Venous Thromboembolism in 2022: A Narrative Review.
7. American College of Obstetricians and Gynecologists. Optimizing Postpartum Care, Committee Opinion 736.

All sources accessed August 2026.

This article is for general education and is not a substitute for individual medical advice. If you or someone you love is in crisis, call or text 988, or go to the nearest emergency department.