In a recent eight-week stretch, 6% of my postpartum patients met criteria for a psychotic disorder—almost six times higher than rates published in the medical literature. I’ve never seen anything like it. Too often, the first time most people hear the words “postpartum psychosis” is in a national headline about a tragedy that has already happened. It’s time we discuss how to prevent the next one, medically and legislatively, before it reaches that point
Roughly half of women who develop postpartum psychosis have no prior psychiatric history. Postpartum psychosis has historically affected fewer than 1% of new mothers, carrying an estimated 4% risk of infanticide and 5% risk of suicide. Rates remain low, but a national study of over 12 million deliveries found diagnoses rose between 2016 and 2019.
It has long been linked mainly to bipolar disorder, but the same landmark analysis suggests the risk landscape is broader than we thought, with anxiety and other psychiatric conditions playing a significant role too. As Medical Director of the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms), a statewide program covering 72,000 annual deliveries, what I see mirrors that shift: more clinicians raising concerns about psychosis or mania in their perinatal patients
Intense and sudden sleep deprivation is a major risk factor. There is a reason that sleep deprivation has been used as a form of torture. One mother I treated over Zoom—exhausted and anxious—was so depleted she didn’t realize she was feeding a bottle into her baby’s ear. She woke repeatedly through the night to press her finger beneath his nostrils, terrified he’d stopped breathing. By the time she was hospitalized, the psychosis had been building for weeks in plain sight. Sometimes, the warning signs can look deceptively ordinary.
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.
First, pediatricians, doulas and therapists are our earliest warning systems, and we aren’t equipping them. They see mothers during the highest-risk window, the first month postpartum, more often than obstetricians do. Pediatricians and doulas need standardized screening tools and clear referral pathways, not just awareness
Second, it truly takes a village. Family, neighbors, and friends are often first to notice something is wrong. They need plain-language guidance on what early psychosis looks like, and to know exactly who to call when they see irritability, confusion, or paranoia layered on sleep deprivation.
A national awareness campaign, like the one we built around postpartum depression, is overdue. As Kriti Lodha, an advocate with lived experience of the condition, told me: “My family was blindsided by postpartum psychosis—the system failed them as much as it failed me. Timely treatment can prevent trauma or tragedy: we must equip all caregivers and frontline providers.”
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Lastly and legislatively, access programs build clinical capacity for psychiatric care. The successful Massachusetts Child Psychiatry Access Program (MCPAP) is the model for MCPAP for Moms, which was noted in the White House Blueprint for Addressing the Maternal Health Crisis in 2022 and has since been replicated in 29 states.
Due to organizations like the Massachusetts Mind the Gap Coalition, I have worked alongside senators, legislators and advocates so Massachusetts can move towards decriminalization legislation so a postpartum psychosis diagnosis can be addressed as the illness it is rather than a crime. Punishment should be reserved for the guilty, not the sick, and postpartum psychosis, by definition, impairs a mother’s ability to process reality. Other states should follow.
Postpartum psychosis can happen to any mother, regardless of race, ethnicity, or income. We know what it looks like. We increasingly know who is at risk. We have the clinical infrastructure to act. What we lack is urgency—and these mothers cannot wait for us to find it
