Postpartum Psychosis: What to Do If You Think It's Happening Right Now
Written by
Phoenix Health Editorial Team
Expert health information, double-checked for accuracy and written to be helpful.
Clinically reviewed by
Dr. Emily Guarnotta
PsyD, PMH-C
Last updated
Written by
Phoenix Health Editorial Team
Expert health information, double-checked for accuracy and written to be helpful.
Clinically reviewed by
Dr. Emily Guarnotta
PsyD, PMH-C
Last updated
If you are reading this because something is wrong right now, act first, read later.
Call your OB, midwife, or mental health provider immediately and describe what you're seeing.
If symptoms are severe, go to the emergency room now. Say: "My partner (or I) gave birth [X days/weeks ago] and I'm concerned about postpartum psychosis."
If there is any immediate concern about harm to the mother or the baby, call 911.
988 Suicide and Crisis Lifeline: Call or text 988\. Available 24 hours a day.
If things feel urgent, stop here and make the call. The rest of this article will be here when you need it.
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What Makes This an Emergency
Postpartum psychosis is one of the only perinatal mental health conditions that qualifies as a medical emergency. It typically begins within the first two weeks after birth (though it can occur later), escalates within days, and requires immediate medical intervention.
Signs of postpartum psychosis include:
- Hallucinations (hearing or seeing things others don't)
- Delusions (beliefs that experience completely real but don't match reality, unusual convictions, feeling like there's a special mission or message, paranoid beliefs)
- Inability to sleep for days, even with opportunity
- Severe confusion or disorganized thinking
- Extreme, rapid mood swings
- Behavior that is completely out of character and frightening
These are not signs of a difficult adjustment. They are signs of a mental health crisis.
What to Say at the Emergency Room
Tell them immediately, don't wait for triage to get to it on their own timeline:
"My partner (or I) gave birth [X days/weeks ago] and I'm concerned about postpartum psychosis. She is experiencing [describe: hallucinations / delusions / severe confusion / inability to sleep / frightening behavior]."
Using the words "postpartum psychosis" helps the ER team understand what category they're dealing with. Not every ER clinician will think of it automatically. Your naming it helps.
If the person is resistant to going, do not argue about whether something is wrong. The goal is to get to medical care, not to win a debate about the person's current state. Delusional thinking feels real to the person experiencing it. You may need to be matter-of-fact: "I need you to come with me to see a doctor."
What Happens After You Arrive
The ER team will do a medical evaluation to rule out other causes of the symptoms (neurological issues, thyroid crisis, medication reactions). They will involve a psychiatric consultant. Depending on severity, the person will be admitted for inpatient psychiatric stabilization or referred to another level of care.
Inpatient care for postpartum psychosis involves:
- Medication to stabilize mood and reduce psychotic symptoms (mood stabilizers and/or antipsychotics)
- 24-hour monitoring during the most unstable phase
- A safe environment
This is the appropriate level of care for a medical emergency. It is not a failure. It is what should happen.
The Prognosis
Most people who receive proper treatment for postpartum psychosis make a full recovery.
This gets said too rarely and too quietly. Full recovery is the typical outcome with treatment. The episode passes. Functioning returns. Parenting continues. The terrifying experience of the acute phase is not the permanent outcome.
What makes the difference is treatment, specifically, treatment that starts quickly. Early intervention leads to shorter episodes and more complete recovery.
After the Acute Phase
Once stabilization has occurred, the recovery phase begins. This involves:
- Gradual reduction in acute monitoring
- Therapy to process the experience and rebuild confidence
- Medication management with a psychiatrist
- Planning for the future
For family members: your own wellbeing matters too. Watching someone you love go through postpartum psychosis is traumatic. Seeking your own support through therapy or peer support is not a distraction from caring for your partner, it's necessary.
For future pregnancies: postpartum psychosis does recur in some people, particularly those with a history of bipolar disorder. The risk is real (roughly 25 to 50 percent in future pregnancies for those with a relevant psychiatric history), and it is manageable with advance planning. A psychiatrist who specializes in perinatal mental health can help develop a monitoring and prevention plan.
For full information on what recovery looks like over the weeks and months that follow, see our guide to postpartum psychosis recovery. For families who want to understand the experience from the partner's perspective, see our article on the postpartum psychosis partner guide. For a clear explanation of what postpartum psychosis is and how it differs from other postpartum conditions, see our article on what postpartum psychosis is.
The therapists at Phoenix Health work with people recovering from postpartum psychosis and with families affected by it. Learn more about therapy for postpartum psychosis.
Frequently Asked Questions
- It doesn't matter for the immediate action. If symptoms include any combination of hallucinations, delusions, inability to sleep despite exhaustion, severe confusion, or frightening behavior in someone who recently gave birth, get a medical evaluation. The ER or an OB can sort out what's causing it. Your job is to make the call.
- Lack of insight, the person not recognizing that something is wrong, is a feature of psychosis, not a barrier to getting help. You can call the OB, or mental health provider, or ER to ask for guidance on how to bring someone in involuntarily if the situation requires it. If there is immediate danger, call 911\. You do not need the person's agreement to act.
- In a true emergency involving risk of harm, involuntary psychiatric evaluation is possible. This can be frightening, and it's appropriate when the alternative is harm. Emergency responders are trained to handle psychiatric crises. If you're calling because of genuine concern about safety, you are doing the right thing.
- Mild presentations can sometimes be managed intensively in outpatient settings with very close monitoring. Severe presentations, where safety is a concern, require inpatient care. A clinician's evaluation determines the appropriate level. Do not attempt to manage a presentation that involves delusions or hallucinations at home without psychiatric guidance.
- Push. Use the words "postpartum psychosis." Describe specific symptoms with specific examples. Ask explicitly to see a psychiatric consultant. If you're not being taken seriously and you believe the situation is serious, escalate, ask to speak to a supervisor or attending physician. You are your family member's advocate. ---
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About the Expert
Dr. Emily Guarnotta
Verified Phoenix Health contributorPsyD, PMH-C
Dr. Emily is a clinical psychologist licensed to practice in over 40 states through psypact, a certified perinatal mental health specialist (PMH-C), and the founder of Phoenix Health. She created Phoenix Health to make specialized mental health care accessible to every parent.
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