Postpartum Psychosis after Traumatic Cesarean Delivery

Abstract

An emergency cesarean delivery can be a traumatic childbirth experience for a woman and a risk factor for postpartum psychosis, especially in a patient with a history of bipolar disorder. This article describes the case of a pregnant woman with an unknown history of bipolar disorder who developed an acute psychotic reaction during the procedure of an emergency caesarian section and switched to mania. The purpose of this case study is for perinatal health care professionals to identify suspicious symptoms and promptly refer to psychiatric services so as to ensure the mother’s and the newborn’s safety. This case study highlights the importance of assessing women with bipolar disorder or a previous psychotic episode for the risk of psychiatric complications in pregnancy and after childbirth. Midwifery education on perinatal mental health is crucial for the detection of suspicious symptoms and early referral to a specialist.

Postpartum Psychosis: The Role of Women’s Health Care Providers and the Health Care System

“…These can include assessment of personal or family history of mental health concerns, particularly previous PPP or bipolar disorder, education about possible postpartum mood fluctuations, discussion of signs to look for as indication of a need for intervention, and involvement of family and support network. Providers can prepare women for what to expect during delivery to mitigate the potential trauma that could trigger mental health symptoms 118,119 . For example, women with bipolar disorder have been shown to have an increased risk of cesarean delivery compared with age-, gestational age–, and parity-matched control subjects without bipolar disorder 120 ; women's health providers can educate women with bipolar disorder about this risk and prepare them for this possibility.…”

“…Providers can prepare women for what to expect during delivery to mitigate the potential trauma that could trigger mental health symptoms. 118,119 For example, women with bipolar disorder have been shown to have an increased risk of cesarean delivery compared with age-, gestational age-, and parity-matched control subjects without bipolar disorder 120 ; women's health providers can educate women with bipolar disorder about this risk and prepare them for this possibility. Education can also include information about the importance of sleep hygiene, the benefits of social support, and potential adverse effects of pharmacotherapy or its discontinuation, or the ideal timeline for titrating down of medication if discontinuation is possible.…”

The effect of postpartum psychosis on partner’s and infant’s life

“…The onset of PP has been linked to the sharp drop in hormones (estrogen, progesterone, cortisol) immediately after birth, as this time coincides with the onset of the symptoms of PP [7]. Also, a possible relationship of postpartum psychosis with obstetric, psychological and social factors has been investigated [10]. It is estimated that one in five women with BD develops a psychotic or manic episode after delivery [11].…”

“…Medications usually include mood stabilizers, antipsychotics, and often antiepileptic drugs. Common drugs in these categories are lithium, lamotrigine, carbamazepine, benzodiazepines, quetiapine, olanzapine, etc [5,9,10].…”

“…Chaotic thoughts and distorted perceptions of reality create phobias in women.As a result, they do not trust the people around them, nor do they trust themselves [12]. This traumatic experience, which frightened them with its sharp escalation, is exacerbated by their admission to a psychiatric department, their separation from the infant and their isolation from the family [10]. An aggravating factor is the lack of counseling about the disease in high-risk women and their families before childbirth or pregnancy.…”