Overcoming Postpartum Psychosis
Sarah R. Fields
Hobart IN USA
From NEW BEGINNINGS, Vol. 23 No 4, July-August 2006, p. 158.
One in 25 mothers with postpartum psychosis goes on to kill her children. Fortunately, the condition is quite rare, affecting just one in 1,000 women after birth. Could I continue to breastfeed after my postpartum depression turned into late-onset postpartum psychosis? With the help of La Leche League publications and a progressive psychiatrist, I was able to continue to tandem nurse my children, Anna (two-and-a-half) and John (seven months) while recovering from a psychotic episode and depression.
When my thoughts became disordered and illogical and my tone angry and accusatory, it became clear that I would be hospitalized. During the intake process, a nurse took down my irrational attempt to give a personal health history while my husband and mother were interviewed by the psychiatrist to give him some background information. My mother, a retired La Leche League Leader, explained to the doctor that I would want to continue to breastfeed. A nurse brought me an electric pump from the labor and delivery floor, but she did not know how to use it and neither did I.
When it was my turn to meet with the psychiatrist, through my ranting about conspiracies, lies, lawsuits, and secret codes, I was able to talk rationally about one subject: I wanted to nurse my baby and I trusted publications from La Leche League to help me do so. When the doctor suggested he would be treating me with drug therapy, I asked for a copy of Dr. Thomas Hale's reference, Medications and Mothers' Milk (available at http://store.llli.org), to look up the psychiatric medications he planned to prescribe. He noted the title as well as the address for the LLL Web site and agreed to look over the materials before our visit the following day.
The first night I stayed in the hospital, nurses took away my shoes and removed the hangers from my closet for fear that I might attempt suicide. After an uneventful dinner followed by some angry ranting on my part, I was restrained by four security guards and given a shot to sedate me when my irrational behavior became a threat to the well-being and safety of other patients. I spent that first night alone, and I was able to sleep for the first time in nearly 100 hours. My parents and husband cared for our children at home, where they spent the whole night trying to comfort them. My son refused formula and cried for me.
The next morning at 5 am I woke up asking to see my son. The nurse on duty contacted the psychiatrist, who agreed to see me. When I met with my doctor, I explained what I had learned from an LLL Leader, Pam, who has helped me through many mothering struggles: "Healing begins at the breast." I told him that I would like to cosleep with my baby. The hospital staff agreed that if my husband, Carl, would take responsibility for supervising John at all times, the two most important men in my life could join me in the hospital. We pushed two hospital beds together in a double-occupancy room and raised the outer sidebars so that John would not fall out of bed. The nurses enjoyed coming to visit with my family, and I was released sooner because of the support of my family, who came together to make a plan for my care after leaving the hospital. My daughter, Anna, stayed with my parents during the nine days I was away. She came to the hospital every day to reconnect with me and to nurse. Breastfeeding both of my children kept them close to me when my world was crumbling.
I vividly remember the feeling of panic I had before my children were returned to me. When they came back, things began to feel right again.
From Dr. Hale's book, my psychiatrist learned that the levels of the drug I was given peak between two and six hours after administration. Instead of prescribing medicine twice a day as is customary, he prescribed a dose only at bedtime so that levels would peak in my bloodstream and in my milk while John and I were sleeping. I made it a habit to nurse my son for a long while before taking the pills so that John would be exposed to the least amount of the medication possible.
I have been home for five months now with no relapse in symptoms. My depression has lifted and I am being weaned off the antipsychotic medication by another psychiatrist whom I see every six weeks. It took several attempts and many phone calls to find a doctor who would consider allowing me to continue breastfeeding during treatment.
I spoke by phone to Kathleen Kendall-Tackett, PhD, IBCLC, author of Depression in New Mothers. She reassured me that I would get better, and her confidence gave me hope. I am ever grateful to La Leche League for helping me to maintain my nursing relationships with Anna and John while my world was turned upside down through psychosis. When my mind lost track of how to care for the needs of my family, my body remembered what to do, and nursing my children kept them close to me.