Rachel, sorry this is late for you, but I have had two clients with
postpartum psychosis.  The second one I only found out about much later, had
seen her only once, nothing very unusual as I recall, but her husband phoned
much much later to say she had been hospitalised with post-partum psychosis,
and the baby had been cared for in another town by the grandmother.

However, the first one I had come to know quite well.  She had attended one
of my antenatal classes and then called for a hospital consult to check on
latching, and general info.  Then I did two home visits, and there were
several phone calls too.  She had a little engorgement, but was dealing with
it effectively, exclusive breastfeeding was going well, and she was enjoying
her baby daughter. I spent probably 4 - 5 hours in her company.  It was only
after her breakdown that I realized that her extreme talkativeness (relating
the same incidents and her impressions of various things several times)
might have been a sign that all was not quite right.

On the ninth postpartum evening she answered the door to her friend's
husband and bit him on the neck!  She was hospitalised and given massive
doses of IV chlorpromazine and the family asked me to make a hospital visit
the following day.  I expected to find bad breast engorgement, because the
grandmother and aunt were now caring for the baby and bottle-feeding.  But
the most vivid and completely unexpected memory I have is that lactation was
just about completely suppressed - whether this was from severe emotional
shock or the chlorpromazine (which in smaller doses is supposed to act as a
galactogogue) I don't know.   I ascertained from the psychiatrist and the GP
that they would be happy for breastfeeding to continue, but the family were
obviously reluctant, and kind of took over everything, and so it was over.
Once the mom was out of hospital I talked to her again a couple of times on
the phone, but was never able to see her again.  There were no problems with
the breasts.  She remembered the breakdown and hospitalization only vaguely,
though she did remember that I had come to see her, and described it as
"when I was in my dream" ...  Thereafter I received just a few sad reports
from another client who had been her friend - that she was very drugged for
a very long time, and not really able to respond to her baby.  And then I
lost touch.

I remember this client very sadly.  She had seemed bubbly and happy, had a
lovely husband, and then a baby daughter that she was really enjoying.  And
then a psychosis, and everything was gone.

I wish your client well Rachel.

Pamela Morrison IBCLC
Harare, Zimbabwe

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