Optimal care for mother and baby in severe postpartum mental illness

Severe postpartum mental illnesses (PPSMI), including postpartum psychosis, bipolar disorder, and major depression, affect approximately 1-2 per 1000 deliveries and can lead to serious consequences including suicide, infanticide, and long-term disruptions in the mother-infant relationship. In many low-resource settings, the absence of specialized mother-baby units (MBUs) necessitates alternate models of care.

This narrative review synthesizes current evidence and clinical guidelines on managing PPMI in outpatient and inpatient settings. Key focus areas include rational psychopharmacology, indications for electroconvulsive therapy (ECT), identification of organic conditions, psychosocial interventions, and family involvement, particularly in low- and middle-income countries (LMICs).

Effective management of PPSMI requires timely diagnosis, individualized medication plans compatible with breastfeeding, and consideration of conditions such as autoimmune encephalitis or cerebral venous thrombosis in atypical presentations. ECT is a valuable, often underutilized, option. Multidisciplinary teams play a key role in psychiatric evaluation, pharmacological and nonpharmacological treatment. Family engagement, telepsychosocial support, caregiver education, safety planning and community-based care are essential in the absence of MBUs.

A multidisciplinary, biopsychosocial approach adapted to local resources is vital for managing PPSMI. Strengthening perinatal mental health services and policies can improve maternal outcomes and ensure safer environments for both mother and infant.