By Olaolu Fawole
It often begins quietly. A new mother stops sleeping. Not because the baby is crying, but because her mind will not rest.
She becomes unusually anxious. Then suspicious. Then disconnected from the world she knew before the delivery room.
Within days, reality begins to blur. What follows is not stress. It is not baby blues. It is not a spiritual episode.
It is postpartum psychosis.
One of the most severe, least understood, and most dangerous complications of childbirth.
And in Nigeria, it is hiding in plain sight. Postpartum psychosis is medically recognised as a psychiatric emergency.
Though rare, affecting approximately one to two in every 1,000 new mothers. Its consequences are profound and, without intervention, potentially fatal. It typically develops within the first days to weeks after child delivery, announcing itself through hallucinations, delusions, severe mood swings, and a disorientation so complete that the woman standing before her family may seem entirely unrecognisable.
It requires immediate medical intervention. Every hour of delay is an hour of preventable deterioration. Postpartum psychosis does not exist in isolation. Studies show that between 10 and 20 percent of women experience mental health conditions, including depression, anxiety, and psychosis during pregnancy or in the period following childbirth.
The silence is not accidental. It is cultural, systemic, and deeply entrenched. In the case of postpartum psychosis, delay is dangerous.
Women have harmed themselves and their babies. Women have died from a condition that, with timely psychiatric care, is treatable.
The nation’s maternal healthcare system has made measurable progress in addressing the physical risks of childbirth.
Maternal mortality, though still unacceptably high, has attracted policy attention, funding commitments, and public advocacy. Mental health has attracted none of these things in comparable measure.
Routine postnatal care in Nigeria does not include structured mental health screening.
There is no standardised mechanism for early detection of postpartum depression or psychosis at the primary healthcare level.
The healthcare worker who delivers a baby in a rural clinic or a community health centre has almost certainly received no training in recognising the early signs of postpartum psychosis.
She is not equipped to ask the right questions. She is not equipped to refer.The consequences of this gap extend beyond the mother.
Evidence shows that untreated mental illness after childbirth produces lasting consequences for the child, disrupted bonding, developmental delays, emotional instability and for the family structure.
A mother in psychosis cannot reliably care for her new child. She cannot protect herself. The damage radiates outward, quietly, for years.
The Federal Ministry of Health must move maternal mental health from the margins of policy to its centre.
Mental health screening should be mandatory at every antenatal and postnatal care visit, not optional, not occasional, but routine. The tools exist. The evidence exists.
What has been absent is the political will to act on both. Healthcare workers at every level, from tertiary hospital psychiatrists to community health extension workers, must be trained to recognise the early signs of postpartum mental illness and to respond with clinical competence rather than cultural assumption.
The National Health Insurance Authority must include psychiatric care for postpartum conditions within its coverage framework, ensuring that treatment is not a privilege reserved for women whose families can afford private care.
Religious and community leaders, who remain the first point of contact for most women in crisis, must be engaged as partners in awareness, not dismissed as obstacles.
Sensitisation that reaches the church, the mosque, and the community meeting is not secondary to the health response.
Postpartum psychosis is not common. But it is consequential. And in a country where millions of women give birth each year, even rare conditions translate into real numbers, real families, and real losses.
The first step is recognition. Not every behavioural change after childbirth is emotional. Not every crisis is spiritual. Some are medical. A woman who gives life deserves a system that protects hers.
Until postpartum psychosis is named, understood, and treated with the urgency it demands, it will remain what it currently in many homes.
That looking away must end. Now.
