If you've had a baby, you're no doubt aware of the risks of postnatal depression and anxiety.
However, there's another postnatal condition that women are at risk of, that they may not even know exists - postnatal bipolar disorder.
Postnatal bipolar can have devastating consequences for new mums if left untreated, and it can often be mistakenly diagnosed as postnatal depression (PND) – with one recent study finding that up to a fifth of PND diagnoses are actually misdiagnosed bipolar.
The symptoms of postnatal bipolar are the same as regular bipolar – primarily being a fluctuation of high and low moods – but the onset is often very fast, and happens in the two months following childbirth. PND, on the other hand, can be slower onset, and can occur during later months.
The high moods can be as simple as feeling energised and talkative, but they can sometimes turn into a mania – where that wired feeling lasts for a week or more – which may require hospitalisation. In extreme cases it can also lead to psychotic behaviour.
The high moods can then be replaced by low moods, which have the same symptoms as PND: feeling sad, distant or disconnected from the baby and other family, lack of interest in hobbies and socialising, loss of appetite, and sadness.
Kylie*, a mother of two from Brisbane, says she suffered from bipolar after the birth of her second son, Aiden*.
"It was almost instant," she says. "I was in labour overnight and Aiden was born just before 10am the next morning. And I didn't have a proper night's sleep again for over a week – not because the baby kept me up, but because I just felt so wired I just couldn't settle."
Kylie says she spent her evenings while her husband, baby and two-year-old daughter slept, cleaning, writing letters, and organising old boxes in her laundry.
"I could feel my thoughts coming much faster than they did before, and words tumbled out of my mouth when I spoke – it was like I was afraid if I didn't say them fast enough I wouldn't be able to get them all out," she says.
Kylie says family and friends just thought she was excited about the baby, but she knew there was something wrong.
"I didn't feel in control," she says, "I seemed happy, but I felt awful."
After the mania came a crash, which is when Kylie went to see her doctor.
"I feel lucky that I was able to articulate exactly what was going on," she admits. "I told my doctor I'd felt manic and high, and that now I felt awful and low. She was quick to put the pieces together and diagnose postnatal bipolar.
"I started on medication immediately and within a couple of weeks I was feeling a whole lot better, but I'm aware I was lucky to have it diagnosed so quickly."
Dr Nicole Highet, psychologist and founder of COPE, the Centre of Perinatal Excellence, says women who have a family history of bipolar disorder or other types of mental illness are more likely to suffer from it than other new mums, but she adds that the condition is manageable.
"Like someone who may have Type 1 diabetes, bipolar disorder needs to be managed," she says.
"And usually involves the need for medication, and specific types of medication which can differ to that for more common conditions like anxiety and depression."
Dr Highet adds that most women who have postnatal bipolar disorder would have experienced symptoms before, but that's not always the case.
"Usually by the time a woman has her baby, there is likely to have been previous episodes or a diagnosis," she explains. "Bipolar disorder usually manifests in late teens, early/mid-twenties, so for some it may indeed be their first episode.
"It is for this reason that all women are screened to ask them whether they have experienced a mental health condition, in order to detect those who may need extra support in pregnancy or early parenthood, as they are most at risk of relapse."
Dr Highet says that although bipolar affects a lot less women (1 to 3 per cent) than anxiety (20 per cent) and depression (14 per cent), it's still "critical to be aware of the signs and symptoms and have access to the right treatment."
"When a woman with bipolar disorder is unwell, it affects the way she thinks, feels and behaves. As a serious mental illness, it can impact on her perception of reality, and hence her ability to care for her infant.
"People with bipolar disorder need understanding and support, again as do people with debilitating physical illnesses, especially around the time of having a baby."
More information about the disorder, as well as a range of support for the emotional challenges of becoming a parent, are available on the COPE website.
Dr Highet says if you're concerned you may have postnatal bipolar, she encourages you to initially see your GP and consider getting a referral to a specialist psychiatrist for a proper assessment.
"By identifying symptoms and getting a diagnosis early, this can help someone to stabilise and get more control over their illness and how it impacts upon their day-to-day life."