Abstract

Background: Postpartum psychosis (PP) is a rare but severe psychiatric emergency that usually emerges within the first two weeks after childbirth and carries risks of maternal suicide and harm to the infant. Even after clinical recovery, the disruption it causes to early caregiving may affect the emotional relationship between mother and child. In Southeastern Nigeria, postnatal care remains largely oriented towards physical recovery, mental health services are limited and stigmatised, and published evidence on how social support, maternal functioning and postnatal care shape bonding after PP is sparse.

Aim: To synthesise the available evidence on the relationships among PP, mother–infant bonding, social support, maternal functioning and postnatal care, and to draw out implications for nursing practice among women in Southeastern Nigeria.

Methods: A narrative integrative review informed by the Whittemore and Knafl (2005) framework; this is a non-systematic synthesis and no reproducible search log was available. Peer-reviewed studies, clinical guidelines and policy documents on PP, bonding, perinatal social support, maternal functioning and postnatal service delivery were appraised and thematically synthesised. Because PP-specific evidence from sub-Saharan Africa is limited, evidence from high-income settings and from perinatal mental disorders in low- and middle-income countries was used, with its transferability explicitly assessed.

Findings: Four organising themes were identified in the selected literature. First, PP produces an acute, often prolonged rupture in caregiving that places bonding at risk, although recovery and secure bonding are achievable with timely treatment. Second, social support, particularly from partners and female kin, may facilitate recognition, recovery and caregiving continuity, although a direct protective effect on psychosis relapse or bonding has not been established, but it can also become a channel for stigma and delayed help-seeking. Third, maternal functioning is a hypothesised mediating pathway, not an empirically demonstrated mediator between illness and bonding. Fourth, national-level evidence raises concerns about screening, referral and follow-up; state-specific service audits are needed. A conceptual model and a phase-based nursing action framework are proposed.

Conclusion: Nurses and midwives are the health workers most consistently in contact with postpartum women in Southeastern Nigeria and are therefore central to early detection, safe care, family mobilisation and bonding-sensitive recovery. Locally grounded empirical research is urgently needed.

Keywords: postpartum psychosis; puerperal psychosis; mother–infant bonding; social support; maternal functioning; postnatal care; psychiatric nursing; midwifery; Nigeria