My second child is due next week after having PP in 2011 with my first. With the possibility of a re-occurrence I have been reflecting on this episode and feel it would be a good thing to write down my experience. (It is a long account so thanks if you manage to read it all) I am in the process of deciding what actions to take after the birth of my second child. I have also posted a question related to this.
Mania
I am normally a happy, positive, chatty person. So when, within days after giving birth, I was quite euphoric and somewhat manic it was not really a massive difference to my normal personality. On reflection these were the first signs that something was wrong and I was somewhat aware that this may not be normal and was able to articulate this to others. The initial stages of mania and fast running thoughts as well as google searches were mainly focused on my son and ‘solving the problems’ (as I saw them) of how to care for him including feeding and sleeping patterns moving onto preventing allergies through what I ate. I started focusing (obsessing) on the patterns in the timing of his feeding and started stretching out his feeds quite early (1-2 weeks old) as he seemed to not be too demanding (this led to low milk supply and issues with him putting on weight which I became aware of many weeks later). I feel it was relatively normal for a first time mum to be this way, although perhaps not the very high level of confidence in my actions. I described myself as a ‘village mum’ able to draw on the knowledge of all the people around me that had, had children.
Things started to vamp up a bit about 2 weeks in. My manic thoughts started to then spread to solving other problems. First with any issue that I perceived my family members had. I became quite open with my thoughts about them and what I thought they should do to ‘fix’ their problems. (Fortunately that hasn't caused much animosity since). I then moved onto fixing wider problems. I started looking into links between things and solving anything from cancer to political problems. This still remained somewhat in reality though.
Delusions
Week 4 is where things started to move further from reality where I was seeing patterns of 3 in almost everything and was placing everything on a scale. I thought that everything always had two distinct sides and started making notes about all my thoughts. I seemed to be able to make connections between everything and was able to remember things I’d read, seen or heard like never before in my life. I was likening my life to movies and tv shows to try and explain my mind’s thoughts to my husband.
I started looking into/thinking about religion (I'm not usually particularly religious). I then made a link between my son and god. Firstly I linked his name, which I thought my father (the most religious of my family) had a hand in (although really he only announced it). Secondly he was born on Good Friday and thirdly his name meant belonging to god (which we didn’t know before we named him). This also linked nicely to my ‘everything in 3s’ theory. On top of this I thought that my dog was a reincarnation of my grandfather and that he was there to look out for my son. Most of this I shared with my husband but did it in a joking fashion so not sure how he took it all.
I was still outwardly functioning in a relatively ‘normal’ manner so that those that didn’t know me wouldn’t really be able to tell what was going on. My husband and family started to become concerned for me and my son who was now looking extremely thin. I was ringing and talking to family members for long periods at a time, which I’d never really done before. I was contacting friends via facebook with long rambling posts.
My husband bore the brunt of my ramblings and was becoming exhausted by my constant philosophising but we both still mostly considered that this just might be the way that I’d responded to becoming a mother. I had been looking into postnatal mental health but most things focus on depression and the brief summaries about peri-natal psychosis mainly talk about negative thoughts and paranoia which I didn’t really recognise in myself. I probably just skimmed over the mania aspects. I wasn’t able to sleep so started looking into ways of getting myself to relax and sleep as I saw that this was a problem. But my mind would not shut down. My husband and I started arguing, which is very unusual for us.
My Son’s issues
While this was all going on I was still trying to solve the problem of my son not seeming to put on weight. I was constantly changing between he’s fine and there was something wrong. We were trying to get into see a childhood nurse as the GP we had taken him to at week 3 didn’t seem to know much about babies and said he was fine. I was also ringing help lines about breastfeeding and sleeping and mostly got reassured that we/he was doing well. We finally went back to the hospital to visit the midwife and she shared her concerns about his weight.
We were scheduled to have an appointment with a childhood nurse the next week which was Wednesday of week 5. Unfortunately a mix up with communication meant that the nurse never came. We then saw another GP (also inexperienced with babies) on the Friday who tried to get us into see a paediatrician as he thought there might be something wrong with my son, not just that he wasn’t getting enough to eat. Throughout this appointment I was trying very hard to keep my brain in check. Unfortunately there was no suggestion to go to the hospital although this was probably what my son needed. I had rung the childhood nurse and rebooked for the Monday. She reassured me and said to just keep breastfeeding as much as I could.
Psychosis
Over the weekend, with all this going on with my son I pretty much lost it. I was trying to hold it together but then the childhood nurse said she wasn’t coming till the afternoon. My husband was trying to keep it together by keeping away from me because I was stressing him out. The childhood nurse finally turned up and saw him Monday afternoon. I lost it when she arrived, going from screaming at her to making a cup of tea and sitting in silence. The nurse was extremely worried about my son who was severely underweight and dehydrated. When my sister-in-law turned up the nurse suggested that the mental health team be called in. So they came and after much discussion we went to the emergency room first for my son then for me.
While my son was being assessed I tried to help the medical staff saying I knew everything but was just stressing them out even more. The machines were showing me things through their noises more than what they actually were. I became convinced that my breast milk was like heroin and my son was having withdrawal problems. After they stabilised my son, as he was severely dehydrated, I was walked down to the adult emergency department. Not the best place for someone in the midst of a psychotic episode. Everything was about me, every snippet of a conversation that I heard I managed to relate to my life.
I was admitted to the emergency department overnight as I needed to wait for a psych consult. This was probably the worst night of my life (although being the optimist that I am I can also see it as an interesting insight into the way ones brain works). I tried to stay focused on the things that I knew were real. While I had family around me I was able to remain somewhat focused or at least was able to check in with them. When my obs were being taken I became more lucid as I knew that was real. However when I had nothing to ground me I spent the whole time trying to work out how I’d gotten to this point. At some stage I thought that my son had died and that had sent me into this state. That was hard to take so I mostly tried to not think about that.
Every time a new Dr/nurse would come they’d ask you your name etc so I started to think maybe I had been giving them different answers and that’s why they kept asking. Thus I thought that I had a multiple personality disorder. Maybe I wasn’t really a mother at all. Another thought was that my family and I had been in an accident. For some reason I thought that my Grandfather was not actually dead but in the bed next to me and that he’d been kept here waiting just for me.
I finally settled on the idea that this was all an elaborate plan so that I would forget the birthing experience. My mother and others often talk about the birth and subsequent weeks being a blur, this was obviously why, everyone must go through this process of memory transformation.
I relaxed a bit after that “realisation” so just went with it all. I wasn’t given anything to sleep so basically spent the whole night making out that the people in the emergency were people from my “real” life. Most of the people that I thought were there were there with good reason it wasn’t completely random. For Example, a girl I went to primary school with who studied medicine became one of the Drs.
I spent a lot of the night looking at the time, as I had been given 8am as the time that someone would come to assess me again. The next day is a bit of a blur of family visiting, updates about my son. I was told there was a place for me in the psych hospital and that I would be transferred there sometime that day. After visiting my son later in the afternoon the ambulance arrived to transport me to the psych hospital.
One of the strangest things is that I have no recollection of actually going to see my son in the hospital. I remember coming back into the emergency ward from seeing him but have no memory of actually seeing him. I suppose my brain just blocked it out as it was too terrible. I see photos of him now and can’t believe how small he was. It must have been horrible seeing him so small and hooked up to machines, especially since it was mostly my fault that he was there.
Psych Hospital
My family were under the impression that I was going to admitted to the psych hospital straight away so no one accompanied me with the ambulance. Unfortunately the ambulance just dropped me off at the hospital admissions and I was left to fill out my own form. That took me quite a while and from memory a few people came in to assess me and ask me questions. I again was relating people in the admissions room with people from my ‘real’ life. The TV was showing me things about myself that I thought my family and friends wanted me to know eg that I needed to eat more healthily and exercise. The whole time I was trying to concentrate on filling in a stupid 3 page form. I’d love to see what I wrote. I remember writing that I could speak all languages (or at least thought that I’d be able to learn it just by listening to it on tapes for a couple of hours).
After a couple of hours I was taken into a general psych ward. Most of my possessions were taken including my phone as it had a camera. I decided that meant that I was going back in time, as phones didn’t have cameras. It also might be to do with the fact that the ward looked like something from the 1960’s. I spent the next couple of hours reliving my life. I think I thought this was just part of the process of getting better. I again thought that patients were from my ‘real’ life and used them to relive some parts of my life. I was using coke and water to balance out my racing thoughts and believed that they had an impact of my brain going slower and faster.
My grandfather again came into the picture and I managed to talk to this patient as if he was my grandfather which was quite nice. I was able in my own way to say goodbye as I had not had the chance in real life. I would come back to this man during the night to calm myself down. I was running around and quite high. One of the nurses I’d turned into a ‘real life’ good friend from high school. I chased her and tried to kiss her. This, I think, led them to finally sedating me. So after probably 4-6 days of not sleeping I was finally getting a rest.
The next day I was much more subdued although still not quite in reality. I was moved to a smaller, quieter ward with mainly younger (18-23yr olds) and older (65+) patients. The psychiatrists (not perinatal) were still working out if my episode was possibly bi-polar related by asking me about my life. They also talked to family members. I was prescribed Epilim (Sodium Valporate) and Seriqual (Quetiapine) which were not their preferred meds but I wished to continue to breastfeed so these were the suggested meds to reduce the risks to my son. For the next week I gradually came back to reality with a few hangovers of the psychosis including a propensity to see connections between things that weren’t really there.
I mainly focused on the other patients and helping them. I thought that they weren’t really getting the care that they needed. I am a person who believes in talking things out and I felt that there was too much time in the ward where things weren’t being done. Of cause people had problems. They had nothing to do except think about their problems. So I did a lot of talking with others and trying to get them to be more active like playing card games. This by some staff may have been seen as being manic still but my husband knew it was just my way of coping with the situation. I didn’t really want to think about my son. There was nothing I could’ve done anyway so what was the point of thinking about it and going over the events. The fact that I’d stay up later talking to some patients may have also gone against me. I fought the drowsiness that the drugs gave me because I liked talking to people. This was very normal behaviour for me.
I mostly knew that I would now be fine. I just wanted a way to get out of the hospital and back to normality as that’s what I felt I needed. I had a little set-back after seeing the peri natal psychiatrist who thought that I was still manic (he didn’t know me before and the fact that rambling and jumping between topics is quite normal for me). Although I wouldn’t say that I was back to normal I was far from the manic high and psychosis that I was at a few days previously. He was not supportive of me being released. I had envisaged him saying that he knew what was wrong and that I could go home with further support.
Home
I was an in-patient at the psych hospital for just over a week. My son was released from hospital on a Friday. After a difficult weekend where all I wanted was to go home as that’s where my son was. Unfortunately my psychiatrists don’t work on weekends so nothing was going to happen till the Monday. I pushed to be released so that I could be with my son. As I had a large amount of family support the hospital was relativity happy for me to be an out-patient. For 2 weeks I returned for a few hours during the day to meet with the psychiatrists.
I was then released to the care of a community health psychiatrist (not peri-natal experienced). I could have gone to a peri-natal psychiatrist but it would've been expensive and a much further travel time. I was relatively happy with my Dr’s care.
I feel that I was very fortunate in that my recovery time was quite quick and did not lead to further mental health issues like depression or anxiety. I responded well to the meds that I was prescribed and actually requested they be reduced after only 6 weeks as they were making me drowsing and keeping me asleep in the night and morning when I needed to care for my son. Unfortunately the psychiatrist was very conservative and cautious of reducing my medication too quickly. However, my husband was supportive of me. So against Dr’s advice I stopped taking Seriqual (Quetiapine). We monitored my moods and racing thoughts. I was much happier as I could now function more fully all day. Luckily there were no signs of a relapse. I was still able to sleep which I knew was the most important thing to remain healthy.
About 2 weeks later we found out that the Epilin (Sodium Valporate) was affecting my son’s liver. I discussed with my husband about stopping or reducing the amount that I was taking. He was not keen for this to happen so I kept on it for a little while. I had a habit of forgetting to take it and noticed that I would be a little more elevated than normal but not unmanageably so. About 3 months after starting to take medication and without my husband’s or psychiatrists knowledge I stopped taking Epilin too.
I was very aware of the risk that I took doing that but was also very aware of the guilt associated with my medication affecting my son. Fortunately again there was no signs of a relapse. Shortly later my husband did notice my mood being more elevated and me rambling a little more than usual. After I revealed that I’d stopped taking the meds he was a little annoyed but was relatively supportive of my decision as long as we both were happy.
I never did let my psychiatrist know that I’d stopped taking the meds he prescribed. He still had me taking them by gradually reducing the dose until almost 18mths after I was diagnosed. I felt at the time being honest may not have played well as social services had been involved in regards to my son. (We had to have weekly check-ups for months after he was released from hospital. Painfully monitoring weight gain which is such a fickle thing especially with newborns).
Another Baby
So here I am 2.5 years after my son was born about to have another child. I am a little worried that I’ll have another episode. But at least this time we are a lot more prepared. I have decided not to take any medications even as a precaution. I feel that as I was very lucky to respond so quickly to meds and recover I would prefer to wait and see if I have any unmanageable symptoms. I now also have insurance coverage for the only mother/baby unit in the state so that’s where I’ll be going if I need to. This is much more comforting than thinking about going through the separation that happened previously.
Hopefully I’ll be able to report that I am fit and well and enjoying the newborn stage that I missed out on fully appreciating with my son.
How did you know it was time
Hello all, My question relates to how people have 'moved on' from their episodes of PP - is it ever a good idea to look back and remember?
Its a year after my pp and the guilt and anxiety leaves me exhausted still.
Feeling Guilty
