Confused please help!

[smiles1975]

I'm 20 weeks pregnant and I'm under quite a few health professionals because I have bipolar and have a history of ill mental health and psychotic episodes. I don't actually know who's supposed to be helping me with what. I have a care worker under a new care team. I have a dr under a mother and baby mental health team. I have an obstetrician at the hospital and a midwife. Im on quetiapine 600mg per day and I have been perfectly stable for coming up to two years now. As far as I am aware I don't have a labour care plan but I'd like one. Who's responsible for putting it together? I've got my first appointment with the obstetrician next Wednesday. What should I be asking him? They're going to be keeping me and my baby in hospital for a few days for observations to do with possible withdrawal symptoms. Lack of sleep is a major trigger for my mental health. Would it be ok for me to ask to have a room to ourselves during our stay? Do I need to have a care plan for our stay in hospital as well?

[Lilybeth Volunteer]

Hello smiles 1975,

Congratulations on your pregnancy. This must be a very confusing time for you but we are all here to help. I have very little knowledge of Bipolar but there are many mums here who will be able to advise you. I too have had psychotic episodes in the past following the births of my children.

It sounds as though you have all the professionals available. Perhaps they are watching and waiting before they all agree which is the best care plan for you? I'm not sure who is responsible for putting a care plan together but there are professionals / mums on this forum who will be able to give you such information, as well as giving you ideas of what to discuss with your Obstetrician next week. If possible, I'm sure you will be offered a room to yourself with baby. Everyone will want what's best for you.

Try not to worry, easier said than done I know but there's lots of help and support here for you. Wishing you all the best for next week.

Take very good care of yourself.

[BronSyd in reply to Lilybeth]

Hi Smiles 1975,

Congratulations on your pregnancy. It's unfortunate that a mental health history can complicate and make what should be a wonderful experience into a worrying time for everyone involved. It's great that you're planning so far ahead of time.

PP has characteristics of bipolar but is different in that it is isolated to the perinatal period. Your experience is probably similar to those of us who have gone on to have subsequent children after having PP as we need to make decisions prior to giving birth.

Basically from my understanding your chance of having a psychotic episode increases due to hormones in the perinatal period.

Your care plan should be written in consultation with you and your care providers, that is anyone that may need to be involved. Especially in the postnatal period.

I had mine drawn up with my GP and community health staff (childhood nurse, mental health nurse, maternity nurse and a coordinator) My psychiatrist also had input. It stated what everyone's role was in terms of monitoring me in the perinatal period. It included the need for me to stay in hospital for up to a week (if I wanted), to be in a room by myself as well as the possibility of my husband staying overnight to help out so I could sleep more.

It also had the childhood nurse and mental health team coming to visit me in the postnatal period at home.

I'm not sure if you intend to breastfeed, you can with Quetiapine but I'm not sure with your dose mine was only 300mg. That's something else I had in my plan.

I also had 2 birth plans both only 1 page so that busy hospital staff could just quickly read it. One relating to the actual birth not really my mental health that I wrote myself. Including what I wanted for the birth and some basic information for post natal things. My psychiatrist wrote the other one with me which was more related to my mental health and included that I wasn't taking medication but would be reviewed by the hospital mental health team.

It didn't turn out quite as planned as I had to chase up the community health teams to come visit but at least they had it on record so they knew what was what.

My experience with the Obstetricians were not related to my mental health at all, but I wasn't taking meds at the time. So that's something I'd be asking. How it effects bubs and how to balance that with keeping you well.

In terms of who does what, your OB and midwife will mostly just deal with the medical side of giving birth. You definitely should be asking to stay in a room by yourself as you stated sleep is vital. The Dr from the mother baby team should be able to deal with any mental health issues as well as any postnatal concerns with you and the baby. The care worker I assume is there to coordinate community health personnel and liaise with others involved (I'm in Australia so our system may be different).

This forum is a great source of information and support so don't be afraid to ask more questions as you progress through your pregnancy and journey into motherhood.

Hopefully I've helped. Good Luck.

[smiles1975 in reply to BronSyd]

So it looks as if I will need to speak to my care worker and make an appointment with her and the mother and baby dr so that we can make up a care plan regarding the birth and after care. My gp hasn't had much experience with bipolar nor does she know much about me as we're new to the area so I won't include her for this. I will ask about getting our own room when I'm with the obstetrician next week. I'd love to be able to reduce my meds now but up till recently I've been going through a hard time with sickness and low moods. I am feeling much better lately and have been for the last 2/3 weeks. If I'm going to cut down I was thinking about taking it down by 50mg every fortnight. This is another thing I want to discuss with the obst. Next week. Thank you for your helpful reply x

[Naomi_at_app Volunteer in reply to smiles1975]

Really glad you have found the forum helpful and as others have said it is great that you are planning well ahead.

Getting the mother & baby team Dr together with your community support worker sounds a good plan. For your birth and immediate few days postpartum plan you can ask the Dr to liaise with the labour & postnatal ward midwives so that they are aware of your plan. A short summary can go into your midwifery notes. I had a private room and access to the midwives to look after baby while I slept, and also a prescription of sleeping tablets ready to go if I needed them.

The community part of my plan outlined what to look for in terms of early warning signs and who would visit when. Also who to contact out of hours if I had symptoms of mania or psychosis (crisis team in my area)

Hope your meeting goes well

Naomi

[andrea_at_app Volunteer]

Hi Smiles1975,

Just to add to the great advice from Lilybeth, BronSyd & Naomi, here are a few links that you might not have seen yet.

These are to threads about care plans from a while ago:

healthunlocked.com/app-netw...

healthunlocked.com/app-netw...

Also there's plenty of information about pregnancy & Bipolar here:

app-network.org/what-is-pp/...

I hope you find them useful. Congratulations on your pregnancy & as the others say, it's great that you've got plenty of time to prepare & that there's a team of professionals to support you. I'm sure once you've had your first appointment, things will click into place & the discussions between them about your care plan & needs will be started.

[Hannah_at_APP Administrator]

Hi Smiles1975,

It looks like you've had some good advice already but I wanted to share my recent experience of having a baby after an episode of PP in 2009. And congratulations on your pregnancy and it's a great idea to be thinking about things now.

Although I don't have bipolar (my PP was "out of the blue") we were very conscious of having good plans in place for our 2nd pregnancy and birth experience. I wanted it to be different if at all possible and to reduce my risk of becoming unwell again. As I'd been discharged from my psychiatrist last year (I mean 2012, can't believe we're in 2014 already!) I had to do things through my midwife and GP. I got a referral to the CMHT but you already have a Care Worker so that's half the battle. Having extra time in hospital was another thing I wanted the choice of (I went home very early after my first) and you've got this sorted too which is great. I also requested a side room and my CMHT worker contacted the hospital and set me up a meeting with them, where they agreed to this - and waived the cost which was great. I found having my own space, privacy and quiet time so I could sleep (which was one of my big triggers) was brilliant.

As I went to a hospital which was in a different Trust area, my midwife in the community didn't link to the hospital, and the CMHT didn't link from the hospital, it was from my GP - so try and make sure that all parties are talking to each other. I found I had to do some of this "chasing" type stuff myself, to ensure everyone had all the information they needed. And more importantly what I wanted them to know.

There were times where I would have to repeat myself in terms of requests/ history, so in the end I wrote a Care Plan myself and gave copies to my midwife, CMHT worker and the hospital. My husband said I was doing someone's job for them but I felt a bit more in control and I could ensure everything was in there that I wanted from the birth and post-natal period. And the CMHT worker took info from this into his official Care Plan (CPA I think it's called). Everyone said it was really great to have this, so it worked for me. If it helps, here are the areas of info I put into it:

About Me & History (about my episode of PP and any other physical or mental health conditions, also where I live and that I was happy to talk about my past experiences - so people weren't afraid to ask!)

Contacts (phone numbers of NoK, professionals etc. I also put here that I wanted my husband to make decisions for me if I couldn't)

Pregnancy (info on any issues such as an extra scan I had and other appointments related to PP/ Mental Health too)

Birth (past history and preferences - I had an elective caesarean for example)

Post-Natal Period (including our wishes for me to stay at home if I got ill and it was manageable, and reducing visitors etc)

Medication (you've already said what you'd like, I also made a note of things that worked and didn't last time)

Support at Home (Who and What - for example, I couldn't drive and it was useful for me to have people help with childcare transport for my eldest, and things like ironing!)

Triggers (What Works and What Doesn’t, with examples from my PP in 2009)

Family & Friends (I listed who I would like to help with things, and their contact details. It was useful as we have an older child who spent time with some people, and if I had become ill, the info is all there about our wishes)

Sorry for the mammoth post, but I hope this gives you some more pointers. I had my baby at the end of November and have kept well to date. Having something in place if I had become ill was really important to me and I hope you get all of your wishes and preferences recorded and the rest of your pregnancy goes really well. All the best.

[smiles1975 in reply to Hannah_at_APP]

I think I will find this info very useful when putting my care plan together. My episode too came out of the blue. I went from being normal to being sectioned in the space of a week. I was kept in psych wards for 3 months. My episode was extremely severe and I suffered a complete loss of memory for the initial 4 weeks. The next month was a bit blurred and I was still behaving rather strange and doing things that made no sense. I became more stable the final month before they discharged me. My episode didn't follow giving birth and my youngest was 3 years old at the time. They diagnosed me with bipolar and I have had a couple of relapses but these have been mild in comparison and although I had to stop working I was able to stay at home and look after myself. During these periods I would stop caring for my kids and my ex would do this for me. This is the first time I've been expecting since the episode. I'm sure that things will turn out fine and I know that if things don't go too well for me I have people around me who will be able to help me get through it. I just wanted to put together a plan so that midwives and Dr's based at the hospital are made aware of the problems I have to face everyday which will impede on my abilities to take care of a newborn such as nighttime feeds and lack of sleep due to being in an unfamiliar place. Also if I take my meds and then go into labour I will be too sleepy and have a total lack of energy to give birth and will need to have an epidural to help me get through it. I would like to have an epidural anyway but I'm not sure how realistic it would be for me to ask for one and get what I want. Like would I need to have a really good excuse for having one? or would it be possible for me to be given one purely on the grounds of having a mental health disability?

[Hannah_at_APP Administrator in reply to smiles1975]

Hi again smiles1975.

A lot of your story sounds similar to mine, in terms of your psychotic episode. Losing those first few weeks is awful but I do think it protects us and helps recovery too. I was a nightmare by all accounts!! I think this forum is great for people sharing experiences and I'm glad you have found some useful and helpful info.

As for the epidural, I'm no expert but I think you would have plenty of reasons for wanting this, linked to your meds for example. Something you can perhaps discuss with all the professionals in advance and record in your Care Plan so it's there? For example, I had an elective C-section as I'd had an emergency one the first time and it was so awful. Again, any woman can ask for this whatever their circumstances (I had a friend do so a few months back) and although I had a bit of resistance from one of the Drs I saw at the hospital, the others were entirely supportive. I know it's major surgery but for me it was the right choice. Again, consistency of staff will help, together with your Care Plan, to avoid repetition and the same conversations.

Good luck with it all anyway, take care and all the best.

[andrea_at_app Volunteer in reply to Hannah_at_APP]

Thanks for the great advice Spannerb & sharing things you included in your care plan. Smiles1975 don't be afraid to ask for what you want (& expect to get it), after all, the professionals want exactly the same as you, for you to stay well. You deserve good treatment so do ask & discuss it with them until you make decisions you're all happy with. Good luck!