How likely is it to suffer PP again after a subsequent baby?

[raspberries]

I'm on my way to recovery and I definitely am not ready for another child yet but we've always wanted a 4th child at some point. I'm wondering whether or not its worth the risk, it wouldn't be for another 4/5 years yet but I'd like to do some research before, to know whether its a possibility one day or not.

[BronSyd]

There are a number of us on here that have gone on to have more children after an episode of PP. The key is just too be more prepared. I had my 2nd child 6 months ago. Although I did start showing signs of mania in the first few days we quickly got on top of it. I was back to normal within a couple of weeks. It was hardly an issue at all.

The lead up was probably more stressful than anything. I had decided not to take medication as a precaution (most Drs would suggest taking small doses postnatal or even in your 3rd trimester before sypmtons occur) and that's probably why I actually had symptoms. But I'm glad I did it that way as it showed me that my first episode was definitely not related to anything that I'd done but completely a chemical imbalance.

I had things in place so that if I needed to be hospitalised it could happen quickly. I was a lot more aware of what was going on in my head so it was easy to say yep I need the medication. I also had started up a relationship with my psychiatrist before I had my baby so I knew I could trust her and she could trust my judgment when I wanted to quickly reduce my medication and come off it completely within weeks.

So in answer to your question I think it's about 50-75% chance of it happening again but with foresight it shouldn't be as traumatic.

[kellbell]

The key is to be prepared. My eldest will be 3 in June & my youngest is just coming up to 6 months. I spoke to my psychiatric nurse prior to trying for our 2nd & he assured me all would be well if they kept close eye on me during pregnancy & postnatally. Sadly for me I got pp again & what was worse was that it took almost a month to get me into mbu so this time round I ended up spending even longer in hospital & coming out on higher dose of olanzapine.

I'm so grateful to have both my beautiful boys but cannot risk illness again so will not be having anymore children.

if & when you decide to have another please just make there's a proper care plan in place. I felt really let down by the midwives & community health team and a bit cross with myself for not realising how ill I was becoming right away.

All the best xx

[Naomi_at_app Volunteer in reply to kellbell]

Hi kellbell

Just wanted to say really sorry to hear about your experience. You are right it's not enough for professionals to say 'you'll be fine this time' as planning what happens if you do notice early warning signs of relapse is so important.

Similar to you I also had early signs of mania and PP after our second baby. It was hard to accept that I was one of the 50% who do go on to have a recurrence. I'd been so determined during pregnancy that it would be fine this time.

However I had a detailed plan in place so knew what to do (call the Crisis Team as it was a weekend and start my antipsychotic medication). Luckily for me this nipped the psychosis in the bud. Sadly I had a further period of postnatal depression but made it through the other side eventually.

Raspberries - glad you have asked this question and as you can see each woman's pregnancy after PP experience is different. As others have said a subsequent pregnancy does carry a high risk of PP - around 50% - and it's important to plan for this risk. If you live in an area with a specialist perinatal mental health service, you will be able to meet with the team during your pregnancy and put together a plan for your birth, postnatal care and action if you have any early signs of relapse. Many women choose to take medication during or immediately after their pregnancy to reduce risk of relapse and it's worth talking this through with your psychiatrist or GP even if there is no specialist perinatal team in your area.

Like you are wondering about, we had a five year gap between our children and this did help my recovery in that I could talk to my eldest and reassure her, and I could have bonding time with the baby when she was at school. Even though it was a very hard time being ill again, I feel glad that we do have two lovely girls now.

Thinking of you lots as you go through this important process of thinking about the future and whether the risks of illness in expanding your family are manageable. We are here to support you and to chat any time.

Naomi x

[kellbell in reply to Naomi_at_app]

Thank you Naomi. It was terrible, like you I was convinced all through my pregnancy I'd be fine this time. Having 2 episodes so close together has been really tough & I'm really struggling with low mood at the moment.

I'm glad to hear from your experience that there's light at the end of the tunnel & I'm so grateful for my two beautiful boys I would never be without them. Everyone keeps reminding me I've recovered once & I'll do it again but I'd forgotten what a long road it can be & it's harder this time.

[Naomi_at_app Volunteer in reply to kellbell]

Hi kellbell

Yes I can really identify with you - my depression was harder to treat second time around and for a season we did have to dig very deep to keep going at times. It was my fifth medication that really did the trick so there is always hope.

Do you have any support alongside medication with your low mood? My local children's centre offers free counselling which has been excellent - maybe see if this is available in your area. Do feel free to use us here at the forum too. We can cheer you on for your courage to keep going and remind you that yes, you will recover (I too remember thinking 'really?' when my friends and family said it!

Try not to feel guilty that you got unwell again - it's not because of anything you didn't do - like me it's just being in that 50% whose brain chemistry is vulnerable second time around. My girls are 8 and 3 now and life is good again - my eldest has a lot of empathy now and understanding about mental health which I hope will stand her in good stead.

Here anytime you need to chat.

Naomi xxx

[andrea_at_app Volunteer]

Hi Raspberries, this is such a big issue on our minds after having PP that this question comes up a lot. It's good that you're asking questions & making sure you're armed with all the correct information in advance of making any future decisions. I agree with BronSyd & Kellbell that preparation & a good care plan in place is key.

Obviously the risk differs for everyone but here's what the APP website says about: 'Who is most likely to get PP?'

"For many women with postpartum psychosis there may be no warning. For other women it is clear that they have a high risk. If you have ever had a diagnosis of Bipolar Disorder or Schizoaffective disorder your risk of postpartum psychosis is high. You may also be in this high risk group if you have had a diagnosis of Schizophrenia or another psychotic illness. If you also have a mother or sister who has had postpartum psychosis, your risk may be even higher. Women who have had postpartum psychosis before are also at very high risk. If you are in one of these high risk groups your chance of having postpartum psychosis is between 1 in 4 and 1 in 2 (25% to 50%). You should discuss your individual risk with a psychiatrist."

It also says, "Many women who have had Postpartum Psychosis go on to have more children. There is a risk of having another episode and so it is important to plan carefully and to put the right support in place. About 1 in 2 (50%) women who have had postpartum psychosis do not experience PP again after the birth of another baby – but about half do. With the right care, if you have another episode, you should be able to get help quickly and recover more quickly the second time."

For those diagnosed with Bipolar, this page has lots of really useful advice about pregnancy & Bipolar: app-network.org/what-is-pp/...

There are lots of threads here on the topic of subsequent pregnancies (in the 'Pregnancy' category on the RH side when you click 'Questions' in the top blue menu-bar), here are a few of them you might find useful at a later stage:

Care plan for second pregnancy?

healthunlocked.com/app-netw...

Advice re care plan/preventative medication for 2nd baby following PP?

healthunlocked.com/app-netw...

Danger zone timescales in subsequent pregnancies?

healthunlocked.com/app-netw...

What were the early warning signs of PP?

healthunlocked.com/app-netw...

There's a lot of information here & there's obviously no rush to read it yet but I hope it reassures you. Kellbell's experience of being told that everything would be OK if they kept a close eye on her highlights the lack of awareness & knowledge in some professionals & how important getting correct, specialist advice in advance is. Lots of people here have had further pregnancies without becoming ill again or if they did they felt it was less of a shock & recovery was quicker 2nd time round. So I would say it all looks very positive & your future options are open. All the best, A x

[Lilybeth Volunteer]

Hello raspberries,

There's a lot of info here for you. I had my sons in the mid-70's and early 80's and at the time I wasn't aware that I had PP. Much has changed for the better since then and I think with time the memory fades of just how ill we were. Especially being in the psychotic stage when our nearest and dearest had to witness our very odd and in my case, self-harm behaviour.

Children are a joy but you have to be careful with your mental health. I know that you are not considering this for another 4 / 5 years but if you were unfortunate to have a PP episode it would mean having to struggle with not only your illness but a newborn, three other children and your husband.

You are very wise weighing up your options in advance. Other mums here have added to their families without PP striking but it is a risk. I know it's not the same for everyone but with each of my sons I 'lost' their first six months as I was so ill. We have all been through hell and high water for our children and you are still on your journey to recovery,

My advice would be to give yourself time to enjoy your growing family. Look forward to the times just around the corner when the good days will outweigh the not so good and most of all be very proud of how far you have come.

Take very good care of yourself.