Stuck!!!

[Cherry5909]

So I have a diagnosis of bipolar with psychosis, and I have recently had my baby (4th October) although I'm now starting to notice that I think I'm heading downhill, I keep getting these delusions in my head and sometimes the voices are so loud and persistent I just don't know what to do with myself! I feel like I cannot talk to anyone as social services are involved because of my bipolar, I don't have a very good relationship with my mental health worker and I feel I can't ask for a new one as she might get offended. Should I just go to t doctors? I just don't want anyone to think I can't cope with my baby

[andrea_at_app Volunteer]

Hi Cherry5909, well done for recognising that you're going downhill & doing something about it. It's really difficult knowing who to trust when you don't have a good relationship with you mental health worker but the important thing is to get the help you need as soon as you can so you can get better quicker.

Were you diagnosed with Bipolar before you had your baby & are you taking your medication OK now? Do you have a Psychiatrist you can contact straight way? Or the number of your mental health team or early intervention/crisis team you can ring directly as soon as possible? If you can't get an appointment with them soon enough, yes go to your GP, he might be able to speed things up.

Is this your first baby & is there someone with you who can help out with the baby care today? It's exhausting & so hard getting the rest you need, are you sleeping OK? Sorry for all the questions, so many I know! Just answer what you feel you can (after you've got the Psychiatrist appointment sorted).

It can feel so difficult having social services involved but they really want to keep families together so don't stay quiet because of the fear of them thinking you can't cope - you getting the help you know you need actually proves that you can cope. I think just going with the flow & talking to them can actually help a lot on both sides.

If you get the chance, let us know how you get on & how you're feeling. We're thinking of you & we're here for you.

[Cherry5909 in reply to andrea_at_app]

Hi there, thank you for your reply. Sorry I didn't really give much info, yes I was diagnosed a few years back, and this is my first baby. I do have my partner to help, but I'm quite a paranoid person and the delusions are somewhat focused around him. I saw my psychiatrist a few weeks back, as I had to stop taking my medication as they said it wasn't safe whilst breastfeeding, and that is what I'm trying to do. So sleepiness nights are basically the norm now, I never realise how hard breastfeeding actually is! My case worker said she can be here Monday at the earliest, so I think I might have to go to the walk in centre and just speak to a doctor. I was taking ariprprizole (can't spell) and my psychiatrist said that the medication I can take whilst breastfeeding is olanzapine but I've had it before and it didn't help, just made me put on weight so she said we shall see how I can on without :/

[andrea_at_app Volunteer in reply to Cherry5909]

Hi Cherry5909, thanks for replying so quickly. Yes, I'd go to the walk in centre as soon as you can & explain that you've stopped taking your medication due to breastfeeding & you need to talk through your options with your Psychiatrist. Monday sounds a long time away to me, the sooner you get help the better so things don't escalate & you'll feel better quicker. I know olanzpine works well for many but there'll probably be other options for you too. I know how awful weight gain is but that can be sorted later, the priority for you & your baby right now is that you stay well.

There's lots of info in our guide for women with Bipolar or previous PP at high risk of PP here, have a read through especially page 8 about medication. app-network.org/wp-content/...

Well done again for recognising things are going downhill & reaching out to sort it!

[Florence21 Action on Postpartum Psyc in reply to Cherry5909]

Hi Cherry,

I agree with Andrea that you need to see a psychiatrist as a matter of urgency: I have bipolar and tried to breastfeed after the birth of my first child and the combination really isn't a good one; the hormonal changes combined with the lack of sleep can have a really bad effect and you need to stop yourself getting any more ill for your sake and the sake of the baby. When a similar thing happened to me I stopped breastfeeding immediately so I could take the meds that worked best for me (in my case lithium). Having delusions and hearing voices would suggest that you are escalating towards a postpartum psychosis and you really need to get some help quickly.

Don't worry about Social Services, they really do want to keep families together and where there is a partner as in your case they are very unlikely to take the baby away and would be more focussed on supporting you both through this tricky period.

Re what you should do: get your partner to phone the crisis team and ask them to consult a specialist perinatal psychiatrist, or call your GP and say it is an emergency and you need a perinatal psychiatrist. If you need to stop breastfeeding please don't feel bad about it: lots of children are bottle-fed and turn out fine (I put my second straight on the bottle so I could take my meds and had no problems at all - they're both very healthy mentally and physically). Your baby needs you well more than he needs breast milk.

I would make sure you have your partner or family member/friend with you when you call or visit the doctor so that if you get upset/are having a hard time, they can explain what you have told them is happening and that you need to do something about it as a medical emergency. They can also help looking after the baby. In the last resort you could go to A & E (do you know if there's a perinatal mental health service at any of your local hospitals? - the GP should).

You're doing a great job so far holding it together - please get help quickly and think seriously about stopping the breast feeding so you can take the best medication for you, I really think it would make a huge difference very fast.

Take care and good luck, we'll be thinking of you

Florence 21

[BronSyd]

Hi Cherry,

Congratulations on your new baby.

Sorry to hear you're having a rough time. I'd echo what Andrea and Florence have said and get some help ASAP. Unfortunately especially on little sleep and with a newborn things can escalate very quickly. Definitely don't worry about social services they are there to help and will see your attempts at getting help as a positive.

Well done for recognising things aren't quite right. Well done for making the hard decision to start and continue so far to breastfeed. It definitely is something that can be very difficult to do and often requires a lot of practice and perseverance and is doubly hard to do while you are not well.

It can be a bit of a balancing act between deciding what is the best thing to do. You can continue to breastfeed while trialling medications which hopefully work and hopefully you won't get worse. Or you can start taking a medication that you know works for you and then hopefully recover quickly and start to fully enjoy your newborn.

There are many options for medication while breastfeeding. I took quientiapiene and resperidone (both anti-psychotics) and sodium valporate (a mood stabiliser) while in a manic (psychotic) state and continued to breastfeed (although I'm in Australia and sometimes recommendations vary in countries and change over time).

Sleep tends to be a big trigger for mania and psychosis so often Drs will recommend that someone else does night feeds if possible either formula or expressed breastmilk. That way you can try to get a 6-10 hr block of sleep at night (which for some reason is the key).

Although it may seem scary, seeking out a bed in a mother baby unit might be a good option for you. There you'll have specially trained staff to help you with your baby and get you back to a mentally healthy place. That takes away some of the problems associated with trialling new medications if you've got that support in place.

I know how hard it is to decide between your and your babies health. There are great benefits to breastfeeding however if it is adversely affecting you and you can't get on top of your mental health then there are other options. You may just decide that formula is the best option for you and there is nothing wrong with that decision. You have provided your baby with 4 weeks of breastmilk which is a great start.

Here is some more information re breastfeeding that I found useful if you are interested. I in no way mean it as pressure to continue but simply provide it as another option to full formula feeding if you feel up to it. I know for some people (like me) it can be an important part of recovery to continue breastfeeding but it is also important for you to be well.

If you decrease your night feeding or have to take a break from breastfeeding for while this can mess with your milk supply so try to keep feeds and/or expressing up during the day. You can also look at things to build your supply up if this becomes an issue (fenugreek and motillium worked for me).

You can also often successfully supplement feed with formula, that is breastfeed and give formula top-ups. I did for about 6mths. Some babies don't seem to have problems switching between bottle and breast but there is also the option of a supply line (basically it encourages them back to feeding at the breast with a little tube that drips milk (formula or expressed) so that they get a faster flow which is often why they like the bottle more).

It's definitely not recommended while taking medications but you can look into safe co-sleeping which if done safely can help you get more sleep and still breastfeed overnight. You'll need to learn to breastfeed lying down (if you haven't already) an invaluable skill even if you're not co-sleeping.

It's not for everyone but if you're not aware there are breastmilk banks where you can actually get donated breastmilk from. In Australia the breastfeeding association has been a great source of support for me. I know there's a similar helpline in the UK.

I have given you way too much information especially while you are not 100% but this is a subject that I feel quite passionately about so if you want anymore support around breastfeeding feel free to msg me. But please note I do not judge anyone for decisions they make I simply think it's important to make decisions based on all available information.

This forum is a great source of information and support. We are always here.

I hope to hear that you get the help you need soon.

Good Luck.

[jododo]

Did you know health workers are not allowed to advise against breastfeeding? Sometimes it's just not best for mother or baby. I really wanted to as well but I see now how big a part it played in me getting ill. It sounds like you really need your meds. It's no good for baby if you are ill.

[Nic_at_APP]

Hi Cherry, There is so much pressure these days on mothers to breast feed, but its very important to remember that it doesn't make you any less of a good mum than if you do. I was unable to breastfeed my daughter and thankfully realised that my health was more important.

Did you manage to get to your walk-in centre or get in touch with a specialist Perinatal Psychiatrist? Where abouts are you in the country, we may know a specialist in your area that can help.

Thinking about you and hope you can get the help you need soon,

Nic

[Hannah_at_APP Administrator]

Hi Cherry5909, hope you have managed to get in touch with a GP and Perinatal team, feel free to come back and ask for more advice if you'd like. Have you been able to talk to anyone else in the mental health team if you don't get on with your key worker? Don't worry about offending her, it's her job and I'm sure she's had a lot more to deal with than you think! Please be reassured about social services' involvement too, as others have said, they want to keep families together and should do whatever they can to help you as a family.

As others have said, breastfeeding can be really difficult, please don't beat yourself up about it, especially if you're not feeling 100%. Nevermind the tiredness a new born brings! When I had pp, I was desperately trying to breastfeed and it wasn't working, my baby lost a lot of weight, but I wouldn't listen to people who asked me to try bottle feeding and basically the breastfeeding battle I was having only stopped when I was sectioned. It's not done my son any harm to have not been breasfed, as he obviously switched onto bottle at that point when he was left with his Dad and I was at my worst in a psych ward before being transferred to an MBU - which was honestly the best thing for us all, as a family.

It'll be the furthest thing from your mind now, but when I had my 2nd child, I took a low dose of anti-psychotic on giving birth to try and avoid becoming ill, so didn't breastfeed at all then. And he's a very healthy and happy baby.

I hope you've been able to access the support you need and are able to do things that helping you with your mental health too. Take care, x

[Naomi_at_app Volunteer]

Hi Cherry

Really sorry to hear that your mental health has deteriorated - please don't feel guilty - the first few weeks after having a baby is a hugely vulnerable time for experiencing psychosis, even for women without a diagnosis of bipolar disorder the risk is 20x higher than at any time in life. What's happening is not your fault in any way. Things can get worse quickly in this postnatal period so you are right to seek help as soon as possible.

I was sorry to hear that you were advised to stop medication completely in order to try and breastfeed. There are lots of options for staying on antipsychotic medication and breastfeeding and it sounds as if some specialist advice from a perinatal psychiatrist would be useful here for you - you can ask your psychiatrist if you can have a phone consultation if there is a perinatal psychiatrist in your area. Quetiapine is now considered safe for breastfeeding, and sometimes there are 'work-arounds' for other medications where you can express and discard a couple of feeds after taking your meds and then feed as normal.

However, as everyone else has said, if you are finding breastfeeding exhausting, and hard work there is absolutely no shame in stopping and switching to bottle feeding. So many of us on this forum stopped breastfeeding or decided not to breastfeed - and as others have said, your mental health and wellbeing as a new mum is a much higher priority. One thing I now know is that you can keep the bottle-feeding experience as close as possible to breastfeeding by tucking your baby close to your body, feeding with your top lifted in the same was as you would for breastfeeding, and snuggling in bed to bottle feed (lots of this advice is given to mums when they adopt tiny babies and it all helps with the bonding/skin-to-skin experience)

Thinking of you lots - we are here for as long as you need us so keep asking any questions you have

Naomi xx

[Naomi_at_app Volunteer]

p.s.

Thought you might find p.13 and p.14 of our guide for mums at risk of postpartum psychosis helpful - it has lots of advice for the first few weesk after birth. Here's the link

app-network.org/wp-content/...

Naomi x

[Ellie_at_APP Partner]

Hi cherry, I'm so sorry you're going through a hard time. How are you doing? I hope you are ok and are able to get the support you need. to just say what others said, please just be honest etc with professionals and let them now how you are feeling. I know from being here as well the sooner you get support the better. re the breastfeeding I just wanted to share my experience, and perhaps it may be helpful. I really wanted to breastfeed and managed for first four days until I became suddenly acutely unwell with pp. I had become obsessed with it even and was so unwell I couldn't. I was on olanzapine and was told I couldn't or had to express etc. breastfeeding was just too much with everything else going on. anyway as many others have said my boy is healthy, happy and I have an amazing bond with him, for me the most important thing was to get well.

I did used to feel bad when I saw mothers breastfeeding, but I now see my experience though hard as it was, and not what I would have wanted and chosen, has given me many gifts as well including meeting some amazing women on here, and also a huge thankfulness for my life, happiness, and my beautiful boy.

There are lots of great advice and experience on here. I hope at least some of it is helpful.

Take care

[Cherry5909]

Hi everyone, firstly I just want to say thank you for all your advice and comments. I do find it helpful talking on here as I do find it hard to put things into words so I never really stick up for myself or say how I really feel. Just an update, I have spoken to a psychiatrist, my first time seeing her as the other one unfortunately left. She said I'm doing such a good job breastfeeding she advises that I carry on without medication for as long as I can. I then set up for a home visit by my case manager and mental health worker, but unfortunalty they never turned up and obviously realised a few hours later so apologised and rescuduled for next Wednesday I feel a little bit let down but I understand everyone is so busy. I want to go to the walk in centre as I feel they might get me help sooner, but everytime I think about going out, I get so paranoid about everything. I just feel like I'm going in circles, I want to tell people what's going on but on the other hand I can't trust anyone :/

[Ellie_at_APP Partner in reply to Cherry5909]

Hi Cherry,

Thanks for the update, I had been wondering how you were doing and hoping you were OK.

That's good you've seen your psychiatrist, and it's really good to hear that they want to support you re the breastfeeding etc.

And yes, it's really disappointing that your case manager and mental health worker didn't turn up! and that you have to wait until Wednesday to see them. What a blow, it seems such a long time. Sorry for all the questions but - Do you have support around you? Family? Friends? Do you have numbers you can call and are at hand - a mental health crisis team? Can you phone the walk in centre, and maybe tell them that you feel paranoid and unable to get there and what would they advise? Or can a friend / relative phone for you? Do you have someone who can go with you to the walk in centre? I think anyway new mother's feel nervous and scared about going out initially anyway with the baby - it is a lot to go there by yourself - and like you said to talk to people you've never met and to trust them is very difficult. But I would definitely encourage you - get support - and the more honest you are the better it will be, the more they will be able to support you.

Take care, we are all here for you, you're not alone. X

[Hannah_at_APP Administrator]

Hi Cherry,

Good to hear your update and a positive appointment with the psychiatrist, even if the others didn't turn up - how frustrating! I know when I was still seeing a psychiatrist after my PP, and just when I was due my final appointment, he cancelled on me, I was so disappointed. The reason he gave was the weather as it had been raining lots and there were some roads in the area flooded, but I knew I could get there, he just hadn't even tried! Grrrr, soooo frustrating.

But at least you have another date in the diary with them. I hope it all goes well and you are able to access some support in the meantime to get you through. Like others have asked, are there family or friends who would be able to support you in the next few days? It can be hard work leaving the house with a baby at the best of times, and if you're not feeling your best, it's almost impossible. Try and get someone to go with you if you feel you want to go to the walk-in, although I know it can be difficult to trust when you're feeling unwell. I know that the rainy weather here has stopped me walking to a local coffee morning today as I can't face getting drenched, which sounds really silly - I drove instead!

Is there a telephone support line in your area, linked either to your mental health time, or perhaps a charity like Mind? Do your GP surgery offer any telephone consultations so you can let them know you are struggling a bit? I know these things are around the local area to me, but not everywhere is the same. I hope it works out for you anyway, and your Wednesday appointment goes to plan this time. Keep us updated if you feel you'd like to come back on the forum again. And some of the guides which Naomi linked to will be helpful I'm sure. Take care, x