Action on Postpartum Psychosis
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Thinking of second pregnancy and advice on breastfeeding with meds

Hi all.

i suffered from pp in march this year after birth of my son. I was hospitalised and prescribed Aripriprozole, so i couldn't breast feed. I luckily recovered quickly. I'm still on meds but starting quick reduction. I am thinking of trying for number two in the next year or two. My initial thought is to take aripriprozole again as it worked well and quickly but part of me really wants to breast feed so was wondering if there is any meds that you can breast feed on and wondered if anyone had tried it? Its like my head says take the meds that worked before but my heart wants to breastfeed

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Hello I will send you more details when I get chance. I used progesterone for my second and third pregnancy and had no relapse and I did breastfeed. Helen

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Hi sally

It's great to hear that you are making such a good recovery - well done! We have produced a detailed guide for mums thinking about another pregnancy which you can download here

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

Lots of mums who were treated in the 70's and 80's report really good outcomes with progesterone therapy however unfortunately this tends not to be recommended by specialists today as research suggested some links to postnatal depression.

Perinatal psychiatrists tend to advise that you take medication straight away after birth or have it ready to take in the early days. Quetiapine is now considered safe for breastfeeding so might be a good option for you. I can understand though that you are torn between going for Aripiprazole which you know works well for you and trying something 'unknown'. These are important things to talk through with your husband and you can also ask for an appointment with a perinatal psychiatrist to talk pre-conception. One thing we always say to mums is there is no guilt if you do decide nor to breastfeed or are unable to - the best thing for baby and you is to look after your mental health.

Wishing you all the best and do keep asking questions - it's what we are here for.

Naomi x

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Hi there. I too suffered from pp earlier this year and was hospitalized. I was on olanzapine and so I wasn't allowed to breast feed or it was highly recommended that I didn't I have since had many conversations with my phyc and she has said that you can be both pregnant and breast feed on seroquel which is what I am currently on. It's great to hear o someone else who is thinking of having another baby 'soonish' after pp we are thinking of tryingin arch next year :)

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I had PP after the birth of my first child in 2009. Trying to breastfeed my baby didn't work out well - as it doesn't for some women - and when I was hospitalised I had to stop anyway as I was initially on a general psych ward on my own. When I moved to the Mother & Baby Unit, I too was on Olanzapine (after a number of other meds) and by then it was too late to think about breastfeeding and it was not recommended on that medication by my team.

I had a 2nd child in 2013 with no recurrence of the PP. As I'd struggled to feed my first child, we made the decision not to do so with our 2nd. For me it was about giving it the best chance of being well and able to enjoy my baby, in other words to try and dodge PP if at all possible! I was lucky and with a care plan in place, a referral to the CMHT so I had a worker allocated (after being discharged, this was hard work but I'm glad we had something in place in case it was needed and for monitoring) everything worked out. I also decided to take a low dose of Olanzapine again on giving birth, as I wanted to minimise any potential symptoms. This also took the breastfeeding decision out of my hands, although I gave birth in the morning and gave my baby a couple of feeds from me before starting meds (and bottles) in the evening.

There are several things out there which you can do to try and avoid becoming ill again. Are you still under a Mental Health team or psychiatrist now, and what is their advice? Have you had involvement with a perinatal team or a general one? In my experience, the perinatal team were much more knowledgeable and supportive - when they contacted my midwives, hospital and even the general psychiatrist, it really made them sit up and listen which was great! It'd be a good idea to make everyone aware of your plans to try for a 2nd child and have the right support there - in my case when I was ill, part of the problem was getting access to services to try and get support and we were keen not to be having our 2nd child "from scratch" with no mental health input. It was a struggle, as I'd been discharged and had no ongoing diagnosis (my PP had been "out of the blue") but for us it was the right decision.

Deciding whether or not to breastfeed is a very personal decision. All I'd say is try not to feel any guilt about whatever decision you do make. I know in the early days of me becoming ill, midwives and health visitors were trying to make me persist in breastfeeding and it really didn't help. You are doing the best for your baby in whatever choice you make. Having my husband support me through everything was very positive too. Even with all the notes on my file, there were some professionals I saw in my 2nd pregnancy who tried to suggest things which were not in my care plan, or were in direct contradiction of it (with triggers being listed etc). You and those close to you know yourself best. Good luck with it all, take care, x

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I don't have time to reply fully however wanted to say that I had PPP after the birth of my daughter in 09. I was placed onto olanzapine and chose to stop breastfeeding at 12 weeks although I was told I was on the safest drug for that. My son was born in 2012 and again I was placed on olazpnzapine, for prevention and chose to research into breastfeeding on that drug. I contacted the breastfeeding network and had communications with their pharmacist Wendy who helped me. It's actually considered safe to breastfeed on olanzapine :) so this is what we did for ten months with no ill effects. I also stayed well. I'd advise contacting the bfn so that they can assist rather than trusting the views of others or Drs with no specialist training

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I was diagnosed three years ago and I was put on risperdol i breast fed a happy healthy little boy for a year

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I'm sitting here with my very healthy and robust second child asleep on my knee. I suffered from PP five and half years ago and was gutted that I couldn't breast feed my first child. I had a very carefully thought through action plan for my second child. I had no meds during pregnancy and then I took 15mg of Apriproprazol the night after my second and carried on with that dose for 6 months. It was hard but I didn't relapse. As for the feeding I hand expressed as much colostrum as I could at the end of my pregnancy and I fed my second as much as I could that first day (she mostly slept though). Do you know what though? I have two very healthy happy bottle fed children. A lot of immunity is passed through the placenta to your baby and breast is not best if it could jeopardise your health. I still went to my NCT group and I felt a lot happier getting my bottle out the second time round. Good luck with whatever you choose to do.

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Thank you for your reply. It totally put breast feeding into perspective. The guilt not breast feeding was hard but now I have a 2 and 4 year old I don’t care, I’m just happy I stayed well.

My eldest has autism and had I breast fed on meds I would have always wondered but as I didn’t, it’s just down to genetics likely x

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Thank you for your reply. It was really lovely to hear you stayed well and that you’re now in a position to realise any guilt was unfounded. It is just generally nice to hear something so positive, thank you.

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No as I said thank you, your reply made me think staying well is the most important thing at that time x

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I'm on Risperdal and I breastfeed my son. I was also on Zyprexa and breastfeeding. Lactmed is a good resource for info on medications and breastmilk. Here's the link:

toxnet.nlm.nih.gov/newtoxne...

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Thanks but my daughter is coming up 2. I chose to formula feed to enable me to sleep at night and family fed. I was also concerned about passing meds to baby in milk. I guess I will never know if I could have breast fed. I didn’t suffer from pp again but won’t be having a third.

Hopefully others will see this on feed

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The link you sent I meant x

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Oh, I didn't realize it was such an old post. Sorry about that. I'm so glad you went on to have a second child without getting pp again!

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Me too! Don’t worry, it brought back memories of how fixated on breast feeding I was and made me chuckle x

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