Planning Second Child Following 2 Episodes of PPP, any advice please?

Dear all,

My wife and I are planning to have a 2nd child following 2 previous episodes of PPP. We are looking for any advice on preparation, planning, what to ask for etc....

In June 2013, my wife gave birth to our daughter and then started showing signs of PPP a couple of days after (obv we didn't know it was this at the time!!) . She was admitted to an MHU for 10 days after a week of the medical profession deciding what was happening to her. In this week, I had to get to grips with being a new father pretty quickly as well as trying to keep my wife as calm and as relaxed as possible! Inevitably, it didn't work as the PPP took hold.... She was treated with Sertraline and Sulpiride.

After this initial episode, Jen was never quite herself. She had good days, bad days, mediocre days. My Great Aunt died in Feb 2014, and we were both very close to her and this seemed to be one of the main catalysts for what happened next. It was in late May 2014, that she started to show signs of being unwell again. It was a week of escalations that culminated in Jen calling an ambulance herself and being taken to the local hospital. She was sent home again, with instructions to rest!?!?! However, two days later, with insistence on my part, she was admitted again to an MHU. She was in there for a month this time. Initially treated with Sertraline and Sulpiride again and then her medication was changed to 300mg Sertraline and 5 mg Olazapine.

After this second episode, we have looked into our particular situation at the time and I would like the community's thoughts on this? Just before Jen got bad again, she started her menstrual cycle , the first time since having our child. We strongly believe that our particular situation was exacerbated by the extra hormones in her system. Have you encountered similar examples of this?

Now, for the 2nd child plan... Jenny is still on 50mg of Sertraline and the 5mg of Olazapine. I have read a few posts on similar situations but I am still unsure of the best approach on this...

I believe we need an action plan in place in Jen's notes for all the professionals involved in her care. We are having our initial planning meeting with her Perinatal Team Doctor in two weeks.

What are the sort of questions that we should be asking?

I presume we are likely to continue with her current medication throughout the planned pregnancy? (I have read that Olazapine is safe for this)

Should we plan to have the baby at our v.small local birthing centre like our first (which has no doctor on site, just Midwives) or should we plan to have it in the big city hospital 30 mins down the road? (Where the 'Crisis' team is based should any signs of PPP appear...).

What should we look for? Any advice would be very much appreciated!!

Thank you very much,

Ollie and Jen

7 Replies

  • Hi Ollie and Jen,

    I'm sorry it's been such a rough couple of years for you both.

    That's great that you are planning a second pregnancy. I've not had a second child so can't share any experience on this but I know you will get helpful advice from others here.

    You may have already seen it, but if not the APP 'planning pregnancy: insider guide for women at high risk of PP' is a really useful guide -

    I guess decisions around where to plan to have the baby etc will come down to weighing up the pros and cons of each and personal preference (and the advice you get from your healthcare team perhaps) but in terms of questions to ask and ways to plan, I'm sure you'll get great advice here.

    All the very best.

  • Hello Ollie and Jen,

    Welcome to the forum and firstly, can I say well done you for being such a supportive partner, through a very challenging time- I too, have a hero husband. I hope I can offer some insight- however I'm not a clinician and can only tell you my experience of having 2 babies.

    My first baby was 10 years ago, we had a very traumatic birth and my illness developed slowly over 12 weeks post delivery. We had never heard of PP, it was mild, went undiagnosed and untreated- resulting in very deep depression for 4 years.

    8 years later, we decided to have another baby and thought I could not be unlucky to suffer what I thought was pnd again. I opted to do everything differently to make the bond, minimise trauma and not suffer again. I had a fantastic, perfect natural water birth, using meditation techniques. I breastfed baby from birth, all was wonderful, I was so in love...but sleep was becoming a problem because of the feeding. 2 weeks postnatally the onset of PP was rapid, intense and very noticeable. I was straight to the GP and straight to acute services. I was given Sertraline as a breast feeding mother, I was given sleeping tablets and told I must have a minimum of a 6 hour block of undisturbed sleep (hubby had to introduce formula, and took up night feeding duties), when this didn't stop the symptoms, they added in Olanzapine, that I was to take at night and not feed for 7 hours. I was treated at home because I was feeding, and services came to me daily. If I had not of been feeding, they would have taken me in and treated it more aggressively.

    What I know now from my history is...if I was to have a third, they would allow me to labour, begin medication from birth- I would opt to combination feed, and hubby would take the nights again. I realise not every mum has this level of support from their partner or family, so perhaps a mummy and baby unit where the nurses can help with the night feeding would be best?? I'm so glad I had the opportunity to stay at home, especially as I have a 10 year old, but we did catch it very early!

    Good luck guys x

  • Hi Ollie & Jen, and welcome!

    I have 2 children and had an episode of PP after my 1st in 2009 - it was a very quick and dramatic onset, and I was sectioned to a general ward at my local hospital within 10 days of giving birth. The birth itself had not been straight-forward and I'd had an ambulance transfer in the last stage and an eventual emergency C-section. After 2 weeks in a general ward I went to a MBU and had 3 months in hospital all in all, including a course of ECT (which sounds scary, and was, but really saved me I believe). I had great support from a nurse in the community when I got home and stayed on anti-psychotic meds (Olanzapine) for a year and Lithium (mood stabiliser) for 3 years.

    We had our 2nd baby in 2013 and I struggled to access any MH services, so it's great to hear that you have an appointment with a perinatal doctor. The MBU I was in had since closed and although I had the same GP and midwife team, the psychiatrist at my local hospital (whose community team I had been under) had also left and they were backed up. I eventually saw a psychiatrist when 8 months pregnant, which was not ideal! Luckily I had a supportive GP and had managed to stay stress-free and not worry too much. Being relaxed and having family and friends support was really important. In the meantime, we'd drawn up a care plan - like an extension of the birth plan a lot of women have - and had recorded all the relevant info on my history, triggers, contacts (professionals and family/ friends who could be called on), what we would like to happen with the pregnancy and birth and what treatment we would like if I was to become ill again.

    We chose to go to a different hospital for the birth and I opted for an elective C-section to try and minimise risk of a difficult birth. This is what worked for us but I know it's not for everyone and is still major surgery. The 6 weeks I couldn't drive was actually nice to be home and not have to do anything and friends and family rallied round, without it being too busy and stressful. The elective was different in every way from an emergency too. I'd been transferred between hospitals as there was only midwives on duty and I needed doctor input to the birth so we chose to go somewhere which was fully staffed - and a different hospital to try and make it different from the 1st time. This was again a personal choice and not without it's challenges as although it was no further away, as it was different trust to the midwife team, we repeated things a lot, messages got lost and computer systems (let alone people!) did not talk to each other!

    What helped us enormously was having a 2nd opinion consultation through APP with Dr Ian Jones at Cardiff Uni. As we had no perinatal service available and a delay to get seen by CMHT as I mentioned, this was very useful in pulling everything together and getting the expert opinion. He wrote to my midwife, hospital and eventually the psychiatrist, which really helped in getting them to listen - some professionals sadly didn't see the 50:50 risk as an issue. I also had the consultation via Skype as we're a long way from Cardiff. As you have a perinatal team in place I hope you will get everything you need from them but this might be worth knowing, just in case.

    As far as questions to ask, the bits about medication, plans for birth, all that kind of thing would be useful. I also decided to take a low dose of Olanzapine on giving birth to try and ward anything off - or at least stop it escalating as bad as it had been before. We discussed feeding options too and chose to bottle-feed, again a very personal thing but I'd struggled to breastfeed with my 1st which had led to him having a lot of weight loss and it'd all been very stressful and possibly contributory to my PP. You could also ask what other appointments you will have with the perinatal team throughout pregnancy and post-birth, whether you'd be willing to have a MBU admission if needed or if you'd prefer to stay at home, as I know it was helpful for us to have plans in place in case of the worst case scenario. And also just to know what was available.

    The good news is that I did not get PP after our 2nd child who is now 17 months old and full of the joys! I'm pleased you have perinatal teams to consult but feel free to pop back here if you have any questions you feel we might be able to help with. Good luck with it all. xx

  • Hi Ollie and Jen,

    First off I want to congratulate you in reaching the decision to have another child - whether you choose to or not after PP, making that decision, whatever it may be, is a huge positive and a significant step.

    I suffered PP after the birth of my son in 2012, I barely slept for 10 days and I was sectioned and spent 4 weeks in hospital, and it took me a good year or so to feel like 'me' again.

    My Husband and I decided to have another baby, and our second son was born near the end of last year. (An extremely condensed version, I'm just laughing reading back as it all looks very matter of fact but I know you will know all the trials and tribulations of recovery and decision making!) this time round, we were lucky and I did not suffer PP.

    I was treated with Olanzapine and Lithium after the birth of my first son, I had full blown psychosis and don't remember much of my first two weeks in Hospital (probably just as well!) I came off lithium by the time I left Hospital and remained on Olanzapine for 6 months, the dose steadily reducing.

    Second time round a care plan was in place - I saw a perinatal psychiatrist twice before the birth, first time was a general chat and I went over our questions, etc. I was already forearmed with my 'care plan' and second time round we formalised everything and put it all in writing.

    I chose to give birth at the main hospital, as per our care plan, I took medication straight after birth, I stayed in for 3 days, had my own room (obviously not guaranteed but this was in my care plan and I lucked out) and we made rest and sleep a prioirity.

    We had told family and friends that we would not have any visitors for the first 2 weeks, only Grandparents, and that when we did start receiving visitors that visits would be kept to half an hour and everyone should please call beforehand, no unannounced visitors (this also helped me feel like I had control over something that I really didn't have control over at all) I stayed on Olanzapine for 6 months.

    There are some really good examples of care plans on the forum, these helped me think things through, perhaps think what you would both like and then anything you're unsure of you can discuss at your appointment.

    I would say at this point that if it wasn't for APP we wouldn't have had the information we needed to make the decision to have a second baby and he probably wouldn't be here (and I sincerely mean that) their existence and this forum (and a lovely lass I met on here) helped me greatly in my recovery, and when I was pregnant I signed up for support from APP's peer support service which was invaluable - I would highly recommend this and it was comforting knowing that it would still be there after the birth of our son, regardless of whether I suffered PP again or not.

    As we all know, PP and its recurrence does not discriminate and there isn't anything we could have/should have/would have done to prevent it - life's a funny old game at times and sometimes it just doesn't make sense - but I felt that, if it did happen again, having the care plan in place and knowing what we wanted to do, etc. well at least we had done all that we could have and what was within our control to prevent it (of course, I write this in the privileged position of having a fantastic perinatal mental health service on my doorstep, which I am all too aware varies greatly across the country and isn't in existence in some parts, and being well informed via and thanks to APP)

    All the very best to you both :-)

  • I have just joined this group, Im 60 and had postpartum Psychosis after the birth of my first child 35 years ago. We didn't know what it was, I had support of my mother and Husband, I told my health worker how I was feeling and she just brushed it aside,so I had no treatment,I think it stopped at around 18 months.

    Im replying to you, as after the birth of my second baby 3 years, later this time a son, I was absolutely fine. Seven years later I lost a baby at about 16 weeks, and apart from normal grief, I was fine after this too.I always tell new Mums about my experiences incase it happens to them, so they don't feel 'odd' or bad about themselves and get help. So, your wife might be fine, I so hope she is.

  • Thank you for all your replies.

    We have recently met with our consultant again and have agreed a plan to come off the final meds, and start trying for the 2nd! Consultant very helpful, will meet regularly and agree care plan when needed.

    Fingers crossed that all goes well.

    Thanks for the advice again!

  • That's great! Wishing you both all the very best :)

You may also like...