A hello and a question about c-section

Hi everyone,

I am so grateful there is a community for people to share experiences on PP and support one another.

My wife had an episode of PP following the birth of our son 2,5 years ago. She was hospitalized for 3 weeks and given shots for another 6 months. Everything went back to normal.

Now that we're expecting a daughter, due in Dec., we're trying to be very careful for obvious reasons.

Our current dilemma is about c-section: the psychiatrist, who treated my wife, says it's safer for reducing the risk of a relapse while the gynecologist thinks the other way.

Does anyone here have any knowledge/experience in that matter (c-section vs pp)?

Many thanks, in advance, for any response.

18 Replies

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  • Hello merkava

    Welcome to the forum which is a great place to share our experiences and help if we can.

    I am pleased your wife recovered from her first PP, supported by you. I had PP twice many years ago and due to my frame being much smaller way back then (!) I had no option but to have C-sections on both occasions. Thankfully I eventually made a full recovery after both episodes.

    I'm sure there will be other mums here to offer their advice. For some mums who have had second pregnancies PP has not returned. In the meantime try not to worry and make sure you take care of yourself too.

  • Hi Lilybeth,

    Many thanks for your support and the warm welcome!

  • Hi Merkava

    Welcome, great to have you on the forum. And congratulations on the pregnancy!

    I'm afraid I don't have any experience of 2nd children but I'm sure others will reply here, including some who may have chosen to have an elective C-section. I think sometimes it is recommended, or suggested, just so you can avoid a traumatic birth or long labour that could mean lack of sleep, or trauma etc. But each person is different with the decisions they make.

    I just wanted to direct you, if you haven't seen it already, to the APP inside guide on planning a pregnancy if you are at risk of PP. app-network.org/wp-content/...

    I've looked and it doesn't actually say anything about C-sections etc but still has a lot of useful info.

    I also wanted to let you know that if you are in the UK you could access the second opinion psychiatry service offered by APP. Info here: app-network.org/what-is-pp/...

    Other women on here have used it when planning a second pregnancy (or are pregnant with their second). As far as I know Ian Jones (perinatal psychiatrist) advises them of their options and will write a letter to their care team recommending what treatment you should get (after discussing with you). Again, I'm sure others will be able to give you first hand experience of this.

    Thanks, and good luck with it all, I hope it all goes well

  • Hi sunnyandwild,

    This is great, thanks. Will check them out. We're based in Poland and here, unfortunately, the perinatal psychiatrical care is not a common thing. But we're in touch with our private psychiatrist who's helped in the first episode of PP (natural birth) and is advising a c-section this time.

  • Hi merkava,

    Welcome and congratulations to you and your wife on your second pregnancy. I can completely understand your dilemma in this and hope that my experience may help in some ways to give you an insight into how we made choices around our 2nd baby.

    I had PP in 2009 and had an emergency C-section which was pretty awful. I was then discharged home in less than 48 hours, having had no sleep and was struggling to feed my baby. Looking back I did want to get home and back to some sort of normality away from a busy, hot and stuffy hospital ward but it was way too soon. And then the PP struck a few days later and I ended up as in-patient in a couple of different hospitals and latterly a Mother & Baby Unit altogether for 3 months. Whilst no-one knows the causes of PP, there are quite a few ladies on here who have had bad birth experiences and I personally think that mine may well have contributed to the illness (along with lots of other things).

    We then had our 2nd child in 2013 and were both very clear that after all the horrible experiences of 1st time round, we wanted an elective C-section. We knew from pretty early on really and it was about minimising stress and reducing risk of the PP returning if at all possible. My midwife was generally supportive but a little clueless on the PP bit. It was a little challenging as I chose to go to a hospital out of area for delivery (due to changes in staffing at my local one) and messages were not passed on. So when I saw obstetricians, I was constantly repeating myself - if not about the elective C-section then about other things, including blood test results, it was really poor communication between the professionals.

    I also saw 3 or 4 Drs from the obstetrician's team - never the same one twice, and the actual consultant only once, quite near the end of the pregnancy. Repeating myself on the elective got different responses from each staff member; one who completely understood and was very supportive, another who thought I should really try a VBAC (natural birth) and another who wanted me to decide later. When I eventually saw the Consultant and explained my choices, they then got the diary out then and there and booked me in - phew!!

    It's an odd situation to be choosing your baby's birth-date but was completely right for us. It was explained that any surgery is a risk, and it is quite major abdominal surgery, that physical recovery after a C-section can be longer, you can't drive for up to 6 weeks and should really minimise all lifting and doing things round the house for example. But for us this fitted with how we wanted to have things after the birth, as calm and restful as possible.

    I recovered physically really well from the elective - much better than the emergency C-section (although throwing myself on the floor and running about whilst psychotic probably didn't help!) The 2 C-sections I had could not have been more different and the good news is that I didn't get PP again either.

    It's good to hear that you've got a psychiatrist's input and that they are supportive of your choice. I had no mental health input until really late on as I'd been discharged from the 1st time. But that's a different story... anyway, the 2nd Opinion Service sunnyandwild mentioned was fantastic in getting that specialist input, and the letter which Ian Jones wrote to all of my care team, outlining recommendations and my personal choices (including the C-section) really helped in getting listened to, in my experience. Are you in the UK? I got a referral via my GP but the psychiatrist can also do it I think if they are not a perinatal specialist (there is no service in my area and I eventually saw a general psych).

    How was your wife's first birth? It might be no indication whatsoever but I know for me, having had 1 C-section there was then a possibility of another and I wanted to avoid the emergency situation if at all possible. I cannot emphasise enough how different the 2 were. I know there is a "too posh to push!" reputation in some ways, but it really was the right choice for us. And you will know if it is for you and your wife too. You might need to think about practical things like help around the house, someone to drive your wife (or first child - I had friends to help get my eldest to nursery for example). But again this was what we wanted to do, to plan the first few weeks to be as calm and stress free as possible.

    You are absolutely right to be thinking ahead and wanting to be careful. I don't know if there is any research around a C-section lessening the chance of pp, but I'm quite convinced that my experience of a really stress-free, relaxed birth via elective C-section helped. And we wanted to do everything we could to try and avoid the PP returning, as I am sure you do too.

    Everyone is different and in some ways I do think I somehow "missed out" on delivering my children naturally, that sense of achievement almost. But we got through the hell of PP and that is enough of an achievement I reckon. It might also be worth looking up the NICE guidelines on an elective C-section, as certainly when I had mine 2 years ago, a friend who was pregnant with her 2nd at the same time, requested an elective due to having a long labour and forceps delivery, which she didn't want to repeat. The Dr's said to her that it might be longer to recover from the surgery etc but she had a quicker recovery than from her first.

    Anyway, hope some of this is helpful to you. I really feel that the professionals need to listen to women and families making birth choices, whatever that may be, and even more so when they are trying to avoid a really awful illness such as PP. All the best with it, please let us know how you get on if you have chance, take care, xx

  • Hi spannerb,

    Many thanks for this! My wife's first birth was indeed murderous (20h) and it was a close shave from emergency c-s. It is highly likely that the trauma has contributed significantly to pp. That's the main reason why our psych is advising an elective C-s. We need to ask her more about this. Again, great advice - thanks!

  • I have 4 children, first 3 normal birth had no Psychosis, no depression etc. 4th child born April this year by c section and I am currently receiving treatment for first episode of Psyhcosis. Obviously not sure if this contributed in any way. I personally think natural birth allows the hormones in the body to readjust the way they are meant to if that makes sense. That is only my experience tho.

  • Also my first two labours were long and involved forceps etc were pretty traumatic, had an epidural and third was very quick. Would be quite interesting to know the percentages of psychosis and c section delivery.

  • Hiya,

    I wouldn't have really thought that having a C section would make much difference to a relapse. Unless the gynaecologist is really expecting a traumatic and difficult birth. I would think both natural and C sec have their advantages. With a natural birth you are able to recover physically much quicker. If you feel physically more well and able to care for your baby then that in turn would suggest you will feel better mentally. There's nothing worse than feeling that you can't cope.

    My PP illness was quite unusual in that it didn't immediately follow the birth. It was in fact 9 months later when I returned to work and had to stop breastfeeding. I think the stresses of working combined with the changes in hormones due to stopping breastfeeding contributed to my illness. I do think everyone is different though so you and your wife need to do what is best for her and your family.

    I think the most important thing in avoiding a relapse is for your wife to surround herself with a good support network. Including psychiatric consultants, cpn, family and friends. Also to have a care plan already in place should she become ill. Don't be afraid to ask for help. Even if your wife just needs someone to talk to or get out with for an hour with your young family. I used to know straight away from the minute I got up on a morning whether it was a day I needed company or if I was going to sail through the day just fine by ourselves doing my own thing. I was very lucky that I had family or friends I could ring up for extra support if needed. You have the advantage of everyone being aware this time and good support is crucial. I can't stress this enough as ultimately I think this is what will get you through as opposed to you a natural birth or C-sec.

    After a 7year gap I went on to have two further children and although I had wobbly moments now and then I never, fortunately, had a relapse. Good luck and I hope you get to enjoy every moment with you wife, son and your baby this time around.

  • Hey tstewart,

    Thanks for your kind advice. I too think a lot of it is about the external conditions. We're hoping for the best this time :)

  • I doubt that it is as simple as one causes relapse and the other won't. I can testify to one emergency Caesar, due to posterior 4.4kg baby not progressing, one bad case of PP, diagnosed at 3 months of age. Better prepared second time around, planned caeser because sizing scans looked like over 4kg again (4.03kg!), still got PP this time picked up at 6 weeks because I was being closely monitored.

    2 years on, I'm back to being me, but don't think Caesar or natural would have made the difference for me.

    My one piece of advice to you as the support person, is don't take the responsibility of being 'on watch' for her symptoms. Let someone else, like a perinatal mental health nurse, or your psychiatrist, or even GP, do that. My husband was so burdened with that, and I felt afraid to tell him what I was feeling, because he may overreact.

    Do you have a Mother Baby. Unit in Poland?

  • Thanks DEb12W! No MBUs here, unfortunately :( The watchman's role is to be considered here.

  • DEb12W is right in that it really is hard on our husbands. I don't think people realize what a strain it is. For me though my husband was most definitely the best person to be able look out for me and also to converse with professionals, cpn etc. He can read me like a book and knows me and my moods better than I know myself! Quite often I would blow things out of proportion and be very negative. Then my cpn would turn to my husband and say . .and what do you think . . .and he would sometimes answer . . Well you know she's doing quite well etc etc basically he would put it all into context. Other times he would say . .yes she's getting worse in that she isn't sleeping or eating, she's scared to be alone and feels unable to cope (not adding that I would ring him at work around 20times a day!) Then my cpn would have that extra view point instead of only mine on how I'm feeling that day. Then maybe my meds would be altered a little or she would arrange to come out the next day etc

    I once gave a talk to health professionals on postpartum psychosis n one of my main points in the talk was that there was very little if any support for partners and family of suffers. I still maintain that as their primary carers partners and families need more support themselves in order to help their loved ones.

    Personally I think I married a Saint. Many a guy would have run for the hills! Lol

  • Hi,

    I don't really have any information but for me, I had an emergency c-section (and then a second one 2 weeks later because they left a swab in me and caused an infection) and I believe that lead to the onset of my PP. I don't think it was just the c-section, as I live in Brazil and it was the combination of being away from family, the infection etc. Plus the fact I really wanted a normal birth as C-sections are extremely common here, so when I had to have one (which I later found out I probably didn't need, but it's more convenient for the doctors and they get more money) so when I did, that was really upsetting for me.

    Not sure if that helps at all, but take care of yourselves!

  • Thanks Jossykate!

  • Thank you all for your wonderful responses! This is greatly appreciated. Reading your posts, I am now more convinced that's more about individual comfort overall rather than the type of birth. We're yet to see our psych again to discuss options at lenghth.

    If anyone has more advice, please keep them coming -- I can't begin to stress how important this is for us.

  • Hi Merkava,

    I don't think there's any evidence suggesting PP is more likely with either c section or with a vaginal delivery so it seems a case of weighing up the pro & cons to see what's best for you. It's obviously a personal decision & will be different for different people.

    It sounds like a good idea to look at your wife's first birth experience & see if it's something you'd like to repeat or not? I found my 1st birth experience traumatic & I know if I was having a 2nd I'd choose elective c-section - but that's my personal choice. I'd find having more control over when it's going to happen would be far less stressful & knowing it wouldn't be a prolonged labour would be of some comfort. Minimising the amount of sleep I'd lose & the exhaustion afterwards would be major factors for me too.

    But obviously C sections are operations & therefore have risks, they're painful & you're less mobile after delivery, needing more support from family etc. which can be difficult if you already have a little one at home.

    Also trying for a normal vaginal delivery doesn't mean you get a vaginal delivery & conversion to a c section as an emergency is more risky than a planned c section. About 10% will convert to c section. Vaginal deliveries can be prolonged & can have complications - less likely though if first delivery went smoothly.

    So there's lots to think about & I hope the comments here have helped. It was lovely to read Spannerb's post above comparing her emergency c-section 1st birth (with PP) with an elective c-section 2nd birth (no PP), showing there's plenty of hope!

    All the best in your decision, let us know how you get on.

  • I had PP with my first (natural and traumatic birth) and didn't with my second (C-section).

    It seems that nobody knows what causes PP. My husband was convinced it was to do with the hormonal changes after a natural birth and was overjoyed that I ended up with a C-section. I was worried about taking any kind of morphine (opiates) and ended up with a lower dose of pain killer.

    I feel it was what I had in place after the second birth that worked for me. I breast fed once and then took a whack of medication and gave up caring for my baby through the night for two weeks.

    I wish you all the luck I can and I hope everything works out for the best.

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