Thinking about 2nd baby

[Jessi_D]

My doctor has suggested we have a plan in place - a coping strategy - if we decide to have another baby. I spent 5 months in hospital after the birth of my son, recovering from a severe psychotic episode. I was transferred from a mother and baby unit to a more secure unit, and separated from my breastfed baby because I tried to hit a member of staff and absconded from the unit twice as a result of paranoia. I'm not sure how my husband will cope to maintain his full-time job, care for a newborn and toddler, visit me in hospital (where children are not allowed) or care for me if I'm recovering at home, and manage mentally, physically and financially. My Mum lives 1.5 hrs away and works full-time, my husband's parents live over 3 hrs away and are now in their 70s. Maybe we shouldn't take the risk, or maybe there is a way to manage this situation.

[Ellie_at_APP Partner]

Hi Jessi_D,

Welcome to the forum! I had a similar experience to you, as in I was hospitalised with PP for about 4-5 months. I was in a MBU all of the time though, I'm sorry to hear that you couldn't stay in the MBU, that must have been so difficult to be separated from your baby.

I'm sorry, I don't have any personal experience to offer you as I haven't had a second child, but I know you will get a lot of replies on here, your question is very common. Many women have gone on to have second children without PP, or if they do get PP again it is usually milder and recovery much quicker because support should be in place, ready, if something does happen.

I just wanted to let you know all the support and information that APP have around second pregnancy that hopefully will help you, if you haven't found it already. First of all APP have written a guide for people planning a pregnancy who are at risk of PP, it is written by women who have had second children, and professionals. The link is here: app-network.org/what-is-pp/...

The guide should tell you everything you need to know, and will hopefully reassure you somewhat about everything you can put in place to prevent PP a second time. The first thing to do is to go for a pre-conception meeting, even before you're pregnant, with your perinatal mental health team if there is one, or you can see the perinatal psychologist from your MBU. You need to go to your GP to request that.

If it's not possible there is the second opinion psychology service. Dr Ian Jones in Cardiff will look at your notes, and advise you what you can put in place and your particular risk, and will write a letter to all the professionals supporting you detailing what support you need. You can tell your GP that this is a free service, so no charge to your health authority. You need to be referred by your GP or mental health team. Everyone on here who has been referred for this service says it was so helpful. Link for info is here: app-network.org/what-is-pp/...

I hope this is helpful, and good luck with your decision, it's a really hard one. Do write again with any other questions, and I hope you get responses from other women who have 'been there' who have had a second child after PP.

Take care

[Jessi_D in reply to Ellie_at_APP]

Thanks Ellie, my psychiatrist in Tower Hamlets referred me to the perinatal psychiatrist for Newham where we've just moved to, but he wrote back to say he'll see me when I'm pregnant. So sadly, I've the impression he's not an advocate of preconception planning. I could contact the Homerton MBU, but I'd hate to ask for their help when they were so horrid to me when I was ill. I've had a look at the guide you suggested, it's quite good. Not sure how to avoid sleep deprivation when caring for a newborn baby though. I had a maternity nurse a week before I was admitted to hospital, but she was totally out of her depth.

[Ellie_at_APP Partner in reply to Jessi_D]

Hi Jessi_D,

That's really frustrating that the perinatal psychiatrist for Newham won't see you until you're pregnant.

If I was you I would go to your psychiatrist, or GP, and ask for a referral to Dr Ian Jones for a pre conception meeting. I would print out the page about the second opinion service and also take with you the second pregnancy guide too and read out what it says about having a preconception meeting! Sadly it is true that some psychiatrists / teams don't seem knowledgeable about the best support for someone who has been through PP, which is why APP's guidance etc can hopefully be helpful to advise professionals as well as give us women information! And do explain it is no cost to them as a health authority, I can imagine that would be there only concern or reason not to refer you.

I hope that helps. Take care

[Amberblack]

Hi Jessi-D.

Firstly I would like to praise Ellie's advice for its clarity. I had PP after the birth of my first child 25 years ago and I can still remember it vividly. Like you I was hospitalised for about 5,months. Our local MBU was closed and l was in a psychiatric hospital for about 3 months before being transferred to a MBU about 1 hour away, where I improved. To make matters even more complicated we moved house to a totally new area about 3 hours away 10 days after our son was born! It sounds as if you had a tough time in the secure unit being separated from your baby.

If you have a good plan in place I think it should be manageable but obviously only you and your husband can decide whether to have a second child. I can only tell you about my experience. We went on to have a second child mainly because of my conviction that everything would be fine this time! Our daughter was born after an uncomplicated birth unlike her brother who was in special care with breathing problems. I had a progesterone injection to prevent another PP which worked brilliantly for me and I was able to breastfeed with no problems.

Good luck

From Amberblack.

[Jessi_D in reply to Amberblack]

They can give an injection to help prevent PP? That's interesting. I had a great pregnancy and was lucky there were no complications at birth. I was distressed being separated from my baby, especially when I was producing milk with no baby to feed. But the most distressing part of my experience was being sectioned and held in hospital against my will. The hospital was horrible - many of the patients were rough, staff were unhelpful, beds were uncomfortable, food was not edible and occupational therapy was juvenile. It was like going to prison, and I'm hoping I can avoid going back there! I have BUPA but there's no private MBU.

[Amberblack in reply to Jessi_D]

Hi Jessi-D,

Yes I did have progesterone to help prevent the onset of PP which worked for me but I'm not sure if it is still prescribed for this. I expect the researchers at APP could give you some information about this. Your experience at the hospital does sound terrible. I agree that when you are sectioned it does feel like prison and it is very frightening! Hopefully second time around could be very different.

Best wishes

Amberblack

[Ellie_at_APP Partner in reply to Jessi_D]

Hi jessi_D and Amberlack,

Just wanted to write and just say, from everything we know, progesterone has been discredited as a way to prevent PP. Research has shown that it doesn't have affect, and actually in a few cases that it was a contributing factor in causing PND. Though I know some people had it, and say they found it helped them. I hope that helps.

[Amberblack in reply to Ellie_at_APP]

Hi Ellie

Just to thank you for clarifying the progesterone question.

Amberblack.

[lucinda123]

I am also considering a 2nd child. I spent 10 days in a secure mental hospital separated from my baby at 10 days old. I went voluntary so that I would not get sectioned to find once your there you can't get out otherwise you are sectioned! My MH team really wanted me to be home treated as there was not a MBU near me.. not sure whether I had PP or not, but I didn't not sleep for the 10 days before getting admitted so went a bit manic. My husband just couldn't cope with looking after a newborn and me.

I would also want a plan in place before conception but wouldn't know who I would be referred to as no specialists where I live.

Good luck whatever you decide.

[Ellie_at_APP Partner in reply to lucinda123]

Hi Lucinda123, I can't remember if you are in the UK or not, but if you are again I would advise you to ask your local authority to refer you to Dr Ian Jones (through your GP or if you're still under a mental health team). I wish you all the best with your decision, I know how hard the decision is to make.

[uksarah]

Hey. I'm in a similar position to you. Considering a second child but need to know what the plan would be to avoid pp! I had a hellish experience like everyone else on here and do not want a repeat. At the same time though if I had to to have another child then I'll do it. I have just been referred by my gp back to my original mental health psychiatrist. Seeing him next week. Def worth finding out I think before you take the leap!

[Jessi_D in reply to uksarah]

Thanks uksarah, yes I suppose planning how to mitigate the risk of getting ill would be a good start. But I'm really most concerned with the outcome if I'm ill - want to plan for worst case scenario. I've BUPA so am trying to find out if there are better mental health facilities available privately. Also considering setting up power of attorney. Giving all my social media passwords to my husband so he can change them to prevent my access. So on...

[Hannah_at_APP Administrator]

Hi JessiD,

Welcome to the forum. I had PP in 2009 after my first child and then had another baby in 2013 and stayed well. As others have said, preparation is really key. I too live in an area without perinatal mental health support and had a long wait to see a general psychiatrist, until I was 8 months pregnant in fact, as I had been discharged from all MH services and was off medication with no other MH diagnosis. A lot of people (midwives etc) thought I had just been unlucky and that I would be fine - there is a high risk of becoming unwell again so pushing for input and support is really important.

I had the 2nd Opinion Service Ellie mentions through APP (before I had a 1st opinion!) and it was absolutely invaluable. Just talking to someone who truly understood and took me seriously (as it felt that some other professionals were shrugging it off, it was not their problem etc) was fantastic. Prof Ian Jones also wrote to my GP, Midwives, Hospital and they took notice and started to put things in place too.

I wrote my own care plan, and found this to be useful rather than having to repeat myself. It contained brief history, triggers, treatments/ meds that had worked 1st time (and what hadn't), what my preferences were and who family/ friends could be called on. This last bit was important so that if I had become unwell, my eldest would have been cared for well and it was one less thing for me to worry about. And someone to look out for my husband too, they are important aren't they?! I appreciate that it can be difficult with family a way away, but do you have close friends you could perhaps talk to? I know 1 friend in particular that I made after having my 1st child, she was high up on the list of people to support us as a family (and my son was friends with hers). My oldest friend had also recently moved back to the area so she was there for me. I'm lucky that I live in a lovely community where neighbours are also friends and they pulled together for me too. If you don't have this, perhaps there are some local voluntary groups you could look into?

I also chose an elective c-section (after a horrid 1st emergency one), slightly longer hospital stay and side-room (after being discharged after less than 48 hrs 1st time) and to bottle-feed after initial breastfeeds for colostrum (I'd struggled to feed my 1st and husband had to switch to bottles when I'd been hospitalised and separated from my baby). I haven't heard of the Progesterone therapy but all professionals involved in your care should be able to advise of the most appropriate things for you.

My 2nd childbirth experience was completely different and staying well was such a relief. However, we told ourselves that even if I had got ill, I'd recovered once so could do it again. And having prepared, the thought was that it would be caught sooner and never got to the extent that I did 1st time, when I struggled to get any support and no-one knew what on earth was happening!

I completely understand your fears and it's a very individual choice whether to have another child after PP. For us, it was the right choice and I count my blessings every day with my wonderful family. All the best with your choices and take care, please feel free to ask any more questions. xx

[AllisonR]

Hi Jessi_D, I also had a progesterone injection after my second baby and didn't develop pp like I did the first time. I'm so glad I went on to have a second baby. My children are now 15 and 18, so a long time ago now! Good luck with whatever you decide.

[Frank1i]

Hi Jess

I also had a second child after a first episode of PP where I was in hospital for 4 weeks. I was unable to breast feed and extremely unwell. I saw my psychiatrist before I became pregnant a second time and I did some research myself and we discussed options I felt listened to. I felt confident that things would be different although it was an incredibly anxious time. I had progestrone injections after my child was born and was able to breastfeed and in fact had a homebirth. I also followed Katarina Doltons starch diet and use to eat ever three hours generally rice cakes so I did not put on more weight. I felt more in control being at home and having the injections and later suppositories too.

First time round plans were not followed as it was anticipated I would be unwell antenatally.

Good luck with what you decide to do.