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[BrokenChloe]

Hey, i'm 28w pregnant with my first baby (due end sep). I have schizoaffective spectrum bipolar and bpd, among a few others and so have a high risk for developing postpartum psychosis.

I've beeen seeing a specialist perinatal mental health team since week 12 (at the moment, a psychiatrist and a psychologist, but will work with other professionals later). I'm on 150mg of seroquel, which makes it my choice if i interact with the voices. My obgyn/midwife team are all aware and everyones trying to get the hospital to work together to provide a psych eval before discharge (any sign sometimes up, i can get shuttled up to mum and bub unit easily) as well as giving me a single room postpartum so my husband can stay overnight. Parents in law are also aware they'll be required to put us up for a couple nights when not coping and such.

Are there any measures anyone else put in place to prevent PP and what helped the most?

[Jenny_at_APP Partner]

Hi Chloe,

Welcome to the forum and congratulations on your pregnancy

I had PP in 2012 after the birth of my first son, out of the blue with no history of any mental illness. I was told it was about a 50% risk of having PP again with a subsequent pregnancy. I had another son in January this year with no recurrence of PP.

In terms of professional support, I had very good support from my midwife, GP and health visitor. The midwife kept me on her books longer than the usual 2 weeks and rang me daily to 'check in'; I always had the option of requesting a visit. The health visitor then also visited more than is standard and I could contact her any time. They were both brilliant.

I saw a mental health specialist nurse antenatally but was never under the care of a psychiatrist (there is only an outreach perinatal service in the area I live). I was lucky enough to be in contact with Prof Ian Jones via APP, whose second opinion service I used prior to deciding to have a second child, and he advised me around medication towards the end of my pregnancy.

I had an advance directive in place setting out my wishes and preferences should I become unwell again; there was a copy of this in my maternity notes and it was shared with my GP. I also had a written plan at home that I put together with my husband then kept in a drawer - this included things like who to call under what circumstances, plans for my older son, signs to look out for and who was on my approved list of visitors (!) in the early days/weeks...

I also had a side of A4 that I put at the front of my maternity book for the midwives to refer to when I was on the unit after delivering - high risk of PP, main symptoms/signs to look out for, a request to be in a side room, a request for help with night feeds, a plea not to be pressured in any way to breastfeed, my husband's mobile number...

My basic plan was to formula feed, take a low dose of antipsychotic and get as much rest as possible. Sleep deprivation and anxiety around breastfeeding felt like major contributing factors to my PP.

I breastfed my son for the first 36 hours in the end then started taking the medication (PP didn't hit until week 3 the first time so there was no immediate rush), I'm taking 150mg Quetiapine for 6 months (until the end of this month in fact). I stayed in hospital just the one night, I could have stayed longer but wanted to be at home - the staff were wonderful. My husband and mum (my heroes!) did the night feeds for the first 8 weeks, sleeping downstairs with our son so I could get a decent night's sleep. I then took over for the day shift - filled with lots of cuddles

Getting past the 3 week mark was a big milestone then after 12 weeks I was considered low risk and out of the danger zone.

It sounds as though you have great support in place which is excellent, and that everyone is communicating which is so important.

For me, I wanted everything planned and for at least my husband and I to be very clear on those plans, so that I was then confident that I could put everything away and know it was there should it be needed, and try not to think too much more about it.

I had very supportive family and friends - I contacted my friends to say it would be a case of 'no news is good news' and not to worry if I went radio silent for at least a couple of weeks. They had my husband's contact details.

Being rested was the most important thing to me after the birth and having lots of support and reassurance. Accept all offers of help! My mum was bringing meals round for the freezer regularly which was fantastic. Maybe decide with your partner a strategy for visitors - I found I was desperate for company after a couple of weeks but it's good to find a balance that you're happy with, it can all get a bit fraught so make sure it's all on your terms, don't feel bad about putting people off for a while.

If you've not come across it already, there is an excellent insiders guide on the APP website - 'planning pregnancy: a guide for women at high risk of PP' - app-network.org/what-is-pp/...

I'm sure you'll get plenty of other replies here too.

Sorry I've rambled on a bit. I hope there's something helpful amongst my ramblings!!

Wishing you all the very best with everything.

J x

[Hannah_at_APP Administrator]

Hi and welcome to the forum, many congratulations on your pregnancy. I share similar experiences to J-B-55 and had a PP episode in 2009 "out of the blue" after the birth of my first child.

When I had another baby in 2013 I was keen to get support and plans in place, and I'm really glad to hear that you have linked in with the perinatal team locally. There is no service where I live, so it was a bit of a frustrating time before I saw a psychiatrist quite late in pregnancy. In the meantime, I had written my own care plan and made sure that my husband knew my choices, we had friends and family on stand-by for my eldest (as I didn't want him to see me ill and wanted him not to feel left out) and I also had a consultation with Prof Ian Jones through APP. All of this came together when I finally saw MH locally and the info got transferred into my official care plan. This was then in my maternity notes and the GP, Midwives and Health Visitor were fully briefed. I was lucky to stay well afterwards which is the happy ending to my story.

Some of the things already mentioned are what we did too; a side room in hospital, some extra (but discreet) monitoring so anything would be picked up in the 4 days I spent in hospital rather than going home straight-away and support for my husband too - they are very important! The timetable of visitors and other things when I got home was great, it might sound a bit much, but it helped to know who was doing what and when, and avoided us becoming over-whelmed or people just dropping in. Again like J-B-55, I had a bit of time, just the 4 of us, away from all but a few close friends/ family.

You mention the meds you are taking in pregnancy and I guess that will be reviewed and altered as needed. I took a low dose of the antipsychotic that had worked for me when previously ill for about 3 months. It did make me sleepy, but maximising sleep was also helpful for us. We chose to bottle feed after an intial couple of feeds for colostrum and this way my husband could also help out.

In some ways, it did feel like risk management/ military planning rather than the typical pregancy and early days that a lot of people talk about. But I would have done anything to try and minimise the chances of being ill again. It was scary at times and I did occasionally feel anxious (another one of my previous pp symptoms) but nowhere near on the level of being ill. Professionals told me that it was very natural to be apprehensive - there would be something wrong if I wasn't!

The APP Guides which J-B-55 has linked to are really good and I found having others look at them too was good so I did't have to explain myself all the time. The Partners Guide might also be good for your husband. And the FAQs link might also give some more info: app-network.org/what-is-pp/...

I think what helped us the most was the knowledge that if it had happened again, we'd got through it before and could do so again. It sounds like you have already got a lot of things in place and I hope me sharing has given you some more ideas. Please come back and let us know how you are getting on if it would be helpful for you. We've all "been there" and are wishing you the very best, take care, xx

[Lilybeth Volunteer in reply to Hannah_at_APP]

Hi, I would also like to add my congratulations on your pregnancy. You seem to have lots of professional support in place and I hope the replies here have been helpful.

We are all here for you if you need any more advice.