Number two - yes or no and devising an action plan

Hi there, I am new to this site and already loving the sharing of stories and info. What an awesome resource. I have a two year old daughter and suffered PPS for the month or so after delivery ( officially un diagnosed - although I suspected it was as I could identify many of my symptoms were similar to those my brother with bi polar suffered this only made me more paranoid and anxious though ! - tried to be open as possible with symptoms with my doctor but probably half back on answering do I have delusions or hallucinations because I had many religious/ spiritual experiences but to me they were 100% real and I new doctor wouldn't understand them! I was prescribed sleeping pills two weeks in which were my saving grace as I found with a couple of nights proper sleep everything settled and felt more controlled and manageable. guess I suffered psp for the following month or so but it was overall an elevated feeling of bliss and connection with the world without the terrible paranoia and gripping fear I had experienced.

My husband and I throw around the idea of having another child. Some days I get super excited about the idea and find myself jumping ahead thinking of names, (no we are not pregnant or even trying) but on other days I am paralysed by fear and think "no way" can I get through this again. For me my world falls apart if I don't get my sleep and so I'm not only worried about PpS recurring but how I'll cope with the demands of another wee person taxing my energy levels sleep etc over their childhood. I'm trying to weigh up whether I'm a better mum at one or whether I can cope with another with the right support around me. It has always been my life mission to be a mum- I'm not sure I'll feel satisfied at one,. I've decided that to even know if I want another child I first need to know that I am not basing my decision on fear of psp Recurring. I think I would always regret this if it was fear based? So I met with my doctor today- before a conscious decision on weather to get pregnant or not again I said I need to speak with a psychiatrist in the Area who can help me with an action plan for meds depending on different scenarios that may come up (psychosis/ depression/ sleep aids etc) one of the things that really threw me into fear last time as I could not get my head around breastfeeding (which I was absolutely fixated and besotted about doing) and taking mediPcation. I did to see how they could marry up and thus it felt more important for me to breastfeed than medicate although by sleeping pills and "expressing and dumping milk" for a few nights I could get my head around it and thankfully was enough to get me through the worst of my psychosis that seemed to be fed by sleep deprivation.

So my questions are

1. If I needed antipsychotic med what are peoples experiences can you breastfeed alongside. If not and I needed them then I need to get my head around not breastfeeding.

2. Anyone in or has been in a similar space re having another baby ? And thoughts...

3. Any other action plan tips. I see a few people mentioned Ian jones? Who is he and did he post tips on here?

Many thanks for yur help :)

7 Replies

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  • Hi Bellsy,

    Welcome to the forum!

    I, like many others here, have been exactly where you are. It took me a long time to decide whether or not to have a second child. So many unknowns and what ifs, a lot of fear, but I too had always wanted more than one child and didn't want to look back in the future and regret a decision based purely on the fear of PP.

    Are you in the UK? If you are I'll start with question 3. Prof Ian Jones is a world-leading expert in PP, perinatal psychiatrist and former chair of APP. He provides a second opinion service through APP (http://www.app-network.org/what-is-pp/getting-help/second-opinion-service/). I got a referral from my GP to see him with my husband to discuss the risks and options around having a second child. I found this invaluable. It still took a while for us to settle on a decision but I really recommend accessing this service if it's available to you and you think it would be helpful. Something he made clear to me, which is important, is to not base your decision purely on wishing to avoid the risk of a recurrence of PP without being aware that there is a risk of a subsequent psychotic episode not linked to childbirth. I was told the risk of recurrence of PP after a second child was around 50%. You can read more about the risk of future episodes in the FAQs section of the APP website - app-network.org/what-is-pp/...

    The insider guide for women planning pregnancy who are at high risk of PP is also an excellent resource - app-network.org/what-is-pp/...

    Re breastfeeding - I was absolutely adamant about breastfeeding my first child and like you it became a real fixation. I was devastated when I 'came round' from the acute phase of the psychosis to find my baby had to be put on formula as I refused to feed him. Over time I came to terms with this perceived 'failure'. Second time round I decided to remove this as a factor - I didn't want to risk passing medication to my baby (personal choice, I know some, including the antipsychotic I took, are considered safe) but I just didn't want it to become a 'thing' again and a potential cause for anxiety and obsession. Also, it was a major reason for sleep deprivation first time, which seems to have been a big trigger for my PP. I did think about combination feeding but in the end (and this was a decision I agonised over) I just decided to take it out of the equation altogether. I did breastfeed for the first 36 hours in the end, switching to formula when I started taking medication (I opted to take a low dose of medication for 6 months, I'm weaning off it currently).

    I happily had no recurrence of PP after my second child, who is 7 months this week. If you click on my username you can read previous replies I've written detailing the plans I put in place. I'll never know if I was always going to be one of the lucky 50% but being prepared really helped us.

    You're right that disturbed and lack of sleep with children stretches far beyond the risk period for PP. My husband and I both love and need our sleep and we didn't relish the thought of going back to sleepless nights! I have to say I'm finding it all much more manageable second time around (though I have been blessed with pretty good sleepers), I think the knowledge that things are usually a phase and it's not going to last forever helps. We take it in turns to be the one 'on duty' at night and getting up early in the morning, so at weekends we have a lie in each which helps :) I'm aware once our youngest gets moving properly (and he's not far off, far keener than his older brother was!) it's going to be complete chaos, but we'll cope!

    I hope this is useful, there's nothing like reading others' stories and experiences. Wishing you all the very best with your decision making, hopefully once you've decided one way or the other you'll feel you can move forward happily either way. I'm sure you'll come to the decision that's right for you.

    Best wishes, J x

  • thanks for you reply. very helpful. unfortunately i live in new zealand so won't have access to seeing proff jones but thanks for the links you sent :)

  • Hi. We have a 'beyond pp in aus/nz group on FB if you would like to join. Search for it in groups if you like! A lot of mums in group and me have been in this exact position as you.

  • Hello bellsy and welcome to the forum!

    I had PP in 2009 after my first child and then had a second child in 2013 and stayed well. I can really echo a lot of what J-B-55 has already said, and can relate all too well to your questions and fears around another child.

    For us, and I know it is a very personal decision, there was no way that PP was going to stop us having 2 children, as we had planned to! I do realise for some it is just too much, but we were heartened and encouraged by the stories of others on here and also the support we had when recovering from being ill. I was lucky enough to be in a mother & baby unit (after an initial time on a general ward locally) and my MBU psychiatrist was excellent. When discharging me after 3 months, she very firmly, but nicely, said that I needed to be recovered before thinking of having another child. For me, this meant being off medication, off the case-load of MH team at home and coming to terms with what had happened. As recovery can take a while, and I was on meds for 3 years, this was an important piece of advice for us.

    You have taken a valuable first step in asking for input before you get pregnant and depending on where you live, there might be a specialist perinatal service who offer pre-conception counselling. There wasn't when I had my second, but it has just been set up this year in my area. Planning and preparation were our watch words throughout and although it might seem like it takes the "magic" away from the special time of pregnancy and looking forward to having a new baby, it was really important for us. What seemed like an exercise in risk-management was just being as prepared as possible - we would have done anything to avoid or minimise PP - and throughout, we knew that if it did happen again, at least it would be picked up, as it hadn't been easy to get diagnosed and then treatment the first time.

    Prof Ian Jones' 2nd opinion service was fantastic and gave us lots of very good advice. He also wrote to my midwife, GP and hospital and with an absence of specialist services at that time, it was invaluable to get them to listen as they had previously been a little clueless on PP unfortunately. Awareness is still really key I believe. We also wrote a care plan, which I gave to all the professionals involved, including when I finally got into see a MH worker, when I was 8 months pregnant.

    I had a traumatic birth with my first, struggled to breastfeed and sleep/ obsessions were some of my key triggers and signs of PP. We tried to negate each of these as far as we could and I chose to have an elective c-section (after an awful emergency one) and chose to bottle feed after a few initial feeds for colostrum. We don't know whether the plans helped or not, but it was helpful for us to feel like we were doing something.

    I know breastfeeding is an emotive subject (even without PP involved!) but for me it was too much of a risk after the problems first time. My eldest had lost a lot of weight with me persistently and stubbornly refusing to give up trying (in hidnsight being quite ill already). Bottle feeding helped me get some sleep too and having my husband more involved was lovely for him to bond too. The incredible bond he had, and still does with our eldest, from being the sole carer for the initial weeks when I was in hospital, and then some time afterwards when I was still unwell and recovering, is one of the positives I take from the awful time of PP.

    Medication is again a very personal decsion, and one that healthcare professionals can advise you on. I took the same anti-psychotic that had worked for me first time (a number hadn't) for the first 4 months after having my 2nd child. Again, I don't know if this was one of the factors which helped, but it seemed a good idea to minimise risk and my psychiatrist was supportive of it. I had my 2nd child in the morning, gave the initial feeds myself and then took my first tablet at bedtime and switched to bottles. I also stayed in hospital a little longer and had a side room, as the first time I had been discharged home very quickly and we live in a rural area and wanted some reassurance of being "in the right place" rather than at home with limited people around, if things had started to deteriorate.

    I hope some of my experiences have been helpful for you. It's so true that hearing from others who have "been there" is a very valuable resource. Wishing you all the very best and please come back if there are any more questions you have. Take care, xx

  • thanks for your reply. interesting to hear your experiences with feeding. it took three weeks to get my baby to latch and I'm sure this added to the stress in those first few weeks and a significant factor in PPS. however its good to hear that others took breastfeeding out of equation altogether. although this thought saddens me (i guess i could still look into doner milk so at least there is not the guilt of not providing breast which is rather a compulsive obsession...) it would alleviate so much stress for me if i took it out of the equation at least in those early few days. i occasionally take an anti anxiety for sleep on a normal daily basis and being concerned about this or other medication transfering into milk thus not taking and not sleeping is a recipe for disaster in my case! sleep is defianately key and should be number one priority for me. thanks again for your insights.

  • Hi Bellsy,

    Your comments on becoming 'fixated and besotted' about breast feeding resonated with me. I was sectioned with 'hypomania' after the birth of my first child 34 years ago and in my sleep deprived, hypomanic state, was determined to be the 'perfect mum'. I do remember hiding my medication from the nurses as I wanted to continue to breast feed, then flattened with haloperidol and handed a bottle of formula. So distressing, makes me feel quite tearful thinking about it after all those years!

    I took the decision not to breast feed the second time just in case I became unwell again and needed to take medication. I couldn't bear the thought of being forced to give breast feeding, also it meant that I would not be so sleep deprived as the feeding could be shared.

    The thought of a recurrence is a daunting prospect when thinking about another child. Luckily, I had no problem the second time around. I am blessed with my wonderful 30+ year old children.

    All the very best to you. VeeXx

  • Hi Bellsy,

    You're post resonates with me a lot as we are also considering a second baby & I was also very fixated on breastfeeding!

    I had PPP in 2014 completely out of the blue after the birth of our little girl. I had not had any health problems previously. I was very fortunate that I was able to return home after an 11 day stay on the post natal ward with 10mg of Olanzapine & some zopiclone for the first few nights. I took the Olanzapine for a year, but struggled with the side effects at times.

    It took 7 days to get a diagnosis and start medication but I knew something was very wrong and refused to accept I was just an 'anxious first time mum.'

    I recovered well & feel very lucky that I have been fine since.

    However, like you, we are both anxious about taking the risk again.

    I would highly recommend a consultation with Prof Ian Jones in Cardiff. I found out about him on this forum. My GP refererred me a couple of months ago and we had an appointment to see him very quickly. Although we live in the UK we are far away so he offered a Skype consultation, which was brilliant. He told me Skype consultation was relatively new but he had Skyped as far as Australia! So there is a high chance you could do the same.

    I am also now a participant in some research they are doing.

    He has given us the confidence and reassurance to get pregnant again & given us some invaluable advice with regards to my episode and pregnancy and delivery planning.

    We are hoping to try again in the new year with a very clear and succinct care plan in place.

    I would highly recommend trying to get a consultation with him but you will need a referral.

    Best wishes

    K x

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