Am I irresponsible to consider pregnancy?

[Megannn]

Hi, I'm new here.

I've been looking for help and advice recently. I had an episode of pyschosis about 10 years ago when I was a teenager and was in hospital for a few months. It took ages to recover and was the worst experience of my life, very scary and I felt like I'd lost myself completely, in self-confidence and self-identity. I've had clinical depression also, a couple of times in my life. At the moment though, I'm approaching my 30s, life is pretty good, I enjoy my work, spending time with friends, I'm healthy and happy and in a great same-sex marriage to a lovely woman. Lots has happened since my psychosis and I've had some great adventures as well as doing a lot of normal things too!

My wife and I have been thinking about having children. My wife doesn't want to be pregnant. We looked into adoption and decided it wasn't right for us. So I'm left wondering about carrying our child myself. I could imagine being a parent could be really stressful and tiring and that worries me, not to mention the pregnancy part being unpredictable. As my psychosis was triggered by a lack of sleep and high stress levels, it worries me.

I went to the GP earlier this year and asked for a referral to mental health services for advice. I didn't hear anything. So in the meanwhile I booked an appointment with a psychologist privately. She had never heard of post partum psychosis and said to me, you shouldn't ever make decisions based on fear. I didn't see her again, as we weren't a good fit. I went back to the GP to ask them to chase up the referral and I still haven't heard anything from the local mental health services!

I'm not sure where else to get some help, so I thought I'd join this forum and see if anyone has any thoughts on the following:

Am I being irresponsible, thinking of trying to get pregnant when I've had psychosis and depression before?

Is there a way to just go straight to a perinatal psychiatrist without having to wait forever for the mental health team to give me an appointment? I'd really like to talk to someone who is an expert in psychosis and pregnancy to get a bigger picture of it all before I think about going to a fertility clinic/sperm bank etc.

Looking forward to hopefully hearing some advice or anecdotes!

Thanks.

Megan

[BrokenChloe]

i think ur more than responsible if ur already keeping that in mind. make sure u get in touch w a psychiatrist and have a plan, and remember when it comes to psychosis, meds are always ur friend.

[BrokenChloe]

personally, i was psychotic for 5 or so years when i was a teenager, have other comorbid issues (mood disorder, anxiety disorder, personality disorder, sleep disorder). getting pregnant was just something i needed to do for myself, but both me and my husband knew the risks of postpartum psychosis, and that PP or PND was inevitable.

i talked to my psychiatrist (not perinatal specialist) a few months before we started trying, and then when we were trying and then when i was pregnant (certain meds had to be taken away before we started trying, and once i was i could transfer to a perinatal psychiatrist). since i was about 12w pregnant, ive been under the care of a specialist perinatal team (seeing a psychiatrist occasionally, and a psychologist regularly), and have been keeping aware of any mood shifts that have been concerning and changing meds accordingly (there was a big hormonal shift at 18-20w, and then one at 29-30w). i met with a lactation consultant at 32w to check my meds (im on clonazepam for night terrors, and noone was giving me a clear 'yes' or 'no' about taking it while breastfeeding).

now im about to give birth, i have a plan in place to catch anything as early as possible which encorporates the hospital and the specialist team (full inducement to keep things as certain as possible, single room so my partner can stay, psych eval before discharge which will be carried out by my psychologist if possible- she only works 4 days a week- or by the hospitals youth mental health team- they werent too happy about doing one if i wasnt acute). my birth plan details my triggers and early warning signs, and everyone has been told to listen to my partner, if hes saying something doesnt seem right, something probably isnt.

postpartum, ill be seeing a two maternal and child health nurses (one through my perinatal mental health team and one through the hospital), and have continued support for the first year from the perinatal mental health team. i know the plan if i have to go back into the hospital, or if im only a little unwell. im worried about the lack of sleep, as i know thats a big trigger, so i splurged a little earlier than i was expecting on a breast pump so my partner can do some or most of the night feeds. other things i have in place is not being narrow-minded, im prepared to formula feed if necessary, i have cloth nappies ready if i can manage but i wont mind using disposables, i have told everyone that noone is seeing me, baby or husband for the first 2 weeks post partum so i can bond as much as possible with baby, and my husband knows he'll be needed more than before esp in the first couple months (he occasionally volunteers or contract works, but has put that aside for a couple months for me).

the biggest thing, has been seeing that my health does actually come before babys. if im not well, then how can i be the mother my baby needs?

[Megannn in reply to BrokenChloe]

Hi Chloe,

Thanks for your reply and for sharing your story. It sounds like you are being looked after really well by your team and it's great you're keeping an open mind. I hope the rest of your pregnancy and the birth goes well. It's reassuring to hear how much they are helping you with.

I'm haven't been on any meds for a few years, so I don't have a psychiatrist to begin with like you had... hopefully I will be able to see one soon, the referral process just feels so slow. I chased it up this afternoon with a phone call and they told me the team's gone home now, so I'll chase it up on Monday morning too.

Thanks again for sharing your experience.

Megan

[Ellie_at_APP Partner]

Hi Megan

Welcome to the forum, it's great you've found us. You already have a great reply from BrokenChloe about what has worked for her and some of the things to think about / decisions to make. As you can see she is really lucky to have such amazing professional support, sadly this isn't available yet for everyone in the UK but I know new NHS funding is available and they're hoping to ensure all areas of the country do have a perinatal mental health team. I just wanted to write to give you some links to information / support that might help.

You're right to seek support and get advice before trying. Ideally, if there is a perinatal mental health team in your area you should ask to be referred to a perinatal mental health psychiatrist for a preconception meeting who can advise you. If you're in the UK and you don't have a perinatal mental health team then you can actually ask your GP to refer you to APP's second opinion psychiatry service with Dr Ian Jones, a leading perinatal mental health clinician, who will advise you on how to stay well in pregnancy and afterwards, and advise on medication etc (all the things BrokenChloe has said). There is no cost to you or your NHS authority so emphasise this as this is what might put them off referring you! The link to the service is here: app-network.org/what-is-pp/...

Also APP have written a guide for planning a pregnancy if you are at risk of PP. It was written by women who have had PP and leading perinatal mental health clinicians. It's a really good booklet and should give you all the information you need. It's free to download from our website here: app-network.org/what-is-pp/...

It is definitely possible to stay well, from being in touch with many women who were at risk of PP and planned a pregnancy well. I had PP after my son out of the blue with no previous mental health history, and I haven't had anymore children so I'm afraid I don't have personal experience to offer of planning a pregnancy when you know you are at risk of PP but I hope you will get lots of other replies on here with good tips for you.

Good luck with your planning and decisions! I hope all this info is helpful.

Ellie

[Megannn in reply to Ellie_at_APP]

Hi Ellie,

Thanks for getting back to me. Yes, I've been googling "perinatal mental health team" in my area and not getting anywhere so far. If I manage to get an appointment with my local mental health assessment team I'll take your advice and ask for a perinatal psychiatrist for a preconception meeting. Do you think that's something they'd know about? If I need to go with your plan B for a referral from the GP to Dr Ian Jones, how should I explain it? Will they know about him? Would I need to tell them how to refer me? Would it help to get in touch with Dr Ian Jones before going to the GP for advice on what I should say to the GP?

That's reassuring that it is possible to stay well, thanks for telling me about the people you know who have. Sometimes I also wonder about the ethical dilemma of having a baby knowing I have a history of mental health, not only because I wonder if I could get ill again, but what if my child were passed on genes that make them more prone to mental illness? But then I also think, maybe I'd be better equipped to help educate the child about mental health and how to prevent mental illness because I have this personal experience. It's a tricky thing to think about and I suppose there's never going to be a simple answer.

Thank you, yes it is helpful and I really appreciate you taking the time to respond!

Megan

[Ellie_at_APP Partner in reply to Megannn]

Hi Megan

Thanks for your reply... just to answer quickly I think the best thing to do is print off the page about the second opinion service and give it to your GP - I've even known someone who stood over their GP and helped them fill out the referral! It depends how good / knowledgeable the GP is in perinatal mental health etc.

I know what you mean re the ethical dilemna of whether to have a baby because of your history with mental health...I don't know, my mum actually had periods of psychosis during my childhood (she had catatonic schizophrenia) and yes, it was traumatic and had some kind of effect on me, but at the same time in a strange way there were positives that came of it - for example I am inspired by my mum and dad's relationship and the way they have supported each other through thick and thin, and I knew my mum (and dad) understood when I was ill, and they didn't freak out like a lot of parents do because they had been through something similar. I guess what I'm trying to say is the impact is not always just negative, it is a mixture I would say....And I don't know about you, but I think my own struggles with mental health with the PP I am so grateful for in so many ways, it's made me really grow as a person. And well, 1 in 3 people will suffer some mental health problem in their lifetime.

Anyway, enough waffle from me Really hope the planning etc goes well and you do manage to get some good advice

Ellie

[Megannn in reply to Ellie_at_APP]

Hi Ellie,

Thanks so much for sharing. It's really interesting to me to hear about the other side of it - with you having a mum with psychotic episodes. Sometimes I think about how it must have been hard for my parents and family with me being ill, but it's nice to hear that you are able to reflect on the positives of it at least. Definitely a new perspective I've never heard before.

I went back to my GP again the other day... I really don't like my GP surgery! Hopefully I'll get successfully referred soon. I didn't try asking about Prof Ian Jones this time as I researched a bit more into where might be my nearest perinatal team so thought I'd try seeing them first. I have discovered it's not that easy to find out where your nearest is. I've been finding this whole referral process a bit stressful because it feels like going round in circles. This was the third time I've been to the GP to get this referral!

Thanks for your support.

Megan

[Jenny_at_APP Partner]

Hi megann,

You've already got some great advice and information above but I wanted to say too that I don't think you're being irresponsible to consider having a baby. I think you're being very responsible being aware of the risks and proactively seeking out advice.

I had PP in 2012 out of the blue with no history of mental illness. I had a second baby in January with around a 50% risk of having PP again. Happily I did not become unwell this time.

I would highly recommend accessing the second opinion service with Prof Ian Jones - I asked my GP to refer me and saw him with my husband in Cardiff. I was never under a psychiatrist during my second pregnancy, I saw a mental health specialist nurse antenatally through an outreach service as the perinatal team doesn't cover my area, so the contact with Prof Jones was invaluable and my GP (also excellent) contacted him with queries around medication as I wasn't happy with the advice I was given. I had a conversation with him over Skype towards the end of my pregnancy.

I do hope you get good input and support locally should you choose to go ahead. Sadly mental health services are so thinly stretched aren't they - I was expecting to be referred to the local CMHT but was told they would only become involved if I did get ill. I had excellent support from my GP, midwife and health visitor and plans were in place should PP hit.

Do keep in touch here as much as you like - I think the forum is an amazing source of support and information as we are all experts through our experiences.

Take care and good luck. You're doing the right things and forewarned is forearmed xx

[Megannn in reply to Jenny_at_APP]

Hello,

Thanks for your response.

It is good to hear about your experience without having a psychiatrist during pregnancy and it is reassuring that you were ok. I got very stressed out when my GP dismissed my question about whether or not I'd get a psychiatrist if I decided to get pregnant. In reality he didn't really know, but it upset me to think I might just feel alone and unsupported if I was pregnant. Yes, you're right, the services are just stretched so thin. I'm really thinking again to get some private therapy in the meanwhile.

Do you mind me asking if there's anything you did differently, that you think helped you avoid getting PP in your second pregnancy?

Thank you, really appreciate you sharing your experience, it does make me feel better!

Megan

[Jenny_at_APP Partner in reply to Megannn]

Hi megann,

I'm glad you're finding the responses here helpful. I don't mind you asking at all.

I didn't really do anything differently during pregnancy as I'd had no issues antenatally. I was naturally quite anxious second time and had to make more effort to rest and relax and find 'me' time. After the birth, the main things I did differently were prioritising sleep/rest, taking medication and formula feeding. I got quite fixated on breastfeeding with my first son, and sleep deprivation, a lot of which was down to the constant (what felt like constant anyway) feeding, was a major factor in my PP I'm sure. So I made the decision to formula feed my second after some initial feeds, partly as I'd be taking antipsychotics and didn't want to breastfeed on medication (personal choice, I appreciate I could have done), partly so my husband and mum could help with the night feeds (which they did for the first 8 weeks I think), and partly to avoid it becoming a 'thing' again. I opted to take a low dose of Quetiapine which could be upped quickly if I started showing symptoms, as I'd responded well to this after PP, and had plans in place for if PP hit and good support from family, friends and my GP, midwife and health visitor.

So being on medication and getting as much sleep/rest as I could (formula feeding being a big part of this) were the main things I did to try and reduce the risk of recurrence. I'll never know if I would have been one of the lucky 50% anyway but I guess we did what we felt we could and accepted that it was out of our hands beyond that, and I was ok with that.

It's been a much different experience this time. Despite all the planning and worry, I've definitely been able to enjoy it this time around. I feel very lucky.

xx

[Iconoclast]

I have a history of bipolar disorder and have one child. I did not suffer PP after his birth, but had a psychotic episode nine months later. Now I contemplate having a second child. Visiting a perinatal psychiatrist did a lot to reassure me. She told me it would be best for me to stay on my medications and prioritize sleep after the baby is born. I've decided that I will do formula feeding and have my partner feed the baby at night as sleep deprivation is a big trigger for manic episodes in my case. There is a lot of research out here in the US suggesting that lithium is a good preventative for post partum psychosis. And I know that a lot of women have found success taking an antipsychotic medication either during their pregnancy or right after the birth. One website I've found helpful is (womensmentalhealth.org).

[Megannn in reply to Iconoclast]

Hi,

Thanks so much for the advice. I agree sleep deprivation is a big trigger, and definitely triggered my psychosis! I have been thinking about surviving after the pregnancy with a baby not letting you sleep. I was wondering about the idea of employing a night nurse for the first few months until the baby slept through the night... It is so kind of your partner to offer to feed the baby at night.

I will check out the website you suggested, thank you.

Megan

[suzannah0]

I would employ a night nurse if I could! And a cleaner