Psychosis during labour

Hello all,

First of all to those who run this forum and the APP website, it is amazing. Although I have only posted on the forum once before, I often read the posts. Myself and my family found the charity so helpful and useful at the time of crisis and afterwards - it really felt like a lifeline.

I suffered post partum psychosis in July 2015 during actual labour -To briefly explain I gave birth to my first child following an uneventful pregnancy, previous to which I had no experience of mental illness. The labour was long and sleepless, and after ~ 24hours (~50hrs no sleep) I had an epidural. As this happened I remember hearing what I can only describe as a 'zing' across my brain and from that point on I was psychotic for approximately 1.5weeks. I was medicated (olanzapine) but had a relapse when I came off medication 3 months later (this was with medical agreement) and then suffered severe postnatal depression. I am now recovered and only take a small dose of sertraline for the depression which I will soon be stopping.

During and since my recovery I have done a lot of research on postpartum psychosis and I have yet to find an example of the psychosis starting intrapartum as opposed to postpartum which is mostly reported. Has anyone else suffered this? And specifically at the time of epidural administration?

At some point my husband and I would like to try for another baby, and I will obviously discuss this with my perinatal mental health team. However I would like to get as much more information as possible on how to try and prevent the psychosis happening again, especially with regard to pain management.

If you are reading this and are trying to cope with PPP or postnatal depression please know that you can recover and it does get easier. When you are in the midst of it, it can seem like forever and there is no end - I remember every single day being such a struggle and had real difficulty bonding with my daughter. Slowly things improved and I am now fully recovered, back at work and really enjoying life. My advise would be talk to your family, GP and other health professionals and get some therapy if you need it (I did). I love my daughter so much despite the initial struggle, and my worries that she would somehow be affected by it never came to fruition. She is a happy confident 18 month old, and I find this age so much easier than the newborn stage (although the psychosis and depression probably had a lot to do with that).

Thank you for any advice you can offer,

Helen

19 Replies

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  • Hi Helen,

    I had a very similar experience to you, with PP and drug regime (no setback though). My episode came on 2-3 days after birth, and also I think linked to no sleep for 7 days (1 hr per night) from being induced onwards.....until during the psychosis started. I just couldn't sleep after that point. I have not heard of it coming on during birth, but am not surprised, with the hormones flowing and lack of sleep, you mentioned. I also had the PND badly after, and am still on the Sertraline (post months post birth). But hope to wind down in the Spring.

    I found the previous posts about planning next pregnancies very helpful about prevention, and also the advice service. Sounds like you got good support, and may need it again, given how quick it came on for you last time (of course I am not a professional). Can I ask roughly where you based, as its interesting you got such good care in your local area? I also had good care based out of Livingston.

    I have not had a second pregnancy, but others on the forum indicate good planning can help, keeping stimulation to a minimum during birth and after, and sometimes prophylactic meds (but see specialist advice). Perhaps one of the volunteers can direct you to these links I mentioned?

    Great to hear your doing so well now. I am also now on forum a lot, and want to do what I can to help raise awareness. I think it is important NCT and NHS classes pre-birth name-check the condition and the 'warning signs', so fathers are aware of it (as women will often be unaware, when it comes on). Warm wishes xxxx

  • I was at the MBU in Livingston too, Orea.

    Really good point about raising awareness at ante natal classes, fortunately my husband is a medic and I had watched a documentary on PP so we realised what was happening relatively quickly but sure other people are completely in the dark.

  • I had my episode of PP in July 16. Still recovering but was thinking in the future of campaigning groups like NCT to share the warning signs of PP.

  • Hi I wasn't sure whether to comment as my story somewhat different. I had my first experience of PP BEFORE my first son(now 5 years old)was born. It came in my 6th month of pregnancy. Yet with the birth of my second son (now 2 years old) I got PP about a week AFTER he was born. Like you I literally had a moment where I almost felt a switch flick over in my head that time and boom it was back. But I knew what to do this time. Exactly as you said. Talk. Keep talking. Breathe. And keep talking. And trusting. Trusting the people you always have. Despite what the voice inside tells you. And keep talking some more. Even saying those things brings a shiver of painful memories back. Keep hopeful. That this too shall pass. And make time for yourself. Sleep when your baby sleeps. Listen to music, dance, draw whatever helps your mind to slow down. I never took medication as thankfully I maintained a level of insight throughout but second time around I had a visit from a CPN on/off for a year. I suppose all this shows the variety of experiences and the need to consider the mental health of a mother throughout pregnancy. There is a lot in the news today about better awareness and support for mental health in the UK, which is great to hear. Much love to you Helen and everyone on here. Recovering from PP takes time and at times the road isn't easy. But I now have two wonderful sons who people often comment are smiley, confident, lovely boys xxxxx

  • Helen me again, your mention of the term intrapartum has made me realise that there could also probably be such a thing as 'prepartum' psychosis. I never really thought of it before as the term was never specifically mentioned to me throughout my illness. Anyway first time round I never told any medical professionals because my family just looked after me and as the acute phase passed relatively quickly that was possible. But I still suffered a lot with hallucinations, panic attacks and racing /strange thoughts running right up to my first son's birth and for a long time after I wasn't right.I'm sad to say I never told even my midwife. But second time round I did tell her and it was fantastic to know I had a full safety net around me amidst all the fear and confusion I felt. So thankyou for this and I hope u get all the further advice you need x

  • Hi Helen,

    Your experience sounds similar to mine, I had a lengthy labour which eventually resulted in a caesarean and although I don't think I was psychotic during labour I think having the epidural also made my brain 'zing' and I was very hyper from then on. I couldn't sleep at all for days after and finally when my milk came in I became psychotic.

    I wondered whether the epidural had an effect too or whether the damage to my brain had been done by the lack of sleep and the hyperactivity was just what was left when you take away the pain?

    Hazel

  • Thank you all for your replies, they are very helpful.

    I live in Havering, and am fortunate that there is a dedicated perinatal mental health team within the trust. However unfortunately the nearest MBU in Chelmsford was full and so I was admitted to a psychiatric hospital - this was I think the worst point for me, I was away from my family and daughter and the service was so poor. The staff laughed at me and forced the tablets into my mouth saying I was difficult. They were constantly on their phones, I was on overnight watch and the woman literally sat at my door on her phone and shouted at me any time I tried to get up - I was terrified, absolutely the worst way to treat vulnerable patients. I haven't yet but am go to complain to the chief executive of the trust.

    Lilly it is great to know you have had a second pregnancy and although you suffered PP again you recovered well with support. Hopefully second time around it it happens again I will be supported better, I am going to try and get it in my plan that if I need to be admitted it is to an MBU. My daughter was in NICU for 10days so I think even if a bed had been available this wouldn't have been possible.

    Hazel that is so interesting it's such a relief to know someone else has experienced something similar. After the 'zing' my mum and partner immediately noticed a difference, I think I was manic - I had this immense feeling that I suddenly understood everything and it all made sense and everything was going to be ok. Everyone was trying to get me to sleep but I couldn't. I also ended up with an infection ( had a temp during labour) and I think I may have passed out around delivery, I don't really remember it. I have vague recollections waking up after my daughter was born - I thought she had died it was awful, the worst feeling in the worldl. I was definitely psychotic then, I thought I had to choose between losing my mum or losing my husband in order to get my daughter, and because I wouldn't choose she died. Then I thought I had died as well. Absolutely tortured myself.

    Because for me it definitely started with the epidural I am really concerned about pain management. I don't know if I want an epidural again, but I found the pain so bad I don't know how I will cope. Also I imagine that there will be a limit to how long I will be allowed to labour for, and then they will want to do a c-section. What should I do then? Go for a general anaesthetic instead of an epidural?

    I am going to discuss this with my perinatal mental health team and midwives/consultants but it seems there isn't much experience with it - hence wanting to know if anyone else has experienced this and if so how did they manage he second labour. Xx

  • It's so daunting to consider having another baby when there's the potential to get ill again, but it's good to know that there are options to minimize the risks.

    Your experience in hospital sounds really difficult. I was in a general psych ward for 2 nights until a bed became available at the MBU and it was very upsetting being apart from my baby and surrounded by strangers in a very clinical setting. The staff were more caring than in your experience but I definitely found it hindered my recovery to be apart from my son, especially when breastfeeding. Let's hope services do improve.

    It is amazing though how much we've come through and survived. ..

  • I just had a look at the MBU availablity in England and Wales, it is so poor. There are 87 beds available, just 87! I looked at some stats there are approx 700,000 births in England and Wales a year, if you assume 1000 cases of PP a year ( approx 1-2 per 1000 births) and each person requiring 4 weeks admission (I am estimating this, does it sound about right?) people suffering with PP alone would fill up the service, without even accounting for any other mental health illnesses requiring admission.

    (I only did England and Wales as stats on live births are reported like this)

  • Hi Helen_84 thanks for your post. I'm so glad this forum has been helpful. It has been so important for me too in processing everything that happened, and just to feel not so alone and different from other mum's!

    You're right, the lack of MBU beds is awful, as you sadly had to experience yourself personally... I just wanted to let you know though that the government has pledged money to perinatal mental health and the money is being spent by NHS England to try and ensure that every woman in the UK does have access to a perinatal mental health team. So perinatal mental health teams are being expanded or started. More MBU's are being built or expanded as well which is so good. So let's hope that we will start to see improvements in the next three years. It's a total postcode lottery what you get at the moment. And yes - general psychiatric care is definitely not the right place to be when you have PP. I was fortunate in that I was in a MBU within 24 hours of going into A&E.

    I also wanted to make sure that you have seen the guide for planning another pregnancy, as you mention that you are thinking about what you would do if you wanted another baby. The link is here, it is free to download. You can show it to your perinatal mental health team too. It was written by leading perinatal mental health clinicians and women who had PP and had further children.

    app-network.org/what-is-pp/...

    I do hope you continue to recover well.

  • That's good to know Ellie, I saw Teresa May's announcement in the media so it is good to know the details.

    I had seen the guide, i have found it really helpful. I was really looking for information regarding pain management - given that for me it started with the epidural, I am quite keen to avoid it second time around but really worried about how I will cope with the pain. Also ideally I would like to give birth naturally rather than c-section if possible - saying that if a c section is strongly recommended I will probably go down that route

    Thanks very much

    Helen

  • Hi Helen_84

    Yes, totally understand. It sounds like you could do with some input from midwives etc who can recommend things for pain management in labour etc too, and to empower you with all that?

    Good luck with your thinking, it's a huge decision whether to have another child isn't it? I do hope you can get the support you need from the perinatal mental health team etc, it sounds like you're getting good support now.

    Ellie

  • Hi Helen, again I am not an expert so you should really get advice from mid-wife and peri-mental heath team. But if you are keen to avoid an epidural, my understanding is you can go for the diamorphine options (I think they are drip fed?) but can make you woosy. Alternatively, if you go down the c section route, I think a spinal block is how it usually works, so this is different from an epidural again. Then of course, you have the more 'soft' pain relief options (tens machine, gas and air). I found the latter really worked for me, as my epidural didn't really work properly and I was numb but still had pain. Hope this helps, but speak to your obstetrician. xx

  • Thank you I will ask, diapmorphine wasn't mentioned before. I was very keen to have as natural as possible delivery last time - I actually wanted a waterbirth, and did lots of classes on breathing and positioning. However about 2 days in I was just unable to cope with the pain anymore. I said to the midwife what do you think? She said I think you should have an epidural, after that I lost all confidence in being able to deliver without 'proper' pain relief and cried my way through contractions whilst I was moved ( was originally in a birth centre) to the labour ward... Can't believe I am going to try and do this again! 😖 They say it's easier second time right?

  • I have only done it once! But I also wanted the birth you described. But had gestational diabetes so had to be induced. I think you shouldn't beat yourself up about having the perfect birth - to my mind it is much more important for you to be well mentally - so whatever it takes to achieve that, even c section (personally). I have heard that the most calming, relaxed, stress free birth experience may help to reduce your risk of PP again, plus also making sure you get plenty of sleep before and after. This can be tricky with a long birth I guess. Ultimately whatever you decide, will be best for you. Good luck! xx

  • Yes completely, every birth is different - 2nd time around all I hope for is my health (mental and physical) and the babies health, and to me that would be perfect, regardless of how it was achieved. Sleep is definitely a big factor for me so I already plan to get lots of rest before, and lots of help after. I will definitely aim for a relaxed stress free delivery, hopefully my psychiatrist and/or physiologist can offer advice to help. I think I will need it because as the moment I would be very nervous about labour. Thank you for all the advice, helps consider all the options

  • Yep, let's hope there is a better future for perinatal mental health and continuous after care for those once, who are still struggling.

    I do not want to start talking about politics & mental health issues-promises need to be put into practise & Theresa May has a huge job on her hands!

    Women who have given birth to a child and suffer acute PPP should not be put into psychiatric mixed gender units. I absolutely can relate to the experience of Helen_84.

    Best wishes to you all!

    Sabine :-)

  • Hi sorry to hear this happened to you during labour. I had epidural, 33 hour labour, and no psychosis till five weeks after. So I plan on having epidural again

  • I found epidural so important to reduce stress/ sleep disruption. It was in my care plan. If husband can help with night feeds when you go home. Rest is very important. Medication important after birth esp. The hospital should keep you in a few days extra. Nurses should help at night. I tuk lithium after birth and quetiapine short term to relax and sleep was good

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