Birth plan and meds...: Hi all, I was... - Action on Postpar...

Action on Postpartum Psychosis

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Birth plan and meds...

vix28 profile image

Hi all, I was wondering if anyone had a good birth plan template to use (following experience of PP) - I can't really find anything.

I had baby boy at 39 weeks, mild PND. Then baby girl at 27 weeks, full blown PP and went to MBU in Birmingham (live in Cornwall!). I've been on lithium for bipolar for a while now. I'm currently 14 weeks pregnant with number 3, baby wasn't planned - I've stayed on my lithium and I've been talking to my psych about meds change as I want to breastfeed. They've suggested olanzapine or carbemazepine as good evidence that you can breastfeed. I must admit I'm terrified of the weigh gain (not been on olanzapine before) but also of PP relapse but I do really want to breastfeed if possible.

Thank you :-)

17 Replies

Hi congratulations.

I had pp with my first in 2013. I had a care plan with my second in 2016 and was fine. I was on olanzapine, I started taking it 3 weeks before baby was due, and stayed on it for 5 months.

I did put weight on but I managed to lows a little while on meds, hat to exercise 3times a week. but now I am off them the weight is slowly coming off sill going running, swimming & eating sensible.

After having baby they did blow me up for a while my feet where a size bigger and non of my rings would fit. But now they fit.

I know it is not nice putting the weight on but your mental health is really more important at this time.

I also wanted to breastfeed but I got my husband to do night feeds. From first night, So I could sleep but as he gave baby a bottle, baby would not take to boob after bottle and I was getting anxious about it so we went straight to bottle. This eliminated my anxiety. After I was told we should of feed baby out of a small tub rarther then a bottle as bottles make baby lazy.

Please feel free to ask me any questions.

Good luck and let's hope this time it is more enjoyable experience.


hi there

I'm currently trying for my second baby after much deliberation.. like so many mum's here I had such an awful experience on the birth of my first child 5 years ago

I'm actually still on maintenance 2.5mg of olanzapine and 200mg of anti depressant sertraline

my psychiatrist has told me that both are relatively safe to take during pregnancy I did have a misscariage at 9 weeks last Sep but I do not think this was due to the medication

I just have 2 questions firstly I didn't think you could breast feed on olanzapine I would love to do even one feed a day and then my husband can do the night feeds I wonder would that be possible I wouldn't put any pressure on myself if it didn t work I would go straight to bottle

my second question is I am looking for advice as what action plan I can put in place if I do get pregnant and I get PP again following the birth, you see both my parents are deceased and my husband's parents are elderly and my only sister lives in the middle East

I would get an au pair leading up to the pregnancy and for months following the birth as I know the most important thing is to keep myself well and I will go to any lengths for that to happen

obviously an au pair couldn't be expected to do night feeds when husband can't

I'm wondering did anyone ever get a night nurse or is there any free support services in Ireland to support mothers will mental health history? thanks all in advance for your time

nickey xx

Hannah_at_APP profile image
Hannah_at_APPAdministrator in reply to MaryMary007

Hi Nickey,

I'm sorry to hear you had awful experiences too and have recently had a miscarriage. I took Olanzapine but chose not to breastfeed - mostly because I had really struggled after my 1st and also that I wanted to be able to sleep without night feeds, a little selfish as that might sound. I did find it really great for my husband to bond with our little one as he dealt with the nights so I could rest - plus the meds made me tired too. I would say to take the advice of health professionals involved in your care, keeping on meds that keep you well is usually preferable to stopping things in an unplanned way and being unwell yourself. There may be something about the timing of meds and breastfeeding which they will be able to advise you on.

I don't know about services in Ireland I'm afraid or having an au pair. I prepped my husband and some close friends to be my support network, which included looking after my eldest and giving him some time just for himself (even remaining well, I think they need something for themselves with a new baby. And of course it would have been really needed if I had got ill, and he had friends and family to go have sleepovers at too, if needed. In fact, he did do this to have some special time just to himself whilst my husband and I did baby things).

If I find anything out about Ireland, I will come back to you. All the best, take care, xx

hi hanna h

thanks a mil for your response

I don't think opting not to breast feed is selfish at all we have to do whatever we can to try and keep ourselves well

I wish I had a crystal ball and could see in to the future and be told I won't get PP again!!

my main concern is what effect it would have on my 5 year old daughter if I was very unwell and had to go back to hospital

would that be fair to put her through I just don't know xx

Hi Nickey, have you looked at the website Bumps? Has advice on all meds in pregnancy and is a good, evidence based site, informed by the UK teratology information service (UKTIS) and funded by public health England.

It's at

Hope that helps some, and good luck ☺️


thanks a mil for your reply I will defo look up that site to see if I can't find more info on my medication x

Hannah_at_APP profile image
Hannah_at_APPAdministrator in reply to MaryMary007

Hi Nickey, there is the Nurture charity in Ireland if you have come across them? They are not PP specific but to support all perinatal mental health condititions:

Hope this helps, take care, xx

hi hanna h thanks so much for the reply I will defo look up that site tomorrow x

Hi Vix,

Nearly 13 weeks here!! I ceased sodium valproate before trying to get pregnant this time, and am on 10mg of olanzapine now and will probably go up to 20mg postnatally. If I do become manic or otherwise psychotic after the baby is born they will try using valproate first, and if that doesn't work well I have already agreed that I want ECT which I had following the birth of my son. I really want to breastfeed as well, so we're going to work really hard at it!!

As far as a birth plan template - I'm not a fan of them as a midwife or as a mum! I really like birth plans, but I think they need to be tailored to your needs, and I think that people often look at templates and just copy ideas that they might not have really researched. By all means check some out online because it will give you some ideas about what to include - things like who your support people might be, what kind of pain relief you'd like, and parenting decisions like vaccination, or cord blood banking, etc are things that you might want to put on there. Also talk to the midwives and doctors about what they do as standard practice - because you might find that you don't need to put as much because it's already what happens at the place you're birthing at.

My birth plan has a couple of specific things for me in regards to my mental health - the first is a bit of a disclaimer that I've had a previous loss and asking them to be mindful of that, and the third is one that I think most of us who've had a previous PP can relate to - something like "I have had a previous episode of PP. I am planning on taking ________ medication following birth. I am planning to have an extended hospital stay of 5-7 days. Before discharge please give me and my support person contacts to call in case I start to become unwell." I'm terrified of it all to be honest. My mood has been fine so far, but I've had really crippling anxiety and feeling pretty awful at work and jealous and resentful of mums who are having normal trouble free pregnancies. I don't know if it's more to do with fear of stillbirth or fear of a complication or psychosis. But I didn't expect to be so anxious. I'm getting super anal about birth plans, and plans for the postnatal period and everything because I can feel in control of that at least.

Hannah_at_APP profile image
Hannah_at_APPAdministrator in reply to Cicerenella

Hi Cicerenella,

Good to hear from you, I hope you are keeping well. There are some great tips in your response about doing the care/ birth plan, and highlighting choices/ preferences without it being too rigid or formal. The "I had PP, please be aware, please respect my choices and here are the contacts you may need" is a really good approach in a nutshell without making it too rigid.

The anxiety sounds tough - this is something I was really aware of in my 2nd pregnancy and also afterwards.

I think there is probably a fine line between doing what you can and then doing it too much, if that makes sense. But it is definitely the case that we feel we want to do anything and everything we can to be prepared, or minimise risk, try to retain some element of control over what is a really uncontrolled time in many ways. I definitely relate to this!

I hope you are able to get some good professional input and family support, with some rest where possible. Easier said than done, I realise! Take care, thinking of you, xx

NicJK profile image
NicJK in reply to Cicerenella

Hi Cicerenella I'm going through old posts regarding olanzapine and pregnancy. Did everything turn out fine with your little one? Are you still on olanzapine? I will most likely be taking olanzapine during my next pregnancy

Hannah_at_APP profile image

Hi vix28,

Congratulations on your pregnancy! I had an episode of PP after my first child in 2009 and had a 2nd child and stayed well in 2013. I hope you are getting good mental health input from a local team, is it a general team rather than a perinatal team? There was nothing locally when I had my 2nd, and my CMHT wouldn't see me without any other diagnosis and being well - so annoying! I ended up writing my own care plan, which looked something like this:

- Key info, contacts, intro "about me"

- History (what happened with my 1st delivery and the PP)

- Birth plan/ choices (I opted for an elective c-section and a longer hospital stay after an awful emergency one and quick discharge)

- Triggers & Treatments (early warning signs, what worked and didn't and any choices on treatment if I needed it, eg MBU rather than staying at home, ECT if needed as it worked before)

- Medication (what I was on before and what I was going to take and when, including what I would prefer not to take. I took a low dose of the antipsychotic that had worked before, after delivery and for about 3-4 months afterwards)

- Feeding choices (we went for bottle after a few feeds as I was taking meds to help me sleep)

- I also included names and contact details of trusted friends and family who could be called on for childcare for my eldest, if I had become ill. Also that I wanted my husband to make choices for me if I couldn't (sounds obvious, but we talked about that and how important it was to us as a family)

What also helped us, as I struggled to see a psychiatrist locally until 8 months pregnant, was APP's 2nd Opinion Service with Prof Ian Jones. As we are some way away from Cardiff, we did this via skype and it was amazing to talk to a health professional who truly understood. As most of my midwives etc locally were well meaning but without specialist knowledge, the letter he wrote to them, and the hospital, was amazing for pulling everything together and they really took notice of it, rather than just what I was saying (sadly....) Here is the link, it is a referral from your GP or psychiatrist and there is no cost:

In the end, the hospital and midwives - together with the social worker I was eventually allocated and only saw a handful of times - really appreciated my care plan and added it to the front of my file (I think the social worker used a lot of it on his assessment too!)

Pregnancy after PP can be really scary but ultimately, being prepared and feeling that you are doing what you can was really empowering, in my experience. I have no idea if anything we put in place had anything to do with the outcome of staying well, but it felt like we needed to do something (anything!) to try.

Please feel free to ask me any more questions on this, it's something I feel strongly about and having all the information to hand - for yourself and other professionals - is really the best thing you can do. Wishing you all the best, take care, xx

Hannah_at_APP profile image

Hi again all, in case you haven't seen it (or for anyone else reading this) APP has a Guide about Further Pregnancy and also Bipolar & Pregnancy (produced with NCMH & Bipolar UK) on this link;

Thanks everyone for your advice and comments. I've got an app with my psych tomorrow, we do have a perinatal team in Cornwall but they seem pretty inexperienced so I found the meeting with them extremely disheartening. My own consultant seems to know more so going to stick with my close knit care team. One of my main issues is contending with not just having PP but also having a prem again. Only time will tell!


Hannah_at_APP profile image
Hannah_at_APPAdministrator in reply to vix28

It's a tricky one isn't it? I'm sorry that you found the meeting disheartening. You can make the right decisions for your pregnancy, birth and beyond with the care plan, along with the support of family and friends and professionals. It's good to hear you have a good consultant you trust. I hope all continues to go well, feel free to pop back here and chat with us if that would be helpful for you. Take care, xx

Hazello profile image
HazelloVolunteer in reply to vix28

Hi Vix,

You mentioned wanting to breastfeed and olanzapine, I breastfed my son on olanzapine and was told that this was safe to do. I didn't gain any weight on olanzapine and I wondered if the breast feeding can counteract the meds regarding weight. I had PP 5 days in and lots of people told me to allow other people to do night time feeds to catch up on sleep but I was determined to feed him myself so didn't take this up much, which possibly meant it took me longer to recover but I felt so good about having been able to feed my son myself despite being ill it was definitely worth it. He's a year tomorrow and still feeding and I'm off the meds now.

Hazel x

I had epidural in my plan with last baby which really helped. The reduction of stress and pain I think helped a lot in avoiding a relapse. U need a lot of rest after. Try arrange someone to help with night feeds if possible. I took quetiapine after short term but it was very good at helping me relax and sleep well. Don't know bout breastfeeding with it. Just try take the best medication after. I think it's more imp to stay well than to breastfeed. If the doctors suggest medication where you can achieve both then that good too.

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