High risk of PPP - Meds & Bottle Feeding

[Jessi_D]

I met with a Perinatal Psychiatrist yesterday who explained that the risk of me getting PPP is high, and it’s likely to be very severe if it happens. I’m currently well, and not taking any medication. To reduce the risk of PPP, he suggested I take lithium and low dose of haloperidol about two months before due date. These are the same drugs I was taking when I started to become well when suffering PPP last time. He explained that even with this medication in advance of the birth, I could still develop PPP.

Has anyone else had experience of taking such medication before the birth of their baby? If so, did you become unwell again or stay well? Do you think they had any impact on your baby’s health?

This also means I won’t breastfeed (lithium is not compatible), which seems to have a lot of benefits: good quality sleep while others help with bottle feeding, taking whatever medication I need, well fed baby, no stress or pain (got mastitis previously) etc. I’m concerned that if I don’t breastfeed (not even one drop of milk) that it will affect my baby’s health. Does anyone else have experience of not breastfeeding at all? If so, is your baby healthy?

[Hannah_at_APP Administrator]

Hi Jessi_D,

Good to hear your update and also from your other thread that you have been referred to a specialist midwife.

To share my experience, whilst I had a second baby, 4 yrs after my pp, I did not take meds in pregnancy. Where I live there is (still!) no Perinatal service and as I remained well after the recovery from pp after my first baby and in pregnancy, I didn’t have any mh input until late in pregnancy. Luckily I had the APP Guides and a consultation with Prof Ian Jones through the second opinion service - before I’d had my first!! He also said I was high risk for becoming unwell again but we chose to take meds on delivery (a low dose of the anti psychotic which had worked when I was unwell). I also had in my care plan that I would take lithium if I’d become unwell and it was needed - as it was in my episode after my first.

Anyway, to answer your query around breastfeeding, from my own experience, I also struggled after my first & chose not to after my second. As I had to stop abruptly when sectioned to a general wars without my baby, I knew my eldest had been bottle fed and was well and healthy. There is so much guilt/ pressure (or so it can feel) around breastfeeding! The idea of sleep promotion, stress minimisation and not worrying about meds in my milk were also big things for me. I honestly can say my youngest is a very robust little chap who I really don’t think has been affected by our feeding choice. Fed is best and a well mum if at all possible. We’d have done anything to try and minimise the risk of me becoming unwell again. And it is a joint decision in many ways, and was for us, as my husband was involved (& obviously impacted by pp too).

I hope some of this helps. All the best, xx

[jododo]

I’m 30 weeks with my second. I tortured myself trying to breastfeed my first and have decided not to even try this time. I spoke to my obstetrics consultant, who is very experienced, both here in the uk and running maternity hospitals in the developing world. She was very reassuring that actually the disadvantages of formula feeding are minimal in the developed world - we have access to clean safe water, good quality formulas, antibiotics, all the best health advice, and so on. The World Health Organisation advice is designed to suit the majority of the world, the two-thirds which is developing, where they don’t have all those advantages.

It’s still a subject I’m super-sensitive on (yesterday I had a little cry when I got a late Christmas present of maternity pyjamas because, as always, they’re bloody nursing ones too, with easy boob access, because everyone just assumes...). But my sanity comes first - I will need sleep, medication, and as little pressure as possible if I’m to remain well this time.

[jododo in reply to jododo]

Oh, also, I was exclusively breastfed, while my younger brother was combination and the exclusively bottle fed. My immune system is flipping useless but my brother is strong as an ox. It doesn’t necessarily correlate!

[Jessi_D]

Thanks Hannah and Jo, will I need to do anything to stop the milk or just leave it to go by itself?

Also, did you have much support from family after the birth? My husband and I don’t have any family nearby, so I’m wondering whether we should contract someone for extra support - but I’m not sure how much support we’d need or what type (there are postnatal doulas, maternity nurses, nannies etc).

[jododo in reply to Jessi_D]

There are drugs that can stop the milk but apparently they increase the chance of mental health issues so not recommended. I’m told if you don’t feed at all it dries up pretty quick.

We have family support not too far, but sometimes it’s more hindrance than help! Church, friends, and professionals are much better at understanding boundaries I find.

[Hannah_at_APP Administrator in reply to Jessi_D]

Hi Jessi_D, the midwives advised me that I just needed to give it a couple of days and the milk would go. So although it was a little painful, which I took painkillers for (plus I’d had a c-section) their advice was to “strap them down and leave them alone” (!!)

In terms of support, my experience would be to do whatever you’d like to do and definitely have plans in place. For us, this was close friends nearby, some family (although they’re not too close geographically) etc and practical things like activities for my eldest and meals were the most valuable. We kept things very quiet and had people round on our terms (& timetabled in mostly) so as not to be overwhelmed or crowded. Jododo’s tip about boundaries is a good one too and was definitely something I can relate to!

Take care, xx

[Parent_1]

Being on Lithium is not an absolute contraindication to breastfeeding although most people don't. There are certain things that need to be thought about carefully though. I don't know specifically about haloperidol. The important thing is for you to have a careful think with all of the information. The breastfeeding network have very good information and specialist breastfeeding pharmacist who can give you the info to discuss with the doctors. Having said that It is not a problem at all to formula feed babies. The most important thing you can do for your baby is to look after yourself and do everything you can to keep yourself well.

There is very minimal (poor quality) evidence of some problems with Lithium in pregnancy but that is in the first trimester not later on.

Most important thing is to have the right support/team/plans in place for the perinatal period.

Hope all goes well. Get the information and remember it's your decision.