Action on Postpartum Psychosis
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Care Plan for Second Pregnancy

What do you think we should include in my care plan for birth of baby #2?

These are our thoughts so far:

- Key contact details: GP, Midwife, Perinatal Psychiatrist, Hospital, Labour Ward, Obstetrician, Crisis Team, Postnatal Doula, Me, My Husband, My Mother, MBU, Health Visitor, Maternity Mates

- Expected due date, Risk of PP and early warning signs, what action to take if I become unwell

- Health and Medication details, plan to not breastfeed

- Planned location for birth and who will provide support after birth

- Who will look after our son and dog when in labour

- Key resources and other contact details e.g. apps to book babysitter, local Children’s Centre, APP Peer Support, friends contact details

- Arrangements if I go to MBU (reminders for my husband), dog to stay with in-laws, financial arrangements (HMRC, mortgage provider), my wishes (e.g. daily visit, healthy food, massage, mattress topper)

- Plans for our son: First day of school, school contact details, reminder about first optician appointment etc

- Contact Details for Private Medical Insurances, Health Cash Plans, Chiropractor and Reflexologist

We’ll keep Power of Attorney Docs, Private Medical Insurance Cover and Health Cash Plan Allowance Details, Employee Leave Policies, Employee Benefits (Sharesave), Line Manager Contact Details and Occupational Health Contact Details in a dedicated folder at home (reference the contents and location of this folder in the care plan).

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Wow that seems very complete! do you have a list of birth preferences?

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Good point! Looks like NHS have a good template I can complete nhs.uk/Conditions/pregnancy...

Also, I should add to my care plan what I need to reduce risk of PP - no stress, protected sleep, medication; and my preferences regarding my social media/email/bank account access after birth and if I become unwell; also I don’t want to risk losing anything irreplaceable when in the MBU (e.g. jewellery).

Looking at some other posts, seems like providing a brief history would be helpful (so people understand how severe my episode was i.e. admission to MBU JUN14, separated from baby to go to acute ward, sectioned, discharged JAN15). Also, include a list of people who will look out for my husband if I become unwell (his parents and friends).

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Hi Jessi

That’s a very comprehensive list! I did a lot of planning when pregnant with number 2 as well - lots of lists, trying to think things through step by step, talked it all through with my husband then put it all in a drawer and hoped we wouldn’t need it.

I had an advanced decision document that I was given a template for by the mental health nurse specialist. That helped as a prompt around my wishes - I remember one of the questions was what I wanted my older son to be told if I had to go to the MBU, I can’t think of anything else you haven’t mentioned.

I did a one page sheet for the front on my maternity notes for when I was on the maternity unit after the birth - that was an idea from on here and is a good one as hopefully you won’t have to keep repeating yourself when shifts change. Mine included that I was high risk of PP, asked for staff not to put any pressure on me to breastfeed, requested help with night feeds if possible etc., had my husband’s mobile number on it.

I’d discussed with my husband who of my friends to contact if I got ill and let my friends know I was planning to stay off social media for a bit (and asked them to check in on my husband if I did get ill).

I can’t really think of anything else you’ve not listed already. There’s a lot of great advice on here on similar threads if you do a search.

Hope this helps!

Jenny x

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Thanks Jenny, I was planning a summary (good idea to put this on front of maternity notes!).

I’ll add what I’d like my son to know if I’m admitted to the MBU.

I need to talk to the psychiatrist about other medication, as I feel stressed when I’m in pain (last time I had acute back pain when I was caring for baby alone), and sleeping tablets could prove useful if I’m not getting enough rest.

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i really like the visual birth plans in this book amazon.co.uk/Positive-Birth...

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Hi Jessi_D

Not sure if it's an option in your hospital but I am due to give birth in March and I was referred to a 'mental health midwife' who works in our birth centre and she looks after high risk women immediately after giving birth. She talked through my birth plan with me and recommended that I stay in the hospital for 48-72 hours after birth. I agreed to this but I know some women don't like hospitals so she has stressed to me that we can cut the stay short if I'm not feeling comfortable etc.

Best of luck with your baby, I hope it will go well for you and your family xxx

Dorota

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Hi,

This is a very complete care plan and I wish you the best of luck with your second baby.

Id maybe include who you are happy to visit you in the event you become unwell and are admitted to a mother and baby unit.

Also requesting an individual room following the birth so sleep can be prioritised.

Lauren x

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Us hospital keeping you in a few extra days to restart meds? Midwifes should help you at night. Are you taking sumthing to help you rest short term after delivery? I took Quetiapine last time was quite good : low dose. Plus lithium. I Thinking to start lithium in last few wks of preg even though all is ok thank God without meds at the moment( 26 wks) this is to lower post natal risk and I have a toddler at home this time. Are you having early epidural this is a must for me as a definite trigger. You need help with night feeds at least for a few wks . Good luck

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