Action on Postpartum Psychosis
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Feeling really low

I’ve just been diagnosed with gestational diabetes and it’s really knocked me. I’m not very occupied with work as things are winding down as maternity leave approaches. I’ve stopped taking haloperidol for a few days on the advice of my perinatal psychiatrist, tried eating differently (avoiding sugar) and now I just feel utterly miserable. I love food and hate diets.

I’m not looking forward to these next few months at all. I’m thinking of re-starting the haloperidol tonight to see if it makes a difference with my mood, especially as I’ve been so tearful and sleepy today.

This pregnancy has been one thing after another - anxiety about getting postpartum psychosis again, flu, hypomania, waters breaking early and now gestational diabetes. My last pregnancy was nothing like this! It feels like I have such bad luck and worry about what more could be thrown at me - maybe a shit birth to top it all off.

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Hey Jessi - I’m so sorry to hear this. What a stressful time you’re having, to say the least! Do you have anyone you can talk it all through with? I’m not very familiar with the symptoms of GD but hopefully your midwife will be able to reassure you and give you some good support.

Did your Perinatal psychiatrist explain why they were recommending you come off your haloperidol? I would be wary of going against doctor advice, and restarting it on your own, but perhaps the APP second opinion service could be an option here?

Whatever you decide we are all here for you and wishing you all the best! Just think of how well you’re doing to make it so far. Amazing work!! X

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Hi KatG,

I was taking haloperidol because the baby might come early, but since nothing else happened after the waters broke it’s now business as usual and I don’t need to take medication to prevent PP for the next couple of weeks. The doctor doesn’t mind if I feel the need to take it, but thinks I don’t need to if all is OK.

I called my Mum earlier and she was a little helpful. I’d like to speak to my husband about how I feel, but don’t think he wants to hear it as he’s had a bad day too and is very tired now.

We’re going to a GD education session at the hospital tomorrow morning, and seeing my midwife in the afternoon. I expect it will only make me feel worse as the reality sets in on all the restrictions, risks and complications.

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Ah I see thanks Jessi that makes sense. I’m glad baby seems to be staying put - that must have given you a real fright when your waters went early. The education session will hopefully be balanced - it’s good to know the risks etc, but maybe you could arrive a little early and explain about your anxiety and ask them to be mindful of this in the session? Hope it goes ok and sets your mind at rest a little. Take care x

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I asked about GD impacts on mental health and her answer was quite insensitive. She said that there’s no evidence of impact other than some women having bad reaction to the news as if it’s ‘the end of the world’. So ignorant 🙁

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Argh what an unthinking response! Sounds like one midwife who hasn’t received any training or read any of the recent guidance on Perinatal mental health! The education work APP and others do, must continue...

I hope the session was at least helpful in terms of practical help in managing the physical symptoms of GD...

Lots of love and good wishes x

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Hi Jessi_D,

Again no expert here but you might want to look into (without stressing yourself, remain calm) a second opinion about GD. There is some debate about this (my daughter refused a second test to confirm GD, she might not be the best example about obsessing, but she did know her stuff). Especially if it is going to conflict with other treatments that are keeping you safe and healthy.

The multidisciplinary team is so so necessary in all perinatal treatment that it should be required by the NHS.

Best Wishes for your healthy and happy pregnancy and birthing!

Peter

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A second opinion about whether I have GD or not? I think the test is conclusive - I didn’t produce enough insulin to tackle the glucose in the drink they gave me, which resulted in a high blood sugar level. I’ve asked both diabetes and mental health teams to work together.

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I'm sorry if I upset you. Let me swallow my words (not as bad as the the glucose drink) and restate what I tried to say (poorly).

I'm not a doctor (thank goodness), but there are some, who believe that the massive blood volume changes (50 to 70 cent) cause transient peaks in urine and blood osmosis.

The body struggles to manage your water intake verses water retention during pregnancy to support this new blood volume, not to mention the growing baby pressing down on your veins going to your kidneys!

As you state, diets are not fun, (but better than pills) and monitoring your fluid intake, perhaps changing sleeping and sitting positions could help?

Again forgive my clumsiness!

Best Wishes for good health and a Happy Pregnancy!

Peter

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Dear Jessi

I am sorry you are feeling low. It must be a very stressful time. I know when I was on medication for PP I craved sugar all the time, which really affected my mood. I was tested for Gd when I was pregnant and met several people who have had it previously. The only thing I was told was that the baby maybe slightly bigger at birth, this was certainly true for my friend. The professionals should monitor you and guess this will already be happening to make sure that you are both safe. Look after yourself, Marie x

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I’m so hungry and tired! This is so hard. I just want to eat some cake or carbs!

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Hi Jessi_D,

It's me (Mr. Sensitive), again, no, keep reading! I promise I get better with time (just like red wine).

Try this midwife's blog on carb cravings and how to do it without blowing your sugar levels!

cavegirlplusone.com/blog/20...

Hope you are feeling better!

Peter

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I have zero energy and am totally useless. Also, my husband seems to be so pissed off with me today. Rubbish.

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Hi Jessi_D, I’m not surprised you’re tired and lacking energy, it’s a tiring time being pregnant, never mind worrying about other factors such as PP and GD. I hope you’ve managed to do something for yourself or alternatively doing nothing at all and just relaxing is all important at the moment. In my second pregnancy, after PP with my first, I know I had the gestational diabetes test and was borderline. I remember feeling tired too and there’s something about chasing around after another child in pregnancy whilst having the worry or at least knowledge of PP potentially happening again, which we never had the first time.

As for husbands, I really do think they’re on another planet at times and have no clue, bless them (or not! Perhaps with a big stick?!) I hope that by writing here you’re feeling you can offload and perhaps you have a friend you can confide in too? I know how beneficial peer support can be and hope it’s helpful for you too - we’re all thinking of you, wishing you well. I hope the rest of the long weekend is better for you and you’ve got some nice weather to try and enjoy too. Take care, xx

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Thanks, the day is getting better.

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I just think husbands get in bad moods like the rest of us, and maybe it’s not easy when he feels like he’s doing all the domestic work and DIY (while I do nothing as so tired). We had a better afternoon, with the pool in the garden and some neighbours joined us with their little boy. We popped over to theirs for dinner which was lovely too. My neighbour has offered to help once a week with night feeding, to give my husband a break - unbelievably kind!

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I think it's difficult for husbands as they tend to try to keep a lid on things when they are struggling too. After all they have seen us when we were totally on another planet! I'm glad you had a good time with your neighbours and were invited to dinner .... that must have taken some of the pressure off for you both.

Take good care .... try to plan another relaxing evening soon where you can both unwind.

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Hi Jessi - I can't tell you about gestational diabetes but have first hand experience of type 2 diabetes. It has taken me over 6 years to get my blood sugar down. I could not take the drugs and was threatened with insulin and other drugs, I have recently had an allergy test and found to my horror I had multi food allergies with grains fruit and dairy and eggs.

Having removed wheat rye barley eggs rice banana and eggs my IBS symptoms and sugar levels have gone down. I eat potatoes, and crisps, but so many foods you buy even milk has added sugar. Drinking no added sugar fruit squashes, and cutting down on cakes and biscuits and avoiding certain tonic waters with sweetners might help too as these sweetners might be calorie free but convert to glucose in the liver. My hubby sits with choco bars and eats bisucits so I just have to have an oatmeal bisuit with no gluten or wheat in it with some sandwich spread or fish paste! Lactase free milk and yoghurt might cut your sugar levels too.

My dreams of mars bars and romantic chocs and gateau ice cream and banana splits have all gone out the window. However my blood sugar is below normal average so I feel that is

an achievement. Diabetes can make you feel extremely low and you must be anxious with your past history. I hope you have a full thyroid test before an after birth as some post partum problems are due UT! or ear infetions or kidney, and even diabetes. Thyroid and diabetes diseases are closely linked. Sometimes the post partum psychosis can be due to

the sex of the baby which is a hormonal rejection. Some get it badly when carrying a girl - but everyone is different. Hope you might try cutting out some of the unnecessary carbs but might feel better after a few days - so you might think twice about going back on medication.

I didn't have PP after second birth but had definite hormone problems and may be thyroid problems after the first birth which gave rise to a bi polar condition with a serious kidney infection with delirium. Delirium symptoms are now being monitored in our area as so much misdiagnosis can occur with especially elderly folk who may have sepsis rather than dementia. Nowadays PPP is not seen as a post natal medical condition due to puerperal fever but as a pure mental health condition with no reference to thyroid disorder which is common after birth. Suggest you look at Thyroid unlocked website and the list of symptoms

for hypothyroid and see how many boxes you can tick. It is an eye opener!

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I just wanted to say that from what we know from our clinical advisers, that if a woman presents with postpartum psychosis, they should be, and are usually, checked for infections, and also thyroid, and these can be a reason for any psychotic episode. It's really important any possible physical causes of PP is looked into first, and treated.

The causes of PP are still not known, and research is ongoing into the causes of PP. However currently the thinking is that it is a mixture of factors that can cause it (lack of sleep, infection, the psychological impact of having a baby, etc) and will be different for each person.

I hope this is helpful.

Ellie

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I think better screening techniques are available in some but not all areas. Recent research from UK thyroid org shows that bi polar disorder can be linked to thyroid particularly after birth. As you mention infections are treated but with cuts in NHS there have been cases pf puerperal fever untreated post partum infections in the news.

As you know diabetes may be present before birth, but it can be linked to endocrine disorder and post partum depression. Delirium is sometimes unrecognised post partum and gives rise to toxic confused states with delusions and hallucinations and may be missed leading to sepsis.

This can re occur during the menopause. At present women are compartmentalised into mental and physical health when as you say it can be a combination of factors including insomnia. and sleep deprivation. I would suggest that men don't suffer this condition so it has to have a female chemical and hormonal background for post partum

psychosis. It is the after effects of post partum psychosis where women are at a disadvantage as they face their families and friends and feel marginalised by the condition. They may not be able to go back to work, or undertake a training. I beleive the psychological factors may be secondary to the illness, and the symptoms of paranoia and rejection of partners may be due hormonal and physiological factors such as sudden body changes with breast milk.

The psychological impact of the illness may relate to the attitude of those around after birth and the right support. This can be a marriage breaking condition as the partner may not want to know. Let us hope there will be more research into why this happens and the blame being negated and related to peri- natal post natal complications.

May be some drugs may not be applicable and might mask underlying symptoms of a medical condition?

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Are you getting an early epidural. This is in my plan as I can't cope with labour pains. Also just plan for urself to have night help with baby. Try rest as much as you can. I'm at end now wish I had more chance to rest before as pain been on off last few wks

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No plans for an epidural. I have no birth plan, as I was supposed to have the support of a Maternity Mate but that’s not worked out. My husband will do the night feeding for the first year. I’m on holiday this week, then back to work for three weeks until maternity leave.

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Hi Jessi_D, good to hear your update and that you are approaching maternity leave now, but sorry to hear that you haven't had the support of the Maternity Mate. Are you still with the Perinatal Mental Health (PMH) team, can they help you with a birth/ postnatal plan perhaps? I also wanted to share the link to APP's Insider Guide for women at risk of PP: app-network.org/wp-content/...

I know when I was struggling to access any services locally in my 2nd pregnancy, it was good to have this information and also share it with the health professionals who weren't as familiar with PMH as they might have been, as there are no specialist services where I live. As a family we put together a plan which we wrote down and gave to the professionals (some of whom then used it on their own paperwork!) This was helpful in getting it all down on paper; including my history, any triggers, preferences for birth and postnatally and feeling like we were doing what we could to try and prepare. I was lucky to remain well after my 2nd, but "planning for the worst and hoping for the best" was something we found helpful.

I hope you have a lovely holiday and are managing to relax and enjoy these last few weeks; I know how exciting yet potentially stressful it can be having another baby after PP, so if there are any more questions or info we can help with, please don't hesitate to write here. Take care, xx

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I’ve been feeling really low again for the past few days. I just want to eat whatever I want, and the restrictions are really getting to me. I’m often tired and hungry - it seems really cruel to make a heavily pregnant woman diet.

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Hi Jessi_D, sorry to hear you’re feeling low. Pregnancy is definitely a tiring time (more so when you have a little one already and after pp too I think). I can relate to the food thing too, it would make me feel upset too I think. Have you been able to talk to your PMH team, I hope you are getting good support from them? Take care, xx

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How are you, Jessi_D?

I hope you have some good support in place such as the PMH team, and possibly other professional help in order to guide and inform and to cover your needs. It is good to talk.

We are here to listen!

Look after yourself.

Kind wishes and sending you a hug and a :-)

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Thanks for your responses! I called up the PMH team and spoke to a nurse who was helpful in the absence of my family (my husband and mum were at work).

I’ve been feeling better since the weekend. Next week will be my last week in the office, so I’m really looking forward to focussing more on preparing for the baby’s arrival and getting plenty of rest.

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Hi. I’ve only just seen this. I had gestational diabetes in my first oregancy and this time it came back early at 5 weeks and I was incredibly low with the diagnosis. I’m over the low mood of diagnosis now at 27 weeks now the end is in sight but I totally get how you feel. For me it was the added worry of the complications but if you have a good diabetic team around you for support it helps. Are you in the UK. The website gestationaldiabetes UK is fab and I’ve been in the Facebook group gestational diabetes UK mums for over two years and it’s so supportive- not read the full thread sorry if someone has already suggested this but I chat in there regularly and the admins will answer a lot of your worries. Xxx

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Having had two pregnancies with gd if you have any questions ask away I’ve researched it a lot can’t say I can answer everything I’m not a medical expert but have been there

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They will also accept people to the support group outside the UK if you are my cousin in New Zealand had it and they added her

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Hello Jessi,

I am pleased you are feeling better and it is great to focus on some "nesting". I remember it, too.

Great that you managed to talk to a nurse. It is good to open up the lid and talk about your feelings. Sometimes having a one to one can be very beneficial.

Look after yourself.

:-)

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I’m really angry today. A care plan from PMH team came in the post and it’s written a load of shite about me and sent it to everyone - my GP, health visitor etc They should stick to the facts and not over exaggerate!!!

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Hello Jessi,

How are you today?

Maybe you could talk to an appropriate professional, somebody you trust and feel at ease with, in order to bring across your view point of further recovery and stepping stones.

I wonder whether you could suggest in writing to the community mental health team that you want to be involved in the care plan, as you disagree with the content.

I always discussed my care plan together with my care coordinator, thus always new how to continue with "self management" and thus, knew my path of recovery focusing on therapeutic aspects. I usually was referred via the mental health team to courses such as group therapy, peer support, art therapy etc.

Wishing you well.

x

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This was not the care plan I created, it’s a different one that the hospital have put together using their template. They didn’t give me an opportunity to review it before they sent it out. Today I spoke to the nurse who wrote it and we’ve made amendments so that it is accurate, and she’ll re-distribute.

I had a good day today! I’ve had really low energy lately, but had much more today so I was more productive.

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Hello again,

I am so pleased that you had a good day and that you were able to talk to the nurse.

Well done for making those important amendments.

Wishing you a good night

x

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Hello Jessi_D

I hope you are managing to stay cool and relaxed in this hot weather. Take care.

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Hi Lilybeth,

It’s 30 degrees in the shade here so I’ve just had a cool bath and have a fan on to keep me cool as I dry off. I’m booked in for an induction this Wednesday, due to the size of the baby. I’m really looking forward to finding out if it’s a boy or a girl!

My mood has been good lately, I’m now taking lithium and haloperidol to keep me well once baby arrives. Fingers crossed this will work, alongside my husband doing the night feeding.

I can’t wait to eat ice cream once this baby is born and I have the all clear for gestational diabetes!!!

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Hi Jessi_D

Thanks so much for taking the time to update ..... what an exciting week ahead !! Really pleased your mood has been good lately. Wishing you all the best for Wednesday .. great plan for your husband to do the night feeds so you can rest. We'll be thinking of you .. :)

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Hi Jessi_D

Wishing you the very best for tomorrow! I hope all goes well, very exciting :)

Will be thinking of you.

Jenny x

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