Post-partum Psychosis after first baby - chances of it happening again?

[RachelK_at_APP]

I had my daughter nearly three years ago and was diagnosed with post-partum psychosis. Fully recovered and considering second baby. What are the chances of it happening again? Has anyone gone on to have a second baby and not relapse?

[Jenny_at_APP Partner]

Hi Rkmummy

Welcome to the forum

I had PP after my first son was born in 2012. I went on to have a second son in 2016 without recurrence. I had no previous history of mental illness and have been well since, I was told my risk of recurrence after a second child was around 50%.

You’ll be able to find lots of shared experiences on here, you can search for posts about second pregnancies and there’s at least one ‘pinned post’ on the subject of planning further pregnancies.

APP also have an insider guide for women planning pregnancy when at high risk of PP - this was put together by experts, of the research and medical kind and also the lived experience kind app-network.org/what-is-pp/...

If you’re in the UK you may be able to access APP’s second opinion service with Prof Ian Jones - app-network.org/what-is-pp/... - I did this and would highly recommend it if you have that option.

There’s certainly a high risk of recurrence and no guaranteed way of avoiding that risk, but plenty of planning you can do to prepare and hopefully be much better placed should PP hit again...

I hope this helps

Jenny x

[Revans86 Volunteer]

Hi Rkmummy,

Belated congratulations on your now three year old, and well done on your recovery from PP.

As I understand it the chance of reoccurrence with further pregnancies varies hugely from person to person. In my case with no previous mental health diagnosis (prior to my PP) it’s approximately 50%.

I don’t know if you’re aware, but in most areas of the UK Specialist Perinatal Mental Health Teams are in place who can provide pre-conception advice to anyone in your situation. You can access this service through your GP, if there is one in your area.

Also the APP insider guides that Jenny has linked are excellent. And there are various previous posts with peoples experiences here too.

Welcome to the forum, nice to “meet” you. Xx

[RachelK_at_APP Moderator in reply to Revans86]

Thank you for your response

I too had no previous mental health issues before pregnancy/birth.

I will go to my gp and discuss what support I can get, thank you

[Hazello Volunteer]

Hi rkmummy,

So glad to hear you feel you're recovered and thinking about having another baby. I'm in very similar circumstances as my boy turned 3 last month and we are hoping to have another baby. I spoke to prof Jones through the 2nd opinion service when making plans, very helpful.

I've been told the chance of recurrence is 50% for me. I think I'm just going to make choices to keep things simple. Once I fall pregnant I'll have involvement from perinatal mh team to plan. My hope is that the medication that worked for me first time will be on hand for straight after the delivery. I may not decide to take it but I think I'd feel safer knowing I have access to it. Your situation will be unique to you and so there may be different things that will help you but the professionals should help you to feel that every eventuality is covered.

All the best with your decision!

Hazello

X

[boat1 in reply to Hazello]

Dont rely too much on statistics. I was bi polar and stopped meds but had no relapse even after baby. They woukd put my risk at even higher and it didnt happen

[RachelK_at_APP Moderator in reply to boat1]

Good point - first time round I had a 1/1000 chance of getting ppp and got it. If it a 50% chance next time then it doesn’t mean it will happen.

Medication after birth - just going straight on antipsychotics?

Are any antipsychotics safe for breastfeeding? I stopped after being hospitalised first time round, then breastfeeding support came to see me in hospital and said they didn’t know the effects of olanzapine on infants. So Daughter on bottles after that, frustrating as I produced milk for well over 12 months!

[boat1 in reply to RachelK_at_APP]

I didnt breastfeed after. For me essential to have night rest after baby esp first 4 weeks. I did do a few feeds before starting meds for the colustrum for baby. I tuk low dose quetiapine to aid sleep. Not sure about safety in breastfeeding

[Hazello Volunteer in reply to RachelK_at_APP]

Hi RkMummy,

My psychiatrist told me that I could breastfeed on olanzapine. Which I know some people would still not feel comfortable doing but I breastfed my son for 16 months and was on olanzapine for about 10 months of that.

I think that there is always a risk that medication could have a detrimental effect as they will never do a proper study into the effects on breastfed infants for ethical reasons but some women are so ill they need to take medication in pregnancy and breastfeeding as the benefits to the baby of having a well mum outweigh the risks of the medication, if that makes sense. But I'm sure the advice is different for different medications and other doctors may not feel happy with recommending you breastfeed on medication in case something did go wrong.

Personally I was struggling so much with being ill and feeling unable to be the mother I wanted to be, being able to breastfeed was really important to me, despite how difficult it could be and detrimental to my sleep. But other people in the same situation could take the opposite approach to make life easier on themselves.

If it's any reassurance my wee boy has so far had no health or developmental difficulties despite the olanzapine in his system!

Plus I have heard somewhere that actually olanzapine can increase milk production, which may explain why you had milk for so long...?! I don't know my sources though so maybe check that out for yourself...! I certainly always had a very good milk supply.

Hazello

[Hazello Volunteer in reply to boat1]

Hi boat 1 I suppose when you have a stat like 50% it means you're equally as likely to have an episode as not but there's no way of knowing which way it'll go! Like gender of your baby it'll always be 50/50 but that doesn't mean you'll not have 6 boys! But I suppose helps me to realise I need to think and plan for a second baby...

[boat1]

Yes ive had two after and no relapse. I was v high risk due to bi polar illness history. Main thing is good perinatal care plan. Medication after baby a good idea. Even if just to help you rest. Need help with night feedsso you rest esp 1st month. I would advise bottle feeding or at least during night. I had a planned epidural to reduce stress and pain.

[Teresa_K_S Volunteer]

Hiya Rkmummy,

Lovely to hear you recovered from PPP and are now considering adding to your family. I hope you find all the info useful from the APP website

50/50 It's a scary statistic isn't! I had PPP with my first child. Quite a few years after I was diagnosed as being left with Bipolar following my psychosis. It was 7 years after my first child before I felt strong enough to take the chance of another baby.

I didn't have PPP with my second child nor did I have it after my 3rd child. I think the most important thing is not so much whether you will get it again but more so do you feel you could get through it again? I remember crying and saying to my husband that I was scared to risk it again and he reassured me that we got through it once so we could get through it again. It was only at that point when I realised I had my husbands support come what may, that I accepted I was ready to take that chance.

I had my family in 1997, 2004 and 2007. When i was pregnant with my second I did everything I could to get appointments with the psychiatrist to make sure everthing was planned. My meds were changed to safer ones during pregnany and as I wished to breastfeed I stayed on these meds until my mood dipped a couple of month after the birth and then I was quickly put on my original meds and moved onto bottle feeding. The only thing that frightened me in the planning of my care was that in 2004 & 2007 there no MBU's near us and the prospect of being separated from my baby and sent to a gerneral psychiatric ward filled me with horror. Thankfully that didnt happen. I think I was helped by planning ahead and also the quick access to psychiatric care through a CPN for urgent medication changes and in general a lot of support from family , doctors, cpn and the psychiatrist.

My daughter is 15 tonorrow and how special was she when she was born! Her brothers are 22 and 12. I had cried many tears thinking I would never have a second child because of PPP and then I ended up with three. Such a personal decision that is different for everyone.

I wish you well on your journey and hope you can make the choices that feel right for you and your family

Teresa x

[RachelK_at_APP Moderator]

Teresa, I was in the situation three years ago, the nearest mbu is far away so I was put on a secure ward at a local hospital and separated from my two week old baby for three weeks! They mentioned a mother and baby unit but said it was difficult to get a bed on there.

[Hazello Volunteer in reply to RachelK_at_APP]

That sounds really difficult for you, I was separated from my baby only for 2 nights but it was really upsetting. It hopefully will be much easier a second time as you will have support from the get go.

[Pikorua Volunteer]

Hello RKmummy,

I was sectioned and without my baby for 39 days...I was so poorly & my brain shut down for a long time. Over the years I tried to make more sense...

We all have choices, sometimes one just does not know about any risks...PPP just came out of the blue and 8 years later finally I was diagnosed with Bi-Polar.

One has to reflect upon and family planning is such a personal choice...

Wishing you well,

x

[Bumblebeeee]

I was told it’s 50/50. I found out I was pregnant after failed contraception, and the thought of going through it all again was so awful I was considering not having the baby. But she’s now 9 months old and I’m so glad Iv been through it all again and have her. She’s such a happy bubble beautiful little baby. I was I’ll affer I had her and went in mbu but was so much support in place so as soon as I showed any signs I went in there and wasn’t in there long. It’s an awful thing to have to consider but if you do get it again it will only be a short time in your life and there should be a lot of support in place before you have the baby to look out for any warning signs. And then you can live the rest of your life with another beautiful baby 😍

[Teresa_K_S Volunteer]

HI Rkmummy,

Such a familiar story is yours of being separated from your baby as the MBU was too far away or they are often full. It is a devasting time. I had PPP late as my baby was 9 months old. We had such a strong bond as I had breast fed all this time too. so to be separated was bewildering. I was extremley poorly and was a danger to myself but the bond with my baby boy kept me tied to this world as I didnt want to abandon him by doing what the voices in my head were telling me to do. I had lost touch with reality but it most definitely hindered my treatment by being separated from my son for 2months. I was convinced he had died.

Thankfully I never suffered a psychosis after my subsequent pregnancies but I remember one of my concerns was of the possibilty of being separated from my new baby but also from my 7yr old son and the effect it would have on him were he to see me ill.

However, if there is one thing I have learnt from being a mother to a now 22, 15 and 12 year old it is that children are more resilient than we think and they are very good at adapting. We as mother's can take too many guilt trips and are prone to being too hard on ourselves

Take Care

Teresa x