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Action on Postpartum Psychosis
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Pregnant again after pp

Hi everyone

My daughter had pp almost 2 years ago after the birth of her first child. She has now made a full recovery and been off medication for 6 months. She is now pregnant it’s early days just 6 weeks into her pregnancy. I’m terrified it will all happen again plus she has a toddler too. Does anyone have any advice?

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I had my son in March 14 and suffered pp and my daughter July 16 with no pp.

It was vital for me to ge a block of sleep so my family took turns on night feeds for first 6-8 weeks and I was pp free. They viewed it as it was difficult but easier than me before my sectioned.

Having a baby and toddler was ver hard but I’m so happy now as they are best friends and love the same activities. It would be hard whatever age gap.

Anyway, my advice would be protected sleep, there are night nurses in UK (expensive) but very worth it if family cannot support nightly Or every other

I opted to take medication on delivery. There will be no third baby but not sure if I would again.

Good luck

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Hi LoganJ12

Welcome to the forum and thanks for your post. It's good to hear your daughter made a full recovery after her first PP and is no longer on medication. I can see how on the one hand you must be excited about the thought of a new grandchild but worried your daughter might be unwell again. I hope you will be reassured that there are mums here for whom PP did not return.

There is an APP Insider Guide "Planning Pregnancy : a guide for women at high risk of Postpartum Psychosis" at app-network.org/what-is-pp/... which might be helpful. I'm sure there will be other mums here to share their more up to date experiences. I did have PP twice many years ago but support and awareness have greatly improved since. Thankfully I made a full recovery.

If your daughter is in the UK it is possible, if she is worried about a second pregnancy, to have a consultation with Prof Ian Jones at Cardiff University, as mentioned in the Guide under "Planning for a baby" (page 7). Take care .... we are all here to listen.

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Hi LoganJ12,

Nice to “meet you”, welcome to the forum.

I have no direct advice I’m afraid, other than to say, us Mummys will always worry. There’s not a “pause worry button” you can press that I’ve found myself yet.

I hope your daughter will be well supported by local mental health teams, for example a Specialist Perinatal Mental Health team.

But do take great care of yourself too, I can’t imagine how hard it is watching your own child (although an adult now) go through such a trauma as PP. It really does affect the whole family, I had PP myself in 2016. So I can wholly appreciate your worry and concern for her.

I think someone else has mentioned the PP insider guides, worth a read as the more information you have the better. It can just support and aid your understanding too.

Take care, and wishing your daughter a good pregnancy. Xx

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Hello LoganJ12,

Welcome to the forum. It is good to hear that your daughter has made a full recovery and congratulations on her pregnancy.

I had my PP after my first baby in 2006. I had a very traumatic delivery (emergency c-section). I gave up breastfeeding after 6 days which really devastated me at the time. I got ill when my Son was around 2 months old, and at first was treated at home by the local Crisis Team (My Mum took time off work to help me as at the time my husband was self employed - she really was my rock, and my Mother-in-Law helped a lot too) Unfortunately, I deteriorated and eventually was admitted to a MBU where I spent 3 months.

When I got pregnant with my 2nd baby in 2010, I asked my GP to refer me back to the Perinatal Consultant Psychiatrist at the MBU who treated me when I was poorly. At this consultation we discussed things such as medication during pregnancy, breastfeeding whilst on different medications after delivery, and the possibility of combination feeding (which I opted for as I wanted to breastfeed but it also meant that my husband could feed with a bottle at night so I could get a decent stretch if sleep). She wrote a letter to my GP advising him to refer me back to the local Crisis Team so that I could put a care plan in place to help with prevention of PP, and also in case I did get PP again.

The Crisis Team came out to see me (luckily one of the nurses who had treated me 4 yrs previously still worked there, so we already had a very good relationship/trust). He referred me to a fantastic Social Worker who came to see me regularly whilst I was pregnant. She helped me to discuss and set up a good care plan.

She came with me to see the Mental Health Midwife at the maternity unit I wanted to go to, and we discussed things that could help me on delivery (I was having a planned c-section) like having my own room to recover in as sleep deprivation was a major factor in my illness, and also the midwives taking the baby off me for a few hours at night so I could get some rest. I also asked for support with breastfeeding , and put in my notes that I would like to stay in hospital for a week or so after the c-section so I could get support with this ad also try and rest (if I was able to have my own room). It was also made clear in my maternity notes that I had had PP, and that I wanted to take sertraline (an anti-depressant that is safe to breastfeed on) immediately on delivery.

We also met up with a local psychiatrist, to give her my history/discuss my case whilst I was pregnant, and put in my care plan for her to visit me in the maternity ward along with my Social Worker as soon as possible after delivery.

The Social Worker also arranged for the local Health Visitor to visit me whist I was pregnant so we could build up a relationship, and once my baby was born she visited me more often than she usually would which I found a great support.

After my baby was born and I was discharged from the hospital the Crisis Team used to visit me (for no longer than 5 mins) every day for the first week, then every other day the 2nd week just to see how I was doing. I also had 5-10 min visits from the Social Worker the first few weeks which then tapered off as the Health Visitor took over.

The combination of breastfeeding and my husband giving our baby a bottle of formula at night so that I could get a decent stretch of sleep worked really well for us.

For the first few weeks my husband/Mum who lives close by helped with all the school runs as I wasn't able to drive, and I really tried to limit visitors so that I could get as much rest as I could when my baby was asleep and my Son was at school. My Mum also really helped out by doing some cleaning in the first few weeks and bringing me food! I am very lucky in that she worked part time and lives in the same village as me - my Mum was and still is my rock, along with my husband, I am very blessed.

I am happy to say that I did not have any re-occurance of PP and it was lovely to have a 'normal' experience of Motherhood. I think it was a combination of all of the above factors, having a planned c-section, taking medication on delivery, getting extra support with breastfeeding/doing the combination feeding, all the support from the medical staff/care plan, and my husband and Mum/family.

Hope the above helps but please feel free to ask anymore questions.

Take care

xxxx

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...so pleased that you can share this with a mum, who is worried for her daughter...

Kind regards,

x

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Dear Loganj12,

pleased to meet you on this forum.

There are a lot of wonderful replies, which will hopefully put your mind a bit more at rest.

A lot of detailed replies and some good guidance...

I can not add much more, as the situation does not apply to my circumstances. I have had only one pregnancy.

Despite PPP I feel so very blessed in a spiritual sense that I have my son, who is now 8.5 years old.

You are such a wonderful mum, expressing your concern and worries.

Do take care of yourself, too.

All my love,

x

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Hi LofanJ12! Congratulations on your daughter's pregnancy x I recommend searching this forum for 'second pregnancy' etc as it has a lot of good advice. Here is mine: I had PPP after my first in 2015 and last March I gave birth to a healthy baby girl while I stayed well. We live in Hertfordshire and to address all your points, please see the list below:

1. Mental health team - my team is based in Stevenage. They are a community antenatal mental health team and one of the things they offered was a visit to the MBU in Radlett as part of our prep for birth. In 2015 I was admitted to a general psychiatric ward but I didn't end up going to view the MBU (it's a bit far) but it was a great option to have. My mental health team worked really closely with the community midwives and I had someone check on me every 2 days for about 2 weeks once discharged from hospital.

2. Labour and delivery - I was told in advance that I will have to stay in the hospital for 48-72 hours post delivery. I opted for 72, but that was once I was in hospital and that's what I was comfortable with. There was a letter on the front of my purple book detailing my plan and my situation, so the hospital (addenbrookes in Cambridge) ensured I had a private room, plus midwives were taking the baby to nursery at nights and wheeling her back for feeding. Particularly 1trainee midwife followed that plan to a T. If they don't, don't be afraid to speak to someone about your daughter's needs. I appreciate midwives and all NHS staff are overworked, but the ones on our ward were so used to people snapping at them etc, that someone kindly just asking for some help was just so refreshing they were very happy to help!

3. Partner-my partner ended up in the hospital for maybe 3-4hours a day while I was there. His main job was taking care of our older daughter, house and dogs (we have 2). His parents came over for 2 weeks around due date (they went away and came back again when I was actually induced), but with all the care I was getting in hospital, he wasn't worried about my wellbeing at all. This is something to consider, given your family's circumstances :)

4. Breastfeeding/self care postpartum-i was adamant I wanted to breastfeed but obviously that's quite a challenge if we also need to prioritise sleep! I ended up pumping quite soon after my milk came in, to make sure I had a good reserve for the nights and my partner bottlefed our baba at nights while I slept. I was going to sleep quite early (maybe 8pm or so), and baby was sleeping well, so once my partner fed her at midnight - 1 oclock, and then she was waking up at 4 am or so, I had at least a solid 6 hours sleep by then so I was alright. We had a 'just in case' box of formula at home, but I ended up throwing it out because we just didn't use it (I ended up producing so much milk I was donating it to my local milk bank!).

5. Medication - I started taking antypsychotic medication (quietapine) at 37 weeks pregnant. I really hate the side effects (weight gain, groginess and no energy) but overall it definitely helped me stay well. I ended up taking it for 7 months and was so glad to finish it.

If you have any unanswered questions, do not hesitate to contact me on here, I will follow this thread to make sure I see your questions!!!

Best of luck and hope your daughter stays well xxx

Dora

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Thank you so much. This has been really helpful

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At least this time they will put lots of support in place during pregnancy. I was quite ill after my daughter, and just as I was starting to get better I fell pregnant with my baby after failed contraception. But during this pregnancy I had so much support in place. I was monitored during pregnancy and on medication. I had a midwife with me during my whole labour. Then had a private room after delivery and stayed in hospital a while to recover with help. I did get I’ll this time but it was picked up on so quickly I got into an mbu and had lots of help and support. And see a nurse and a perinatal nurse every week. As well as my hv and we have a sw for now just so I have extra support and not doing too much. This time it has been a completly different experience and there will be so much more support in place for your daughter incase of any signs of the illness reappearing. Hopefully with all the right planning during pregnancy it will really lower the risk of getting ill again x

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Hi Loganj12

Congratulations to your daughter's pregnancy.

I found second time round a totally different experience and didn't suffer PP, again due to close monitoring and a brilliant care plan.

Having had PP and sending 6 weeks in MBU following the traumatic birth of my son in 2008, mine was a positive experience second time round with my daughter in 2013.

I had a planned c-section and was referred back to the perinatal m/h team who had looked after me before. I was told I had a 50% chance of suffering again. A care plan was put in place and I was monitored throughout my pregnancy. Coming off all my meds. I went back on olazapine immediately after delivery and a bed was booked for me at MBU if I required it. Thankfully I didn't need it.

On the maternity ward the nurses were great I was taken first for the c- section as I was so anxious and they took her away for periods during the night so I could sleep.

There was no clear research about taking meds and breastfeeding so reluctantly I chose to bottle feeding this time round. My husband did the night feeds for the first 6 weeks, then we split them. This ensured I got plenty of sleep which helped me as sleep deprivation way a big trigger before. I also limited visitors.

Once at home I was visited by CPN, midwife and health visitor.

Hope this helps x

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Hi LoganJ12,

As I read your message, I was thinking, "maybe one day this could be my mum writing the same message, and what would I want to tell her?"

It's a worrying time for all of you but I really feel it's important for your daughter that you give her as much reassurance as possible, as there's every chance she'll be even more scared! And I suppose the main thing for her to help avoid a recurrence is for her to feel that she's prepared.

Some people who have been through second pregnancies have given ideas of things that they did but I'm sure your daughter's care team will be able to advise her and help her tailor a unique care plan to her.

Speaking personally I know that I wouldn't want to discuss the details of my care plan with my own Mum but your daughter may not feel that way.

However as a Mum, rest assured that PP is taken very seriously by professionals and she should be monitored and supported throughout.

Is there somewhere you can access support for yourself? Eg friends, counselling, although i suppose you've also got on here so feel free to keep messaging us and we can always lend an ear (Or technically an eye but you know what i mean!)

Hazello

X

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Ps your daughter may not actually be as worried as you are about it but actually that could be protective as long as she is engaging with professionals to make a good care plan, in that case your job is to try to trust her and them! And I suppose as parents we can't stop bad things happening to our children which is a scary reality (which as the mother of a 3 year old I've not had that much chance to learn about yet but dread it coming!)

Hazello

X

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Thank you so much. My daughter appears not to be worried at all she just says it won’t happen this time because I am prepared. I wish I thought as simply as she does. We are along with professionals in the process of preparing a care plan. The advice form everyone on here plus the insider guides has made me feel better and ready to move forward. Thank you

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I'm glad to hear she's feeling positive about the future plans. Whatever worked last time will work this time, if needed. though it sounds like it may not if she's feeling confident about things!

I'm glad she's well supported too.

All the best for both of you!

X

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Dear Loganj12,

I am so sorry that your daughter suffered from PP, my daughter did too. It is difficult to see a daughter suffer such a traumatic illness. I fully understand your worries, however, I am very glad that you have found APP, they are great aren't they. You have had some brave, real insightful replies and information and it's good to know that you are feeling less anxious.

PP doesn't have to happen again but we can't totally stop worrying about our children can we.

Wishing your daughter the best of experiences this time.

Best wishes to you too from one Mother/Granny to another.

Judith x

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