Considering second baby : I’ve recently... - Action on Postpar...

Action on Postpartum Psychosis
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Considering second baby

Nicolaba
Nicolaba

I’ve recently had a pre conception appointment and we are considering our options.

Has anyone had their second or third etc without taking medication whilst pregnant.

I have a diagnosis of Bipolar 1 so the psychiatrist has suggested weaning off Lithium and going back on to Olanzapine.

if you have, how did you approach staying well?

Thank you

7 Replies
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Lilybeth
LilybethVolunteer

Hello Nicolaba

Good to hear from you. I think it's a good idea to weigh up your options. You might already have seen the PP Insider Guide "Planning Pregnancy : A guide for women at high risk of Postpartum Psychosis" at app-network.org/what-is-pp/... with helpful advice. Prof Ian Jones at APP has also advised mums about second pregnancies with the Second Opinion Service offered free of charge to your GP or Consultant who can refer you, the link being app-network.org/what-is-pp/... Prof Jones is based in Cardiff but I think it's possible to have a consultation via Skype if necessary.

On the right of this forum page there are related posts about second pregnancies which might be helpful until there are more shared experiences here? Take care. x

The pregnancy I tried to come off everything I didn't cope at all. The pregnancy I kept on some medication and then increased near delivery and as soon as baby born, I copied better. None of my children were affected by my medication and I breastfed them etc.

Nicolaba
Nicolaba
in reply to louise4

Hi Louise, that’s great.if you don’t mind how long did you take medication after they were born when you did take it?

Thank you

Hazello
HazelloVolunteer

Hi Nicolaba,

I'm currently pregnant with my second. For almost 2.5 years post PP I was very stressed that I was unwell and that my plan for a second child was not going to go to plan (that 2 year gap fast disappeared!) I kept having setbacks with anxiety or depression and ended up on medication a further 2 times after the initial episode. However I consulted with Prof Ian Jones (very worthwhile by the way, he does online consultations) and he felt that given how mild my symptoms were and that i didn't have any other diagnosis than PP that it made sense to wait to conceive when I was well enough to be off medication.

If at all possible then that is a good way to do it, but I was aware that I felt I was under pressure to get "well" and come off medication at times found it really hard and frustrating. I always felt like the clock was ticking and I think that perversely made it harder to get well and to come off medication!

Eventually I just thought, sod it, maybe I'll just go on a medication that is safe in pregnancy (well safe in relative terms) and I don't know if maybe there was something psychologically freeing about that as I then tried to change medication for this reason, and found that the anti-depressant did not agree with me at all... I then came off all medication while I decided what to do and after initial few days of symptoms realised that actually I didn't really need it any more!

I would never suggest that anyone do it the way I did as I think it was just a complete fluke that I happened to have some sort of psychological breakthrough at that point in time (loads of positive things were going on that I think helped me move on a bit). But I would say that it taught me that actually the most important thing was not to put myself under pressure. Many things we end up doing post-PP are not what we would ideally like to do (eg parenting whilst on sedating medications, breastfeeding on drugs, having in-patient stays) but it is what we needed to do for survival... I hope that you're able to find a plan for you that works well but I personally am trying to keep myself open-minded to going on to medication again. I have an emergency supply of olanzapine just in case that the psychiatrist has given me. However if I were unwell again I would not hesitate to take a regular prescription as I don't want to have the long journey that happened last time, just want to nip it in the bud!

So if you are able to come off medication, then great, but if not, then that's not the end of the world. I have been told that Olanzapine is safe in pregnancy.

I hope that what I'm talking about is relevant, as not sure if you're saying you want to come off all medication or just changing to a new one... Anyway, these are just my thoughts on my experience and hope it chimes in a bit with you!

Hazello

Nicolaba
Nicolaba
in reply to Hazello

Hi Hazello,

Thanks for coming back to me. If it was my choice I would come off medication but the psychiatrist is suggesting a medication change.

I’ll look in to Prof Ian Jones.

Thank you

I think ppp is due to a severe drop in progesterone

Estrogen is excititory whereas progesterone calms things right down so without progesterone things go haywire

I think this is worth bearing in mind you can buy progesterone cream that could be on standby after giving birth

Check with your medical team first

Hannah_at_APP
Hannah_at_APPAdministrator

Hi Nicolaba,

You've had some great replies and info shared here - just to add my own experience. I had PP after my eldest was born and then had a 4 year gap between children (like Hazello, it was not having any other diagnosis and wanting to be as well as possible, or recovered to a good point from the PP episode which was important to us). When I had my youngest, I was discharged from MH team and no longer on meds, which had been olanzapine and lithium. I was fortunate to remain well in pregnancy too and didn't need any medication but the the crucial bit was that immediate postpartum period, so I chose to take olanzapine on delivery. This may or may not have made any difference but it felt like something we could do to try and minimise anything, should PP have struck again.

I didn't become unwell again, although I did have some anxiety about it - which was explained to me as really normal, as if I wasn't worried about becoming so unwell as the first time, they would be worried that I perhaps was becoming unwell. This was also because I had been very much in denial with PP so getting treatment was hard, also the right meds to treat my symptoms effectively (hence choosing olanzapine which had worked for me before).

I took a low dose of olanzapine for about 3 months and was monitored closely by a local team, although sadly not specialist perinatal. Is this something that you have access to where you live? I'd really recommend speaking to someone who is specialist in perinatal illnesses as well, as often general teams don't always have all the info in terms of treatment/ risk (some do of course, and this should be getting better than when I had my children).

I hope this is helpful in terms of my own experience. I also wanted to add that in terms of hormonal treatment, APP’s experts say:

"Although hormonal changes may well play a role in PP we need more research to understand this better. At present, there is not enough evidence that treatment with oestrogen is beneficial in PP or for maintenance of mood stability after PP.

The key clinical guidelines in the UK and around the world (e.g. NICE, SIGN) do not recommend oestrogen or progesterone in the treatment or prevention of PP. More research in this area would be very helpful."

I also think there are lots of things you can do in terms of planning pregnancy and having plans in place should you become unwell again. We personally found it very reassuring to know that professionals would know what to do in terms of having a care plan, which included our choices and preferences for treatment and also thinking about our eldest child and practical things which we put in place for him - perhaps useful for anyone having children, as a new baby can be a big thing for older siblings!

Take care, and feel free to ask any more questions, xx

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