Post-partum psychosis and second pregnancy

[Orea]

I had my son 4.5 years ago and suffered PP. I was in a MBU for 2 months with my son and was able to breast-feed with their help. Since then I have had two manic/psychotic episodes, one adult mental health hospital admittance, and been diagnosed with bipolar. I have been well for about a year and a half now, but on medication (Lamotrigine 225mg and Olanzipine 5mg).

I am considering having a second child but am extremely anxious and depressed trying to make the decision. I am concerned about being on medication and pregnant, as I don't want any risks to the fetus. But I know my chances of becoming unwell again are high. I know I could suffer from PP again, and while I can accept that, I am so worried about what it would mean for my son if I am in an MBU for a long period of time. I also worry that I may never get well again - with PP and bipolar - it seems like no one really knows what can happen.

I am so scared, but I can't seem to come to terms with the decision not to have another child.

Has anyone gone on to have another child and decided not to have medication? Or have you taken something at a certain stage of the pregnancy? I seem to respond well to Olanzipine, but don't know if its that, or a combination of that and Lamotrigine that is keeping me level. But I've heard taking Lamotrigine during pregancy can be risky.

[Lilybeth Volunteer]

Hello Orea

I'm sorry you had PP after your son was born and have suffered psychotic episodes, hospital admission and diagnosed with bipolar since.

I can understand how anxious you must feel as it is a difficult decision knowing how unwell you were. My PP experiences were many years ago and at the time, due to stigma and fear of being judged, I wasn't aware that I had suffered PP. So I wasn't as aware of what had happened as you must be.

It is a hard decision to weigh up. There are mums here for whom, thankfully, PP did not return. Have you seen the PP Guide,"Planning pregnancy : a guide for women at high risk of Postpartum Psychosis" at app-network.org/what-is-pp/...?

I had PP twice many years ago, six years apart, with my treasured sons. At that time there were no MBUs and I was treated under general psychiatric care without them being with me. Thankfully I eventually fully recovered and we are very close. I'm sorry I don't know about the medications you mentioned. Perhaps the Related Posts at side of the forum page might be helpful as there are posts and replies there, e.g. "A second child after Postpartum Psychosis?" from Victoria1982?

There will be other mums here for you. Take care.

[Jenny_at_APP Partner]

Hi Orea

Thank you for posting. I had PP in 2012 after the birth of my first son, with no previous history of mental illness. I’d always wanted more than one child but after PP we really weren’t sure. I found the process of making the decision to try for a second baby really hard, I really agonised over it. I was recovered and off meds and had been well since the PP and it was still pretty terrifying so I can only imagine how you’re feeling... there’s so much to think about isn’t there, and my main worry was also the effect me being ill again might have on our son.

I found the guide Lilybeth has linked to really helpful, as well as reading about others’ experiences here on the forum. I wasn’t under any services so asked my GP to refer me to have a consultation with Prof Ian Jones through APP’s second opinion service - that was extremely helpful to go through the risks and what we could do to try and reduce the risk of recurrence. If you’re in the UK this might be something to consider? app-network.org/what-is-pp/...

I had my second son in 2016 and am happy to say I didn’t get PP again. There was a lot of planning and we did what we could to reduce the risk of recurrence (sleep seemed to be a major factor for me so we did what we could to ensure I got as much rest as possible, and I took a low dose of medication after the birth that could be upped if I started showing symptoms) but I did get to a position where I was kind of comfortable that if PP did hit again we knew what to do, and it couldn’t be as bad as the first time when we had no clue what was going on...

You’ll be able to get advice around medication, there will be some that are not recommended in pregnancy, others where it’s a case of balancing the risks... is it something you’ve discussed with anyone as yet? Ideally some planning / pre-conception counselling with a perinatal psychiatrist / MH team would be a good first step if you do decide to try for another baby, or to help you make that decision.

It’s not an easy decision and it’s one only you can make, but if you do decide to try for another child there is support out there, you’re not alone

You’ve clearly been through a lot with your PP, subsequent episodes and bipolar diagnosis, you must be one strong and brave lady!

I hope you can find enough advice and support to help you make a decision that’s right for you.

Take care and keep in touch.

Jenny x

[Lilybeth Volunteer]

Hello Orea

Just a thought about medication in pregnancy ....

There is a site which has been mentioned on the forum, i.e. Bumps (best use of medicines in pregnancy) at medicinesinpregnancy.org which might be helpful, although the professionals will be able to guide you.

Wishing you all the best in whatever you decide is best for you. Take care. x

[justamother]

I am a mother of two and my wishes to you are to stick with what your medical team tells you. I was a believer that I would not have PPP a second time and well it happened. I wish that I would have listened to my first Midwife and that I would have had treatment, the second time around was a lot worse. Best wishes.