Seeking advice pre-pregnancy

[AnxiousInbiber]

Hello all, thanks very much for having this resource in place it's a huge help.

I actually joined healthunlocked for help on a different issue but I'm looking for information on Postpartum Psychosis, I hope this is an ok place to post my query as it's a bit different to the posts I have read here so far. Sorry id it's a long post.

My wife and I have started to talk about trying for a baby (first baby).

My wife has had two episodes of Psychosis, one last year & one 8 years ago.

Although they were terribly difficult times, I feel we were lucky in some ways as my wife recovered relatively quickly. 8 years ago she took meds for 3/4 days and then improved quite rapidly and was in hospital less than a week (This was in Ireland) and after 10 days/2 weeks was in my eyes fully recovered.

After the more recent episode she took meds for a week then refused to carry on taking them, which I was very worried by she got better again fairly quickly, but more like 3-4 weeks from episode to recovery. We are in the UK now and I found the help from the mental health support team very good, although it was more a stain for me this time as we are living abroad and don't have family support (My mother-in-law was a major support during the first psychosis). My wife was at home the whole time. One nurse wanted to admit her but I really pleaded for this not to happen and thankfully it didn't.

My wife's father had a psychiatric Illness so I've always known these issues were possible and I wouldn't change anything about her, I loved her more after these episodes than ever.

I should add that we believe the episodes were at least partially triggered by smoking cannabis. My wife went stopped smoking cannabis after the first episode but despite my protests started smoking a bit again last year (I think due to lockdown boredom as she couldn't work during lockdown 1/2). I obviously feel stupid for not trying harder to get her not to use drugs again but at the end of the day she's her own person and you get complacent after nearly 8 years. I'm confident she will never use drugs again.

So I guess I just want us not to bury our heads in the sand about the possibly of Postpartum Psychosis happening, we have talked about it but naturally this is very difficult for my wife and I don't want her to feel that her previous mental health issues are stopping us from having a baby.

I've looked for this online so there's probably no easy answer but it'd be good to know that chances of Postpartum Psychosis happening for us (based on some things I've read it may be 50/50).

Baring this in mind it would be helpful to know how can we prepare (If there is any way to prepare).

And although this mind sound harsh I also have to wonder is it selfish on us to want to bring a baby into a situation where this might happen.

If anyone has been in a similar position I'd be very grateful of any replies. Thanks

[Jenny_at_APP Partner]

Hello AnxiousInbiber,

Welcome to the forum, it’s absolutely fine to post your queries on here and I hope we can help

Firstly I wanted to make sure you’d found APP’s website (app-network.org/) which has some really good information and resources. You can read about postpartum psychosis, including some FAQs here: app-network.org/what-is-pp/...

There is also an insider guide for women planning a pregnancy when at high risk of PP: app-network.org/wp-content/...

Everyone’s individual risk is different. PP happens in 1 to 2 in every 1000 births and women with a diagnosis of certain mental illnesses (e.g. bipolar disorder) and women with family history of PP or previous episode(s) of PP are at a known higher risk. I don’t know what the risk of PP is where there has been previous history of psychosis not linked to childbirth, but it definitely seems very sensible to research this and have these discussions.

I had PP in 2012 after the birth of my first child, out of the blue with no history of mental illness. It wasn’t something we’d heard of, and I think even if we had we wouldn’t have considered there being any risk of it happening to me. Not knowing what was happening as I became ill was incredibly scary. I went on to have another baby in 2016, knowing the risk of recurrence was around 50%. We were able to plan and prepare, we had really good support in place and knew what to do should I display any symptoms. For me, prioritising sleep was really important as sleep deprivation seemed to be a major factor for me developing PP. I also took a low dose of the antipsychotic I took when I had PP. Fortunately I didn’t have PP second time around.

I think the fact you are aware of PP is a really good start! Hopefully you can access preconception counselling to discuss previous medical history etc. and identify any increased risk of postnatal mental illness. But with or without there being a known increased risk, postnatal mental illness can happen to any woman after having a baby so I think being aware and alert to this is really important for anyone, not to scare them or put them off considering having a baby, but so help and support can be sought quickly should it be needed.

I’m sure you’ll get other replies but I hope some of this is helpful. Do ask any questions

Wishing you both all the best.

Jenny

[AnxiousInbiber in reply to Jenny_at_APP]

Thanks Jenny. It was very brave of you to have another baby and I'm delighted it worked out well.

[Maria_at_APP Moderator]

Hi AnxiousInhiber,

Welcome, I am so pleased to hear you have found out about the forum and done some research in postpartum psychosis.

As Jenny mentions it is something that should be more common knowledge. Even though a woman may not be at risk of pp, it can come out of the blue in 0.1 or 0.2% of cases and it is hugely shocking for the mum and partner and family as no one has any idea what is going on. We are much more aware of the risk of other natal complications for mother or baby which have a smaller chance of happening in the general population.

I had pp in 2018 after the birth of my daughter and I had no previous history of serious mental illness, a couple of depressive episodes in my previous life which were treated with a low dose of antidepressant and some lifestyle changes.

Last year I attended a preconception counselling meeting as I was planning a second pregnancy and having had pp before puts me at a 50% risk of pp in subsequent pregnancies (but I don't know the risks around having previous psychotic episodes unrelated to childbirth, sorry). This is a meeting with a psychiatrist to discuss risk factors, how to manage them, medication, services available in the area and more or less how the follow up would be during pregnancy and after giving birth. I hope you are able to access this type of counselling. If not possible, then getting a referral to a perinatal mental health team once your wife becomes pregnant will be a good idea, as they can follow her more closely and be more aware of any early signs.

Jenny has already pointed out to many resources on the app site which have lots of information on risk factors and ways to manage that risk of pp occurring, so yes there is indeed many ways in which you can prepare for it and reduce the chances of an episode.

It is also possible to get support even when family is not nearby, the UK charity home start, is a good example, they help young families with a variety of support:

home-start.org.uk/

Another possibility is to look into some hired help for a couple of weeks if it is possible to afford it, Doula UK is a good site to search for postnatal doulas in your area, which can support you both in the early days after having a baby:

doula.org.uk/

I feel for you both that arriving to the decision of becoming a parent has this whole other dimension to consider as well that makes it not a straightforward decision. But I think the best advice I can come up with, is to inform yourself first, know the risks particular to your wife's history and the way in which you can manage them and then decide, it is a very unique and personal decision between you both.

I wish you all the best, and please ask any questions or share any thoughts here whenever you want to

[AnxiousInbiber in reply to Maria_at_APP]

Thanks EmiMum. I will do as much research as possible. It is tough discussing it with my wife as she doesn't like going over her past episodes but I'll do my best

[Lilly53 Volunteer in reply to AnxiousInbiber]

Hi AnxiousInbiber. It’s great you've found the forum and are aware that postpartum psychosis exists. I also think it's so positive that you’re actively thinking about possible implications for you/your partner should you decide to start a family.

EmiMum and Jenny have already given you some great insight and suggestions to look into so I really hope you will find those useful.

Personally I've had PP twice despite having no previous serious mental illness. My first time was when pregnant with my first son. That episode was not diagnosed and was an horrific experience. But thankfully my second episode was picked up and was a totally different and better experience. By then I had done my own research to try and understand what on earth had happened to me. A big part of that was finding this forum and hearing, for the first time, stories similar to my own. So the second time psychosis struck(around 10 days after my second sons birth) my family and I were now aware the illness even existed and we all knew the signs I was getting ill again. For me, as for Jenny, extreme lack of sleep was a key trigger for my psychosis (which was in some ways pretty inevitable with the demands of breastfeeding a newborn!). So the help of family and grabbing rest whenever possible were key.

It's understandable your partner would find talking about her past difficult. Psychosis (whatever the cause/s) is such a traumatic experience to go through. The after effects really can last some time too and everyone’s experience is different.

For example, for me, years later, even reading a certain picture book with my son, that I originally read while psychotic some years earlier would initially trigger intense feelings of anxiety and thoughts from my episode back to the surface. Also saying/seeing particular words/images that held meaning for me when I was psychotic could do the same. But Im pleased to say these reoccurrences have faded over time.

So I wonder might your partner consider seeking any specific support/counselling to help process/ come to terms with some of the difficult feelings that might have occurred in the past or might resurface now when talking? I think my CPN said recovery from psychosis can be most successful when people do talk about what happened. Although that can be very difficult initially (!) it gets easier.

Please do visit/post here when you need. And I wish you and your partner well in your future. Whatever you decide to do.

[Jlou84]

Hi in a round about way, I posted something very similar to your question, but I'm obvs in the position of having had a baby and Postpartum Psychosis (PP). I dread the thought of going onto meds as they make me feel dead inside and present as a zombie, even at small doses!

I'm worried about the reaccurance of PP but am a little scared to the do the 'watch and wait' approach but equally aren't keen to 'pre-load' my brain whilst pregnant for fear of the unknown consequences to the baby. Probably minimum bit they can't ethically test these medications on babies and the placenta is where the baby gets all its nutrients from (including any meds, drugs or alcohol) you drink.

Most harmful in the first trimester (3mnths) as that's when baby is developing and at risk of damage.

If you wife likes to feel calm/happy following cannabis use, maybe suggest meditation (calming) or a hobby she enjoys (fitness/fun).

Without any diagnosed mental health history I believe you chance of PP again is 50%.

With family history of mental illness, I believe is more like 70%. Although obviously check with your Perinatal team and/or Psychiatrist for pre birth planning.

There are also male peer support advisers at PP, which will be able to relate to your position as a man...

But I can imagine how difficult it must be feeling like you haven't/can't help your wife at this crucial time of poor mental health and planning for a baby.

Please continue to reach out.

APP can out you in touch with a second opinion Psychiatry service, than can explore your wife's families mental health history so you can figure out the percentage of it happening again...

Take care and all the best for the future!