Hi there, I was just hoping for some encouraging words and advice regarding having a second child following Postpartum Psychosis.
I suffered after the birth of my son last Jan, was sectioned, admitted to a psychiatric unit, discharged the admitted to an MBU after severe depression. I was there for 3 months then came out to face the real world. Very gradually I have made progress, I have gone back to work, I am now off all meds, had months of therapy and I finally feel stronger.
My hubby is keen to start the chat about having a second baby but I have concerns. For those who have gone onto have another child, did you have pre conception counselling? We're you referred to your Perinatal team straight away? Was the possibility of having to go to an MBU again discussed? How did the process of having the second baby go I term of support from your hospital?
My biggest fear is those first few days after birth. With my son, I had a very traumatic birth and he struggled to latch. I was desperate to breastfeed and, part of my spiral was not being able to do this. I certainly won't be putting pressure like that on myself again! I also had a grand total of about 4 hours sleep over 4 days. I was moved the side room during my psychosis for safety but I'm wondering if you can have a side room pre arranged? I suppose it depends on the hospital trust. Or do I do a home birth?
Sorry, so many questions are going through my head!
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Mummy1986
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Thank you so much for writing, this is such an important topic and one that I know a lot of other mums here will be able to relate to. I know I can.
I’m so sorry that you had a traumatic birth followed by PP last January, it’s a horrid illness. You have done amazingly by the sound of it, and to be writing here feeling stronger… recovering during a pandemic too – wow I think you’re amazing!
I had PP in 2016 after the birth of my first baby. It was completely out of the blue with no prior history of mental health problems. We went on to have our second baby nearly nine months ago now and safe to say – I can totally empathise and relate to all the questions and ponderings you have written about. It’s A LOT to consider and think about isn’t it.
My husband and I went for pre conception advice prior to conceiving, it was really helpful to have the space with a specialist psychiatrist. We were able to ask questions specific to my case, all the things that I wouldn’t necessarily be able to read in a leaflet – it helped to unpack a bit of what happened with my first baby which was helpful. It actually resulted in me then going for counselling which was brilliant – emotional, but super helpful to do to help with the trauma of what we went through.
Once we had decided to try for a second baby and were lucky enough to conceive, we were then referred to the Specialist Perinatal Mental Health Team. At that point, it was a case of unpacking further what happened with my first baby, practically trying to identify triggers, and risk points in my particular case. For me, the planning really ramped up in the middle trimester, where I was given a “lead professional” and meetings with the Psychiatrist became more frequent. There were a lot of people involved, from specialist midwives, normal midwives, specialist health visitors, psychiatrist, consultants, lead professionals… and then of course my family too who were a huge support.
I chose to take medication as a preventative from 34 weeks approximately. It was a low dose of the same antipsychotic I was on when I was poorly before. A lot went into planning my care as I said, all led by the psychiatrist who wrote, and rewrote and rewrote my care plan as we went along. I was given options to consider, including not taking medication in pregnancy, but I decided that on balance I wanted to minimise the risk of being poorly as much as I could. So I did take medication again.
An MBU was always on the table as an option, should the need arise. My psychiatrist recommended a five day stay in hospital (on the maternity unit in a side room) after the birth of the baby so that I could get all the help and support I needed. I was very fortunate that the hospital had a brilliant small team of specialist mental health midwives, who were with me every step. I really got to know them all, and felt well supported. They actually took me on a visit of the maternity unit again prior to the baby coming, so that I could revisit one of the rooms I’d been so poorly in with PP. It was an emotional visit, but well worth doing to put some of my demons to bed. It made it a less scary place to return to.
I chose not to solely breastfeed, I decided that prior to the baby arriving as I just knew how much it would “consume” me if I were to try and solely breastfeed. I was a very sad about that decision and felt guilty, but I had to look at the bigger picture. Myself, my older child, husband and the baby, and ultimately how I could minimise the risks. Instead, I harvested A LOT, and I mean a lot of colostrum prior to the baby arriving which was amazing and felt like I was able to do something really positive even if I couldn’t subsequently exclusively breastfeed like I wanted to. The hospital supported me throughout the five day admission to care for my baby, and then for most of the nights they were able to care for her in the specialist baby care unit – so that I could get my sleep which the psychiatrist recommended. The psychiatrist wrote the care plan as I said, which the hospital consultant and care team linked in with and listened to throughout which was brilliant.
For me a home birth wasn’t ever discussed. In my case I became poorly at home, so actually being in hospital with all the support and being monitored in a positive way made me feel a lot more secure, confident and supported. I also didn't need to worry about caring for my older child then either, or be worried about him seeing me poorly. It won’t be the same for everyone, but that was how I felt.
I had a “wobble” during labour with my second, either a flashback or hallucination coming in – I’m not sure. And then after a few hours following her arrival they had to call the crisis team as I had a further bigger “wobble”. Odd word choice, but it wasn’t full blown psychosis. But I was very unwell for a short period and actually didn't believe that I'd had my baby yet. Because of the signs showing that PP could / was returning and fast, my medication was increased immediately, and because it was already in my system luckily it worked really well and quickly and it didn’t progress into anything. Thankfully.
After the five days I was discharged back home under the care of my psychiatrist and have remained very well since.
As Jocelyn has said there is a guide on the APP website that you can use, and personally I do think it’s worth having pre conception advice regardless of the resulting decision. Our GP was able to refer us, it was very straightforward luckily. If you have any questions feel free to ask. It is such a massive decision full of emotion for both of you with questions too as to whether or not to choose to try for further children. I know I tied myself in knots over it. I hope this helps in some way.
Take care and sending my best wishes to your whole family.
Thank you so much for your reply - this has really helped. I do like the idea of returning to the hospital before giving birth - last time I was there it was just horrific. I had EMDR therapy to process and recover but it does really scare me with the thought of returning. Like you say though, that's where the support is. I'm so glad you had a network around you and sounds like they did a brilliant job of monitoring your situation. Thank you so much, lots to think about but this is helping xx
Definitely search the forum for 'second pregnancy after PPP' as there are quite a few discussions on the topic. In my house ,I was the one keen for a second- my husband,not so much...he took some persuading and I think he was just so worried about me getting PPP again...
I had ppp in 2015 after my 1st daughter was born,pregnant in 2017 and was prescribed quietapine as a preventative measure. I will describe how my second pregnancy go in the below and try and answer all your questions:
For those who have gone onto have another child, did you have pre conception counselling? - we didn't ...that wasn't something that was discussed or offered by my GP (however we weren't trying very long or discussed it with our GP before we did)
Were you referred to your Perinatal team straight away? my midwife referred me to a perinental mental health team as soon as I was pregnant. I met with my psych nurse and health coordinator maybe 3 times during pregnancy and we had a plan of action for birth and postpartum.
Was the possibility of having to go to an MBU again discussed? As part of the birth plan, there was a plan made as to what could happen if I become unwell-medication,crisis team etc.this is what made the difference in preventing my PPP (i m sure medication played a part too,but it was the wraparound care that made a massive difference I think).
How did the process of having the second baby go I term of support from your hospital? I live in Hertfordshire in the UK and my notes from the perinetal mental health team included the following points:
- i had to stay in the hospital for 72 hours after birth so they could keep an eye on me
- if possible,they asked that i have a private room in the hospital and the ward team was asked to wake me up as little as possible. I remember the hospital stay so well - my ward had a trainee midwife that never dealt with PPP so was so keen to learn about it and help me as much as possible. She read my notes in and out and followed them to a T. She even took my baby with her to reception to keep an eye on her and let me sleep.... she was only wheeling her to me for feeding....honestly,i appreciate that is exceptional service,but it was sooo important to me that they read my notes.
- i also had huge support with breastfeesing in the hospital-again,that was in my notes and I had someone every day with me to help out with it. I breastfed successfully for 13 months (with my 1st I had to stop because of medication) and if you also want to breastfeed,make sure it is in your notes/birth plan. let all the health care staff know and speak loud and clear about it.please don't put yourself under pressure,but be concious that you want to do it and give it a go if you want to. (In your post you said you put pressure on yourself,I was the exact same with my first....my attitude with the second was what helped me breastfeed successfully i think - in my head I wanted to,but if it didn't we had a box formula ready to go if needed - I ended up throwing it out ,but I knew it was there if I needed it )
After care,after I got discharged I had a visit from the community midwife every day for 2 weeks once I was home and I think a phone call from the mental health team every 2nd day or so.the frequency reduced down to maybe weekly afterwards but they kept a really close eye on me for the first 6 months.
Finally,I apologise for my long post,I just really wanted to relay all the information (apologies for the information overload!).if you have any further questions,let me know😊
Thank you so much, that's really helpful to know that the hospital had read your notes thoroughly and it sounds like they really took care of you and the baby. Thank you so very much, this was really helpful to read xx
Hello! I had psychosis in 2004 with an admission to an MBU for 3 months before I was able to start recovery at home. Fast forward to 2021 I have just had my second child and had no psychosis. I referred to Perinatal Psychiatry for preconception advice and then a plan was put in place to start medication just before my due date. They have kept a close eye on me and still are now 3 months on. My advice is not to let past experiences make you worry. There is so much they can do and you will be well looked after xx
Thank you to all the ladies replying to this post it is so helpful to hear positive experiences second time around. I had ppp after my first child in 2016 and I am currently pregnant with my second child. We decided to have pre conception advice from perinatal mental health psychiatry which was so helpful and I decided to stay on my medication for anxiety during the pregnancy. It’s a personal choice but for me the benefits of staying as well as I can before birth outweighed the very small risk of withdrawal for baby after birth. I have a consultant appointment once I’m past 12 weeks and then will be referred to peri natal mental health team. My midwife so far has been lovely and already discussed my husband can stay over night for 2 nights whatever I need to try and stay as well as possible which is so reassuring as after traumatic birth of my 1st he was made to leave the ward after I had come back from Recovery and come back 4 hours later when visiting time was. I think also a trigger for me was I had a different midwife at every appointment with my first as mine was on long term sick, I was seeing a counsellor at the time and was told I was high risk but it wasn’t followed up. For me like the other ladies have said I need to ensure I have sleep as that was one of my first signs I could not sleep at all and was very manic, Racing thoughts, irrational thoughts etc and didn’t sleep for 7 days before I was admitted to hospital. I am terrified obviously and worry it will happen again but part of me also knows I did survive it last time and I am stronger because of it and I will have lots of help this time.
Congratulations on your pregnancy! Hope that you are also feeling physically well. I am also currently pregnant with my second one, I had pp in 2018.
Like you I have found the experience of antenatal care very different this time around and I am currently under the community perinatal mental health team (happy coincidence, the same team that saw me in 2018-2019, so they are very familiar with my history).
As you say, planning around the birth and those first days in hospital is really important, prioritizing sleep. For me, taking preventative medication towards the end of the pregnancy is the plan, and as you say, the risks of some withdrawl effects on baby are less than the chances of me becoming seriously unwell soon after the birth.
I wish you all the best in your pregnancy, it is an anxious time, I know, but I think with the proper follow up and attention the risk of a relapse can be very much reduced.
Thank you so much for your reply, congratulations to you on your pregnancy. Thank you for your advice, really appreciate it. Good luck and best wishes xx
Hello, I had postpartum psychosis after my first (I am particularly at risk to this as have bipolar). This was so traumatic and I spent the best part of a year recovering while getting to grips with motherhood. I was very lucky to have so much support from my husband, family and friends. And I did get there in the end and have the most wonderful little boy who is now 4!
We always knew we’d love another baby but it took a while to get to that place that we’d even consider it. I am so glad we did as the Perinatel team had lots of insights from what happened first time around which really helped. In fact we had the most amazing support from them and I didn’t have any postpartum psychosis second time around.
It felt amazing to be able to feel myself and really enjoy the newborn stage. I was fully prepared for the onset of psychosis happening again but knowing that I had got through it before spurred us on. We were beyond relieved that all was well second time and we have the most amazing little girl, who is now almost 2.
Because of my experiences first time around I was referred to perinatel as soon as I told my GP I was pregnant. With the perinatel team which had a plan for all eventualities so I agreed to go to a Mental Health hospital if needed. You are right, most risky time is a few days after. Once you are passed that the risk really drops.
Everybody will have their own unique birth plans but for me the biggest difference which massively helped was taking Olanzopine from 32 weeks. (This wasn’t considered risky to the baby). We also did bottle feeding so my husband could do all the night feeds. I sincerely hope if you do take the leap to try again that you have a positive experience. Happy to answer any other questions.
Thank you so much for sharing your experience. I was also on Olanzapine and happy to go back on if needed. Thank you again for your supportive words xx
Ah that’s good you are open to taking olanzopine again. It honestly was an absolute game changer. The extra tiredness while heavily pregnant was hard but sooo worth it to escape postpartum psychosis again.
I had ppp after my first baby in 2013, I then went on to have another baby in 2016 with the support of my perinatal mental health team (I live in Leicestershire) I asked my midwife to refer me to the perinatal team as soon as I got pregnant and their support was fantastic I had a care plan and went on to prevention medication two weeks prior to due date.
I was fine with second baby all went to plan and I was on medication for 4 months after baby. I did not successfully breast-feed due to getting anxious about it so just decided not to do it.
In 2020 we had our 3ed baby, again perinatal team involved as soon as pregnant I was Lucky enough to have the same nurse throughout all three. Which helped as she knew me really well.
3ed time round I did not start my Medication until the day I gave birth but was all fine and had grate support from a local midwife unit which really helped with breastfeeding I was able to successfully breastfeed my 3ed, we combined fed him so I breast-fed during the day and he had a bottle during the night so that I got my sleep. This worked well for us.
I hat to introduce more bottle feeds when the Lock down 2 and homeschooling kicked in for the other two children as I had my hands full.
Again was on my medication for 4 months after giving birth.
I was Discharged from my perinatal team one year after having baby then when baby was about 15 months and I was back at work full time I started to get stressed with house move and full time work and felt my self spiraling again so went back on medication this is helping me though a stressful bit and hopefully once the house move is done and we are settled in I can start to come off the medication again.
Happy to help with any questions just ask.
Good luck, 🍀
I thank my lucky stars that we where lucky & brave enough to go on to have more children. Xx
What a great reply to Mummy1986 ..... Sorry to hear you had PP after your first baby but that with good care it didn’t recur in subsequent pregnancies.
It’s good that you noticed you were spiralling again recently and went back onto medication. I think moving house is up there as one of the most stressful things to do! I had PP twice many years ago and we moved house a couple of times before my second son was born six years after his brother, as in some way I was trying to leave behind the awful trauma of my first PP.
I hope when you have moved you will feel much more relaxed in your new home with your treasured family. Take care xx
Such great replies you have had already from other mums that went on to have babies after pp.
It is a really personal decision and entirely dependent on your circumstances. I will definitely encourage you to seek preconception counselling if you are considering a second pregnancy, it can be as early in the process as you want it to be, and your GP can refer you.
I think for me something that I found very helpful was to look into more detail and ask questions regarding the risk of a second episode of pp. 50% is quite a large number, however, this is the risk of getting pp after a previous pp episode if no prevention measures are put in place. When you are under the care of the perinatal mental health team a series of risk reducing measures will be discussed and included in your birth plan. Things like a side room and getting help with night feeding are certainly considered.
I hope the other mums experiences in this thread have been helpful, to gather an idea of how the experience could be for you the second time around.
All the best in the future, I think you are doing amazingly well having gone through pp while in the middle of lockdown and back to work now, you are one strong gal! Take good care and let us know of any questions, all the best
That's really kind of you to say, thank you for your kind and encouraging words. So grateful to for all the guidance and advice. Lots to think about but I'm feeling more confident and better informed already xx
The chance to have PPP again are 50:50. I had it after mu first childe. I was very affreid the second time. But nothing bed happend. Prepared for the worst scenario end everithing will be O.K.
Hello,I totally understand your concerns cause I had the same ones. I similarly experienced a c-section with my first and it was followed by severe sleep deprivation, which I believe was the biggest contributing factor to my psychosis. I just delivered my second baby and it was a planned c-section and the hospital team clustered their care they best they could by trying not to come in more than every 4 hours. I am 5 weeks postpartum now and have done my best to take daily naps. I haven’t experienced psychosis. I hope that this is helpful in your planning. Basically, prioritizing sleep has made a big difference this time around.
Thank you, yes sleep deprevation was a huge contributing factor to my psychosis I think. 4 hours sleep over 4 days was never going to end well.... Thank you very much for your advice x
Hello Mummy1986, I had PP with my first child, like you I had concerns when planning another child.
In answer to your questions I had regular contact throughout my second pregnancy with a consultant and a CPN who helped me to identify my concerns and discuss what solutions were available. The fear and chance of PP reoccurring we’re not taken away but I felt prepared.
Following the birth, the support was amazing, I was offered a side room and I stayed in hospital for 5 days so that I could rest and sleep and so that staff were on hand if I was concerned.
I think you are right to think about it and to ask questions. Maybe write down your concerns and discuss them with your partner and the perinatal team.
Take good care and here to chat again if you would like to.
Thank you so much for your kind words and support. I am so pleased all went well with your second pregnancy and birth. Thank you, I think me having those conversations early and discussing my concerns is key. Xx
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