Second pregnancy and the same old hospital where i suffered from my first PPP

[Varvarita]

Hello dear everyone! Time runs fast, my first child is already 1,7 , i’m finally off all meds and i’m starting to dream about my second pregnancy.

The problem is that i don’t know what’s the best strategy - shall i give birth in the same hospital where i already know every staff member and i already know all their weak and strong sides or shall i better change location so that the memories don’t influence the induce of another psychosis after labour?

i live 5 minutes drive from the biggest and the best maternity centre in my city and it’s the same hospital where i gave birth and the same place where my PPP started.

I visit this hospital pretty often as it’s the biggest health centre in my neighbourhood, so i already was triggered by memories numerous times and every visit is very emotional, and controversial. I wouldn’t say it’s only bad emotions - for example, today i was visiting for a PCR and i met many doctors who were in my pregnancy team and we were all happy to see each other , and i met a doctor pediatric who helped my poor husband with a new born while i was hospitalised with PPP, and today we were all hugging each other and i was showing the pictures of my 1,7 daughter now, when all bad is behind, and it made me feel happy and sad at the same time.

Sometimes i feel like i want to outlive my unhappy first labour PPP experience with another labour, to vanish bad memories, but i know it’s just wishful thinking that i will not have PPP twice.

I think i will always have strong emotions about this hospital, firstly because i will never forget how happy i was to meet my child, and secondly because the onset of my PPP was manic and euphoric, so i have this tendency of having strong feelings about everything which my PPP was comprised of, it’s all still very vivid, very big and alluring in a weird way.

There is nothing like “perinatal mental health team” or “mother and baby unit” in my country, there’s not even a psychiatrist in any maternity centre as psychiatrists work only in psychiatric hospitals, so no matter where i choose to give birth, my mental health will he monitored by my doctors from psychiatric hospital, so this facility is not the deal breaker.

my mental health team don’t advise anything in particular - since there’s no institutional facility for them to work as a team with my OB/GYN , there’s is no guideline or sufficient case base on PPP, they just promise to be by my side if i’m poorly again.

such branch of medicine as perinatal psychiatry or type of service as perinatal psychiatric midwife is non-existant in my country yet, so it’s mainly trial and error with me and i often feel like a man on the moon with my after PPP journey.

If any of you can relate, what would you do?

and maybe there’s some advice you were given during preconception counselling , what they suggest to do for families after first PPP?

thank you all in advance

x X

[guinea1]

Hi Varvarita

Iit takes much courage when deciding to have another child after surviving PPP. I know when I made the decision, mum was very worried, but felt I had to try otherwise I would have always looked back with regret not to have given myself another chance.

You hospital's doctors and nurses sound very supportive to yourself and your husband. I think this helps .. I can not tell you what is the right thing to do, it is a huge decision..... when I had my first child with out going in to details, it was quite a traumatic experience that I went through giving birth.. and then lack of sleep on the ward, breast feeding issues amongst other things I feel brought on my PPP, when I had my second baby, back then there wasn't alot of support or advice... but one thing that did happen the midwife that delivered by first baby delivered my second ... I had total confidence in her and this time I did know what to expect.. they made sure I was on a quiet ward ... I think this helped a great deal.... and I was very confident with this baby , I stayed well with no problems or medication, I did see the psychiatrist a couple of times to make sure things were going well.

I feel, it depends what was the build up or things that seemed to happen before you became unwell... wether it is the building and if being in a different place would help, but it would be a team of different doctors and nurses who don't know you so well..how do you feel about this?

. is there anything that your team now could do to make things easier for you so you feel "safe".. maybe a different entrance if that would help?

I unfortunately didn't have the experience of perinatal psychiatric care, so really feel for you as it can be quite daunting when you are told you have postpartum psychosis not a lot is known, your care is a bit hit and miss. but being here I know you will have support, both you and your family , there will be lots of people to help you through what ever you decide... I do hope your country does get better with caring for new mums with PPP.. I am sure they have learned things from looking after you and you may find comfort and proud that it will help other mums in the future.

Take care of yourself xx

[Varvarita in reply to guinea1]

Guinea1! Thank you for your lovely words of support and sharing your experience! I can totally relate to the lack of sleep on the ward and breastfeeding chaos, which definitely worsened my PPP, i think i wouldn’t be hit with psychotic symptoms so hard if i could sleep on the ward or if i had proper pain reliever injected , which they usually try to avoid when you start to breastfeed. And it’s so great that your second experience was so different from your first. How old are your kids now? xX

[guinea1 in reply to Varvarita]

You are most welcome. My daughter 1st child is 26years old, my son second child is 23 yrs old. I think if you talk to the team, maybe see if a quiet ward or room for you could be available after labour so you would be able to properly recover and get that so needed sleep, with out all the chaos of a busy ward, visiting families and other babies cries.. I know this did effect me as had been in labour all night delivery 8am in the morning, where as with my son he arrived at 6pm in the evening so I could probably rest... also if they have birth plans to have the pain killer if needed as it would give you better piece of mind if it is in place and you may find comfort in that, taking away the worry if you are going to get it of not.

There are some good booklets available here and I was thinking maybe you team who look after you could benefit from the APP website? They definitely seem keen to learn.

I really feel for mothers who suffer this illness, especially where so little is know about specialist care, I went through a very bad time in a psychiatric hospital, before going on to a more specialist clinic so baby could join me... it is heartening to hear your story that your team were so supportive to you, so thank you for sharing your story it gives me hope for the future... take care and you know we are all here to support you xx

[Maria_at_APP Moderator]

Hi Varvarita,

Good to hear from you and such lovely plans you have at the moment, must be very exciting and at the same time filled with some anxiety and worry.

I am currently on the third trimester of my second pregnancy, and I can really say that forwarned is forearmed this time around. Knowing my early warning signs and communicating them to the team has been so helpful, and like you I am repeating the same psychiatric team, it is so much easier when they already know your history isn't it?

There are many factors to weigh in when giving birth for the second time after pp, as you say there is the potential trigger aspect, although I think hospitals sometimes are so similar to one another anyway, but also if you were happy with the obstetric care last time, convenience, and reputation of the hospital too.

In my experience I opted for another hospital the second time around. Me and my husband were not too delighted with the care I received last time. And also the psychiatric wing of this hospital was where I was first an impatient for 10 days and you can see it from the maternity ward. Even though reports seem to indicate that the quality of care has improved since 2018 when I gave birth, we still did not feel so confident about going back. But that was what our evaluation of personal circumstances threw and it will be quite individual for each mum.

I would say that the good reputation of the hospital where u gave birth to your first baby, is certainly a point in favour, as is the fact that you are familiar with the staff there already. At the same time there are so many charged emotions as you say, some sad and some full of happines that makes it a tough decision. But there is no guarantee that those emotions won't bubble up as well in a different setting. Sometimes is the event as well as the circumstances.

If I can offer some reassurance is that the second time around you feel so much more in control of the situation. First, the psychiatric team will be involved from the beginning and not only when you developed pp like the first time around, so they can pick up on any possible wobble along the way, even before the birth. Second and most importantly, you and your nearest are so aware of your early warning signs that you can be very proactive about it, and the chances of a wobble developing into full blown psychosis are much reduced.

You are quite an incredible and strong woman, look how far you have come, as the man in the moon like you say. You have got this.

I wish you all the best, certainly it is a big decision to think through and also talk it with your partner to get his view in.

Write here whenever you have any questions or just feel like it.

[Varvarita in reply to Maria_at_APP]

Hi dear EmiMum! Im so excited about you pregnancy - it’s so great that you are now at this point of the journey! I remember we discussed insomnia last year - and here we are now, you already third trimester! How do you feel, emotionally and physically? 3rd trimester might be a tricky one physically, hope you feel good. Thank you for your reply and advice. Indeed forewarned is foreamed. I hope everything will be different this second time for you and it’s so great your support team is near anyway. Xx

[Maria_at_APP Moderator in reply to Varvarita]

Hi Varvarita,

Times does have a funny way to accelerate sometimes. All has gone well, some minor bumps along the way which is mostly my age showing :). Take good care and thanks for the message of support. Big hugs from a distance