How can you prepare for a second preg... - Action on Postpar...

Action on Postpartum Psychosis
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How can you prepare for a second pregnancy?


It can be a difficult decision to become pregnant again after experiencing PP. What emotions are you experiencing / did you experience during your second pregnancy? If you have had more children after PP, what did you do to prepare the second time around? What do you think helped? What advice would you offer others about how you can prepare? Were things different the second time around?

5 Replies

We had a big gap between our two daughters after an episode of PP with our first. I think this did have some advantages in having had a number of years to really recover from the shock and fear of PP for both myself and my husband. It also meant that my older daughter was at an age where I could explain a little about 'when mummy was poorly after you were born'.

The best advice I could offer anyone thinking about a second or subsequent pregnancy after PP is to access a specialist Perinatal Mental Health Service. In our area this team is led by a perinatal psychiatrist and also has mental health nurses and specialist midwives to help families plan and prepare for any relapse in a second pregnancy. We met three times during my second pregnancy and came up with a very specific plan for the first few days after birth, and for community support after that. Your midwife should be able to refer you if your local NHS trust has a Perinatal Mental Health Service - and if not, see this link on the APP website for consultation with Ian Jones, specialist psychiatrist


Hi Nelan, yes I fully agree, getting advice from a specialist perinatal mental health team, planning & preparing ahead & having your specific care plan in place is key. Thanks for the comment :-)

I am currently 28 weeks pregnant with identical twins. I have always known that I wanted more than one child, and after my son was born and being ill it still didn't put us off, although I do feel that I was robbed of the first precious weeks of my sons life, I hope to not experience that this time. Before we decided to try I asked for a referral to Dr Ian Jones in Cardiff, unfortunately my PCT would not refer even through there is no cost involved to them, I was offered an appointment with an obstetrician, I knew this was not the right way to go but accepted it because it was all that was on offer. When I arrived for my appointment I was asked what I was doing as it was a psychiatrist that I needed to see. I was promised a referral to the perinatal mental health team, it took from May - November for me to be seen and this involved me phoning every week to chase this up. I was seen in November by a perinatal psychiatrist at Birmingham Mother and Baby unit who told me I have a roughly 1in 4 chance of being ill and she would recommend meds from 12 weeks onwards, this is something I strongly disagreed with as I was never ill in pregnancy and did not want to take any medication during pregnancy. She did say I could go against this advice if I wished and I have done. I got pregnant a lot quicker than I expected and sadly this ended in miscarriage. I saw a very supportive doctor at my practice who told me to go and see him when I was pregnant again and he would refer me back to the MBU, in actual fact it didn't happen like this I was referred by my community midwife to see the specialist psychiatric midwife at the hospital who then referred me to the perinatal psychiatrist from the MBU who actually sees you in your local hospital, I find this much better as it is local and also no one knows why you are there. I have met with her, discussed my past history and we have put a plan in place following the birth, I know I will be medicated, but I accept that this needs to happen to give me the best chance of not succumbing this time. I have a very good support network of family and friends and feel very positive that this time round I can remain well and if I get any early warning signs everybody is so clued up that I will not take as long to get well. Overall I have enjoyed my pregnancy and am trying not to worry about being ill again although I do get days where I am worried about it, I try and focus on the positives, this time I have the support already in place. I would advise anybody thinking of another pregnancy to ask for a referral to a perinatal psychiatrist. I hope that later in the year I will be able to provide a positive update. It has also helped me speaking to two other ladies through APP That have gone on to have positive experiences following their subsequent pregnancies and them kindly sharing their care plan with me.

Hi there...

Preparing for a 2nd pregnancy after PP...get a referral to a perinatal psychiatric team at the hospital you intend on delivering your baby at. That way you can have a psychiatrist and a psychologist etc that will be monitoring your mood etc closely prenatally and postnatally so as to "catch you befor you fall" (looking for a better expression!). I was lucky enough to be seeing the head of the perinatal psychiatry unit at the hospital and as soon as I gave birth to my second baby he was able to transfer me straight across from the maternity ward to the psychiatric ward for closer monitoring and medication within a few days as I was not sleeping and my mood became very elevated. My story is a very intense and complicated one spanning over the last 8 years with 2 gorgeous babies of which one sadly passed away and 2 different episodes of PP. Thankfully I was diagnosed with bipolar II disorder a couple of years after my angel, and found the right medical support team that has carried me for the last 6 years. I do believe that a mother should remain with her baby in an MBU if you are lucky enough to have such a service available to you. With my second baby I spent 40 days in hospital with her in a supported public mental health unit where they provided nurses and care to support me in looking after my baby postnatally. Unfortunately this support was withdrawn a few months later when I was hospitalised with PP because the hospital withdrew funding for the additional staff saying it was too dangerous for the baby in such an environment. Naturally, my 2nd stay that time was excruciating. Having lost my first baby 4 years ago, it was like I had lost my 2nd too.

Also, with my second pregnancy I was put on quetiapine (Seroquel) to protect me from a further shift in mood towards the end of my first trimester and stayed on it for the rest of my pregnancy. My beloved daugher is now 4 years old and is just perfect :) We are hoping to try again for another baby next year again with the close support of my psychiatrisc team.

I would say that if you have decided to go ahead with a further pregnancy, you and your family already know how ill you can become, you know where to go to get the help you need, and vitally important, you know that you will recover.

We left 4 years before I had our second baby and I am glad to say, I didn't have the same experience the second time round. Having talked my concerns through with my GP, I chose to think that if it did happen again, I would recognise the symptoms and know where to go for help. I took some Yoga classes, which helped me relax, and cope better during labour. I was more confident as a mother, and had wonderful support from my husband, family and friends. Getting enough sleep was and is now an important part of keeping myself well.

Knowing that there is only a slight chance you will suffer with PP a second time helped me. Being kind to yourself is my advice and keep remembering that we all learn from our experiences, both good and bad.

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