What are the key things you think health professionals should be taught about PP?

[Naomi_at_app]

What things do you think your midwife/health visitor/GP/A&E doctor etc should had known about PP to help you get the best treatment and give you the best advice? I'm going to be involved with producing a DVD/online resource to train health professionals in the South West so your ideas will really help to influence this training!

[andrea_at_app Volunteer]

Hi Nelan, good question & I'm sure there'll be lots of answers! I think it's really important that they're aware of the early symptoms of PP detailed in table 1 in this paper app-network.org/wp-content/... & they should be aware that "Although episodes of PP onset rapidly in the postpartum, they are likely to be preceded by prodromal, often hypomanic, symptoms. The risks of delay in identifying episodes of PP can be serious and costly."

Also, I wish they understood in the early stages especially, the importance & priority of getting 'mum' better, over & above requirements on her to breast-feed, care for baby, change nappies, bond with baby etc. which will all come later (when she's not in crisis!). I certainly would've welcomed far less of this needless pressure & more time to sleep to help my recovery!

[HelenMW Volunteer]

Hello there, I think the main thing from my own personal experience is that if the mum is telling professionals and family that she has suicidal thoughts, then these must be taken seriously and every best effort made to ensure that she does not have access for example, to her medication in great quantities.

[Poulson]

It should be made clear that this is a very serious condition and the mother should be put first,so that she can be reunited with her baby. It should also be made clear that this illness can strike with subsequent births as it was in my case. The woman should always be informed of her status and not kept in the dark as I was on both occassions.

[orac]

I agree completely with the first two answers. I especially think they should focus on getting mum better over turning her into an idealised version of a mum. My husband was wise enough to insist on this despite strong pressure from nurses etc. Another lady who suffered the condition at about the same time as me didn't manage to resist this pressure. It became too much and she unfortunately committed suicide.

[compassion]

They should know where key resources and tools are...i.e. therapist, programs, alternative medicines, etc.... to assist a woman and family that is going through PP, in addition to identifying and understanding the at risk communities that deal with mental health issues but do not have the funding to get the proper help......

[Hannah_at_APP Administrator]

In my case, the trauma of a difficult birth didn't help my situation. I, like others, was pressured into doing things although at the same time being told to take it easy after a caesarean. Pressures from over stressed nurses did not help! Staff on a a general psychiatric ward were also really unaware of the condition and what treatment was needed. My own experience of community midwife and GP was fantastic tho and aside from experience and early signs, they actually listened to me and my husband rather than mis-diagnosing and over medicating me, which is what a general psychiatrist and apparently specialised mental health staff did in the early days. The specialists aren't always very good in general MH I would say. Final thought would be that in recovery, in my experience, a supportive CPN who just listened, advised and built up ?y shattered confidence was invaluable. Hope this helps!

[Naomi_at_app Volunteer]

Thanks everybody for really thoughtful replies. I am interested how many of you felt there was a lot of pressure to be a super-mum even in those early stages; I wonder how much of this pressure comes from lack of understanding about how "bonding" is a much more robust and longer-term process than we think, and it doesn't all have to happen in the first few days. Many of us who have been through the trauma and huge disruption of PP know that somehow, despite it all we managed to form hugely strong bonds with our babies through their early years.

[CatherineT]

"Breast is best" I was really upset that medication prevented me from breast feeding. It's hard bottle feeding a baby when you don't agree with it youself and you're too embaressed about the reasons to tell anyone. I wonder if a difficult birth and a huge feeling of dissapointment in myself, for failing to have a wonderful birth experience, contributed to my episode.

[Simon_at_APP APP in reply to CatherineT]

'Breast is best' the slogan of the time, even though my wife was suffering with anaemia and unbeknown the onset of PP, she desperately wanted to do what she thought was the right thing, be the 'best mum', etc. actually I think it was draining her resources even more. One of the health visitors had a much more realistic and calming view, i.e. it doesn't suit everyone and has to be what's best for mum.

[Simon_at_APP APP]

As said above, it has to be more awareness and speed in identifying the onset of PP, any delay can be serious, even deepen how far someone falls and therefore prolong the road to recovery. Once identified, the right treatment and information has to be given; as a partner/family member you need to know about the illness, how to deal/cope with it and told the possible treatment options etc. and that it gets better...

[andrea_at_app Volunteer in reply to Simon_at_APP]

Yes I fully agree Zapple. The right information to partners & family is vital, especially in the early stages. It makes sense as they're the main carers & in it for the whole duration! It'd help everybody all round.

[CatherineT]

I think health professionals should listen very carefully if a new mum says she's not slept. I don't think this cue is taken seriously, nobody genuinely believes a person may not have slept for a couple of days as it's not normal. The midwife team at my local hospital were fantastic and they did move me into a private room but at what point do you suggest a new mother bottle feeds and has sleeping pills? Probably never.

[andrea_at_app Volunteer in reply to CatherineT]

I agree CatherineT, the lack of sleep should be taken seriously & not dismissed as 'all new mums suffer with lack of sleep'!

I really wish midwives & professionals (& society!) was less focused on breast-feeding being 'best' & more on ensuring the mother feels she has a choice. I think far more struggle with it than they admit to even if they're not ill & for those that are ill, as we know, the consequences can be catastrophic. At that time (not just in hindsight), I would've gladly accepted a suggestion that it might be a good idea to bottle-feed & take sleeping pills - if only someone had suggested that! 'Breast' was definitely not 'best' for me or my baby & I wish there was less pressure to fit into the 'textbook' view of what is best (how many midwives thoroughly read a PP textbook?!) & that more midwives were brave enough to encourage other options based on common sense. Yes you're right, at what point do you suggest this? - yes a difficult one!

[Hannah_at_APP Administrator]

I had the breast feeding pressure too! Even an overnight hospital admission to monitor my effing due to my baby's weight loss. Talk about pressure!!!! I did want to do best by my baby and thought breastfeeding was it. Bottles and a well mother is such a bigger thing. It's no coincidence there are these similarities, this thread should be widely shared.

[Hannah_at_APP Administrator in reply to Hannah_at_APP]

Sorry, that should've been "feeding" not effing! Oh the irony!!

[Naomi_at_app Volunteer]

Thank you all for raising this really important issue around breastfeeding. I have to admit I still get really upset when I go to my local Children's Centre and there are all these idyllic posters showing how great breastfeeding is for you and baby, complete with pretty nursing bras on show - one even says 'Are you a yummy mummy?' For me, I knew it was the right thing to begin medication and stop breastfeeding but it was still a huge sacrifice of the perfect motherhood ideal.

During my second pregnancy, my perinatal psychiatrist did discuss lots of ways around taking Olanzapine and breastfeeding - however I must admit I think it could have been both exhausting and demoralizing to express and throw away two feeds in the night to ensure that the first morning feed was OK. But it's good to know that, for mums who feel really strongly, there are some options. In the end, my little one needed tube feeding and was in the Neonatal Unit for a while and I started to notice symptoms of hypomania so I ended my quest for breastfeeding after 7 days.

I'm meeting my local perinatal team on 9th October so will take this thread with me so we can make sure it gets into our training package!

[andrea_at_app Volunteer]

Also, for me it would've really helped if in the psychosis stage, the health professionals & midwives really understood how much I really needed to sleep & that I desperately needed a few hours away from my baby where I could have time to myself, sleep properly & recover. The mania was utterly exhausting & I was still recovering from the childbirth! I was treated in a private room in the post labour ward at my local hospital where there was a creche available but I didn't find out about this until I left. It would've been great for someone to suggest this as an option - I couldn't ask for someone to look after my baby even for a short while because I was so desperate to prove I could cope & was a good mother for fear of having my baby taken away! I can't imagine the horror of being separated from your newborn for longer, but just a few hours would've made a huge difference. I know midwives are very busy & understaffed, but I think this extra support in caring for baby & taking the pressure of PP mums without the feelings of failure & guilt, would be benefit all round & help promote recovery.

[EmmiLou Volunteer]

Hi Naomi

I think the health professionals need to fully understand what PP actually is and be able to spot the signs and the initial stages of the illness. And also have refresher training courses about this. When I was poorly it was scary the amount of people that either did not know anything about the illness or knew very little. My health visitor referred to my illness as PND and knew hardly anything about PP. I asked about groups to attend to meet other people with PP and she could not advise on this and said I needed to move on and forgot about the illness I had. My first CPN who was new to her role also knew very little so was very unhelpful purely to the fact that she had not had adequate training about PP. It took two weeks for me to be diagnosed with my family going out of their minds as they could get no-one to listen to their concerns. When I was eventually taken to hospital to be assessed I was in a small room for 7 hours (from 10am to 5pm) being asked question after question by various health professionals until at 5pm a lady from the psychiatric ward said you have post partum psychosis and led me away in a wheelchair to a psychiatric ward.

Along with training I also think that all midwives whether they are specialised in mental health or not should have training. The hospital where I gave birth had one perinatal midwife who worked on selected days and you could never get hold of her. My partner told a midwife about hallucinations I was having on day 3 of giving birth which they dismissed as being tired – this was the start of my illness. Every midwife was obsessed with breast feeding and forced me to do this so I was unable to get any sleep. The onset of becoming ill meant I was having no proper sleep until eventually I was unable to sleep.

It would also be helpful when the mother is in recovery (or at some point) to actually explain the illness. It was only when I had a relapse at the beginning of this year that I understood my condition because it was never properly explained. I think it would be difficult to explain this to a mother who is poorly as they are not in the right frame of mind but eventually it would help – I never knew what was wrong with me.

I am not sure whether other hospitals do this but I think it would be really useful for woman to be given leaflets about PP. On leaving the hospital to go home with my baby my partner and I were given leaflets on the baby blues, PND, breast feeding, sleeping in the same bed as your baby but nothing about PP. My mother said this is because it would scare women but for people who know nothing about PP it would be so helpful.

I hope the training you deliver can be carried out in more places across the UK too.

xxx

[EmmiLou Volunteer]

So sorry my reply is so long Naomi, there are just so many failures with this illness....

[JenniferM]

I believe health professionals should be taught how to identify symptoms and risk factors. They should also receive proper training on perinatal mood disorders and screening women, especially if professional or provider working with pregnant/postpartum women. Also believe pediatricians should be taught all the above as well.

[TBird58]

Hi Naomi, I totally agree with Jennifer M, I am a HV Perinatal Depression and Anxiety Lead in our local trust, we train all our HV's and teams in recognising and supporting these women, I do feel that there needs to be robust links with Mental Health and midwives so that consistency of care can be given, this will help mums that are suffering from 'retelling their story' to the various professionals that they meet, this has been a common dislike from women that I have supported over the years

Hope this helps

[Naomi_at_app Volunteer]

Hi EmmiLou, JenniferM and TBird58

Thank you so much for your thoughts on this discussion. We have had the first few project meetings now for the training package in my area. A lot of the material is going to be online so I will keep everyone posted in 2013 when it goes live. I agree with you TBird58 that links between midwifery/HV services and Mental Health services such as CMHT's need to be much stronger.

The plan we have for the website is that it will also connect families based in the South West of the UK where there is no MBU provision at the moment. So there will be a kind of peer-support and local recommendations area, as well as areas for professionals to learn from families and one another.

[haroldmag]

My experience as a husband goes back about 25 years. I think the midwife/health visitor was very experienced, and we were fortunate that she spotted what was happening. But she did not tell me what was happening. Neither did the GP tell me. It has caused me great anxiety which I have not been given adequate support for.