I am currently 24 weeks pregnant with my second child. I developed PP following the birth of my son in 2009. The onset of PP was very quick. I was showing signs within about 3 days from the birth and was admitted to my local MBU unit within 7 days of the birth. I had had a traumatic labour experience where I had been neglected by the midwive when the maternity unit was over capacity. I was left in triage in established labour for around 5 hours reaching 8cm dilated without any form of midwife support or pain relief. There was problems establishing breast feeding and my son became jaundiced and dehydrated. As a result of all of this I was sleep deprived and barely slept more than a few hours the week after my son's birth. I began to think that both my son and I had died while I was in labour and that I was in heaven.
I was admitted (with my son) to an excellent MBU unit and was very ill for a couple of weeks while they tried to find the right medication for me and once I was given olanzapine my symptoms subsided. I was fortunate to only experience the manic side of the illness. I was discharged from hospital a few weeks later and within a couple of months was able to stop the medication completely. I was very lucky in that with a supportive network of close family and friends as well as an excellent counseller experienced in post natal illness I made a full recovery and was able to bond well with my son and went on to fully enjoy motherhood. I was very fortunate not to suffer from the depressive symptoms that so often follow this horrible illness and I have stayed well since.
After much discussion and after taking advice from our gp and local hospital, my husband and I reached the decision that we did want to have another baby and that with the right support we felt this was the right thing to do for us as a family. The complication is that since the birth of my son we have moved to a different health authority and although if I was to become ill again I would be referred to the same MBU unit as before, they are not able to see me antenatally to discuss any care plan or medication. I am therefore under the care of my local psychiatric service during the pregnancy but my husband and I have both been very disappointed in that we have had very little involvement from them so far. I had asked at the outset to be referred to a CPN who I could see through the pregnancy to discuss my concerns. I have met with her a couple of times and she seems excellent and grasps the issues involved. I also have the support of two excellent community midwives who are helping me with decisions regarding a longer post natal stay on the ward and also with support from night feeds etc given the importance of sleep. However, I have had absolutely no contact from the consultant psychiatrist who is supposedly in charge of my care. I am becoming increasingly anxious about this as I keep asking for guidance regarding the medication options I have but so far am not getting any answers. I have asked to meet with him but so far have not heard back. In particular, I am wondering about whether I should simply take olanzapine immediately after the birth or if we should adopt a wait and see approach and only take it if I start displaying symptoms. I am concerned about immediately taking olanzapine after the birth as I remember the detached/numb feeling it gives you and am concerned about the implications this might have with my bonding with my baby. I know there are other medications but given we know that olanzapine worked the last time I am presuming that it would be better to stick with that than experiment. I have also read a little on here about the benefits of taking progesterone supplements to regulate hormones/mood after the birth but am not clear whether this is still something medics advise.
So my questions to any ladies out there who have bravely gone on to have more children following an episode of PP are this:-
1. What sort of care plan did you have in place post natally?
2. What are your views on taking medication as a preventative? Do you think the benefits outweigh the side effects?
3. Has anyone ever used the 2nd opinion service from Dr Ian Jones mentioned on the app website? Given the lack of input from the psychiatrist we have been assigned to date we are wondering if this is something we should explore.
Any guidance/views that anyone can provide me with would be much appreciated...
Firstly congratulations on your second pregnancy!
I too went onto have a second baby after having PP with my first and I know how agonising a decision it can me to embark on a subsequent pregnancy or not. Even though we wanted to have another baby, I know that for me and others, the following pregnancy is a very worrying time, a roller-coaster of emotions, because of all the "what if?"s about PP happening again. And the worry about having another traumatic labour – how awful for you to have been left unattended in triage for so long without help or support. There are lots of reasons to hope that it will all be different next time especially because you sound very well prepared.
I'm glad that you have two great community midwives and an on the ball CPN. Is there any chance of being referred to an obstetrician who could then “pester” the psychiatrist into seeing you about medication? I'm guessing there isn't a specialist perinatal psych team in your area otherwise you wouldn't be left with these questions.
Before I forget there’s a question posted earlier in the site that may have some helpful answers for you as well (you’ll see some of my answers in there too):
I will have a go at answering your questions as best I can, but please do ask further questions (I'm sure you'll have loads) and I will pop in again to answer them to see how you are getting on. [I'm so glad you have found us on this forum because if anyone can understand your worries about your forthcoming postpartum period than the ladies on here can, and there is a wealth of experience to be tapped into.]
Firstly, I'm sure you already know this, but it's important to remember that with subsequent pregnancies after PP there isn't a clear set of guidelines to follow to prevent a further PP from happening with 100% guarantee, but there are certain things that can be done to give it the best shot. Plus, each care plan is likely to be different for every woman because each PP episode is individual and presents slightly differently. For example, my PP came on within hours of the birth, I was hospitalised by Day 5 for 3 weeks with a psychosis that went on about 2 1/2 weeks (some mania but mainly psychosis) and when I was discharged I fell into a deep dark depression that lasted till my son was about 16months. Still, there will be things in my care plan for my second baby that could be really helpful for others like yourself. Regardless of how our PPs differ, we all are desperate for it not to happen a second time.
As this has been a rather long post I will post my answers to your questions on a different reply to make it easier for you to refer back to or read in chunks (sorry, I am known for long answers ... eeek!).
Take care, N x