previous pp,39 weeks pregnant and dont feel right

[Louise13]

I am due to have my 3rd baby in just over a weeks time. I was fine after the birth of my first child but developed PP after the birth of my second. I have kept reasonably well throughout this pregnancy but in the last few weeks I have noticed a change in how I am coping.Not every day but some days I find it quite hard to function.I just want to sit and stare sometimes but at the same time feel very unsettled and dont really know what I should be doing with myself. I am finding it difficult to interact with my children and cant be bothered with them. Angry outbursts are frequent on bad days.i have a very supportive husband and aunt who help alot but are worried.I am not on any medication and do not want to be.I have not had much input from health professionals through choice as I have been keeping quite well and feel the care I received when I was ill wasnt good. Does anyone know if this might be a sign that I will become unwell again?I am very scared but dont want to contact any health professional because I wasnt dealt with well the last time and medication is not something I want to start taking again at this stage.

[Naomi_at_app Volunteer]

Hi Louise13

Thank you so much for finding us and coming to chat. I know it's really brave to acknowledge that things don't feel right. It's great that you have supportive family around.

I can completely understand your reluctance to contact a health professional - you have been let down by your previous experience. Is there anyone though in your support with this pregnancy that you do get on with? What's your midwife or health visitor like? How about your GP (or another GP in the practice)?

In some ways, the benefit of your hard experience with baby #2 may be giving you an earlier heads-up about some warning signs. It does sound like the slight sense of 'disconnection' and getting angry outbursts could be giving you a chance to decide - if you need some treatment, what would you like that treatment to be?

Have you thought about writing your own plan (sometimes called an advanced directive) for what you would like to happen if your symptoms should get worse? It doesn't need to be a formal document - just a list of your ideas/preferences. Would your husband and aunt be good people to help you do this? I think sometimes if our first experience of health services has been disempowering, it can really just help to take a bit of control when still well enough!

How would you feel about looking at your local Mother & Baby Units online just to get a sense of somewhere you could go for a short stay with your baby if you did feel that symptoms were escalating? Here's a map app-network.org/what-is-pp/...

If things did get worse you might need medication - and I know this is hard as you hated it last time - but again if you write something now you could ask about things like starting on a lower dose, or trying a different type of medication (there are a whole range of antipsychotics, mood stabilisers etc) There are also medications you can breastfeed with, or breastfeeding 'work arounds' such as taking later at night after the evening feed - let us know if you want more information.

Well done again for taking this step to ackcnowledge you don't feel quite right. Here for you any time you need - let us know if we can give you more info.

Naomi

[Louise13 in reply to Naomi_at_app]

Thanks for all the advice Naomi.Last time I was put on quetiapine and olanzapine I found the side effects of tiredness and weight gain difficult to deal with. I then was put on I think Abilify?? i found the extra agitation difficult to deal with.Is there any other antipsychotics that you know of that dont have these side effects? I would like to try to breastfeed so would appreciate info on medication that is safe to take while doing this?I was also on the antidepressant Venlafaxine which helped but I dont you can breastfeed on this? Info on mood stabilisers and breast feeding would be appreciated too.

[andrea_at_app Volunteer in reply to Louise13]

Hi Louise13,

There's a really good website for details about various medications here: choiceandmedication.org/ncmh/ Just select the one you're interested in from the 'Medications' drop-down.

I hope you find the information you need,

A x

[Lilybeth Volunteer]

Hi Louise13,

It's good to know you have a very supportive husband and aunt. I too think you have done well to recognise that you have noticed a change in yourself at this stage. I don't know how long it was since your experience was not good with health professionals following the birth of baby 2 but agree with Naomi that this might be the time to reach out to them for support. At least then you will be able to discuss options with your husband and aunt.

Years ago I had two episodes of PP and was very poorly. However, that was back in the days before Mother and Baby Units and all the support available today. Your G.P. will have all the records relating to your condition following Baby 2 and may be able to reassure you that if PP is on the horizon, your care is top priority.

[Louise13 in reply to Lilybeth]

Thanks for your encouraging words Lilybeth.I am going to phone my GP tom

[Lilybeth Volunteer in reply to Louise13]

Hi Louise 13,

Happy to help - we are all here for you.

Hope your GP made time to listen to your concerns and you feel more able to cope with what might be round the corner. Of course, the joy of baby 3 in your arms is priceless and I wish you well..

[caroline-p]

Hi Louise 13,

I do so sympathise with your feelings.

In the light of so many people's experiences, there are few or no warning signs in the period before the birth. PP takes one entirely by surprise, as I imagine it did you after your second baby was born.

So its highly likely that unsettled feelings you have at present are attributable to the supressed anxiety you (and your supportive husband and aunt must all be feeling as this birth approaches). Concentrate on being kind to yourself and forgiving yourself for temporary deviations from being a perfect mother! it probably means nothing.

There is one preventative I'd be tempted to try in your situation. I had PP after my first birth and had progesterone therapy ( by injection immediately after the birth and for a couple of weeks by suppository) for my second and third births. The theory is this protects you from the huge hormonal change which occurs at birth when the progesterone levles plummet.

It worked for me, and I notice also worked for other women who have contributed their stories. It also helped to feel I was doing something to protect myself.

i don't think there is any indication that it could do any harm, and it won't stop you breast feeding and so on. My treatment was prescribed by the GP when I asked for it, and administered by midwife at home birth. This was in the 1980s but I believe it is still possible.

good luck, and look forward to this birth!

caroline

[Louise13 in reply to caroline-p]

Thanks for your advice caroline-p. I am going to phone my GP and ask her about it tom.

[andrea_at_app Volunteer in reply to Louise13]

Thanks for that Caroline. The general consensus is that there is not sufficient evidence to recommend hormonal treatments such as progesterone or oestrogen (perhaps as not enough large-scale studies have been done?).

[caroline-p in reply to andrea_at_app]

True, but that 'consensus' is based largely on the absence of rigorous research which meets the criteria of modern evidence based trials.

[vix28]

Hi Louise, I'm so sorry you're struggling, it sounds like you've had lots of good advice. On one side it really could just be the stress of pregnancy and the worry of what happened before but I think being on the safe side and seeing your GP will be good. I was well after my first but not after my second, also with my second I started getting symptoms at the end of the pregnancy (for me this was about 26 weeks...as my daughter was born at 28 weeks, it was also when I started getting symptoms of pre-eclampsia). It's very scary but one thing I wish I had of done is got help earlier, I did try and tell people but I guess I had no idea what was around the corner. Just remember PP second time around is different (I hope!)...purely because at least your family know its on the cards, for me if I ever have another baby that will be one thing I focus on...that my loved ones will stand up for me with a lot of knowledge about what's going on! Vix xxx

[Naomi_at_app Volunteer]

Thanks all for your supportive and informative posts.

I would also add to what Andrea has said - unfortunately while there is good anecdotal evidence about progesterone and oestrogen therapy from mums in the 70's and 80's this treatment is unlikely to be an option on the NHS in 2013 as systematic reviews of research have failed to find any effect. I know this is probably a research failing but I think it's very important that we give pregnant mums now the best advice relevant to current UK practice.

I've linked below to a very good review of breastfeeding and a whole range of medications (antidepressants, antipsychotics and mood stablilisers: called anti-manic drugs in this article). Hope it's helpful for when you chat with your GP.

apt.rcpsych.org/content/11/...

All the best, Naomi

[Naomi_at_app Volunteer]

Hi Louise13

Hope it went well with the GP today. How are you feeling?

I just had a look at the medication choices link from Andrea and for each drug you can drop down a list of questions, including info on breastfeeding as well as side-effects. V handy and much less wordy than the academic paper I linked!

Most of the newer antipsychotics (e.g. Olanzapine, Quetiapine) seem to be found in very low levels in breastmilk however it's usually advised that women take their dose at night after the late night feed. This is mainly because so few cases are available in the research to help doctors establish the safe levels of medications in breastmilk...

For me personally, I decided to start a low dose of Olanzapine with my second child, about 7 days after her birth when elated/racing mood symptoms began to appear. I had been advised that I could take it at night, then express and discard the night feed (replacing with formula). In the end, I decided to prioritise my sleep & wellbeing, and switched to formula at that point. It was definitely something of a relief to be able to share the feeds with my husband.

For each woman it's a personal decision but I think it's good to know that there can be breastfeeding + medication options - but it's also completely OK if you don't breastfeed!

Look forward to hearing soon about the arrival of your lovely baby #3

[andrea_at_app Volunteer]

Hi Louise13, I hope things have eased for you now & yesterday went OK. Physically I can imagine how you feel - those last few weeks are just really tough! How is your mood today? If you feel up to it, let us know how you're getting on.

We're here for you x

[Hannah_at_APP Administrator]

Hi Louise13, not sure I have anything different to add but I hope you got some good support and are feeling surer about the way forward as you look forward to your new arrival. Writing down any preferences- my consultant suggested as "a letter to yourself" is something that sounds a good idea to me too, although I only have 1 child at the moment. I think it's already been mentioned, but being aware and forewarned is so much better than it all coming out of the blue - although I know that the nature of pp is like a horrid shock. Hope thing are moving forward for you and as others have said, there's people out there to chat to on here if that helps. Take good care and all the best

[Naomi_at_app Volunteer]

Hi Louise13

Just dropping you a quick message to say hi & hope things have gone OK with your last few weeks of pregnancy? If you need us, we're here to talk any time.

Naomi

[Louise13]

Hi everyone,

Had baby early on 26th Feb.Didnt get a chance to phone GP the next day as was in labour.3 weeks down the line and i am unwell again. I have the option of remaining at home under 24hour supervision from family with regular daily visits from Intensive Home Treatment Team or go into MBU,There is a bed available tom. Dont know what to do.Dont want to leave my 4 and 2 year old.Any thoughts or advice?

[Kaiti]

Hi Louise! Congratulations on the arrival of your new baby. I hope you have received. The help you need. How are things? xx

[Louise13 in reply to Kaiti]

Hi.Thanks and thanks for asking...came into MBU.Been in 4 weeks now.Very supportive environment but really want time out!Going to post another question to get some opinions and advice.Would appreciate yours too.