Bipolar and pregnancy

I read this article this morning, and it is incredibly sad.

https://www.tommys.org/pregnancy-information/about-us/pregnancy-news/much-loved-mum-two-dies-following-long-term-struggle

I can’t even imagine how hard it must be for her family. It is so sad, and it hits me quite close to home, as it could have easily been me, if I wasn’t so well looked after. I don’t know what kind of care she was getting, but I know mental health care varies massively in the NHS depending on the area you live in. It made me think about my experience and realise how lucky I am that where I live I get pretty good care, especially whilst I was pregnant and after my daughter was here. Even though the resources here are massively understaffed, their case load is massive and I can’t imagine how busy and stressful it must be for them. So I thought I’d write a bit about my time and how lucky I was to live where I do.

When I was pregnant I got referred to a specialist maternity mental health team. I had a psychiatrist who specialised in mental health and pregnancy, and I got assigned a maternity mental health nurse. I had to go in to see the psychiatrist, but the nurse would come and see me at home, which was incredibly helpful.

Pregnancy and the postnatal period is potentially a very dangerous time for bipolar women. The risk of postnatal psychosis is a particular worry. I think they placed my risk of developing this at around 50% – I may have remembered this wrongly, but I remember being surprised at how high the risk was. I was lucky enough that I remained un-medicated for most of my pregnancy. I was put on Olanzapine in the last month. This was to helpfully prevent any issues. Even though I personally hate this drug, it makes me tired and I gain a lot of weight on it, but it meant that I could breastfeed, which was really important to me. I had to be on it for at least 2 weeks before our daughter was born, so it would be taking affect after she was here. The 2 week period after birth is the most risky. The risk is still high for a few months, but that 2 week period is much higher. The problem with an episode after birth is that it doesn’t follow your normal cycle. For example I tend to gradually go manic, I get higher and higher over a few days, in the post natal period it doesn’t follow that. You can go from ok, to manic or psychotic in under a day. It can also start during labour, with all the hormones and stress to your body, it can trigger a bipolar episode or postnatal psychosis. I found this a terrifying prospect. All of my maternity notes had information on this, for the midwives to read!

Because of being medicated my daughter had to have observations done every 4 hours for 5 days. The mental health team had requested if possible that I could have a private room, as being surrounded by a lot of people is stressful for me, and they wanted to minimize stress as much as possible. I was very lucky that a private room was available, and my husband could stay with me day and night, I don’t think he was meant to, but there was no way I was letting him leave! This was hugely helpful! I kept seeing my maternity mental health Dr and nurse for months afterwards to insure everything was staying on track!

My mental health team was amazing, I felt really supported and listened to, everything was my choice, they recommended what they felt was the safest option for me. But I didn’t have to choose it. I could decide to be un-medicated and they would have supported that option and worked with me to stay as safe as possible. I also had to have really difficult conversations about becoming unwell and potentially being admitted. My options were either a mother and baby unit which was around 2 hours away from my home, or just an adult unit which could be a lot closer. I said I’d prefer the mother and baby unit, if it was available, but really it would depend on how unwell I was. If I was a danger to my baby I did not want her to be with me. Her safety was the most important.

Because of all of this support, me and my daughter remained safe and well. I just wish that this service was available to all women with mental health issues, regardless if they have a pre-existing mental health issue, or one that has developed during pregnancy or post-natal. More money is desperately needed in mental health services. So even though this service was available here, and the support was fantastic, it is still massively over stretched.

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