to fight to consent to a hypothetical abortion?

[APieOfButter]

First I'd best mention I am currently an inpatient in a psychiatric hospital, although voluntary and totally allowed to refuse drugs etc if i want to. But that is why im typing from a phone, and also i dont want to be accused of drip feeding info.

Right. I have bipolar. There are three drugs that could be added into my cocktail. One is lithium, which has been counted out by the fact i forget meds too often. The other is quetiapine, which i had a bad reaction to, but the consultant likes. He does think that valporate would be better, but wont prescribe it due to me being of childbearing age.

Bear in mind that, although I am currently voluntary, by refusing quetiapine, which makes me panic yet have no control over my limbs, and which is proven to be massively bad healthwise, I put myself at risk of being sectioned, despite all the staff on the ward agreeing that i am fully aware of what i am doing, just currently on the way down from a mania.

Right. So, the dr wont prescribe volporate as it carries a 0.1% risk of deformaties in a hypothetical fetus. I had a traumatic crash section with dd1, including a 'T' shaped incision that has left me with constant niggling pain. I also had severe SPD with dd2 which left me with a limp for 18 months. I also have said MH problems and a very low income, am already on a drug cocktail that is a really bad idea for a pregnancy, and DH has had a vasectomy. I have never had unprotected sex with anyone but DH and my ex fiance.

Dr says, because i have been sexually impulsive in the past (ie years ago me and dh had a few adventures with threesomes etc, but obv with protection etc- im not an idiot) i might suddenly run off and get pregnant.

I cant seem to get him to understand that, given all the above reasons, if i suddenly got randomly pregnant, i would have an abortion, whether or not i had the valporate to consider. And in fact controlling my condition with drugs would make it even less likely i would be sexually impulsive in the first place.

His response? 'An abortion is a big decision'. As I am still fertile, I have to go on the drug that will massively reduce my quality of life (which he accepts). I fully accept I need medication, but surely I am allowed to consent to a hypothetical abortion that i was hypothetically going to have anyway?

so we've had no sleep. too many people kicking off, setting off fire alarms etc. hope this doesnt affect my leave. i want to sleep before my case review.

I would ask to be sterilised too, in your circumstances and I think it would show commitment that you are serious about wanting to have the right medication to help you. That would take time to sort out though. Surely you could have an implant within days? I do agree that the consultant seems a bit controlling but I am sure he has seen many, many women with serious MH issues who go ahead and get PG in spite of being in a real pickle, so I sort of don't blame him for being ultra-cautious. From his point of view, (and hypothetically speaking) no-one would be able to enforce a termination on a mentally ill woman incapable of caring consistently for a baby, never mind a baby with severe deformities. It's not worth the risk.

Think offering to get sterilised is a little extreme!

The argument your Doctor has against Valproate is bullshit. All the drugs carry a risk in pregnancy. In fact probably every drug! More likely, as you said, "the Consultant likes" Quetiapine (are you in an NHS hospital by the way?).
Just play the game stick to "Valproate not Quetiapine" calmly and nicely.

yep, im in cherry knowles in sunderland.

ive just been reading the nice guidelines, and id still need blood tests on the quetiapine! so thats part of his arguement against lithiun down the drain.

i need food and sleep before i can do the conversation - ive had about five forkfuls of the food since i got here. luckily, most days ive got hold of a sandwich from my visitors, but yesterday i didnt. i tried to eat tge food but it was literally inedible. I liked the food in the hospitals where i had my babies- no idea why this place is so bad.

I've never had a quetiapine blood test and have been on between 300 and 800mg a day for years!

Why are you so keen on the valproate by the way? Have you taken it before?

Hope you've managed to get some sleep APOB, I've also got rotten memories of being in a psychiatric hospital as a volunteer. Unless I took a heavy sleeping tablet, it was impossible to get any.

And this was before t'internet was available on mobile phones. So I guess what I'm saying is, keep the dialogue open with us. I sure wish I'd have had some kind of connection outside.

As far as I was aware they dont like to use lithium anymore as it is an 'old-fashioned' drug. I too had bad experience with quitiapine, but was on valporate for a while at the age of 23-26 whilst with a partner and trying to get pregnant - my psych had no problem with this as long as I came off when I got pregnant.
Its pretty obvious to me that you are highly unlikely to get pregnant anyway! You need a second opinion and fast. Consultant needs to go back to university and learn some people skills.
Anyone in the health profession seems to think pregnancy is the scariest scenario ever there was - dig your heels in, this is your life, and you are the expert on it, not him. Repeat this to yourself when in doubt!

I've got bipolar disorder and take carbemezpine, because of this the only contraception I could take was depo. Luckily DH as had the snip due to PND and hospitalised because of it.

I was told because I was on this any pregnancy I had would have had to be terminated due to the severity of the drugs and the effects on the foetus. I have one DD so when I did get pregnant again I aborted, because of that and serious PND DH and the snip.

First and foremost, don't panic. You need to keep your points clear and well thought through, so think; is it going to help to make a list? What about showing this thread to your doctor/CPN? Do you have a contact at PALS/ close friend who will speak to the team with you?

Ask to speak to someone about longterm contraceptoin - things like mirena or nexplanon to cover you whilst on the other meds.

If you're going down the road of depot psyche drugs you could ask if it'd be practical to add a prescription of depot provera (the contraceptive injection) to your script when that's due (so effectively your CPN is remembering it for you). I think that's every 3 months, so not as often as depot psy drugs.

The PALS service are there for you, so insist on speaking to them too - they should be able to help you get the support/advocacy you need to get your points accross.

If you're looking at long-term contraception I'd have some reservations about the hormonal options - hormones made my mental health worse. But something like a copper IUD would work. I think your doctor is being a total knob and behaving appallingly. The advocate idea sounds good.

Dont have a coil this can make your depression worse

butter sounds like you are not being respected.

I think you need an advocate to say something along the lines of - I am using long term contraception - because my DH has had a vastectomy and I am not prosmiscous. Further I am prepared to be sterilised myself (could you get a coil?). Therefore I should NOT be viewed as fertile, and would like the use the most appropriate medication.

I agree, second opinion and an advocate.
I hope it all works out.

Sounds like your head is screwed on better than your consultant's! Can you not get a second opinion? Is he the only one who works there? can you change hospitals if you're only voluntarily an in-patient?
I don't know anything about getting an advocate but it sounds like a jolly good idea if being in the room with the consultant makes you tongue-tied.

:( for you that you are going through this on top of your illness - so unnecessary. And you need real food! Can no one bring you anything properly edible on a daily basis? OUtrageous that the food should be so bad.

You need an advocate as has been suggested up thread. Really sorry you are poorly x

I've been in a psych hospital a few times with bipolar too OP. My consultant was always reluctant to prescribe valporate too.

Why can't you remember to take Lithium? Or someone make sure you take it? It seems an odd reason to therefore put you on quetiapine.

I had a friend who was put on roaccutane (really heavy duty acne stuff). She had to use two forms of contraception (in her case it was having a coil fitted on top of always using condoms) and I am pretty sure she mentioned signing a pre-emptive consent to an abortion if she were to fall pregnant.

I imagine he is considering your MH issues and thinking a termination might be damaging?

I have pretty severe memory problems - eg when i was on the pill i always had to use a condom too, due to always being less than seven days from a missed dose. I completely lose chunks of the day, although im safe at the time, i just dont lay down the short term memory. So i can kinda see his point. Although dh manages to remind me to take my drugs most of the time, he dos need to watch me take it or i put it down and forget its there. Also they had to give me tranquilliser to get a blood sample on admission. So, fair enough tbh.

I dont know if im high risk somehow, but i had blood tests on the other antipsychotics. My cholestorol is high somehow, even though i hardly eat, and i have a lot of dizziness and rashes, so maybe they need to monitor that. It is in the NICE guidelines, and i was just told it is non negotiable.

I have been well both times during pregnancy and breastfeeding, then ill as soon as i introduced a bottle. Im thinking this could indicate a hormonal link, but no-one professional will even listen to my theory.

Right, dh has taken time off work, and my usual cpn will be there.
I slept at home last night, and we are going in for my case review at 3pm.

Any more arguments/advice?

We're basically going to ask which drug, regardless of circumstances, he thinks is best. If (as he has done previously) he says lithium then valporate, we will propose that, understanding his reservations about lithium, i go on valporate, at least for the time being, until we can get things in place to ensure i do take things on time. If, as we suspect, he then objects on the grounds of my being of childbearing age, we will restate our case - that i have not had sex with anyone but my husband for over two and a half years, that i have never had unprotected sex with anyone but my husband and an ex fiance, and that my pre existing health issues mean i am unable to carry a pregnancy to term so if i did somehow conceive, i would have an abortion anyway.

If he continues that line of arguement we will ask to speak to another doctor, very respectfully but firmly, as we feel that the drs moral beliefs about sexual behaviour and a woman's reproductive rights are affecting my access to the best choice of healthcare.

If they try to keep me in, i will discharge myself, and i would like to see them try to section me. It just wouldn't happen.

If we continue to have trouble, i will ask for advice from;
The Labour Party
The Fabian Society
The Fawcett Society
The local womens education centre
Mind
Rethink
Here
And my mum :)

Does that sound ok?

Oh, and PALS

OP I really sympathise. Mine gets much, much worse around the week before my period - like very extreme PMT. But my psychiatrist dismisses that too.

Your plan sounds great. Good luck.

Sounds like you have a great plan and are putting forward your points very articulately. You have a right to have a say in what meds you're on so hold your ground. I'm so glad you will have your dp with you for support.