Colleague with horrendous PND already pregnant again...why?

[BlueOysterCult]

Found out today that my colleague who had HORRENDOUS post natal depression (baby is currently 11 months old) has intentionally got pregnant again. Her PND was so bad that she had to have specialist treatment from various mental health services and relied very very heavily on her parents for support in day to day tasks. Her husband works away for weeks at a time and she's made it really clear she struggles with loneliness and the stress of having to look after her son. I just can't fathom why she'd want to do it all again so soon when she is finding it so tough already.

It is none of my business and I'll be nothing but supportive to her but I just keep thinking what the actual F?! I can't wrap my head around her thought process. Surely give it a year or so until things are calmer and see how you feel about going for number two?

None of your business

I once overheard a woman I was 'friends' with make a similar comment about a woman who had PND who fell pregnant again

'She could not handle having a baby'

I have never been more disgusted in my life

This would concern me also. Not from a work perspective though, that will sort itself out. Mental health services can be so lacking. I hope she has all the support she needs, and that all goes well for her and her family

I had horrendous sickness (never diagnosed as I was dismissed by my GP), ended up with pre-eclampsia and a traumatic induction. Could never face doing it again, and got a lot of comments along the lines of 'You can't let a bad experience stop you' and 'it would be different next time'.

Basically, whatever a woman chooses she'll probably get unhelpful comments from others.

OP, it doesn't look like your are being judgmental,at all! Ignore the snide comments from all the "none of your business" posters. You are curious as to why she would do this. I would be too. If you understand her reasoning then maybe you can be more supportive.
It could be that she feels she absolutely has to have more than one kid or it could be that she literally isn't think straight. Maybe it was a mistake pregnancy but she doesn't want to tell people.
I don't think it's possible to guess though and you;can't ask obviously.

TBH I'm less surprised that she would have another baby than the fact that her husband would go along with it.

Maybe she wants 2 children, but didn’t want to go through months of therapy, make a full recovery and then risk being back to square one, so thought well I’ll just have the 2nd, be done with it, and then have all the therapy and recovery all together.

This probably.

Its like asking why do people have a second child after HG- they want another child! It might or might not happen again, but I’m not sure it means they shouldn’t have another child.

The voting doesn't match the comments here. I have voted that you are being unreasonable. Because you are. Full stop.

Hmm. None of your business really is it. The same way it was none of my managers business that I could not have children, but she still took delight in gossiping about it.

@herejustforthisone

Apologies, I forgot how people on Mumsnet like to twist what other posters say.
I was specifically referring to people saying it is 'none of the OP's business'. While the contents of this woman's uterus is indeed none of OP's business, if she knows a colleagues personal circumstances may have an impact on her work - work that she may well have to cover - then she IS allowed to have an opinion on it and, thus, makes it her business.

So I had quite bad PND with my first and went on to have a second quite quickly. Logistically because I knew I wanted two and wanted them to be close in age but actually as soon as my body started producing the happy pregnancy hormones again, the PND seemed to go away overnight. I remember noting it to the midwife who suggested your body might also be 'aware' of that and be keen to get the oxytocin flowing again!

This sort of judgement is exactly why, after my second baby died, we didn't tell anyone I was pregnant with our third baby. "Why are you doing it to yourself?" etc.

She died too and I can't take planning another baby funeral, so we're not trying again.

The hormonal urge to have children can be very strong. And when infertility, pregnancy loss and baby loss in involved it can be almost unbearable. Birth trauma can be the same. The need to make it feel right. And I imagine it may feel similar when faced with PND and the grief around a baby's early years if you suffered.

This sort of judgement is exactly why, after my second baby died, we didn't tell anyone I was pregnant with our third baby. "Why are you doing it to yourself?" etc.

That's a very different scenario and I'm sorry for your losses. I'd never question someone who tried for another after losing their baby. I would (silently) question someone like the OPs colleague. I know two people who were destroyed by post natal depression. The first threw herself off a multi-storey car park when her second baby in 2 years was only 7 months old. The second threw herself in front of a train when her only daughter was 5. The second woman has never recovered from her PND and despite her husband pleading for help, she died just hours after being discharged by the crisis team. They very sternly told her husband that she should be allowed to take the train to her parents for time away (she said she'd be fine if they'd just let her go there). He watched her get on the train, she got off two stops later and waited for the next one.

I also had GD and apart from watching my diet carefully, doing more exercise and taking insulin by the end, there was little impact on me. A few extra scans, yeah they were bit of a pain I suppose. And since the day of my DC’s birth the only impact on me has been an annual Hb1ac test.

Zero impacts on my daughter from diagnosed and controlled GD.

It’s nothing like the impact of severe PND on mother or baby.

That is YOUR experience of GD which (by your own admission) was controlled.

For both GD and PND, there is a sliding scale of severity and the impact on the mother and baby varies according to severity.

I work with women with PND for a living and the overwhelming majority are treated with the appropriate therapies + medication and go on to make full recoveries. Many have subsequent children - as a result of much better awareness, they rarely ever get as bad second time as they know what to look for and our services are involved much sooner (particularly in the severe cases).

Despite having worked in the field for the past 5 years, I am yet to experience any woman I have worked with take their life as @chilliesandspices has described. I have naturally studied as part of risk management and am fully aware of warning signs but it is certainly nowhere near as common as the PP is making out

This depends on the person. I had PND and it was absolutely awful - dreadful. Robbed me of so much, including many happy memories with my son. I wouldn’t risk going through that again, no way. The need to have another child could never trump that.

But that’s me: others are different.

Indeed, that's your experience of GD and the only thing it shows is that you were very lucky to have it so light. For most women, diet isn't a sufficient measure because the underlying issue is hormonal and for women who were already eating well, a good diet won't stop GD and medication is necessary. Not to mention the fact that monitoring is required regardless. Side effects on medication are obviously something you wouldn't know much about, again, count yourself lucky. And don't forget that if you're planning more children, an early onset of GD is very likely unfortunately and regardless you have a 1 in 2 chance of developing diabetes type 2 within 10 to 15 years off GD so you need to be mindful of your diet even if you didn't suffer much in pregnancy.

I work with many who have the same opinion as you too. Sometimes they change their mind as time passes, some choose not to take the risk. There is no right or wrong and it is a very personal decision.

When discharging, I always advise that women know how to access perinatal mental health services before they try again and seek referral/support in pregnancy, long before they get unwell.

Despite having worked in the field for the past 5 years, I am yet to experience any woman I have worked with take their life as @chilliesandspices has described. I have naturally studied as part of risk management and am fully aware of warning signs but it is certainly nowhere near as common as the PP is making out

I'm not saying it's common but I know of those women through working in clinical negligence. They happened within 4 years of each other. Their families were destroyed and it's enough to make me think it's a huge risk to try again.

So rather than knowing two women, you know of two women who have taken their life when experiencing severe PND. That makes a lot more sense as it is extremely rare and the extensive risk training we go through as perinatal clinicians is so we can pick up on the more vulnerable women and provide support and interventions (which include placement in a mother and baby unit for those at highest risk)

As I said, every single case is different and so it each woman's perspective on trying again or not. Support is easier second time as is spotting if becoming unwell. It is not our or OP's place to judge as we don't know the full circumstances

I feel like the whole debate about whether women will kill themselves is a bit of a red herring. The damage done to children is documented and researched, and it’s real. If it happens once, it’s a tragedy for all concerned, no blame or judgement. The second (or third, fourth, whatever) time, it’s an act of pure selfishness.

Oh absolutely @LaLoba and this is something we discuss in depth with women under our care; we spend a lot of time considering the impact of untreated mental health condition on their unborn and existing children and have a specialist pharmacist who has consultations with all women to help weigh this up against antidepressant treatment and its risks. Naturally, they also want to do everything in their power to protect their baby and children too.

It is very easy for us to judge and say that it is complete selfishness. For some people, we can't underestimate how strong that urge is to 'do it right' when things didn't go well the first time. It is also important to remember that the mind does block out the worst of it, the same way it can do for a difficult pregnancy or traumatic delivery

Maybe it was the lesser evil than going back to work.

I do agree that it sounds like a batshit plan, OP.

So rather than knowing two women, you know of two women who have taken their life when experiencing severe PND. That makes a lot more sense as it is extremely rare and the extensive risk training we go through as perinatal clinicians is so we can pick up on the more vulnerable women and provide support and interventions (which include placement in a mother and baby unit for those at highest risk)

Apologies for my English though you could say that after several years it does feel like we know them rather than of them. Sadly despite what you say, they were completely failed by the extensive risk training their clinicians underwent.

Sorry @morechocolateneededtoday realised that was more snippy than intended. I'm not suggesting help from clinicians isn't enough. My point is more that for severe PND it can fail and the consequences are awful. We need to acknowledge that.

I had shocking PND and SPD and tore badly. I won't be having any more because I'm not doing that to my body again. So I completely understand your WTF thinking about her situation. I guess if it's a planned pregnancy she's weighed up whether it's worth risking it again and decided it is. Her choice but no I wouldn't do it and yes sounds like total madness!

No offence taken @chilliesandspices, sadly clinicians don't get it right every time and teams like crisis in particular are really overstretched. I clearly remember one case where I did not agree with the decision to discharge but the consultant insisted and the patient took their own life (not perinatal, adult MH). It is a horrible situation and stays with you forever

As someone who works in perinatal now, I feel we are so much better at the multidisciplinary approach and the national plans have resulted in our staff numbers more than doubling since 2020. We study cases like those you were involved with as part of risk training to make sure it does not repeat and in my case, if I am ever unsure of risk, I will always get a second opinion from my team

Having worked with women in similar situations so much, I don't feel we can judge their decisions. It is impossible to know exactly how they feel and it is so easy in our minds to say that it is crazy. When I first started in the field, I would see women who had severe postpartum psychosis (extended hospital admissions, often separated from their baby due to how unwell they were) and wonder how they could ever consider having more children but that urge to get it right is so so strong. They want to have the experience everyone else does and that is why many do try again. There are other reasons too but it took me a little while before I fully understood it.