Bipolar and Pregnant

[Goingtobeafirsttimemum]

I have bipolar affective disorder and OCD and am currently pregnant this is my first pregnancy. I am absolutely terrified of getting postpartum psychosis or to enter a manic episode after I give birth my perinatal team want me to go to a mother and baby unit as a preventative measure just in case something was to happen but I really don’t want to go I just want to go home with my baby but if I say no will that make things harder for me? i don't quite know what I’m asking I’m just so scared of what could possibly happen. I also have a family history with my mum having schizophrenia and having had postpartum psychosis twice herself. Is there anything I can do to prevent this from happening. I understand that with my diagnosis and my family history I stand a higher chance of developing it.

There is a high chance but somehow there is also a possibility of none of these happening so think positive and your thoughts would definitely predict your behavior in future.

Is there a reason they want a preventive admission?
Do you have support in the community?

I have bipolar and have had 2 children. I did develop severe pnd with depression with my daughter. I was almost admitted to an mbu when she was 10 weeks when I was psychotic and believed she wasn't real and wasn't mine. I was able to stay at home with some extra support in the community. The psychosis improved for a while but the depression remained. The psychosis became challenging again and I believed she wasn't mine/ had been swapped and the depression was classed as treatment resistant. I went into a mbu when she was 10 months for 10 weeks. I went on high doses lithium and this helped the psychosis and moved my depression from severe to moderate. It took another year to get back to me

It was a lot and really hard and she was 3 before we could even consider a second. My daughter had challenges after birth which my team have felt fed into the psychosis.

I had my second a year ago and I have developed depression again but no psychosis and I've not needed an mbu admission. Medication hasn't been super helpful in that there hasn't been a significant boost in my mood but it has stayed in the border of moderate and severe and I can mostly cope with life

What support do you have? Partner, mum, friends? Has a social worker referral been made?
As a social worker who has worked with babies and mums where mental health has taken a bad turn, I would say please take the advice and recommendations of your team. Of course you would prefer to go home after birth but I'm sure you'd prefer not to have OCD and bipolar but those are the cards you're unfortunately dealt so you have to adapt.

Just to add I stayed on medication through my pregnancies (quetiapine) and was able to breastfeed my daughter until 10 months when I went on lithium and I'm still breastfeeding my second on quetiapine, mirtazapine and venlafaxine. I would have to stop if I went back on lithium. I came off lithium when trying to conceive my second due to issues with development in the first trimester but the plan was to restart lithium in my third trimester should I have needed but I didn't.

Support wise, I was under the perinatal mental team from about 30 weeks and was assigned a cpn and saw my psychiatrist every 2-3 weeks, I had access to mental health midwives, and was under consultant care with specialist in mental health with my first pregnancy and jointly under this consultant and a different one for physical issues with my second. I've never had social worker nor any involvement with social services.

To reduce the risk of postpartum episodes in the days after birth they put a birth plan in place where I was prioritised for a separate room so that I wouldn't be impacted less by other babies crying and I could get better sleep, my partner would also have been able to stay although other circumstances meant both times that he couldn't. I was in hospital for 3 days after the birth and had the full 28 day support from the midwives after birth and extra support from my HV, with my daughter I saw her every 2 weeks until 5-6 months then once a month. I saw her more frequently with my son until about 3 months when it looked like things were more stable.

The biggest risk for postpartum psychosis is in the first week, although with my daughter it was about 3 weeks afterwards but it wasn't until 10 weeks that the symptoms became apparent to others