I have changed Psychiatrist as part of an NHS reshuffle (read-money saving attempt). My meeting with the new doctor seems to have highlighted some issues with the old one. As I had already thought I should have been referred to the Perinatal Mental Health team at the beginning of my pregnancy so that they could cover my care, liase with midwives and consultants to ensure I stay well both during and after my pregnancy. Apparently they have been awaiting a referral from my previous Consultant that never materialised. Unfortunately if you have ever accessed mental health services, this won't come as much of a surprise. I have slipped through the net many times, in fact would likely have been diagnosed a year earlier had another NHS reshuffle led to a referral being lost.
However, this meeting at 32 week pregnant has thrown me into a bit of emotional turmoil. My new Psychiatrist has outlined (as should have been the case) the risk factors and dangers of pregnancy and postnatal for women with Bipolar. We have a 40-70% chance of relapse in the first 12 weeks. This could be either mania or depression, added to this a 1 in 2 chance of developing puerperal psychosis (this is compared to a 1 in 500-1000 chance in women without a history of Bipolar). These are scary statistics. The depression experienced postnatally by women with Bipolar has a much more rapid onset than postnatal depression, and more frequently leads to suicide. Mania is very common in postnatal women due to sleep deprivation and is very much more disruptive and dangerous than depression. Psychosis is the scariest. A complete block from reality, hallucinations, believing that your baby or family are in some way dangerous to you.
My appointment involved a discussion of all these, and a worst case scenario outline of what might happen (admittance to a mother and baby unit, psychiatric ward, crisis care team). Explained in the first trimester it may have been easier to here. With eight weeks to go it has left in a some what emotional state of anxiety. I will write a postnatal plan with the Perinatal team, which will be shared with all my carers. This will involve plans for all eventualialities and how the postnatal period will be managed. Top of this list is the question of medication. I have taken lithium for nearly two years before this pregnancy, an anti-psychotic drug that works very well in Bipolar, but no one knows why or how. I have been stable and functioning. But it is not compatible with breastfeeding, it is a metal and harmful substance that can casue serious damage to liver, kidney and thyroid. It takes six to eight weeks to work as the levels are based on individual's metabolism. I have some difficult decisions to make. I want to breastfeed, I want to be able to feed my baby and do what my body was designed for. My medical team want me to formula feed and take medication from the outset. For me it feels like another way that this condition has impacted me and at best seems unfair at worst has made me sob with grief at having this taken away from me.
Mental health in pregnant and postnatal women is still a very much neglected area of medicine. Some NHS trusts do not have any dedicated mother and baby units, Perinatal teams or specialists midwives. And yet suicide is the biggest cause of maternal death in the UK. Women are twenty times more likely to be admitted to a psychiatric unit in the 12 weeks following birth, than in the two years before or after. The last few weeks of my pregnancy are likely to be filled with medical appointments, care plans and anxiety. I want to be well, look after my baby, have happy memories of becoming a family of four. But overshadowing this is a long list statistics and possibilities of what might happen.
