Women who have a history of mental health problems will be able to have children. Sometimes they will need to have extra support and monitoring in pregnancy and after birth to make sure they remain well and that any recurrence of illness is picked up quickly and treated properly. There are links between maternity services, mental health services and GP practices to make sure that women who are at risk of becoming unwell get the best advice about treatment. It is advised that if you are planning to become pregnant you should discuss current medication with your GP or Consultant Psychiatrist as this may be required to be altered.
Many women will have treatment for a mental health problem before they have to decide whether or not they want to have children. In most cases they will recover well, although occasionally their treatment needs to be continued for a considerable time, and maybe long term. This should be discussed with you and explained by a Consultant Psychiatrist along with advice regarding future pregnancy.
After a pregnancy is confirmed, all women are asked routinely about their medical history when they are first booked in for maternity care. These questions include details about any previous mental health problems. There will also be questions about a possible family history of serious mental illness. It is important to get this history in order to plan for the best treatment in pregnancy and after birth. Having a previous history and/or a family history of mental illness may increase the risk of becoming unwell in pregnancy and after birth. This is particularly the case for mood disorders (depression and bipolar disorder).
This is a very straightforward and important question. Unfortunately there isn’t a simple answer!
It is always important to think about the possible effect that any medication taken by a pregnant woman may have on an unborn baby. This includes drugs that are used to treat mental illness. A few drugs are known to be very risky, and these need to be avoided if at all possible; refer to SIGN 127(2012) for further information. However, in most cases medication is probably fairly safe to take in pregnancy, although there may be some concerns about possible consequences. Unfortunately we usually do not have definite information about the risks associated with particular drugs, because it is difficult to carry out research studies on pregnant women. However lots of useful information about individual drugs taken in pregnancy is available. Discuss with your GP who can either take advice from a Specialist Perinatal Consultant Psychiatrist or if required refer you to mental health services. SIGN Guidelines
It is also important that a pregnant woman is as healthy as possible during pregnancy, both for herself and for the wellbeing and development of her own baby. This may mean that the woman would benefit from taking treatment during pregnancy. In these situations, it is a question of balancing risks between taking and not taking treatment. There is usually not one “right answer”
All medication that is taken for mental health problems by pregnant women will pass into the unborn baby’s bloodstream. There are a few drugs that are known to have definite risks for the developing baby and are therefore best avoided. Some drugs may affect the baby’s very early development, or increase the risk of complications at birth. However, in most cases it is possible to take drug treatment in pregnancy. This includes antidepressants.
It is always important to seek advice about drug treatment in pregnancy from a GP or a specialist. It is often useful to have this discussion when planning a pregnancy if you are already receiving drug treatment. This is because medication may have the biggest effect in the first three months of pregnancy (sometimes called the ‘first trimester’) when the baby is going through very rapid development. The pregnancy will have already started for at least six weeks before a woman knows she is pregnant.
There is information available about the possible risks of all drugs when taken in pregnancy. A doctor can give this information, and can have a discussion to come up with the best plan for each individual woman. It will be important also to have arrangements in place to monitor the pregnant woman’s health during pregnancy and after birth, and to check on the baby’s development.
Postnatal depression is a common condition that affects many women in the weeks and months after birth. Women who are affected by postnatal depression experience very low mood and cannot enjoy things that would usually bring pleasure. They may also be anxious and irritable. The depression is more prolonged, unlike the ‘baby blues’ which happen in the few days after birth and pass within a week or two.
The mood changes in postnatal depression are different from how a woman normally feels. They are accompanied by pessimistic thoughts. In extreme cases these thoughts can be irrational. It is not unusual for depressed mothers to feel useless and hopeless, questioning their ability to care for their baby. There may be suicidal thoughts.
Depressed mothers will often experience disturbance in their sleep, appetite, and concentration alongside the changes in their mood and thinking. They may struggle to cope with tasks and situations that they would usually manage without difficulty. This can lead to frustration and self- blame, preventing some women from disclosing that they are struggling for fear of being judged as a ‘bad mother’; rather than seeing this as an illness.
There is no one reason why women are more likely to get depressed soon after childbirth. Hormones may be an important factor, especially as there are very big changes in the levels of particular hormones after birth. Childbirth is also a very major event for every woman, which involves huge changes and responsibilities.
Some women may be at particular risk of getting mood disorder. This may be because they have an inherited vulnerability to being depressed. Sometimes they have had very bad experiences in their own childhood. They may also have had significant stress in the more recent past. Women may also be particularly vulnerable to getting depressed after birth if they do not have adequate practical and emotional support.
In the first place is very important to detect postnatal depression. Depressed mothers are often embarrassed or ashamed about being depressed, and so they understandably try to cover up how badly they feel.
Depression will usually recover by itself, but this can take many weeks or months. In the meantime, the symptoms of depression are very unpleasant. They also get in the way of the developing relationship between the mother and her new baby. There are very effective treatments available for postnatal depression. These include medication and psychological therapies. It is important also that adequate support is given, not only from professionals but from family and friends to make sure that the mother can manage while she is recovering, and that she and her baby are safe.
Occasionally there are significant risks if a mother has suicidal thoughts. These are very frightening and the woman should talk about how she feels so that the appropriate treatment can be offered, this may be additional support from mental health services. Very occasionally it is helpful for treatment to be given in hospital. If admission is required this should be to a Specialist Mother & Baby Mental health Unit, there are two six bedded MBUs in Scotland available where a mother can be with her baby in hospital with other mothers while she recovers.
Many people worry a great deal about having a diagnosis of mental illness. There are lots of misunderstandings about mental disorder, and this makes it difficult for people to tell others when they are struggling, and to seek help from mental health professionals.
Coping with the stigma of mental illness is particularly difficult for pregnant women and mothers of young babies. Mental illness is just as common in pregnancy as at any other time in a woman’s life, and perhaps more common in the weeks and months after birth. These are times when it is particularly important to get help. If your blood pressure was raised during pregnancy you would seek treatment, we all have mental health and like other systems in our body it can go wrong during pregnancy and make us feel unwell. At the same time women at these times understandably worry that they will be judged or criticised if they tell others that they are not managing to cope. It is also common to worry that their baby will be taken away if they are seen to have a mental health problem.
All health professionals aim to help parents be as well as possible and to be able to care for their children. Doctors and nurses are given training in child protection, and will always try and make sure that the children of any patients they see are safe and secure. Children are much more likely to be properly looked after when their mothers get good treatment for their mental health problems.
Occasionally a mother is so unwell that she is unable to care for her baby by herself. The first plan then is to try and find ways of supporting her by getting extra help from family and friends. There are also a number of social care agencies who can also offer support. When this is required, a social worker is often the best person to assess these needs and to organise the additional support to allow the mother to remain the main carer for her baby.
Sometimes these attempts to help a mother manage the care of her baby don’t work. In these circumstances it is possible for the baby to be looked after by other family members or by foster parents while the mother recovers. Very rarely a mother cannot recover enough to care for her baby, and in these circumstances other arrangements need to be made to make sure the baby is safe and secure. Any plans for a baby to be looked after by others are only taken after lots of discussion with everyone involved. The mother and other family members will be included. They will have lots of opportunities to ask questions and to challenge any decisions if they do not agree with the plans that are made to care for the child.