Many women with a severe mental illness have no issues in pregnancy but there is a higher chance that your mental illness will come back or get worse at this time than at other times of your life.
Spotting and treating it early if it happens is very important. Symptoms of severe mental illness can appear suddenly during pregnancy and in the first few weeks or months after the birth so it’s important for you and others around you to know what the signs are and to look out for them
When you feel well, it’s easy to think nothing will go wrong but making plans now just in case your mental health gets worse is a good idea.
It can help you make sure you get the care and support you need before and after the birth.
There is a chance that your mental illness could come back or you could get new symptoms.
This may be more likely if:
- you stop taking your mental health medication (but it can also happen if you continue taking your medication)
- you have bipolar disorder – your symptoms may come back after the birth and there is a risk of developing postpartum psychosis, which is a severe illness that needs treating straight away
- you have had postpartum psychosis in the past
- you have schizophrenia or another psychotic illness.
Keeping a mood diary can help you spot any changes in your mood. Bipolar UK has a mood diary here that you can use.
Your family and friends can help you spot any changes to your mental health if you let them know what symptoms to look out for.
If you notice any changes in your mood or mental health, speak to your GP or perinatal mental health team. It’s important to get treatment quickly to reduce the risk of harm to you and your baby.
The health professionals looking after you will check what support you have at home. They may offer you treatment or change the treatment you’re currently taking.
It’s important to plan ahead because symptoms of some mental illnesses, such as postpartum psychosis, can come on suddenly.
‘The perinatal psychiatrist talked us through all the possibilities and the worries and that was excellent. That reassured us and gave us an idea of what we need to do and which way to go’.
‘We did a care plan and I was very happy with [it] ...in the care plan we made sure that if something happens we all know what to do’.
Your perinatal mental health team, midwife or health visitor can help you make a plan for what will happen if your mental health worsens. They can tell you what support would be available to you.
If there’s a chance of your mental illness returning after the birth, you may have a pre-birth planning meeting at 30-32 weeks of pregnancy.
This will help you and the health professionals looking after you plan what care you may need before and after the birth. It’s also a chance to make sure you have the support you need at home. You can take your partner, a family member or friend to the meeting if you would like to.
Advance care planning
While you’re feeling well, you can say what treatment and care you would or wouldn’t like to receive during pregnancy and childbirth if your mental illness means you can’t make decisions at the time.
You can also say whether you want your partner or family to make decisions for you if you’re not able to.
Advance care planning can help you feel in control of what happens to you if you become unwell. It can also help your loved ones be confident that they are following your wishes while you recover.
‘We now have a care plan, and I’m really grateful for the perinatal psychiatrist’s summary, which is incredibly clear. I’ve been able to give that to the midwife, a copy’s gone to my GP and a copy’s gone to the community mental health team. So I now feel like everybody’s singing from the same hymn sheet.’
An advance decision lists any treatments you don’t want to have. This could include procedures, such as c-sections. It’s a good idea to write down your advance decision and ask your doctor to sign it.
Health professionals must take your wishes into account by law but they may be able to give you treatment you don’t want if it is an emergency.
- An advanced decision is a document to state which treatments you want to refuse in the future.
- An advanced decision is sometimes known as an ‘advance directive’ or a ‘living will’.
- An advance decision is legally binding.
You need to be over the age of 18 to make an advance decision.
An advance statement allows you to say what care you would like to receive. This can also include the care your baby receives. For example, if you need hospital treatment and aren’t able to stay in a mother and baby unit, an advance statement can say who you want to look after your baby.
An advance statement isn’t legally binding but health professionals should take it into account.
You can make an advance decision or statement at any time before or during pregnancy as long as you have mental capacity.
You will be making decisions about things that may not happen to you. But knowing that your wishes will be taken into account can help put your mind at rest. If you want to, you can ask your doctor to sign the decision or statement. You can then keep a copy and give copies to members of your healthcare team.
- You can use an advance statement to say who you would like to manage your affairs, such as paying bills or looking after children.
- Doctors should follow your advance statement. Though there is no legal obligation too.
Bipolar UK have a video showing a couple, Jenny and Henry, talking about their experience of bipolar disorder. Towards the end of this video, they explain why they made an advance statement.