5 top things to think about

The 5 most important things you could do before you get pregnant if you are managing a serious mental illness and are planning a pregnancy

Planning a pregnancy is exciting and takes time and thought for everyone involved. If you are managing a serious mental illness, you will have the same things to think about as anyone else, like finances and childcare, but you might need more time to make sure you are as healthy as you can be and that you have the support you need.

These are 5 top things to think about before you get pregnant. Even if you’re already pregnant, these things are still important. Speak to your GP as soon as possible to talk through your options.

1 Keep taking your medication until you’ve talked to a health professional

Sometimes women think they should stop taking medication when they start trying for a baby, but if you stop your medication suddenly, your mental illness symptoms could come back or get worse.

Ask your GP to refer you to a psychiatrist or a mental health professional who specialises in pregnancy (called a perinatal mental health professional). They will help you find a treatment that is right for you during pregnancy.

If you need to change the dose or type of your medication, you may need time to do this gradually before you start trying to get pregnant. It may feel strange to take contraception when you know you want to get pregnant but it’s important to take time to work out the right medication with health professionals before you get pregnant.

If you’re already pregnant, tell your GP or perinatal mental health team as soon as possible. They will explain the possible risks and benefits of your medication and help you decide on the best treatment for you.

Read more about managing your medication during and after pregnancy.

2 Give up substances that could harm you and your baby

Taking drugs, smoking and drinking alcohol can make it harder to get pregnant. They also contain harmful chemicals that cross the placenta to your baby. It’s important to stop before you get pregnant. If you’re already pregnant you can still increase the chances of a healthy pregnancy if you stop smoking, drinking or taking drugs.

For some women though, it’s harder to stop. There’s a lot of support out there – and it really helps. People who get support are 3 times more likely to quit smoking, for example.

Check out this great NHS free personalised quit plan.

Your GP can also tell you about services in your area. Or you can talk to a doctor or nurse at your local contraceptive clinic or youth clinic. If you already have children, you could speak to your health visitor, family nurse or parenting support worker.

You can also contact some services yourself. There are links to specialist support services at the bottom of this page.

If you have a supportive family or partner, they can help you by going with you to your appointments. Your doctor can also give them ideas for how to support you.

The important thing is to give up safely and with help from your doctor if possible.

3 Be as healthy as possible: physically and mentally

Looking after your health will give you the best possible chance of getting pregnant and having a healthy pregnancy. You can do this by:

Make sure you have talked to a health professional if you have any other health problems, such as diabetes or epilepsy. Your GP can refer you to a specialist who can give you advice on treatment before, during and after pregnancy.

4 Think about what support you might need

Everyone does better when they have support during and after pregnancy, but if you have a mental illness you may need extra support. Your psychiatrist or perinatal mental health team can help you plan what emotional and physical support you may need during and after pregnancy.

At 30-32 weeks of pregnancy you may have a pre-birth planning meeting with the health professionals who will be looking after you. At this meeting, you can agree a care plan for the rest of your pregnancy, the birth and after your baby is born. You will be given a copy of your care plan to keep.The care plan is different from your birth plan, which is where you plan out in advance what your wishes are during labour and birth.

Think about who you could ask if you needed someone to talk to. Do you have a partner, family member or friend you can turn to if you feel you’re not coping or if your symptoms come back or get worse?

You can speak to your GP, perinatal mental health professional, midwife, health visitor or family nurse at any time if you’re worried your mental health symptoms may be getting worse.

There are also organisations and online communities for support around wellbeing.

5 Know your early warning signs of relapse and share them with those around you

Nobody knows your warning signs of relapse better than you and those you are closest to. If you do notice signs of a relapse, it’s important to get help as soon as possible. It can and will be treated, just like any other illness.

Your midwife and perinatal mental health team will ask you about your mental health at each appointment.

If you have bipolar disorder, a relapse can happen more quickly in the days after childbirth and can be more serious than at other times. Your perinatal mental health team will watch closely for any symptoms in the first few days and weeks and treat them quickly if they come back.

You may want to write an advance decision or advance statement. This lets others know your wishes if you’re not well enough to make decisions during a relapse. For example, you could put in:

  • who you would like to look after your baby and other children if you have them
  • what care you would like to receive
  • which treatments you don’t want to have.

More information and support

NHS stop smoking services

England

Wales

Northern Ireland

Scotland

Drug and alcohol support

Adfam

We are with you

Frank

Support during and after pregnancy

Sure Start in England

Sure Start in Northern Ireland

NHS Direct Wales

Ready Steady Baby in Scotland

More information on this topic

More support for you

Thinking ahead

Sources

[1] National Institute for Health and Care Excellence (2013, updated 2017) Fertility problems: assessment and treatment. Clinical guideline [CG156]

[2] Clinical Guidelines on Drug Misuse and Dependence Update 2017 Independent Expert Working Group (2017) Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health

[3] National Institute for Health and Care Excellence (2011) Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. Clinical guideline [CG120]

[4] National Institute for Health and Care Excellence (2013, updated 2017) Fertility problems: assessment and treatment. Clinical guideline [CG156]

[5] Judith Stephenson, Nicola Heslehurst et al (2018) Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health The Lancet, Vol. 391, No. 10132.

[6] National Institute for Health and Care Excellence (2019) Clinical Knowledge Summary. Pre-conception - advice and management https://cks.nice.org.uk/pre-conception-advice-and-management#!scenarioRecommendation:12

[7] National Institute for Health and Care Excellence (2019) Clinical Knowledge Summary. Bipolar disorder. Scenario: Women of childbearing age. https://cks.nice.org.uk/bipolar-disorder#!scenario:3

[8] Pan-London Perinatal Mental Health Networks (2019) Pre-birth planning: Best Practice Toolkit for Perinatal Mental Health Services.

[1] Yonkers KA, Vigod S, Ross LE. (2011) Diagnosis, Pathophysiology, and Management of Mood Disorders in Pregnant and Postpartum Women. Obstetrics & Gynecology 117(4): 961-977.

[2] Darwin Z et al. (2020) Involving and supporting partners and other family members in specialist perinatal mental health services: Good practice guide. Unpublished.

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