What if my mental health gets worse in pregnancy?

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.

Contents

How likely is it that my mental illness will get worse?

Spotting early warning signs

Advance planning in case you become ill

What treatment might I have?

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.

How likely is it that my mental illness will get worse?

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.

Spotting early warning signs

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.

Advance planning in case you become ill

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.

There are two ways of doing this – with an advance decision and an advance statement.

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.’

Advance decision

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.

Advance statement

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. 

You can download an advance statement template here, which has handy tips and instructions.

Rethink Mental Illness also has information on how to make an advance decision or statement.

What treatment might I have?

If you have bipolar disorder and you decide to stop taking medication for it during pregnancy, your perinatal mental health team may suggest you start taking it again after the birth to help prevent a relapse.

If your mental illness symptoms come back or you get new symptoms, your doctor may refer you for talking therapy and support to help you build your relationship with your baby. If you’re taking mental health medication, your doctor may change the dose or give you a different type of medicine.

If you have bipolar disorder and develop severe mania, your doctor will try changing your medication first. If that doesn’t control your symptoms, they may suggest taking lithium.

If your symptoms are severe and there’s a chance you or baby could come to harm, you may be offered electroconvulsive therapy (ECT). ECT is rarely used but it can help women during pregnancy and after the birth. It is always given in hospital and involves passing a small electric current through the brain. If you need ECT, your doctor will talk to you about the risks and benefits.

If you need urgent care, your GP will refer you to a mental health professional or perinatal mental health team if you don’t already see one. You may need to go into hospital for treatment.

If your baby is under a year old, they may be able to stay with you in a mother and baby unit. You may stay in the unit for a few weeks until you’re able to manage your symptoms at home. If there’s a chance you may need to spend time in the mother and baby unit, your mental health team will give you information about the unit and you may have a chance to visit in advance.

If your baby isn’t able to stay with you for any reason, think about who would be able to look after your baby for you. If you don’t have anyone who can help, your perinatal mental health team can arrange temporary care for your baby.

More information and support

Action on Postpartum Psychosis
Information and support for women with postpartum psychosis.

Bipolar UK
Includes information on pregnancy and childbirth. Has a mood diary to help you spot changes in your mood.

Mind
Provides support and advice for anyone experiencing mental illness.

Rethink Mental Illness
Provides information and has a network of local groups and services for people severely affected by mental illness.

Sources

[1] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

[2] Chisolm MS, Payne JL. (2015) Management of psychotropic drugs during pregnancy. BMJ 351: h5918.

[3] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[4] Taylor C et al. (2018) Predictors of severe relapse in pregnant women with psychotic or bipolar disorders. Journal of Psychiatric Research 104: 100–107.

[5] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[6] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

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

[8] Royal College of Obstetricians and Gynaecologists (2011) Management of Women with Mental Health Issues during Pregnancy and the Postnatal Period. Good practice No.14.

[9] National Institute for Health and Care Excellence (2011, updated 2019) Caesarean section

Clinical guideline [CG132]: Information for the public. Your care. www.nice.org.uk/guidance/cg132/ifp/chapter/Your-care

[10] Scottish Intercollegiate Guidelines Network (2012) Management of perinatal mood disorders. SIGN publication no. 127.

[11] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[12] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[13] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[14] Scottish Intercollegiate Guidelines Network (2012) Management of perinatal mood disorders. SIGN publication no. 127.

[15] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[16] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

Hide details

More information on this topic

More support for you

Thinking ahead

    Was this information useful?

    Yes No

    Comments

    Please note that these comments are monitored but not answered by Tommy’s. Please call your GP or maternity unit if you have concerns about your health or your baby’s health.

    Your comment

    Add new comment