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Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study, British Journal of Psychiatry, 2022. Statement from Action on Postpartum Psychosis (APP)

APP has long campaigned for women affected by postpartum psychosis (PP) to have access to a Mother and Baby Unit (MBU). MBUs are essential places of care for new mums experiencing severe postnatal mental illness. In our charity, we hear daily of the importance of MBUs to mothers; and we hear the devastating consequences of such units not existing. Our own research demonstrates the value of such units.

We urge readers of the above paper to bear in mind several methodological limitations when drawing conclusions regarding outcomes and cost effectiveness of MBUs. These limitations, many of which reflect common challenges of conducting controlled trials in this area of service provision, are carefully laid out by the authors themselves in the final section of the paper.

Comparison group used: Because of the nature of severe postnatal illness, it is difficult to recruit large samples for controlled trials. As it would be unethical to deny a woman MBU admission where space was available, a naturalistic study design was used. Due to the small sample, women with admission to General Psychiatric Units (GPU) were grouped with those who received Home Treatment. This combined group was then compared to MBU admission. The authors explain that this grouping may have limitations, with the Home Treatment group potentially masking differences in outcomes between MBU care and GPU care. Women are admitted to hospital normally because they have been deemed unsuitable for Home Treatment: Home Treatment would be unsuitable for almost all cases of postpartum psychosis because of the risks for mother and baby. The paper shows differences between the Home Treatment group and those who become inpatients – in particular, that women with severe and relapsing mental illness are under-represented in the Home Treatment sample. Probably, a better comparison to determine the clinical and cost effectiveness of MBUs would be to exclude Home Treatment, and compare MBU vs GPU admission. When examined separately, rates of readmission in the current study were in the expected direction (22% MBUs, 32% GPU, 21% Home Treatment).

Outcome measure used: There are several reasons why a 12 month relapse may not be a useful outcome measure to determine the effectiveness of MBUs: Firstly, MBUs have a lower threshold for readmission than General Psychiatric Units and so women are more likely to be readmitted; Secondly, with episodes of postpartum psychosis and bipolar episodes triggered by pregnancy, relapses are common and the expected illness course, rather than an indicator of quality of care; Thirdly, women who are admitted to MBUs are willing to be readmitted if they are struggling with their mental health, whereas, we know all too well in APP, if a woman experiences the trauma of separation from her baby during admission to a non-specialist psychiatric unit, she will fight with all her power not to return.

Cost-effectiveness: Some of the outcome measures have been criticised for not being responsive to change in mental health (1,2). The authors have tried to include many of the hidden costs associated with GPU admission, at least up to the month following discharge. Attempts have been made to include services such as midwives, health visitors, social workers, services provided to the father or co-parent, general practice visits, psychological services, physical health checks and services for the baby that would be integral to MBU care, but whose costs would be born elsewhere in the health service during GPU admission. Other costs may occur later; there might be costs that are not considered; and the quality of the services provided (where no specialist perinatal links or training exists) cannot be compared.

The personal stories of mothers who have experienced GPU admission show many other hidden economic costs that may occur after the end of the study period - for example, counselling to come to terms with the trauma of the experience and mandatory separation from their baby; legal aid for women fighting to regain custody of their children after recovery; fathers’ and co-parents’ lost jobs and financial hardship when they and wider family put employment on hold to look after the baby.

The value of MBUs: Consistent with findings from our own work, this study finds women are much more satisfied when admitted to MBU versus a GPU or Home Treatment. If rates of readmission at 12 months are somewhat similar, what is it that postnatal women value about MBU care? The satisfaction scale asks questions such as: “To what extent did the service meet your needs?” and “If you were to need similar help again, would you be willing to come back to this service?”

An APP survey in 2010 of 218 women with PP found not only were women more satisfied, they felt safer, more informed about their illness, more confident in staff, more supported with recovery, more fully recovery at discharge, and more confident with their baby at discharge. More women in the MBU group reported they felt fully recovered at 12 months (70% vs 40%). There is evidence from MBRRACE Enquiries (3) of fewer suicides to women admitted to MBUs versus General Unit.

Unlike MBUs, general psychiatric wards are inexperienced in managing postnatal physical care, leading to feelings of shame and indignity for mothers. They lack facilities to express milk, do not have milk fridges, changing facilities and are without safe spaces for babies, or older siblings, to visit. As postnatal admission may last several months, the impact on family life can be catastrophic. MBUs take account of the mothering role, supporting breastfeeding, attachment and the development of parenting skills. Mothers are treated alongside other mothers – enabling women to maintain their connection with the caregiving role and facilitating informal peer support.

Ultimately, the value of Mother and Baby Units cannot exclusively be measured in terms of clinical recovery. The costs and outcomes are much broader than those considered in the research – including a woman’s long term psychological wellbeing, that of her family – and her legal and human rights. When women are unable to access an MBU, this often results in a domino effect of challenges that impact families in a myriad of ways. The early months of motherhood are a precious experience for many women. As noted by the authors of the paper – women have a right to family life that should be acknowledged and supported by mental health services.

Future work

This paper has been a challenging first attempt to investigate the value of Mother and Baby Units; the study of this is an area of national importance. MBUs are considered an essential service by women and families recovering from PP. The UK is leading the world in the development of such units - and should continue to do so with further investment. There are regions of the country such as Northern Ireland, the North of Scotland and North Wales, with no access to these lifesaving services.

APP is studying outcomes following MBU and GPU care in women who have experienced PP in the 10 years since our last survey, and will report later in 2022.

1. The use of EQ-5D for measuring health-related quality of life for people with (severe) mental illness e.g. Is the EQ–5D fit for purpose in mental health? | The British Journal of Psychiatry | Cambridge Core;

2. The use of QALY more generally in mental healthcare e.g. QALYs and mental health care - PubMed (nih.gov)

3. MBRACCE Enquiries: https://www.npeu.ox.ac.uk/mbrrace-uk

Gina’s story - My paranoia got worse on the psych ward – I only started to recover when I was reunited with my baby

I was taken by ambulance to an acute psychiatric mixed ward without my baby. I’d been having delusions since a couple of days after giving birth and at home things had got much worse. It was only when I was taken to Bethlem MBU and reunited with my baby that I finally started to trust people and get on the road to recovery.

My pregnancy was straightforward, a very lovely pregnancy. But I was overdue so things didn’t exactly go as planned and I ended up having an emergency c section. Unfortunately, both my baby and I had an infection so we ended up being on the postnatal ward for a week rather than the couple of days I was expecting. I had severe insomnia and I was taking strong pain medication and I think this might have all played a part in me getting unwell.

So I was in pain, medicated, emotional and exhausted. But I think the turning point was when I received a message from a friend with some bad news about another close friend of ours, which triggered some strange thoughts and symptoms in me and some extreme paranoia.

For example, I noticed that when someone sent me a message, my response wanted to say happy new year or happy Christmas and I couldn’t understand why I wanted to write it. I also believed that I was being tested as to whether or not I was a good enough mum. And every time there was a bleeping sound on the ward I thought it was because I had done something wrong.

I filled in a form to say that I wasn’t feeling great mentally, but as my paranoia got worse, I retracted the letter. I asked for it back and ripped it up. And then, even though I wasn’t well, at times I appeared, on the outside, to be fine. So it was decided that I was going home with my baby.

When I finally got home, all the paranoia ramped up and I never slept. I was stuck in the house and there were people coming and going – midwives, health visitors, family members.

It got to a point where I was really confused. I couldn’t give the midwife the correct information, and when my family visited from America I was confused about who was who and started imagining that my niece was my long lost daughter. Then I started going through phases believing that my son had died – so much so that when I went to register the birth I was convinced they were going to hand me a death certificate.

I just questioned everyone and everything felt really trippy, and I became obsessed with things like clocks, so my mum removed all the clocks from the house.

My family, realising there was something very wrong, tried to work together to get me some help. Eventually I was visited by paramedics and then a doctor who I think prescribed me an antipsychotic – they were trying to treat me at home at that point.

Meanwhile, my mum was doing her own research and found out about postpartum psychosis – so, in a way, it was my mum who diagnosed me! But I became quite aggressive and frightened, so they had to call the police and the paramedics, and I even had to be handcuffed in order to be taken to hospital.

They took me by ambulance to an acute psychiatric mixed ward without my baby.

The ambulance ride was frightening because I was convinced I was in grave danger and I thought all the medical professionals were fake – I thought they were really all terrorists.

So when I finally got into hospital I refused to eat or sleep or take medication. I was paranoid about everyone and everything.

Nothing was working and I was in full-blown psychosis, at the peak of my illness, and without my baby. Everything seemed crazy to me - but I was the one being crazy. I started doing morse code on the window, and became paranoid about different colours – anyone who had a pen or who was wearing anything in the colour blue I simply couldn’t trust.

As I wasn’t getting any better, they decided to take me by private ambulance to Bethlem Royal to the MBU there.

Thankfully, not long after getting to the MBU, things started to change.

I don’t know if I felt more comfortable because there were more women there, and because my son was able to come and stay with me, but I started trusting the staff and taking my medication.

I think it was also because there was more of a normal kind of atmosphere in the MBU and there was a really good programme with specialists who knew all about mums and babies. I had lots of help learning how to make a bottle up and how to change my baby’s nappy – something that was invaluable because, with PP, everything seems ten times harder. Plus, knowing my son was safe and close by meant I was able to start sleeping. I started getting a good eight hours sleep!

I stayed in the MBU for nine weeks.

I 100% believe that if I had gone in the MBU straight away I would have started my recovery straight away.

I think my parents and my husband were given the option of an MBU at the start, but they didn’t really understand what it all meant so I really wish there was more awareness about specialist services and why they’re so important.

Now I feel I’ve fully recovered. Since my son turned seven months I’ve been so active with him, visiting friends, going to baby groups. I love being a mum and I feel like I’ve been making up for lost time – doing all the normal things new mums do.

I’ve also gone back to work and I now work with a charity that helps people with learning disabilities and mental health problems. And I’ve started a mother and baby group to help provide peer support and a place for mums to be able to talk freely with other mums.

While the whole experience of having postpartum psychosis – and the anxiety and postnatal depression that followed - was frightening, in some ways I’m glad I experienced it. It’s helped me to relate to people, and to provide support to others because of my lived experience which is really valuable in my job, too.

I feel that its so important for me to be able to share that there is light at the end of the tunnel, there is hope - even when you’re seriously unwell like I was.

 

 

Jade’s story - Awareness is so important

I finished work for my maternity leave in February 2020, just before the lockdown. My pregnancy had been smooth but the last few weeks were awful. He was ten days late and I was just so ready for him to come out. I wasn’t sleeping, I had a 72 hour labour, and I had to switch from having a water birth to going into a labour unit because I got to around 4 or 5cm and nothing was happening. Eventually, I went into hospital and had an epidural and forceps delivery.

When my baby was born he was immediately taken away. During the delivery his heart rate had dropped so he had to be put on an incubator in the neonatal unit two floors up.

During this time I started to feel like there was something wrong with me. I wasn’t sleeping well and something just didn’t feel right so I told the nurses. They reassured me that it was probably all normal, I’d been through a traumatic birth, etc. But the sleep wouldn’t come, and I started thinking strange things and not wanting to be around my family (other than my husband) which wasn’t like me at all. I was just pacing around the hospital day and night feeling anxious.

I became really distressed and starting thinking that if I fell asleep I would die. That’s when things really hit me.

I began seeing and hearing things, with imagery of heaven and hell and other religious visions playing a big part in it. I also thought that my own body was trying to kill itself which was terrifying. Plus, I kept thinking that I could hear my baby crying which was really upsetting. But I couldn’t have heard him because he was so far away.

My husband was really worried about me and kept speaking to the nurses and doctors, but the problem was that I sometimes appeared well and lucid when they checked on me. I finally agreed for my mum to come in and see me and that’s when I told her about my fear of dying if I fell asleep.

The hospital then moved me into my own private room because I was in so much distress, which I think they thought might help the other mums around me as well. They allowed my mum to stay over night with me too and, meanwhile, my husband was still urging them to get me some more help, because he knew there was something seriously wrong.

The hospital, however, suggested that I had the baby blues and at one point even suggested I was ready to go home! So my husband did his own research and found out about postpartum psychosis. He recognised the symptoms in me straight away.

He’d read about Mother and Baby Units (MBUs) and reached out to the one in Chorley not too far away. I was so lucky that they sent somebody to see me because, just prior to this, the hospital were considering sending me to a general psychiatric ward, which would have meant being separated from my baby.

I was transferred to Chorley MBU eight days after giving birth and I am so grateful that I got a bed there.

In those first few days I was really anxious. I didn’t know what was happening to me and I’d been googling things like schizophrenia, personality disorders and bipolar. I also remember googling ‘will I die if I have a mental breakdown.’ It wasn’t until I was settled in the MBU that I first read about postpartum psychosis in one of the leaflets they gave me, which also talked about how treatable it was. It was such a relief to know what it was that was happening to me, and to know that I could recover from it. Plus, I knew at that point that I was absolutely in the best place.

I was given anti-psychotic medication and the hallucinations stopped and I started sleeping again. But, after a while, I started to feel really unhappy and detached from my baby. I felt kind of dissociated from him and from being a mother. I wasn’t actively suicidal, but I felt like I didn’t want to live. That’s when the psychiatrist started discussing postnatal depression with me, and I was prescribed with additional medication.

Prior to this I hadn’t experienced any mental health problems at all. In fact, neither had my husband, so we were both really unprepared for it.

I kept telling the MBU nurses that I might be the only one who doesn’t recover from it all, because I really couldn’t see a light at the end of the tunnel, but they kept reassuring me. They told me to distract myself, to focus on my baby, and told me that it does take time to heal.

I also met Jocelyn, APP’s peer support worker, on the ward, as well as other mums who had experienced PP and recovered and that really helped me. To know that there are other mums out there who have gone through these same experiences really makes a difference.

Finally, by the back end of April, I started showing signs of getting better and they started talking to me about going home - just for a couple of hours at first. By this point I was very detached from the outside world so it was really daunting but I did go home for a little bit which felt strange.

I was finally discharged fully on the 21st May 2020. I wasn’t fully recovered, but I’d say there was around an 80% improvement by that point. I was still on meds, still getting support visits to the house however, even though the country was in lockdown at the time, I tried to get back to some sort of normality.

It took a while to get back to feeling like me again and it really affected my marriage. My husband had struggled with the trauma of it all as well. However, eventually, by November 2021 I came off all the medication and started to feel like myself again, which strengthened our bond as a family.

Looking back, I think for us, not having any idea what was happening was the most frightening thing. We didn’t know about PP, mental health was barely covered in the antenatal classes, other than a brief mention of depression, and the midwives didn’t seem to know too much about what was happening to me either. It wasn’t until I got to the MBU and met with specialist workers and peer supporters that things started to look up. I feel so grateful to have got a place at Chorley – I know not everyone is so lucky.

It’s now 2022 and I’m in a really good place. I’ve developed such a great bond with my boy, and he’s such a happy little boy too. So I get that excitement, that joy, that feeling of love now, as a mother, which is so incredible. I’m also back at work, taking care of myself, going to the gym and, importantly, my marriage is stronger than ever.

Now I can reflect on my experience I really want to help others by sharing my story. Awareness is so important, I think it would have helped us enormously if we had been armed with more knowledge from the start. Just being able to spot the signs, to know what help is out there and to know that you can recover would have relieved so much of the distress that I felt.

Peer support service launches in Morpeth for mothers experiencing postpartum psychosis

A partnership between Cumbria Northumberland Tyne and Wear NHS Foundation Trust (CNTW) and national charity Action on Postpartum Psychosis (APP) is creating an invaluable peer support service for women experiencing severe mental illness following the birth of their child.

The Beadnell Mother and Baby Unit in Morpeth, which is run by CNTW, has contracted APP to deliver this much-needed support. APP is currently recruiting for someone who has experienced postpartum psychosis to join the team as a part time Peer Support Worker.

The Mother and Baby Unit exists to support women experiencing severe mental illness in pregnancy and following birth, with specialist support available to treat conditions such as severe postnatal depression and postpartum psychosis. The Unit also provides specialist mother and baby classes, activities such as parent and child swimming and baby massage classes, and overnight facilities for partners – with the core aim of keeping families together to support a faster recovery and better quality of life.

Postpartum psychosis is a debilitating postnatal mental illness that can occur out of the blue. New mums with postpartum psychosis may develop high or low mood, or fluctuate between them, alongside delusions, hallucinations or severe confusion. Many of these mothers have had no previous mental health diagnosis prior to onset – although women with bipolar disorder are at higher risk. It affects around 1400 women and their families every year in the UK and is always a medical emergency. However, it is eminently treatable and most women go on to make a full recovery with the right support.

Allison Spiers, Ward Manager at the Beadnell Mother and Baby Unit, said: “We work very closely with APP to support mothers who are experiencing postpartum psychosis, and we are really pleased to be growing that relationship by welcoming a new Peer Supporter employed by APP into our team.  Not only will they offer vital one-on-one support to new mothers at a very distressing time in their lives, this Peer Supporter will also support group work with the women on our unit, and provide training to ensure our whole team continue to develop an in-depth understanding of postpartum psychosis. At CNTW we believe that service users and carers with lived experience of mental ill-health should be at the heart of everything we do, and employing Peer Support staff is an integral part of this.”

Dr Jess Heron, CEO, Action on Postpartum Psychosis, said: “We know that CNTW are already big believers in the value of peer support and lived experience engagement. The service that they provide to new mothers and families at the Mother and Baby Unit is outstanding, and, by combining this with the new peer support role women will receive a truly holistic and specialist treatment. Being able to support women and families at this critical stage, as they go through this frightening experience and begin to recover, is key to reducing the trauma, giving hope, and helping women and families feel less alone as they navigate the recovery process.

“This vital service will benefit women affected by postpartum psychosis and their families across the wider North East region. As a national charity we are campaigning to see more Mother and Baby Units like this one open up around the UK, to help save lives, promote recovery and to keep families together.”

Hannah Bissett, National Co-ordinator (NHS Contracts & Regional Projects), Action on Postpartum Psychosis, said: “As a woman who has personally experienced postpartum psychosis I know how isolating and afraid it can make you feel. Peer support is a vital piece of the recovery jigsaw and we now have over 2,800 lived experience users sharing their stories and receiving support from trained volunteers as part of our national peer support forum.

“Having somebody there for you who knows exactly what you’re going through and who can inspire hope will undoubtedly bring a sense of relief and reassurance to women in the region who may find themselves experiencing postpartum psychosis. We’re delighted to be partnering with CNTW on this project and I’m looking forward to starting to build our volunteer team and hearing from applicants with lived experience interested in the peer support role.”

APP already delivers successful and award-winning peer support services working in partnership with NHS Trusts around the UK, as well as managing a thriving online national peer support forum. The charity also provides peer support for partners of women who are experiencing or have experienced postpartum psychosis.

To find out more about the Peer Supporter role, click here

 

Links and More Information

For a list of England’s community teams go to: https://nhswebbeds.co.uk/community-team/list

For a list of Mother & Baby Units go to: https://nhswebbeds.co.uk

APP offer support for those affected by postpartum psychosis (personally, or at risk of PP, due to bipolar disorder. For telephone, email or Facebook support for postnatal depression and anxiety, see: https://www.pandasfoundation.org.uk/

For general advice about managing mental health, isolation and anxiety visit:

For advice specific to perinatal mental health during Coronavirus visit:

For more advice about Coronavirus:

 

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During Recovery from PP

You can find APP’s resources on recovery here.

1. How will I get medication? How will I be monitored and supported during recovery?

Urgent home visits will continue. Some routine appointments will happen via video call.

2. How can I manage my anxiety, depression, isolation during recovery while we are socially distancing?

UK wide, online resources and peer support will be incredibly important for recovering women. There is already a wide range of online resources and more are being produced each day. The links below contains further resources, recommended reading, recovery modules, and support.

APP provide support, information and a lived experience community for women & families recovering from PP. You can talk to others on our forum or get in touch to talk to a trained peer supporter via text or email. We have a variety of Facebook groups you can join and zoom activities you can get involved in.

NHS mental health services are open & here for you during this time. Contact them if you need extra help.

3. Social distancing and isolation mean my usual family support, and especially grandparents, are not available. Where can we find help?

NHS services will continue to provide outreach support during recovery via telephone, video and face to face as needed. Do ask for support if you need it.

The support that friends and family are able to provide will depend on your own situation and theirs. As someone recovering from a severe mental illness, a ‘carer’ in a non-vulnerable group can visit to provide support. Please check up-to-date guidelines here.

APP will continue our national peer support services throughout the outbreak. Our Forum is available for you to talk to other women and partners: www.app-network.org/peer-support/

We offer one to one peer support for anyone in the UK, where you are paired with an APP coordinator with lived experience, or a volunteer peer supporter. We can give this one to one peer support via messaging, email, or video call. APP also have trained partner and grandparent peer supporters. If you would like to access this support or join our lived experience community, email us here. We have a variety of Facebook groups and social media activities you can get involved in.

Resources for partners are available here, and you can join our partner’s Facebook page for more information, signposting and support.

 

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In Crisis or Developing Symptoms of PP

You can find APP’s general resources about symptoms of postpartum psychosis here and getting help here. You can find more information on common early symptoms here. You can find APP information guides about PP for women and partners here. If you are a partner, you can also join our Partner’s Facebook group for information, signposting and support from other partners who have ‘been there’.

1. If I develop symptoms of PP, how will assessment happen?

  • If you believe you are developing symptoms of postpartum psychosis (or your partner, family members is) you need to act urgently via the normal routes: telephone your GP, maternity services, or 111. If you believe you or someone in your household is in imminent danger, call 999. Services are still here for you. Urgent home visits are still being completed, but may also include phone & video call contact.
  • Every acute mental health trust in England has a 24/7 crisis line number who can direct you to appropriate services. You can find your local one here – input your postcode in the helplines section.
  • In Scotland, A&E mental health presentations are being diverted directly to mental health sites. Crisis/Out of Hours staff will work in assessment centres with extra resources, seeing people from A&E and other urgent referrals.

2. Are Mother & Baby Units staying open?

  • In England and Scotland MBUs will remain open and are doing an enormous amount of work to minimise any risk of infection on inpatient units. There are no units in Wales; women requiring MBU admission will be offered the opportunity of a bed in England. In Northern Ireland, postnatal women with PP are admitted to General Adult Psychiatric Units for care.

3. How are MBU’s managing coronavirus?

  • MBUs are following general NHS inpatient guidance on barrier nursing and staff will be using personal protection equipment (PPE) for patients with coronavirus symptoms. MBUs have set up isolation areas to care for women separately. To date there have been very few cases of coronavirus in MBUs.
  • Visitor advice varies between units. Some units have restricted visits to one named family member per patient, with specific time slots. Please contact the MBU for more specific advice. For a full list of MBUs in England click here  or here for all UK units.
  • NHS England guidance on visiting during the coronavirus crisis can be found here, and, for Scotland, here.
  • Patients will be supported to use FaceTime and telephone video calling more. Peer Support, including that delivered by APP, will be available via video call, and in some areas, peer supporters are still visiting the unit.

 

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Pregnant Women Concerned about PP

(i.e. those who have had a previous PP or who have a bipolar diagnosis):

You can find APP’s insider guide: ‘Planning pregnancy: a guide for women at high risk of Postpartum Psychosis’ here & APP’s resources on bipolar disorder and pregnancy here. You can take part in a trial of a new interactive workbook to support women through pregnancy by emailing us here.

1. What will happen to my antenatal psychiatric appointments or preconception advice appointments?

  • In England, Scotland & Wales, there are plans in place for routine home visits and out-patient appointments to continue, but some appointments will be done by telephone or video call. We will add information from Northern Ireland when we have it.
  • Perinatal Psychiatrists say that birth planning for women at high risk of PP will in some cases be offered remotely but will still be thorough and comprehensive.

2. How do I get medication during this crisis?

  • In England, Scotland and Wales, medication plans for pregnancy and the postnatal period should be made with perinatal psychiatrists in advance to ensure there is plenty of time to get prescriptions filled. Talk to your GP, Specialist Perinatal Mental Health Team, or Perinatal Psychiatrist, to ensure plans are in place.
  • Women who are remaining on Lithium throughout pregnancy will continue to need the same degree of medical vigilance. Antenatal care is still “open for business” and obstetrics/ maternity and perinatal mental health will work collaboratively to ensure the safest possible antenatal care remains uninterrupted.
  • In Scotland, medication prescribing remains with GPs on recommendation of mental health services. We will add information from Northern Ireland when we have it.
  • You can phone your GP prescriptions line / psychiatric services and they can send prescriptions directly to your local pharmacy for collection. Some pharmacies are operating a delivery service for those who are shielding or self isolating.

3. What impact does Covid-19 have on pregnancy, foetal development or risk of postnatal illness?

  • Our best knowledge to date is that Covid-19 doesn’t seem to cause problems with pregnancy, and it is believed that having CV-19 is unlikely to impact on your baby’s development. Most pregnant women who develop the illness will experience mild or moderate cold or flu-like symptoms. Pregnant women with other health conditions (e.g heart disease, or if you usually are advised to have a flu jab) should be extra cautious as they may be more unwell than other women. It may be possible for you to pass coronavirus to your baby before they are born. But when this has happened, the babies have got better. There’s no evidence coronavirus causes miscarriage or affects how your baby develops in pregnancy.
  • Pregnant women have been placed in the ‘moderate risk group’ as a precautionary measure as not enough is yet known about the virus. This means you should follow guidance on hand-washing and social distancing. You can access up to date government guidance here.
  • You should still attend appointments and scans, unless advised not to.
  • You should still seek help if you are worried about your physical or mental health.
  • Maintaining contact with friends and family, and being active, can be very important to maintaining good mental health during pregnancy, so consider how to stay connected, and what you can do, within government guidelines.
  • The Royal College of Midwives and The Royal College of Obstetricians and Gynaecologists have produced some excellent guidance for health professionals and women, which is being regularly updated here and here. You can access the Royal College of Psychiatrists advice here.
  • We do not yet know whether stresses related to the crisis will impact on women’s chance of developing maternal mental illness. We know that managing anxiety and stress in pregnancy and the postnatal period is important. You can find excellent advice from Mind about managing anxiety and isolation here and from the Mental Health Foundation here.

APP are here for you. If you are a pregnant women with previous experience of PP or bipolar, you can talk to an APP peer supporter by visiting our forum or registering for email or video support here. APP also has a number of Facebook groups (e.g. a book club, an activities & wellbeing group, various volunteer groups) you can join.

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