"Three years later, I had my daughter and, knowing that there was a 50/50 chance of developing postpartum psychosis again, I planned every detail of the birthing experience really carefully."
On this page
- Deciding whether to have a baby
- Preconception planning
- During pregnancy
- After the birth - on the postnatal ward
- When you come home from hospital
- If you do become unwell
- Further resources
This page is for people who have an increased risk of postpartum psychosis because they have a diagnosis of bipolar disorder or schizoaffective disorder or because they, or their mother or sister, have had postpartum psychosis (PP) before. Our Insider Guide for women at increased risk has more detailed information.
For more information on your risk of developing PP, see our page on the causes of postpartum psychosis.
Deciding whether to have a baby
If you know you are at risk of PP, you, your partner and your wider family may have lots of concerns about your wellbeing during pregnancy and birth. There will be more to think about when deciding whether or not to get pregnant.
What feels right for one couple may not feel right for another. It’s best to seek advice from a specialist such as a perinatal psychiatrist before you start trying (see pre-conception planning below).
If you do decide to try for a baby, the most important thing you can do is to make sure that all the health professionals involved in your care know about your risk of developing PP. You will need to ensure that care plans are put in place for pregnancy, birth and the early post-natal weeks.
Planning well for PP can help you and your partner accept that, although an episode is a possibility, you have the best support and treatment plan in place.
The care you can expect to receive is listed in the NICE guidance on Antenatal and Postnatal Mental Health.
The Royal College of Obstetricians and Gynecologists has published a guide to good practice.
Finding specialist advice
Your GP or mental health team should be able to refer you to a perinatal psychiatrist if there is one in your area. If there is no local perinatal psychiatrist you can see a general psychiatrist for advice.
Most mother and baby units (MBUs) offer specialist pre-conception counselling for women at a high risk of PP who are thinking of having another baby.
Our PPTalk forum can help you find what is available in your region.
Second-opinion psychiatry service
If you have experienced postpartum psychosis or bipolar disorder and require advice regarding treatment or planning further pregnancies, you can get support from Dr Ian Jones at the Cardiff University Psychiatry service (CUPS). We have more information here.
Things to discuss
- Your individual risk of developing postpartum psychosis.
- The risks and benefits of medication in pregnancy and after birth.
- The care you can expect, whether there is a perinatal mental health service or professional midwife in your area and which health professionals will be involved in your care.
- Any concerns you and your partner have about trying for a baby, looking after yourself during pregnancy and recognising early warning signs of PP.
You may have some decisions to make about medication. These might include;
- what medications are safe to take during pregnancy,
- whether it is safe to stop or change any medication when trying for a baby or when you become pregnant,
- whether you should take medication before or immediately after the birth as a preventative measure, and
- whether breastfeeding is compatible with your medication.
You will need to work with your health professionals to weigh up the risks and benefits of your decisions. If possible, have these conversations before you start trying for a baby.
If you have a risk of PP you should get some specialist care during pregnancy. The level of specialist care may depend on the level of risk.
"I was understandably anxious at times, but, after being referred to Professor Ian Jones by my GP I saw a psychiatrist locally at eight months pregnant. Finally we were able to plan for that early postnatal period and I took anti-psychotics for a short time after the birth just to be safe."
Your booking-in appointment
Tell your midwife about your mental health and whether you or a family member has had an episode of PP before. You should do this at your first ‘booking in’ appointment so you can discuss who will be supporting you with your mental health and they can make the appropriate referrals.
Support from a psychiatrist
If you are referred to a psychiatrist, they should talk to you about;
- the risk of you becoming unwell in pregnancy or after birth,
- the risks and benefits of medication (they should help you make choices about treatment), and
- who will be involved in your care during pregnancy and after the birth of your baby.
At around 32 weeks of pregnancy you should have a pre-birth planning meeting. This is a meeting involving you and everyone involved in your care. This includes;
- your partner (if you have one),
- family or friends you choose to bring,
- mental health professionals involved in your care,
- your midwife,
- health visitor, and
- your GP.
The aim of the meeting is to make sure that everyone involved in your care knows about your risk of postpartum psychosis. You should all agree on a plan for your care.
You should get a copy of your written care plan. This should include early warning signs and a plan for your care. It should also include details of how you and your family can get help quickly if you do become unwell.
After the birth
Getting enough rest and sleep after the birth of your baby isn’t easy, but it is important to prioritise your wellbeing.
"Because the feelings were familiar the second time around and I was able to recognise them, I quickly shared my concerns with the doctors and requested to see a psychiatrist."
Getting enough sleep
It’s not too late to ask for any changes to your care plan that you find you need. This might include requesting a single room or asking the midwives to help with night feeds or have your baby at night and bring them to you for feeds. You can refer to the importance of sleep in your care plan if you need to.
Feeding your baby
There can be a lot of pressure on mums to breastfeed. Our page on being a parent to a newborn after PP has more support and information about different ways to feed your baby.
The most important thing is that your baby is fed and you are rested.
If you are planning to breastfeed, remember that establishing breastfeeding can be tiring and sometimes stressful. Ask someone to take the baby so you have time for rest and sleep.
If you are bottle-feeding, your partner, family and midwifery staff can all help with feeds, particularly at night.
Try to keep visitors to a minimum and visits short in the first few days. If you need to rest, you partner could always take the baby to another room for your friends and family to have cuddles.
When you come home from the hospital
The first few weeks after childbirth are the highest risk time for PP, so your mental health should be closely monitored when you leave the hospital. Some women employ a doula or other support to help them during this time.
Your midwives, mental health nurse and health visitor should visit you regularly in the first few weeks after your baby is born. If you become unwell this can be picked up quickly so you can get treatment early.
Make sure you have a copy of your care plan and that you, your partner and any family members know who to call if you have any early warning signs or symptoms.
You may also find it helpful to keep a mood diary in the first few weeks.
If you do become unwell
Postpartum psychosis is not your fault and can happen even with the most careful planning. Don’t struggle at home, symptoms can get worse quickly so put your care plan into action and contact your GP, mental health team or crisis team as soon as possible.
With early, well-planned care you are likely to recover much more quickly. APP’s peer support services are here for you throughout.
Here we share some additional resources for those planning pregnancy with a diagnosis of bipolar disorder. Follow these links to written information, academic articles, personal stories, and video resources.
- For advice about factors that could further increase or decrease your own individual risk, you can read our article on the management of bipolar disorder in the perinatal period and risk factors for postpartum relapse.
- APP has produced a Bipolar Disorder, Pregnancy & Childbirth Guide, written in conjunction with the National Centre for Mental Health (NCMH) and the national charity, Bipolar UK.
- You can watch our Pregnancy and Bipolar Disorder Podcast and Module produced in conjunction with Cardiff University.
- APP Trustee and Chair of Bipolar UK, Clare Dolman, has written a personal account of her attempt to avoid having a second episode of PP, which is available here.
- A previous experience of Bipolar Disorder is likely to mean that you and your family are better equipped to identify early warning signs than those who develop PP ‘out of the blue’. Clare Dolman writes about this aspect of PP in her piece ‘Finding a Silver Lining’.
- In this video Clare Dolman, Vice Chair, Bipolar UK and APP Trustee discusses the specific issues around pregnancy and childbirth for women with Bipolar Disorder.