Episode 173 Postnatal Psychosis a chat with Sarah

Could you imagine the emotional and mental whirlwind of encountering postnatal psychosis right after welcoming your baby into the world? Join us as we sit down with the incredibly courageous Sarah, who takes us through her deeply personal journey of battling postnatal psychosis following an emergency caesarean section and her son’s critical NICU stay. We explore the crucial role of perinatal mental health teams, and the struggle of distinguishing physical from mental symptoms when sleep-deprived.

Ever wondered what it’s like to stay in a Mother and Baby Unit (MBU) ? Sarah opens up about her mixed emotions and the relief of being with her child despite the challenging circumstances. Highlighting the significant role of parent-infant psychotherapists and the small yet impactful acts of kindness from healthcare staff, the discussion emphasizes the necessity of early intervention and holistic care.  making this a must-listen for anyone touched by maternal mental health issues. From the shock of mental health issues resurfacing after years of stability to the emotional strain caused by medication changes impacting breastfeeding, Sarah’s narrative is both raw and enlightening. Her reflections on the struggle for self-worth and the irreplaceable mother-child bond provide a poignant look at the postpartum journey. 

This episode offers a heartfelt thank you to Sarah for sharing her story, which provides essential awareness and understanding for healthcare professionals, new parents, and families navigating similar paths.

Want to know more?
https://www.nhs.uk/mental-health/conditions/post-partum-psychosis/
https://www.app-network.org/
https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postpartum-psychosis/

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
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Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
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Transcript

Florence: 0:01

Hello, my name's Florence. Welcome to the OBS pod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife. Maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the OBS pod is for you.

Florence: 0:50

Episode 173 postnatal psychosis. Today I'm joined by a very special guest, sarah um, who got in touch with the podcast, and we're going to talk all things postnatal or psychosis. So Sarah has experienced this herself after the birth of her son and she's very kindly going to share her views and her personal experience to give us a little bit of a feel. Some of us may have looked after women with postpartum psychosis. It's relatively rare, but we do usually see a small number of women every year and I think sometimes we see a woman acutely in a maternity ward and then we don't know that much about what their journey is like afterwards. So welcome, sarah. Perhaps you could start by telling us a little bit about yourself.

Sarah: 1:58

Okay. So I've had a diagnosis of bipolar type 1 for about a decade and so we knew going into my pregnancy that that kind of put me at a higher risk of postpartum psychosis. But I was under the care of my local perinatal mental health team. We had a birth planning meeting and generally I was actually very well during my pregnancy. I was on both a mood stabilizer and also an antipsychotic, which had kept me very stable very well for the like quite a few years.

Sarah: 2:42

But the circumstances around my son's birth were very, very challenging. So he was actually born on the first day of my maternity leave by emergency caesarean section, and then we had the kind of nice photo of him on my chest you know new family and all that um. But straight away staff noticed that he'd stopped breathing and so they had to resuscitate him and was whisked away to neonatal intensive care unit, so NICU, and so that first night. Actually the pediatricians were incredibly kind. They came and saw me a few hours later and kind of allayed my concerns about you know, should I have spotted things sooner or what was going wrong? And then kind of I'd been told I'd be able to see him early in the morning. I was then told actually he's not stable enough, you need to wait a few hours. The first time they told me he'd been intubated which kind of this, was around the time of COVID. So for me this was particularly terrifying because I kind of associated it with people dying of COVID. So the next morning he was transferred to an even more specialist hospital where basically it was full of premmies but he was was term and so that was very difficult and so, to be honest, all the focus went on him and kind of seeing how he got physically better.

Sarah: 4:13

And you know, thank God he did recover quickly, but basically by the time he was well enough to be discharged, I wasn't well enough to be at home, and I think one of the things that I reflect on now was actually there were a couple of nights where I just didn't sleep because I had a cough and at the time coughing like really hurt my cesarean wound and so I think, looking back, I'd assume that that was a physical health thing. But actually in retrospect maybe that was a mental health thing that I just didn't think of because it wasn't or certainly to me at the time it didn't seem to be presenting with other symptoms. Um, but I think so over time I I just kind of stopped sleeping, which I know you're a new parent, that I mean, my son was away in NICU and SCABOO, but I stopped sleeping and then that's kind of when everything um really started going wrong. And I think it was hard because I did have insights at the start.

Sarah: 5:18

You know, that I was probably in hypermania and kind of not wanting to get worse, but I think you know the way if you're a bit ill. And then there's the weekend and it's much harder for, like community mental health teams which are set up for Monday to Friday. Yeah, it's a lot harder for them to do that wraparound care because they're just not resourced for that. Yes, um, and so it took.

Florence: 6:08

So it took a little while. So then I was, my son and I were sent to a mother and baby unit and yeah, I guess that was a big next starts in the first couple of weeks. How, how old was your son? How many days had passed before you started?

Sarah: 6:13

that not sleeping and started to notice things. Yeah, I mean, it's interesting, possibly with hindsight five days, if that makes sense, based on not sleeping with the coughing, but I think maybe it was the second week after his birth that, um, things just escalated yes, I definitely think sleep, not sleeping for me is a big.

Florence: 6:40

It's a really difficult one because it's a big flag. But it's also so difficult because parents are very sleep deprived at that point when they've had a new baby and they're adjusting to looking after it overnight and, like you say, recovering from perhaps a cesarean or the birth. So it's really difficult to tease out. So I'm not surprised when you say you thought it was maybe a physical thing and then started to realise maybe it was a mental thing.

Florence: 7:16

Because I think that's also very difficult for us when we're looking after women, to kind of tease out how much of this not sleeping is. Apart from the not sleeping, what?

Sarah: 7:28

were the other sort of symptoms or things when you did have insight that you were noticing. So I suppose for me one of my signs can be overspending. And so you know, say I was buying stuff for like, there's always a little kitchen in NICU or SCBU trying to buy some food for people to snack on in there, and you know my husband was like, but you're, you're spending lots of transactions, whereas for me it wasn't actually much money. Yes, led to what I'd done in the past and I think you know I can remember popping to a shop or something with my mom and you know, for me it was almost like part of me was like thank God, my son's not died. I want to get a few things to celebrate.

Sarah: 8:10

But I'm just trying to think what else? I mean, I think, the usual things like probably, you know, talking very quickly, yes, um, possibly jump thoughts jumping around, but those are kind of my usual key tells and I suppose, for example, having lots of energy and wanting to do other things. So, for example, when I was kind of waiting in the family room, um, waiting to be kind of called to feed my son, you know I'd taken a language textbook and was like, well, this is great, I'm going to learn a language and for me, kind of having all these projects yeah, those were my other tells. I mean, I suppose I saw a range of other people's symptoms, say in the mother and baby unit, so I think there were some people who were maybe paranoid about how their child was being treated or others were treating their child. So I think it can. I think it can vary. I mean, I suppose for me it was kind of similar to previous signs of hypermania and mania yes, okay and so.

Florence: 9:22

So you were. You'd been discharged, from your perspective, from hospital, but you were staying in the NICU accommodation with your son.

Sarah: 9:34

So we were lucky. Actually, once I'd been discharged from the maternity ward, it was, you know, kind of going forward and back in the city that we live in um visit my you know, our son over there. So I think it was almost, um, you know, things like. I can't remember anything about the recovery from the cesarean, just because my energies were focused elsewhere do you think that I mean as well as perhaps triggering you to become unwell?

Florence: 10:15

do you think the fact he was in neonatal, like you say, the focus is on him? Because I'm conscious. So I do a perinatal mental health clinic and I see women like yourself and we're preparing through pregnancy to try and keep you well and keep you stable in the postnatal period and one of the things we'll do is lots of midwifery support and visits at home after. But when your baby's in the neonatal unit, that sort of gets slightly problematic because you're coming up and down to the neonatal unit and therefore you're not necessarily getting that home support that we might have done for the first month where people are a little bit more focused on your well-being.

Florence: 11:05

So do you think that that also kind of maybe slowed people down in recognizing that you were deteriorating?

Sarah: 11:16

yeah, I mean, I have to say I've never really thought about that because, um, I've only got one, one child, and so I guess I didn't know what the normal experience was. But I mean, I think by the time he was in SCBU, staff were kind of picking up that it wasn't quite you know, things weren't quite right.

Florence: 11:38

Yeah, okay, and was it difficult in pregnancy, knowing I mean, obviously this was all quite unexpected what happened with your son.

Sarah: 11:47

Yeah.

Florence: 11:48

But how did you, did you feel during pregnancy that this is okay, that I've got this high chance, I've got the right

Sarah: 11:58

So I suppose I mean, maybe slightly naively you know we've done the pregnancy planning advice, or you know I can't remember what the proper name is but before you start trying we'd we'd gone through that. Yeah, yes, in all honesty, I think it just came as such a shock because I'd been so stable on my medication for kind of many years, and I think also the fact that I had been well during pregnancy. But I think I mean I look back and I wonder was I a little bit hypo towards the end of pregnancy?

Florence: 12:32

I don't know, because you know it seems like buying things for your son and like everyone's told, well, you know, you do a bit of nesting at the end of pregnancy and it's kind of, but what's, if you like, what's outside of normal yeah, yeah, okay, so you mentioned the mother and baby unit, so so my experience of trying to get a woman a place in a mother and baby unit- it's complicated because they're national beds and when we do our pre-birth planning session with the mental health team, we always explain there's the possibility of an adult bed where you're separated from your baby, or mother and baby unit, but they're national beds.

Florence: 13:19

You might have to travel, there might be a wait, so I'm interested to know from when you were unwell and you kind of tried to get support. How long did it actually take from your perspective to kind of get into the mother and baby unit?

Sarah: 13:37

So I think actually it was quite quick. I think I was admitted to the mother and baby unit about three and a half weeks after my son was born, and I think we were talking about how you know, maybe it was two weeks before it became um obvious that I was unwell. So actually I think I was quite fortunate it was something that had been discussed at, you know, the birth planning meeting. Um also, like we live in an area where there are naturally more mbs to choose from, and I guess the fact that I was already under a perinatal team must have made it a bit easier.

Florence: 14:16

Yes, and so what was it like when you, when you first went to the mother and baby, tell us a little bit about how that felt and what that was like?

Sarah: 14:32

Yeah, so I think when I was admitted I was manic and so you know, when you're manic everything seems great and you know you've got all these other people to speak to in hospital. But my abiding memory was I was just so grateful that I was with my son. I didn't really care where I was because, you know, for three weeks I'd not really been with him the whole time. Yes, and so it was kind of like I'm with him, yes, I'm with him, yes, I don't know. I mean, I think quite quickly I was detained under the Mental Health Act and kind of that had happened to me before. So I wasn't, you know, I knew the process in terms of all that stuff.

Sarah: 15:20

But, um, I think probably you know everyone heard a room in a bathroom of their own. There was common there, but also it was quite hard. It was um during Covid and so you know the staff had to wear masks, so it was harder to relate. But I think also the it was a locked ward and so for me that was quite difficult, because in the past I haven't been somewhere with like an airlock to get in and out. Um, yeah, so I think at first it seemed fine. You know it was very sweet they'd got, I think. When you got there they had like a little box with some toiletries and hot chocolate or whatever, to kind of be like welcome and try and make things feel a bit better yes, okay, and how long were you detained?

Florence: 16:12

for how long were you in there?

Sarah: 16:14

I was in there, I think, for about four months in total, so not like obviously had a period at the end when I wasn't detained, but yeah, for most of that I was that's quite a long journey to get get well yeah yeah, definitely, I mean I have to say I kind of I think quite a lot of us felt lied to.

Sarah: 16:37

When, you know, on a mission you were told, oh, most people are only here six to eight weeks, and actually that wasn't my experience at all, anyone who had a pre-existing diagnosis. You know, a whole cohort of us seemed to graduate around the same time and that was between four to six months of being in the mother and baby unit.

Sarah: 16:55

So I think, yeah, that's really hard yeah um, I mean, I think one of the things that I found hardest was I'd been kind of getting better under different things and I was very keen to be able to like the medication I was already on I could breastfeed on, and so I think, particularly when you've had such an ill child, yes, I really wanted to be able to breastfeed, but there came a point when I had to go on to lithium. You know I didn't have a choice personally or legally, and so for me that was I kind of crashed down afterwards and I think I kind of struggled with almost like what's the point of me? You know, anyone can give my son a bottle, anyone can look after him. You know, the breastfeeding was like the one thing only I could do with him.

Florence: 17:52

Um, so, yeah, that was really tough that that does sound really tough, and I think that's definitely something I see from some women when they've had a particularly difficult birth or a neonatal condition or whatever, that they feel that breastfeeding is that key, bonding with their child. So I can see how incredibly difficult that would be, particularly when your your choices are taken away in that way. And so you said you had insight at the beginning. Were there points when you didn't have insight as to how unwell you were?

Sarah: 18:32

Yeah, I think there were times, like I can remember, there was a ward round when my care coordinator from the community was like I've never seen you like this before. And yeah, there were times was when I thought I'd been kind of inappropriately detained and that I was, that I was well, um, I mean, I would say for quite like once they got me down for quite a lot of that I was.

Florence: 19:02

I was aware that I was unwell yes, yeah, that's a very difficult start to add on to the neonatal stay.

Sarah: 19:14

Yeah.

Florence: 19:15

You mentioned when we kind of prepared for this. You said that the parent-infant psychotherapist was incredibly helpful. Tell me a bit about them and that sort of treatment.

Sarah: 19:30

Yeah, so parent-infant psychotherapy is like looking at, say, how you interact with your baby and the bond, and I think, apart from medication, I got this both in hospital and in the community and it was like the most important thing in my recovery, the most important thing in kind of building that bond with my son.

Sarah: 19:50

And I think, for example, when I was in hospital and I'd come down, you know, because I was depressed, there was kind of, I had, say, feelings of ambivalence towards you know, yes, I've got a son, but I've lost my freedom, and not in the kind of metaphorically like I literally legally have lost my freedom, and so I don't know one of the things. It felt like in the MBU you'd always be asked, you know, do you want to hurt your baby? And it's like absolutely not, like I never felt like that. But I didn't feel like it was really or like, apart from the PIP sessions, or like, apart from the PIP sessions, the staff kind of didn't seem to think to ask about how you're feeling more generally. And I mean, I think also the reality is, when you're held under section, certainly I'm very focused on what I need to do to come off section and so I felt like, actually, if I started expressing these feelings of ambivalence, that wasn't going to help.

Sarah: 20:57

Oh, yes, yeah. So that was difficult. But I mean things like you know, the therapist in the hospital was saying you know, actually you might. You know things like having your freedom takeaway. You might feel like this, like any new mum. It's just the fact that you're here, it's kind of particularly acute yes but I'm trying to think to remember other um specific sessions.

Sarah: 21:25

But I think also I was worried that I'd been very affectionate towards my son at the start and maybe I'd pulled back, and you know, what was that going to do to him? And you know, the therapist was like no, he's a really young baby. He probably kind of you're still around, he probably hasn't picked up on this at all. So yes, I mean, I don't know if we'll speak about afterwards, but certainly the therapist in the MBU was really excellent about afterwards, but certainly the therapist in the mbu was really excellent. Um, it sounds like actually it's. It can be quite hard to get access to parent infant psychotherapy in the community and I just think it's just the most valuable thing going right.

Florence: 22:06

Yes, I'm interested in what you said about the difficulty of being honest about how you're feeling and expressing yourself, because that feeds into that legal detention and that can be really difficult. I can see that and you know.

Sarah: 22:25

I think I had a conversation with staff.

Florence: 22:27

It's like, well, yeah, you're right, it is a higher bar to get off section when you have a child yeah, see, you mentioned to me also about the impact this had on your partner, so your, your rest of your family, because he'd had first neonatal and then both of you effectively removed for four months. So what sort of provision is there in the mother and baby unit for that other parent? Yeah, so, again.

Sarah: 23:02

I mean ours was a bit different because it was during COVID, so I mean there's a family room that you could book for visits. I think most of the time he was able to come on to the ward in visiting hours and spend time in my room and so things like. You know, I think we gave our son his first bath together and so I think people are really conscious of, you know, wanting dad or the other parent to still feel, yeah, still feel involved, because I mean, yeah, it's, it's not what anyone expects. I mean, apparently during Covid comes the spot about um time outside of Covid. You know people just come on the ward and sit in. You know they've got various nice rooms or the garden, and so I think that did impact things a bit.

Florence: 23:57

So you're in the MBU and you've been quite hyper, and then you're low, yeah, and you've had this impact on breastfeeding. How did you kind of, I guess, get to the point where you're well enough to to leave and then also make that transition, because that's a massive step, presumably then leaving the mother and baby unit and continuing? That journey, yeah, so.

Sarah: 24:31

I mean, I think it was difficult. So at the nursing station they had, um, a board with everyone's baby's name written down and, kind of very publicly, what level of observations the baby was on, which was, effectively, you know, how well or able is the mother to look after the child. And so I was on that board at red for you know, a long time and so, in all honesty, if we're, you know, with a cbt hat on, thinking about core beliefs, um, one of the things that I had to shake was that I, like I was an inadequate mother. Yeah, um, that was what the notice board was very publicly telling me and others on the ward. And you know, in honesty, it's still something I struggle with from day to day, that feeling of you know, if my son has a big tantrum like others, do you know, that feeling of being judged and so it. So it's kind of you might leave the MBU physically, but actually the experience stays with you for a long time.

Florence: 25:38

Yes.

Sarah: 25:40

And you know, it's fine, there's more distance now, but it's I don't know. I think it would have quite a lasting impact on most people actually.

Florence: 25:49

Yes, that sounds awful. I'm imagining this board now, like I mean, I understand that they need to know what level of care each each you know, mum, baby, dyad need, but to have that visible and color-coded and what that does sound really unhelpful. Yeah, so when you leave, do you start? So you, you mentioned detention was shorter than your hospital stay. So once you're not detained under the mental health act and you're getting better, yeah, go out for day visits or yeah, absolutely things like that yeah, absolutely so.

Sarah: 26:36

Even under the mental health act, I think fairly quickly I was able to leave hospital with, like my husband or family, yeah, and you know I was really lucky that people lived close enough to do that with me. Um, and then, yeah, they definitely don't chuck you out, um, so you know, it started with like maybe a visit home for a couple of hours, then for a day, then like a first overnight, and you know they're very much kind of wanting you to build up to it because apparently for some people, going back home can actually be a trigger and so they don't want to rush you out. And I think also they keep your bed for like at least a week, just from when you're meant from your kind of quote discharge, just to make sure that everything goes okay. Yes, and you know, again, this is a discharge planning meeting with kind of people from the NBU, people from the community team. So I think you know a lot of thoughts given and I mean one thing that you know my consultant in the NBU was really kind in agreeing to was that actually I could go on seeing the parent infant psychotherapist on the ward until I was able to pick that up in the community, and so for me that was really good.

Sarah: 27:59

I mean, I suppose one thing I'm conscious I've come, you know it was a hard time, and I've shared kind of my views on what it was like, but also, ultimately, I am really grateful that MDUs exist because I think actually for me I can imagine, particularly when I was unwell the thought of being forcibly separated from my son would have just been horrific.

Sarah: 28:28

Yeah, so you know the fact. Actually he was able to stay with me throughout. You know, that's something I think is so lucky because I mean, I think, talking to people, for example, in the States, they don't have MBUs and I think the fact that at least you've been able to stay with your child probably makes things easier than, if you say, had to go on a general ward before transferring into an mbu. So for people who don't know, you've got the kind of various psychiatrists, the therapists, um, and then also, and they have nursery nurses on hand to kind of help with the care of the baby or kind of run groups. So I think I'm grateful that it exists, but it's also a very, very tough thing to go through and you know I can still remember little things that members of staff did you know, that were just just little kindnesses that you know they didn't necessarily have to do, but it does stick with you yes, that's so true.

Florence: 29:30

In much of healthcare care I spend quite a lot of time thinking about, yeah, the little things, the language you use or the little touch or conversation you have, that, yeah, can make a big, big impact. I think you're right. I think we are very lucky to have mother and baby units, and I can see what you're saying. It it's extremely tough. But it would have been even tougher after you've been separated and in a completely different environment that isn't so focused on that mum and baby relationship. When you went home.

Sarah: 30:11

So you had community um, parent infant psychotherapist and presumably then was it then the perinatal team took over or the community mental health team took over in terms of looking after you yeah, I think it was still the perinatal mental health team, you know, had follow-ups um with them for about a year or maybe it was longer, and so again, like when I was in the community, the parent infant psychotherapist was brilliant and just things like I think one of the things I really worried about from kind of you, when you're depressed, you just feel very disconnected from everyone, and so one of the kind of ongoing worries I had was about how it could have impacted the bond with my son, and I can remember like one session um we were new and I'd sat my son down and the therapist pointed out that he'd looked at the therapist in terms of like, oh, you're a new person, looked at me, looked at her again and looked back at me.

Sarah: 31:18

And she was like this is him seeking reassurance from you, and it's a really good sign of bonding, and so it was just such a helpful way for me to kind of explore the relationship.

Florence: 31:32

Yes, yeah and how do you feel that relationship is now? Yeah, how old is he now?

Sarah: 31:43

so two and a half, I don't know. I have to say like for me, the older he, the older he gets, the better he gets. So you know, now he's talking a lot and he's inquisitive about the world, which for me is just magical. You know, there are silly games we can play together. So like, yeah, I think probably what the therapist in the MBU said about like you might just not have enjoyed the baby stage very much, even on the outside, yeah, no, I think we have a really good relationship and I don't think this, for me there's kind of certainly no hangover, yes, with that, um, which is lovely.

Florence: 32:25

Yes, that that does sound wonderful, actually. I can see your face. I know it's a podcast. I can see your face light up as you started to talk about all the lovely things he's doing. That's so great and, in terms of your husband, that relationship with your son and most of you, that you as a family how do you feel that's been impacted, or do you feel there's there's not really a hangover there either?

Sarah: 32:55

so I think in some ways almost our parenting model doesn't fit, then the default, if that makes sense.

Sarah: 33:04

So I was never able to do night feeds for my son and I'm on such a load of medication that I just like I mean he didn't literally have to scream the house down for me to wake up yeah, and my husband's the one getting up with him, my husband's the one getting up early if he gets up early, and so I think, yeah, the kind of almost the societal expectations that that would be the mother doing it kind of hasn't played out.

Sarah: 33:33

But then actually I think, you know, while it's tough for my husband, I think he also loves it because he's he's got such a close relationship with my son and I think it's kind of almost also, as time passes, you kind of there's more and more distance between that difficult time and actually now it's kind of more, you know, planning like, oh, maybe we could go for this day out as a family and that would be fun. And you know, oh, he really, you know our son really enjoyed going on this little fairground ride. You know when can we do that again? And so it's, I think it feels like we've definitely gelled as a family unit. But I mean, my husband was lucky, he was able to flex his work around when I was in the MBU and so I think he was able to see more of our son when we were in hospital, and so I think there's always been that sense of connection.

Florence: 34:32

Yes, yeah, and I think what you're saying about the perhaps slightly different from kind of societal expected roles. I can see that that builds a really close relationship between your husband and your son, the fact that he's stepping in and doing those bits, and it's kind of partnership working partnership, isn't it? You mentioned that you had used app for their peer support yeah.

Sarah: 35:06

So I think, as everyone was getting ready to leave hospital, we were told about this charity called action on postpartum psychosis. It's an absolutely amazing organization that I think really kind of punches above its weight and what it achieves. So they do a range of things. They have really helpful leaflets on their website that kind of act as education.

Sarah: 35:28

But the thing I've found like so valuable is their peer support services so you can be matched one on one with someone who you can meet up in person and then they hold regional support groups. So the one I go to they have once a month and then maybe every three months they have one in person and I think from my perspective it's just so validating to be able to talk to people who've had similar experiences and kind of process. What you've been through and I think also it's you know it just helps you feel less alone in what you've been through. And I think also it's you know it just helps you feel less alone in what you've been through. I think they, you know they also offer support for partners and families and it's brilliant because you don't necessarily stay in touch with people from an MBU or you know, even if you're ill and don't make it to an mbu, it's just it's so useful to be able to talk to others yeah, I can.

Florence: 36:26

I can sense that not feeling alone, feeling like this, is loads of other people that have been through that sort of thing really yeah absolutely perfect, and I will um put a link in the show notes if people want to know more to the charity. I know it's probably a million miles from your thoughts, but having had this experience, does that I don't know what you were intending in terms of does that make you re-evaluate whether you would have another baby or not? Yeah, so.

Sarah: 37:05

I mean, I think we we did talk to um, a perinatal psychiatrist, and I think you know the advice is you know I am high risk, I, I think, I don't know I think she might have mentioned 50%, but then I think she also said but lithium lowers that risk a lot, and so I suppose there's enough distance that I think we would think about it and I think also, I suppose I would just hope it would get picked up a lot more quickly. I mean, oh, for example, you know, when people have had, like, say, a bipolar diagnosis for a while, they kind of know their way around all the psychiatric medicines, and so, you know, I think I'd probably be much more advocating, for I need to have a stash of benzodiazepines please you know, and I think people would just know actually we need to jump into action a lot more quickly.

Sarah: 38:05

But I think also the fact that I would be staying on the lithium and therefore not breastfeeding also makes it a lot easier to medicate quickly. So it's I don't know, it's difficult because it was an incredibly difficult time and yet at the moment it's just like the most gorgeous age with my son, and so I guess realising and you know I was still depressed when I came out of hospital, it was still hard and actually for me getting back to work was actually really important and kind of reclaiming that as part of my identity, but I don't think I think it was one of those things. You know, we're conscious that actually I wouldn't want to be going into hospital because of, you know, the impact it would have on my son now, and I think it was one of those things.

Sarah: 38:56

But do we think we could address the you know, it's that trade-off of like okay, I feel like, you know, if a second came along, probably everyone would be like the monitoring would be a lot more heightened. If I had any night when I slept, you know, a few hours, I'd be like this is a problem. So, yeah, I mean, I suppose it's, I don't know, maybe foolhardy, but it's difficult. It's that trade-off between the impact on your, your child, but also the fact that actually it could just be a few months in the baby's life and so it's. You know, there's no, I guess there's no clear-cut answer yeah, it's a real dilemma, isn't it?

Florence: 39:39

it's a really it's a really difficult kind of balance to to make. So I normally end with a like zesty bit, a bit that I want people to remember and that will be a bit partly for healthcare professionals, kind of what would you like them? Or or know if, if they were caring for a woman with psychosis or a higher chance of psychosis, but also whether there's something for pregnant women, because they also listen to my podcast. So, yeah, thoughts on what your kind of zesty bit, your essence would be yeah.

Sarah: 40:18

so I suppose for professionals, maybe creating a space where it feels safe to talk about how you're feeling towards your baby, I think also just kind of maybe acknowledging the person, because I mean, I know everyone when you take your child to any kind of you know, oh, here are the jabs, oh hi, mum, how are you doing mum? And it's like actually, you know, for a lot of us it's wonderful, but it's not the only part of me, yes, and so I think, kind of as people get better, I think one thing we did an antenatal group and there was no mention of maternal mental health. Now I think any responsible antenatal classes should be covering a bit. You know it's, because what is it? Is it about one in 500 to a thousand who gets postpartum psychosis? You know that's a lot. And you know, with all of this stuff, if you get early intervention it's much easier to kind of start treating it's much easier to kind of start treating.

Florence: 41:25

Yes, certainly some of the women I've seen with psychosis.

Sarah: 41:27

They've not had a pre-existing diagnosis.

Florence: 41:28

Yeah, absolutely, and it's happened completely out of the blue and I think in some ways, that's almost more terrifying, certainly for their families. Almost more terrifying, certainly for their families, because they've never seen them. Well, and they're suddenly like oh my god what has happened to my loved one and and and I think certainly the key thing for me is, if it's recognized, it's easily properly treatable and recoverable from, and so when I've seen women with psychosis, that's what I've said to their partner and family.

Florence: 42:09

It's okay, I know what this is and I know it's treatable and it will take time and it'll take medication and so on, but it's all right yeah we'll get better yeah. I think you're right seeing that person and acknowledging that actually, mental health is a key part of that transition to being a parent. Yeah, definitely anything particular you want to say differently to women, or maybe it's the same message? Actually to think about your mental health yeah, I think so.

Sarah: 42:44

I just wish. I think my main thing would be I wish people would be a bit more open about the challenges with having children. You know, things like this will change the way your relationships within your family work. You know, I can remember you'll have people who you don't know coming up to you giving unsolicited advice and just kind of yeah, and I think it.

Sarah: 43:07

You know, it's just, it can be hard when you know all you're doing is like feeding and changing nappies and actually, if you're used to having a career, this can actually seem a bit like, oh, my goodness, what have I done? Yeah, and I think, talking to a colleague, his, you know, one of the things he said he always says to people was like it's okay not to enjoy it, and so I don't know. I know everyone kind of go, you know, I think I had this idea that I'd be sitting in a coffee shop breastfeeding while I read a book. You know that's not, um, that's not what happened at all, um, and so I guess I know everyone will tell you oh, it's a massive change, it's a massive change. But I think, just going into it with a kind of it's okay not to love everything, I think that's very wise advice.

Florence: 44:01

actually, I sometimes feel this at work because I mean, I'm supporting women through birth and sometimes I'll hand over a baby and there's that incredible moment of joy and exceptional, which is wonderful. And sometimes I go home and I think, particularly for first-time parents oh my god, do they have any idea what's about to happen? So I hear what you're saying. When I had my own first child, I was the first one of my friends and family and I rang my sister and said it's a conspiracy.

Florence: 44:36

No one tells you just how diabolical it is. So whilst I absolutely adore my children, and they're now grown up, I completely relate to what you're saying, that people need to talk a bit more open about the reality and the ups and downs, and that it's tough, yeah, and I think you know, particularly with Instagram now, where you have people with their balloon arches and their baby's name on the wall and it's kind of fantastic.

Florence: 45:03

Well, thank you so so much for sharing your story and your experiences. It's been absolutely wonderful to talk to you and I'm so grateful to you because I think that lots of people will find your, your experience and your insights really valuable. So I know it's not easy to come on and talk about and share what was an incredibly difficult time in your life, but I'm immensely grateful. So, thank you, thanks very much. Recommending the OBS pod to anyone you think might find it interesting, there's also tons of episodes to explore in my back catalogue from clinical topics, my career and journey as an obstetrician and life in the NHS more generally. I'd like to assure women I care for that I take confidentiality very seriously and take great care not to use any patient identifiable information unless I have expressly asked the permission of the person involved on that rare occasion when it's been absolutely necessary.

Florence: 46:37

If you found this episode interesting and want to explore the subject a little more deeply, don't forget to take a look at the programme notes, where I've attached some links. If you want to get in touch to suggest topics for future episodes, you can find me at theobspod, on Twitter and Instagram, and you can email me theobspod at gmailcom. Finally, it's very important to me to keep the ObpsPod free and accessible to as many people as possible, but it does cost me a very small amount to keep it going and keep it live on the internet. So if you've enjoyed my episodes and by chance, you do have a tiny bit to spare, you can now contribute to keep the podcast going and keep it free via my link. To buy me a coffee. Don't feel under any obligation, but if you'd like to contribute, you now can. Thank you for listening.