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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

PLANNING A PREGNANCY

Advice for women with mental health problems

About this leaflet

This leaflet is for:

  • women who have a mental health problem and want to have a baby
  • women who have had a mental health problem in the past and want to have a baby
  • women planning a first pregnancy and those who have children and want to get pregnant again
  • partners and family members who want to find out more about how pregnancy can affect, or be affected by, mental health problems.

The leaflet describes:

  • what you can do to have a healthy pregnancy
  • how pregnancy can affect your mental health
  • support and advice available for women with mental health problems who are planning a pregnancy
  • how to get advice about medication in pregnancy and breastfeeding.

Why does it help to plan a pregnancy?

Deciding to have a baby is one of the most important choices a woman will make. For women with mental health problems there are many issues to consider. You need to have good information, advice and support.

It may be hard to know when it's the best time for you to have a baby. You can talk to your GP or psychiatrist even if you are just thinking about having a baby in the future. They may be able to give you the information you need to make decisions about your care. If not, they may be able to refer you to a perinatal psychiatrist.

It is best for your baby if you can improve your health before you get pregnant.

Planning a pregnancy will give you time to:

  • find out about how pregnancy may affect your mental health
  • get information about medication in pregnancy
  • decide whether you want to change your treatment before you try to get pregnant
  • decide which maternity unit you want to go to
  • find out about mental health services for pregnant women in your area
  • consider what support you will need, especially after birth (e.g. you may need help with night feeds)
  • make sure you get help for any physical health problems
  • get help to stop smoking, drinking or using illegal drugs before you get pregnant
  • make sure you are as well as possible before you get pregnant.

Hopefully this will help you enjoy your pregnancy more.

 

Who can I talk to for advice when I am planning a pregnancy?

All women can ask their GP for information and advice when they are planning a pregnancy. If you are under the care of a mental health service you should talk to a psychiatrist.

 

In some areas there are perinatal mental health services. These are specialist services for pregnant women and women with a baby up to one year old. Ask your GP or psychiatrist if they can refer you to a perinatal mental health service for advice when you are planning a pregnancy. This is particularly important if you have had Bipolar Disorder, Schizophrenia, Postpartum Psychosis or any other psychotic illness. It may also be helpful if you have had other severe mental health problems (e.g. Depression or Obsessive Compulsive Disorder).

 

You may also find it helpful to talk to other women who have had mental health problems and who now have children. The organisations listed at the end of this leaflet offer advice and support.

 

How can I make sure that I have a healthy pregnancy?

You need to think about your physical health as well as your mental health.

 

You will have a more healthy pregnancy if you:

  • Stop smoking
  • Cut down or stop drinking alcohol
  • Stop using cannabis and other illegal drugs
  • Lose weight if you are overweight – healthy eating and exercise may help
  • Increase your weight if you are underweight
  • Take folic acid (400mcg daily) for 3 months before you get pregnant and for the first 12 weeks of pregnancy – this can reduce the chance of your baby having a birth defect called spina bifida
  • Take a higher dose of folic acid (5mg daily) if you are on some medications e.g. Valproate (Depakote) or Carbamazepine (Tegretol)
  • Have a check-up with your dentist – gum disease is associated with premature birth
  • Have a “well-woman” check-up  e.g. a smear test and screening for sexually transmitted diseases
  • Get advice about any physical health problems e.g. diabetes or epilepsy
  • Make sure your vaccinations are up to date e.g. Rubella (German Measles) - a virus which can be dangerous for your baby in early pregnancy
  • Get advice about how to eat healthily and foods you should avoid .

Your GP or psychiatrist can tell you where you can get help and advice in your area. For example, you may want to go to a smoking cessation service to help you stop smoking. If you have a physical health problem, e.g. diabetes, your GP may need to refer you for specialist advice.

 

Should I stop my medication?

Many women worry about taking medication in pregnancy. You need to think carefully about what the risks and benefits of medication are for you and your baby.  For many women it may be safer to take medication in pregnancy than to stop. This is more likely if you have had a more severe illness. Deciding whether or not to continue or change your medication is not easy.

 

If you want to get pregnant you should discuss your medication with your psychiatrist or GP.  They can give you up to date information about medications in pregnancy. They can help you to decide what is best for you and your baby. Don’t stop your medication or reduce the dose suddenly. You are more likely to relapse if you do this without advice.

Always check whether herbal or over the counter medicines are safe to use in pregnancy.

It is best to use contraception until you have seen your doctor to discuss your medication. Unplanned pregnancies are common. If you find you are pregnant you should see your doctor as soon as possible.

In order to decide about using medication in pregnancy, you will need to think about:

  • How unwell you have been in the past
  • How quickly you become unwell when you stop medication
  • Medications you have taken:
    • which treatments have helped you most?
    • have some medicines caused side-effect?
  • Up-to-date information about the safety of certain medications in pregnancy.
  • What might happen if you are unwell during pregnancy. This includes:
    • you may not take good care of yourself.
    • you might not attend appointments with your midwife. This means you may not get the care you need.
    • people who use drugs and alcohol may use more when unwell. This can be harmful for your unborn baby.
    • you may need a higher dose of medication if you become ill. Sometimes you may need two or more medications to treat a relapse. This might be more risky for your unborn baby than if you take a standard dose of medication throughout pregnancy.
    • you may need in-patient treatment.
    • you may still be unwell when your baby is born. You may then find it more difficult to care for your baby. It may also affect your relationship with your baby.
    • if your illness is not treated, this may be more harmful for your baby than using medication. Untreated mental illness may cause a number of problems. For example, some research studies have found babies are more likely to have low birth weight if their mother has depression in pregnancy. Untreated mental illness can also affect a baby’s development later on.
  •  Unfortunately 2-3 in every 100 babies are born with an abnormality, even when the mother has not taken any medication. 

Your doctor should support you whether you decide to continue, stop or change your medication. 

 

Will I be able to breastfeed if I am on medication?

Breastfeeding has many health benefits for mother and baby. Women can breastfeed whilst taking many types of psychiatric medication. You need to talk to your doctor about the medication you are taking. If your baby is unwell or premature the advice may change. You can talk to the doctor looking after your baby about this.

Fully breastfeeding a baby can be very tiring. Some women find it easier to combine breast and bottle feeding. If a partner, friend or family member can do some of the feeds you will be able to get more rest.

Sometimes women feel guilty if they can’t breastfeed. If you are unable to breastfeed you should not worry. It is more important for your baby that you are well. You will still develop a close bond with your baby if you bottle feed.

How may my mental health be affected by pregnancy?

For some women pregnancy may be difficult. Others enjoy pregnancy. Many factors can affect how you feel in pregnancy. These include physical symptoms (e.g. morning sickness), the support you have, and stressful events in your life.

Pregnancy does not protect you from having mental health problems. Most mental health problems are just as common in pregnancy as at other times.

For some mental illnesses (e.g. Bipolar Affective Disorder or previous Postpartum Psychosis)  there is a particularly high risk of becoming unwell after having a baby. This can happen even if you have been well for many years.

If you plan to get pregnant it is important to tell your GP if you have ever had a mental illness. Your GP or psychiatrist can give you advice about your risk of becoming unwell in pregnancy or after birth. They can tell you what support is available and what will help to keep you well.

For more information see our leaflets on Postnatal Depression and Postpartum Psychosis.

What support and help will be available for me in pregnancy?

All pregnant women have care from a midwife during pregnancy. When you first see your midwife she will ask about your mental and physical health. You should let your midwife know if you have ever had a mental health problem. She can tell you about the support available where you live.

In some areas there are perinatal mental health services. These are specialist mental health services for pregnant women and women with a baby under one year old. They will work with you, your family, your midwife and health visitor and any other professionals involved.

After birth all women see a health visitor to get advice about caring for their baby. Children’s Centres have postnatal groups where you can get help, advice and support and meet other new mums in your area.

What if I can’t get pregnant?

It usually takes several months to get pregnant. About 85% (85 in every 100) women will get pregnant in a year if they do not use contraception and have sex regularly. Half of the rest will get pregnant in the second year.

Some antipsychotic medications can make it more difficult to get pregnant. This is because they affect a hormone called prolactin. If your prolactin levels are too high you may not be able to get pregnant. If you are finding it difficult to get pregnant your GP can check your prolactin levels. If your medication means you have raised prolactin you may need to change to another drug. Don’t stop medication suddenly without advice. Discuss this with your doctor.

Some physical health problems can make it more difficult to get pregnant. You may find it more difficult to get pregnant if you are obese or if your weight is very low. Talk to your GP for advice.

What is it like to become a parent?

Having children is often rewarding and satisfying. Many parents also find it stressful and exhausting at times.  Newborn babies are dependent for all their care on their parents. You need to make sure you have practical and emotional support to help you to manage. If you have mental health problems you may need extra support to make sure your child has the care she or he needs. For example, if you often have admissions to hospital, you need to plan for their father, grandparents or friends to provide consistent and loving care for your child if you are unwell.

What about Children’s Social Care?

Most women with mental health problems look after their children very well. Some families struggle to look after their children. This may mean they put their children at risk, usually without meaning to.  

 

Some women are worried about seeking support from Children’s Social Care.  Social workers aim to support parents to provide the best care for their children. They work with families to identify any difficulties.  They can help make plans with you so all family members are supported and children are safe if there are problems.

If the professionals caring for you during pregnancy think it would be helpful for Children’s Social Care to be involved with your family they will discuss the reasons for this with you.

Where can I get further information?

Family Planning Association: Tel: 0845 122 8690

Information, advice and support about sexual health, contraception and pregnancy. Confidential helpline.

 

National Childbirth Trust: Tel: 0300 330 0700

Support and information on all aspects of pregnancy, birth and early parenthood. Local groups and telephone helplines.

 

Tommys: Tel: 0800 0147 800

Funds research into pregnancy problems and provides information to parents.

 

The Royal College of Obstetricians and Gynaecologists

 Information leaflets about pregnancy and birth

 

Bipolar UK

Information and support for people with Bipolar Disorder.

Including an information leaflet about Bipolar Disorder, pregnancy and childbirth.

 

Maternal OCD 

Information and support for women with OCD, including support group and skype support.

 

Action on Postpartum Psychosis: Tel: 020 3322 9900

Postpartum Psychosis information, advice, research and support. On-line forum and peer support network.

 

Pandas Foundation: Tel: 0843 2898401

Pre- and post-natal depression advice and support

 

Association for Postnatal IllnessTel:  020 7386 0868

Information about postnatal depression and support from a network of volunteers who have experienced postnatal depression .

 

Family Action: Tel: 020 7254 6251

Support and practical help for families affected by mental illness, including 'Newpin' services - offering support to parents of children under-5 whose mental health is affecting their ability to provide safe parenting.

 

Home Start: Tel: 0800 068 6368

Support and practical help for families with at least one child under-5. Help offered to parents finding it hard to cope for many reasons. These include mental illness, isolation, bereavement, illness of parent or child.

Drinkaware: Check the facts about alcohol and pregnancy.

 

References

  • Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline 45 (2007) National Institute for Clinical Excellence: London
  • Antenatal Care: Nice Clinical Guideline 62 (2010) National Institute for Clinical Excellence: London
  • Management of perinatal mood disorders (2012). Scottish Intercollegiate Guidelines Network (SIGN) Edinburgh: SIGN; 2012.

Written by: Alison Puffett, Olivia Protti, Maddalena Miele-Norton and Lucinda Green on behalf of the London and South Consultant Perinatal Psychiatrists Association

Service User Involvement: Maternal Mental Health Alliance

This leaflet was produced by the Royal College of Psychiatrists' Public Education Editorial Board.
Series editor: Dr Philip Timms.

© March 2014. Due for review: March 2016. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked to directly. 

For a catalogue of public education materials or copies of our leaflets contact:

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Charity registration number (England and Wales) 228636 and in Scotland SC038369.

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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