Cheryl’s story: my postpartum psychosis

Cheryl McAulay didn’t have a typical 21st birthday. Instead of the big party she’d planned, the mother-of-one saw in her birthday at the mother and baby unit in Nottingham, where she was being treated for postpartum psychosis. 

Cheryl was admitted to the MBU at the Queen's Medical Centre (which has now been replaced by Hopewood), three weeks after giving birth to her son, Joel. Now, inspired by the BBC’s recent In the Mind season, she is sharing her story to help raise awareness of perinatal mental illness.

Cheryl's story

“I was 20 when I fell pregnant. Not many of my friends had children. I attended a few antenatal classes, visits with the midwife and GP, but mental health wasn’t a topic we ever talked about. It never came up.

Cheryl with Joel

A couple of days after I had Joel I went home to my parents’ house and then, shortly afterwards, I went to live with Joel’s dad, at his parents’ house.

I didn’t recognise it at the time, but my behaviour had started to change. I felt so hyper. I was talking at high speed. Sleeping was a struggle. The smallest tasks, just making dinner, felt impossible. One day, Joel’s dad walked in on me holding Joel’s foot under cold running water. ‘I was training him not to cry’ I said. It was after that I agreed to see my doctor.

Learning from experience: plans for our new Mother and Baby Unit

Blogger Eve was cared for at our Mother and Baby Unit, after the birth of her son. She now campaigns to improve access to mother and baby units, and is advising EastEnders on Stacey Branning’s postpartum psychosis storyline. We are creating a brand new site for children, young people and families, so we asked Eve about our plans.

Eve's thoughts on the new unit

I was in the QMC Mother and Baby Unit when I was unwell after the birth of my son. I was at rock bottom and thought my only chance of ridding myself of my despair was by not being alive anymore. But it turned out that wasn’t right; there was another way, and that was by being admitted to the unit.

Eve and Joe, three weeks before Eve was admitted to the Mother and Baby Unit

As a Mum, I needed to be somewhere that was safe, calm, homely and purposeful. And that is what the unit is and needs to remain in its new guise– a warm place with friendly faces with a knowledge of how to get you better. There is no better evidence base than lived experience and I am delighted that former patients have been spoken to with no subject being off limits when discussing improvement options for the new unit.

Pregnancy and bipolar disorder

Bipolar disorder has been the focus of BBC One’s EastEnders recently, as Stacey Branning tries to manage her condition during pregnancy.  Dr Neelam Sisodia is a Lead Consultant with the Trust’s Perinatal Psychiatric Service, which works to prevent and treat serious mental illness during and after pregnancy.

We caught up with Neelam to find out more about bipolar disorder during pregnancy.

What is bipolar disorder?
Bipolar disorder is a serious mental illness which affects mood. Someone with a bipolar illness will have periods of depression, periods of elation (known as mania) or a mixture of the two. In severe cases, it can also be accompanied by psychotic symptoms, such as hallucinations and/or delusions.

Women are often diagnosed with bipolar disorder in their 20’s or 30’s. A woman who has not previously suffered from it, but has a family history of mood disorder, may develop a bipolar illness for the first time during pregnancy.

Usually bipolar disorder is treated with either a mood stabilising medication or a combination of antidepressant and antipsychotic medication. Some people may also use psychological treatments, such as talking therapy, or find lifestyle changes can help. All women are informed about the risks of conceiving whilst taking medication and are encouraged to discuss plans to become pregnant with their psychiatrist beforehand if possible, so that adjustments can be made to their treatment plan.

How is bipolar disorder managed during pregnancy? 

This can be very complex and challenging. Women who have bipolar disorder are more likely to become unwell during pregnancy or after childbirth, than at any other time in their lives. Some are also at risk of developing a psychosis postpartum (the period immediately after childbirth.)   

Treatment during pregnancy will vary, just as the needs of each woman will vary. An individual treatment plan is developed between the woman, her perinatal consultant psychiatrist and her Community Psychiatric Nurse (CPN). She’ll also be supported by a specialist midwife.

What about medication?
The decision about taking or not taking medication is always difficult. The balance of risk and benefit will vary between medications and will be different for each woman. Some of the mood stabilising medications used to treat bipolar disorder can cause serious foetal abnormalities however a relapse can have a significant impact on the mother’s wellbeing, which could, in turn, also have adverse effects on the unborn baby.

If you become pregnant whilst taking medication for bipolar disorder, it’s very important that you do not stop taking it until you have discussed it with your prescribing doctor. You will then be referred to a perinatal consultant psychiatrist. Suddenly discontinuing medication greatly increases the risk of relapse which is extremely risky for you and your baby.

What are postpartum psychosis and postnatal depression? 
Around the time of childbirth, high and low mood episodes can occur in women with mood disorders, including bipolar disorder. Psychotic symptoms such as hallucinations, delusions and persecutory ideas may also occur and can be very frightening. When symptoms are this severe, it is called postpartum psychosis. Postpartum psychosis is a relatively rare, but serious, illness affecting 1 or 2 women in every 1,000 women who give birth. A woman could develop postpartum psychosis without having had or developing bipolar disorder.

Postnatal depression is a depressive illness like any other, but is called postnatal depression when it occurs after a woman gives birth. It is more common and often more easily treated than postpartum psychosis. For most women, antidepressant medication, along with support from family, a GP and health visitor is enough to help them recover. In severe cases, a woman with postnatal depression may also be referred to her local Perinatal Mental Health Service.

What happens after the baby is born? 
This is a particularly risky time; hormone imbalances, disturbances to sleep and changes to medication can all trigger illness.  The treatment plan agreed during pregnancy will include plans for after birth. A mother who has just given birth will also be monitored closely by her CPN, midwife and health visitor so that if she becomes unwell, she can get treatment quickly.  If she needs admission to hospital, this may be to a Mother and Baby Unit, staffed by mental health nurses and nursery nurses.

What about breastfeeding? 
A mother can breastfeed her baby whilst taking some medications. Your perinatal psychiatrist or CPN will be able to discuss this with you. If a woman has expressed a wish to breastfeed she can usually be supported to continue with breastfeeding, even if she becomes unwell. Medications not suitable in breastfeeding are only used if there really is no other option.

How can a woman minimise the risk of becoming ill during and just after pregnancy?
We offer pre-conception counselling for women with bipolar disorder who are considering having a baby. This helps to manage medication and minimise risk before a woman becomes pregnant. Once pregnant, referral to the specialist Perinatal Psychiatric Service as soon as possible is essential as mental illness can complicate pregnancy and put a woman at higher risk of relapse.

If you have a history of serious mood disorder or other mental illness, be open with your GP and midwife, so they can access the most appropriate services for you. Working with mental health professionals allows for your treatment to be planned and implemented, helping to minimise the risk to you, your child and the rest of your family.

Where can I get more information? 
Open House is a peer support group in Nottingham for those affected by maternal mental health problems. You can also find further information on the NHS Choices and Bipolar UK websites.
Action Postpartum Psychosis (APP) campaign nationally for the development of services for women with serious mental illness related to childbirth.

Above all, don’t be frightened. If you’re concerned about your illness and how it may affect your ability to get pregnant and cope with motherhood, talk to you psychiatrist, CPN or GP. There will be someone locally who can help you access the care most appropriate for you.

You've got a friend in me

Last week we shared Alexandra’s story; a mum helped by her local perinatal support service after struggling with anxiety and depression following her baby’s ill health.

Alexandra’s story isn’t a one-off though, and there are many more families in need of support. Emily, a full-time mum to three boys, is the Perinatal Volunteer Befriender who helped Alexandra to overcome her anxieties.

“I had three very different perinatal experiences” explains Emily. “The baby blues, pinks and a long period of anxiety, brought on by my youngest son’s diagnosis of Down’s Syndrome at three weeks old.

“When I heard Sure Start was looking for perinatal befrienders I jumped at the chance to be involved; it was the kind of support that I’d needed at my lowest periods.

“Alexandra was fantastic to be around and very open about her feelings. We went out and conquered lots of personal challenges together. Today, she is a lot more confident and knows she has great strengths and abilities, especially as a mum. She has overcome a lot in a short period of time. It’s simple but so effective, to know that someone is there for you; especially if they understand how you feel or what you’re dealing with.

“Befriending is great. I get to meet and socialise with lots of lovely new families. I enjoy the work role aspect too; I’ve gained lots of experience from working in the office and completing paperwork.”

“Children's Centres are priceless for mums” says Emily. “They can find out about what services are available that suit their needs and how their families can benefit. Brill!”

If you’re interested in becoming a Perinatal Volunteer Befriender, contact your local Children’s Centre Coordinator.

“Why do I need a Befriender? I’ve got friends, I’ve got family. How can they help me?”

For Alexandra, 31, from Eastwood, the first few months of motherhood didn’t go quite as she’d hoped. However, after finding support from a local befriending service, Alexandra is now sharing her story, encouraging other families who are struggling to access the help that's available.

At six-months-old, Alexandra’s son, Cal, was admitted to hospital as the result of a severe milk allergy; a condition that can cause diarrhoea and vomiting, skin rashes and difficulty breathing. In rare cases, it can also result in anaphylactic shock, a potentially life-threatening allergic reaction. At around the same time as his hospitalisation, Cal also developed a hernia which, after a long wait, eventually led to surgery.

All this took its toll on new mum Alexandra, who was eventually prescribed anti-depressants by her GP. He also suggested she try the Perinatal Befriending Programme, run by Nottinghamshire Children and Families Partnership, part of Nottinghamshire Healthcare.

“I went to my doctor and said ‘I think there’s something wrong with me’” Alexandra explains. “Feeding Cal was like force-feeding. I feared he’d go back into hospital. I was anxious that he wasn’t getting enough milk. Doctors told me ‘try not to let him cry too much, because his hernia may pop out.’ It was exhausting. Mentally, I couldn’t cope.

“I lost the confidence to go out, it was just too stressful. I felt I had no one to talk to. I was really isolated.

“When my doctor first suggested it, I thought: ‘Why do I need a befriender? I’ve got friends, I’ve got family. How is that going to deal with what I’m going through?’ But, I gave it some thought and decided to give it a try."

Soon after, Alexandra was paired with Emily and, from then on, things slowly started improving for Alexandra and Cal.

“After her first few visits, I began to look forward to Emily visiting. She had experienced many of the same issues I had; it was so reassuring to talk to someone who knew how I felt! 

"It was baby steps at first; a walk round the block, then to the local park and, eventually, into town. She went with me to groups so that I wasn’t sitting on my own. She introduced me to other parents. If Cal got upset, she’d remind me ‘it’s ok if he cries.’ She’d recognise if I was struggling and say ‘let’s go.’ She wasn’t too pushy. Some health professionals tend to dictate, but Emily would just suggest ideas. She always let me choose.

“Slowly, my confidence built up. The anxiety, the nerves, all calmed down. And, as soon as I calmed down, so did Cal. Having Emily around helped me to relax.

“Now, things are improving each day. And Cal is eating me out of house and home! Weaning has been a challenge but I’m slowly introducing him to new foods. I’ve started a new job and I’m looking forward to enjoying him this Christmas, without worrying about feeding and hernias! I’ve got a bit more of a spring in my step. I’m slowly coming off my anti-depressants and by next year, I want to be off them completely.”

For more information about Perinatal Support Services, contact your GP, Health Visitor or local Children's Centre Coordinator.