Another Twinkle in the Eye

Contemplating Another Pregnancy After Perinatal Mental Illness

Elaine Hanzak

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781315342825
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

Another Twinkle in the Eye is an essential guide for anyone contemplating another pregnancy after perinatal mental illness. The decision to bring a child into the world is rarely one that is taken lightly. When a previous pregnancy and early parenthood has resulted in poor maternal and/or paternal perinatal mental health, making a conscious decision to have another baby can be even more challenging.

This unique book provides facts, resources, and discussion points to support people in making informed and comfortable decisions. It is also an essential resource for health professionals who support or are involved in the decision-making process of couples planning another pregnancy.

The author combines personal experience with real-life stories from other parents. Also included are contributions from healthcare professionals. The book offers comprehensive coverage across five key areas: Reflection on the previous pregnancy, miscarriage or stillbirth, Decisions to be made when considering another pregnancy, Ways to plan for and to have a healthier experience, The role of healthcare professionals and facilities, and Self-help and complementary techniques for good mental health in the perinatal period.

Part 1
Reflection on the previous pregnancy, miscarriage or stillbirth

Chapter 1
Antenatal and postnatal mental health conditions

I felt completely detached from reality. Like I was in a bubble – behind a Perspex screen and the rest of the world was on the other side and I was totally trapped. I could see them but not reach them.

A mum

In this chapter I aim to outline some of the conditions that can happen in the perinatal period that affect mental health. As parents I hope you can identify with what happened to you and to others. For health professionals, I hope that this will help you to have a greater awareness and insight into the impact of these conditions and consequently why facing the decision to become pregnant again is likely to be difficult.

Before I became pregnant I had hardly heard of postnatal depression (PND). I may have read a small paragraph in the volumes of books and magazines I devoured whilst I was expecting, yet dismissed it as something that would not affect me. I had the misapprehension that I would be immune because my baby was desperately wanted; I was in a stable relationship; had a very comfortable home and lifestyle plus a supportive family. I had always been mentally well, was also incredibly organised and lived my life by lists! So it was a massive shock to be diagnosed with postnatal depression when my baby was four months old and to then develop puerperal psychosis three months later. I had never had any previous mental health challenges, so the whole process was a steep learning curve for me and those close to me. It is only since I suffered that I have increased my knowledge of mental illness and recognise how ignorant and wrong I had been in thinking ‘I wasn’t the type’. There seems to be a common belief that ‘it won’t happen to me’.

Of the people who responded to my survey, only around 50% of them knew anything about perinatal mental illness before or during their first pregnancy. Some were aware that ‘baby blues’ were common and that postnatal depression existed; they knew brief details of the symptoms and that it may affect your ability to bond with your baby. Like me, none had heard of puerperal or postpartum psychosis.

Sources of information came from:

• reading books, leaflets and magazines – this usually was very sparse in mainstream pregnancy resources
• media
• internet
• friends and family experience
• antenatal classes and appointments
• GP, midwives and maternity support workers
• professional experience – as a nurse, for example.

Only a small number felt that they knew enough before they became unwell, e.g. ‘Had I heard of puerperal psychosis, it would have been less of a shock to receive a diagnosis of something totally unknown to me and my husband.’

I do wonder whether, if I had been given more details about possible mental health problems, I would have absorbed it when I was pregnant. I had a slight awareness yet dismissed it happening to me for the reasons I have outlined. Maybe it would be like considering divorce options when you are getting married! You do not want to know or think it will happen to you! We must also take into consideration the fine line between keeping parents informed and giving them too much information or details which could be distressing. The balance must be to give enough knowledge and resources to help parents realise that their mental health may be affected by pregnancy and birth then give them a pathway to follow if they do need help.

Here are some other comments from parents regarding knowledge of perinatal mental health when they were pregnant and what could have been better:

• I think that PND is glossed over. In lots of baby books it is given barely a small paragraph of information. I didn’t know what it was at all. To my knowledge it was prolonged baby blues. Postnatal depression isn’t glamorous or idealistic when planning for the arrival of your child really is it? That’s not the reality and it should be addressed to each pregnant individual.
• Better prenatal classes with realistic information; less crowded and a more in-depth talk rather than very rushed.
• More information on signs and symptoms of PND and what to do if you experience them. Also to be told I may have been more likely to suffer with it because of my previous history of anxiety.
• To know that PND isn’t as clear cut as I thought. I thought if you had it everyone felt the same.
• I needed the expertise of other women and mothers but I only knew that retrospectively. I read too many ‘expert opinions’ but never knew I should have made time and space to consider the situation for myself.
• Nothing as I would have skimmed over the info thinking it wouldn’t relate to me. I had no reason to think I would ever have mental health problems.
• More information about the signs of PND to look out for. On the other hand, if I had read up/known too much about PND beforehand it might have made me more anxious because I would have been worried I’d get it before I even did!
• Some knowledge of puerperal psychosis. I do not find the description that PP is severe postnatal depression to be that helpful – I felt many things, but never depressed! I would like to have had a debrief on what happened during my delivery and why labour was so protracted.
• I didn’t know postpartum psychosis existed. I had clear insight into the fact that I was becoming increasingly manic – I have no doubt if this condition was more widely discussed I would have sought help. It is almost completely not mentioned in any of the popular baby bibles. I know it is rare, but it happens and can be severe. I think it deserves more of a mention.
• Some way of being able to mentally prepare for the stress of looking after a newborn and lack of sleep.

Here are some of the main mental health conditions that may be identified around pregnancy:

• previous or existing conditions before and during pregnancy
  1. ◗ depression
  2. ◗ anxiety
  3. ◗ panic attacks
  4. ◗ self-harm
  5. ◗ eating disorders
  6. ◗ personality disorders
  7. ◗ mental illness, e.g. schizophrenia
  8. ◗ body dysmorphic disorder
  9. ◗ bipolar disorder
  10. ◗ family history, e.g. ‘My mother committed suicide when I was 14 years old and her father (my maternal grandfather) shot himself in the heart a year and a half later. I was never counselled.’
  11. ◗ trauma, e.g. bereavement, witnessing or being abused
  12. ◗ undiagnosed conditions that emerged after the birth, e.g. onset of bipolar disorder
  13. ◗ loss of a baby, miscarriage or still birth
  14. ◗ substance abuse related
  15. ◗ mental challenges due to pain, e.g. pregnancy-related pelvic girdle pain (PPGP) or symphysis pubis dysfunction (SPD)
  16. ◗ hormonal conditions, e.g. premenstrual syndrome
  17. ◗ thyroid imbalance
• postnatal conditions:
  1. ◗ baby pinks
  2. ◗ baby blues
  3. ◗ mild to moderate depression
  4. ◗ severe depression
  5. ◗ obsessive-compulsive disorder (OCD)
  6. ◗ anxiety
  7. ◗ puerperal psychosis
  8. ◗ post-traumatic stress disorder
  9. ◗ physical difficulties as a result of birth, e.g. bladder control, mastitis, that can lead to mental health issues, such as fear of leaving home.

There are many sources of information that describe these conditions in detail. I have listed some of them in the resource section at the back of the book. Two most recent collections of journal articles concerning these disorders, screening and treatments can be found in the Best Practice and Research Clinical Obstetrics and Gynaecology (January 2014)¹ and The Lancet (November 2014).²

I think that because the range of conditions are so different and the symptoms can vary so widely, this often makes it difficult for parents and healthcare professionals to approach this area. It is not as ‘straightforward’ as some physical conditions, e.g. getting appendicitis, when there are small number of indicative symptoms and only one or two alternatives for treatment. Sometimes people do not speak out because they consider what they are feeling is possibly normal. These are some of the emotions and thoughts that parents have described to me during or after pregnancy that have impacted their mental health. Not everyone is affected by all of these! As I compiled this list there were many that I could relate to and othe...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• About the author
• Contributors
• Acknowledgements
• Glossary
• Dedication
• Introduction
• Part 1 Reflection on the previous pregnancy, miscarriage or stillbirth
• Part 2 Decisions to be considered about another pregnancy
• Part 3 Ways to plan for and to have a healthier experience
• Part 4 The role of healthcare professionals and facilities
• Part 5 Self-help and complementary techniques for good mental health in the perinatal period
• Appendix 1: Resources and further information
• Appendix 2: Case studies of families with lived experience
• Appendix 3: Planning and screening tools
• Appendix 4: UK policy drivers around antenatal and postnatal (perinatal) mental health
• Appendix 5: Survey used as additional information for this book
• Index