July 12, 2024 • 48 mins
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.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
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.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Florence (00:01):
Hello, my name's Florence.
Welcome to the OBS pod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:22):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.
(00:50):
Episode 173 postnatal psychosis.
Today I'm joined by a veryspecial guest, sarah um, who got
in touch with the podcast, andwe're going to talk all things
postnatal or psychosis.
So Sarah has experienced thisherself after the birth of her
(01:16):
son and she's very kindly goingto share her views and her
personal experience to give us alittle bit of a feel.
Some of us may have lookedafter women with postpartum
psychosis.
It's relatively rare, but we dousually see a small number of
women every year and I thinksometimes we see a woman acutely
(01:41):
in a maternity ward and then wedon't know that much about what
their journey is likeafterwards.
So welcome, sarah.
Perhaps you could start bytelling us a little bit about
yourself.
Sarah (01:58):
Okay.
So I've had a diagnosis ofbipolar type 1 for about a
decade and so we knew going intomy pregnancy that that kind of
put me at a higher risk ofpostpartum psychosis.
But I was under the care of mylocal perinatal mental health
(02:23):
team.
We had a birth planning meetingand generally I was actually
very well during my pregnancy.
I was on both a mood stabilizerand also an antipsychotic,
which had kept me very stablevery well for the like quite a
few years.
But the circumstances around myson's birth were very, very
(02:48):
challenging.
So he was actually born on thefirst day of my maternity leave
by emergency caesarean section,and then we had the kind of nice
photo of him on my chest youknow new family and all that um.
But straight away staff noticedthat he'd stopped breathing and
(03:08):
so they had to resuscitate himand was whisked away to neonatal
intensive care unit, so NICU,and so that first night.
Actually the pediatricians wereincredibly kind.
They came and saw me a fewhours later and kind of allayed
my concerns about you know,should I have spotted things
(03:29):
sooner or what was going wrong?
And then kind of I'd been toldI'd be able to see him early in
the morning.
I was then told actually he'snot stable enough, you need to
wait a few hours.
The first time they told mehe'd been intubated which kind
of this, was around the time ofCOVID.
So for me this was particularlyterrifying because I kind of
(03:50):
associated it with people dyingof COVID.
So the next morning he wastransferred to an even more
specialist hospital wherebasically it was full of
premmies but he was was term andso that was very difficult and
so, to be honest, all the focuswent on him and kind of seeing
how he got physically better.
(04:13):
And you know, thank God he didrecover quickly, but basically
by the time he was well enoughto be discharged, I wasn't well
enough to be at home, and Ithink one of the things that I
reflect on now was actuallythere were a couple of nights
where I just didn't sleepbecause I had a cough and at the
(04:34):
time coughing like really hurtmy cesarean wound and so I think
, looking back, I'd assume thatthat was a physical health thing
.
But actually in retrospectmaybe that was a mental health
thing that I just didn't thinkof because it wasn't or
certainly to me at the time itdidn't seem to be presenting
with other symptoms.
Um, but I think so over time II just kind of stopped sleeping,
(05:01):
which I know you're a newparent, that I mean, my son was
away in NICU and SCABOO, but Istopped sleeping and then that's
kind of when everything umreally started going wrong.
And I think it was hard becauseI did have insights at the
start.
You know, that I was probably inhypermania and kind of not
(05:21):
wanting to get worse, but Ithink you know the way if you're
a bit ill.
And then there's the weekendand it's much harder for, like
community mental health teamswhich are set up for Monday to
Friday.
Yeah, it's a lot harder forthem to do that wraparound care
because they're just notresourced for that.
Yes, um, and so it took.
Florence (06:08):
So it took a little while.
So then I was, my son and Iwere sent to a mother and baby
unit and yeah, I guess that wasa big next starts in the first
couple of weeks.
How, how old was your son?
How many days had passed beforeyou started?
Sarah (06:13):
that not sleeping and started to notice things.
Yeah, I mean, it's interesting,possibly with hindsight five
days, if that makes sense, basedon not sleeping with the
coughing, but I think maybe itwas the second week after his
birth that, um, things justescalated yes, I definitely
(06:34):
think sleep, not sleeping for meis a big.
Florence (06:40):
It's a really difficult one because it's a big
flag.
But it's also so difficultbecause parents are very sleep
deprived at that point whenthey've had a new baby and
they're adjusting to lookingafter it overnight and, like you
say, recovering from perhaps acesarean or the birth.
So it's really difficult totease out.
So I'm not surprised when yousay you thought it was maybe a
(07:03):
physical thing and then startedto realise maybe it was a mental
thing.
Because I think that's also verydifficult for us when we're
looking after women, to kind oftease out how much of this not
sleeping is.
Apart from the not sleeping,what?
Sarah (07:28):
were the other sort of symptoms or things when you did
have insight that you werenoticing.
So I suppose for me one of mysigns can be overspending.
And so you know, say I wasbuying stuff for like, there's
always a little kitchen in NICUor SCBU trying to buy some food
for people to snack on in there,and you know my husband was
like, but you're, you'respending lots of transactions,
whereas for me it wasn'tactually much money.
(07:51):
Yes, led to what I'd done inthe past and I think you know I
can remember popping to a shopor something with my mom and you
know, for me it was almost likepart of me was like thank God,
my son's not died.
I want to get a few things tocelebrate.
But I'm just trying to thinkwhat else?
(08:14):
I mean, I think, the usualthings like probably, you know,
talking very quickly, yes, um,possibly jump thoughts jumping
around, but those are kind of myusual key tells and I suppose,
for example, having lots ofenergy and wanting to do other
things.
(08:35):
So, for example, when I waskind of waiting in the family
room, um, waiting to be kind ofcalled to feed my son, you know
I'd taken a language textbookand was like, well, this is
great, I'm going to learn alanguage and for me, kind of
having all these projects yeah,those were my other tells.
I mean, I suppose I saw a rangeof other people's symptoms, say
(08:59):
in the mother and baby unit, soI think there were some people
who were maybe paranoid abouthow their child was being
treated or others were treatingtheir child.
So I think it can.
I think it can vary.
I mean, I suppose for me it waskind of similar to previous
signs of hypermania and maniayes, okay and so.
Florence (09:22):
So you were.
You'd been discharged, fromyour perspective, from hospital,
but you were staying in theNICU accommodation with your son
.
Sarah (09:34):
So we were lucky.
Actually, once I'd beendischarged from the maternity
ward, it was, you know, kind ofgoing forward and back in the
city that we live in um visit myyou know, our son over there.
(09:59):
So I think it was almost, um,you know, things like.
I can't remember anything aboutthe recovery from the cesarean,
just because my energies werefocused elsewhere do you think
that I mean as well as perhapstriggering 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 mentalhealth clinic and I see women
like yourself and we'repreparing through pregnancy to
try and keep you well and keepyou stable in the postnatal
(10:35):
period and one of the thingswe'll do is lots of midwifery
support and visits at home after.
But when your baby's in theneonatal unit, that sort of gets
slightly problematic becauseyou're coming up and down to the
neonatal unit and thereforeyou're not necessarily getting
(10:56):
that home support that we mighthave done for the first month
where people are a little bitmore focused on your well-being.
So do you think that that alsokind of maybe slowed people down
in recognizing that you weredeteriorating?
Sarah (11:16):
yeah, I mean, I have to say I've never really thought
about that because, um, I'veonly got one, one child, and so
I guess I didn't know what thenormal experience was.
But I mean, I think by the timehe was in SCBU, staff were kind
of picking up that it wasn'tquite you know, things weren't
(11:37):
quite right.
Florence (11:38):
Yeah, okay, and was it difficult in pregnancy, knowing
I mean, obviously this was allquite 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 thishigh chance, I've got the
right
Sarah (11:58):
So I suppose I mean, maybe slightly naively you know
we've done the pregnancyplanning advice, or you know I
can't remember what the propername is but before you start
trying we'd we'd gone throughthat.
Yeah, yes, in all honesty, Ithink it just came as such a
shock because I'd been so stableon my medication for kind of
(12:20):
many years, and I think also thefact that I had been well
during pregnancy.
But I think I mean I look backand I wonder was I a little bit
hypo towards the end ofpregnancy?
Florence (12:32):
I don't know, because you know it seems like buying
things for your son and likeeveryone's told, well, you know,
you do a bit of nesting at theend of pregnancy and it's kind
of, but what's, if you like,what's outside of normal yeah,
yeah, okay, so you mentioned themother and baby unit, so so my
(12:53):
experience of trying to get awoman a place in a mother and
baby unit- it's complicatedbecause they're national beds
and when we do our pre-birthplanning session with the mental
health team, we always explainthere's the possibility of an
(13:13):
adult bed where you're separatedfrom your baby, or mother and
baby unit, but they're nationalbeds.
You might have to travel, theremight be a wait, so I'm
interested to know from when youwere unwell and you kind of
tried to get support.
How long did it actually takefrom your perspective to kind of
(13:34):
get into the mother and babyunit?
Sarah (13:37):
So I think actually it was quite quick.
I think I was admitted to themother and baby unit about three
and a half weeks after my sonwas born, and I think we were
talking about how you know,maybe it was two weeks before it
became um obvious that I wasunwell.
So actually I think I was quitefortunate it was something that
(14:00):
had been discussed at, you know, the birth planning meeting.
Um also, like we live in anarea where there are naturally
more mbs to choose from, and Iguess the fact that I was
already under a perinatal teammust 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 maniceverything seems great and you
know you've got all these otherpeople to speak to in hospital.
But my abiding memory was I wasjust so grateful that I was
with my son.
I didn't really care where Iwas because, you know, for three
(14:52):
weeks I'd not really been withhim the whole time.
Yes, and so it was kind of likeI'm with him, yes, I'm with him
, yes, I don't know.
I mean, I think quite quickly Iwas detained under the Mental
Health Act and kind of that hadhappened to me before.
(15:15):
So I wasn't, you know, I knewthe process in terms of all that
stuff.
But, um, I think probably youknow everyone heard a room in a
bathroom of their own.
There was common there, butalso it was quite hard.
It was um during Covid and soyou know the staff had to wear
masks, so it was harder torelate.
(15:36):
But I think also the it was alocked ward and so for me that
was quite difficult, because inthe past I haven't been
somewhere with like an airlockto get in and out.
Um, yeah, so I think at firstit seemed fine.
You know it was very sweetthey'd got, I think.
(15:56):
When you got there they hadlike a little box with some
toiletries and hot chocolate orwhatever, to kind of be like
welcome and try and make thingsfeel 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 aperiod at the end when I wasn't
detained, but yeah, for most ofthat I was that's quite a long
journey to get get well yeahyeah, definitely, I mean I have
to say I kind of I think quite alot of us felt lied to.
(16:37):
When, you know, on a mission youwere told, oh, most people are
only here six to eight weeks,and actually that wasn't my
experience at all, anyone whohad a pre-existing diagnosis.
You know, a whole cohort of usseemed to graduate around the
same time and that was betweenfour to six months of being in
the mother and baby unit.
So I think, yeah, that's reallyhard yeah um, I mean, I think
(17:03):
one of the things that I foundhardest was I'd been kind of
getting better under differentthings and I was very keen to be
able to like the medication Iwas already on I could
breastfeed on, and so I think,particularly when you've had
such an ill child, yes, I reallywanted to be able to breastfeed
, but there came a point when Ihad to go on to lithium.
(17:28):
You know I didn't have a choicepersonally or legally, and so
for me that was I kind ofcrashed down afterwards and I
think I kind of struggled withalmost like what's the point of
me?
You know, anyone can give myson a bottle, anyone can look
after him.
You know, the breastfeeding waslike the one thing only I could
(17:51):
do with him.
Florence (17:52):
Um, so, yeah, that was really tough that that does
sound really tough, and I thinkthat's definitely something I
see from some women when they'vehad a particularly difficult
birth or a neonatal condition orwhatever, that they feel that
breastfeeding is that key,bonding with their child.
So I can see how incrediblydifficult that would be,
(18:16):
particularly when your yourchoices are taken away in that
way.
And so you said you had insightat the beginning.
Were there points when youdidn'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 mycare coordinator from the
community was like I've neverseen you like this before.
And yeah, there were times waswhen I thought I'd been kind of
inappropriately detained andthat I was, that I was well, um,
(18:54):
I mean, I would say for quitelike 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 tothe neonatal stay.
Sarah (19:14):
Yeah.
Florence (19:15):
You mentioned when we kind of prepared for this.
You said that the parent-infantpsychotherapist was incredibly
helpful.
Tell me a bit about them andthat sort of treatment.
Sarah (19:30):
Yeah, so parent-infant psychotherapy is like looking at
, say, how you interact withyour baby and the bond, and I
think, apart from medication, Igot this both in hospital and in
the community and it was likethe most important thing in my
recovery, the most importantthing in kind of building that
bond with my son.
(19:50):
And I think, for example, when Iwas in hospital and I'd come
down, you know, because I wasdepressed, there was kind of, I
had, say, feelings ofambivalence towards you know,
yes, I've got a son, but I'velost my freedom, and not in the
kind of metaphorically like Iliterally legally have lost my
(20:12):
freedom, and so I don't know oneof the things.
It felt like in the MBU you'dalways 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 wasreally or like, apart from the
PIP sessions, or like, apartfrom the PIP sessions, the staff
(20:36):
kind of didn't seem to think toask about how you're feeling
more generally.
And I mean, I think also thereality is, when you're held
under section, certainly I'mvery focused on what I need to
do to come off section and so Ifelt like, actually, if I
started expressing thesefeelings of ambivalence, that
wasn't going to help.
(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, actuallyyou might.
You know things like havingyour freedom takeaway.
You might feel like this, likeany new mum.
It's just the fact that you'rehere, it's kind of particularly
acute yes but I'm trying tothink to remember other um
(21:24):
specific sessions.
But I think also I was worriedthat I'd been very affectionate
towards my son at the start andmaybe I'd pulled back, and you
know, what was that going to doto him?
And you know, the therapist waslike no, he's a really young
baby.
He probably kind of you'restill around, he probably hasn't
picked up on this at all.
So yes, I mean, I don't know ifwe'll speak about afterwards,
(21:48):
but certainly the therapist inthe MBU was really excellent
about afterwards, but certainlythe therapist in the mbu was
really excellent.
Um, it sounds like actuallyit's.
It can be quite hard to getaccess to parent infant
psychotherapy in the communityand 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 abouthow you're feeling and
expressing yourself, becausethat feeds into that legal
detention and that can be reallydifficult.
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 youhave a child yeah, see, you
mentioned to me also about theimpact this had on your partner,
so your, your rest of yourfamily, because he'd had first
neonatal and then both of youeffectively removed for four
(22:54):
months.
So what sort of provision isthere 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 afamily room that you could book
for visits.
I think most of the time he wasable to come on to the ward in
visiting hours and spend time inmy room and so things like.
You know, I think we gave ourson his first bath together and
(23:25):
so I think people are reallyconscious of, you know, wanting
dad or the other parent to stillfeel, yeah, still feel involved
, because I mean, yeah, it's,it's not what anyone expects.
I mean, apparently during Covidcomes the spot about um time
outside of Covid.
(23:46):
You know people just come onthe ward and sit in.
You know they've got variousnice rooms or the garden, and so
I think that did impact thingsa bit.
Florence (23:57):
So you're in the MBU and you've been quite hyper, and
then you're low, yeah, andyou'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 thenalso make that transition,
(24:21):
because that's a massive step,presumably then leaving the
mother and baby unit andcontinuing?
That journey, yeah, so.
Sarah (24:31):
I mean, I think it was difficult.
So at the nursing station theyhad, um, a board with everyone's
baby's name written down and,kind of very publicly, what
level of observations the babywas on, which was, effectively,
you know, how well or able isthe mother to look after the
(24:55):
child.
And so I was on that board atred 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 aninadequate mother.
Yeah, um, that was what thenotice board was very publicly
telling me and others on theward.
(25:16):
And you know, in honesty, it'sstill something I struggle with
from day to day, that feeling ofyou 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 leavethe MBU physically, but
actually the experience stayswith 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 alasting 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 ofcare each each you know, mum,
baby, dyad need, but to havethat visible and color-coded and
what that does sound reallyunhelpful.
(26:13):
Yeah, so when you leave, do youstart?
So you, you mentioned detentionwas shorter than your hospital
stay.
So once you're not detainedunder the mental health act and
you're getting better, yeah, goout 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 leavehospital with, like my husband
or family, yeah, and you know Iwas really lucky that people
lived close enough to do thatwith me.
Um, and then, yeah, theydefinitely don't chuck you out,
um, so you know, it started withlike maybe a visit home for a
(26:58):
couple of hours, then for a day,then like a first overnight,
and you know they're very muchkind of wanting you to build up
to it because apparently forsome people, going back home can
actually be a trigger and sothey don't want to rush you out.
And I think also they keep yourbed for like at least a week,
(27:19):
just from when you're meant fromyour kind of quote discharge,
just to make sure thateverything goes okay.
Yes, and you know, again, thisis a discharge planning meeting
with kind of people from the NBU, people from the community team
.
So I think you know a lot ofthoughts given and I mean one
(27:40):
thing that you know myconsultant in the NBU was really
kind in agreeing to was thatactually I could go on seeing
the parent infantpsychotherapist on the ward
until I was able to pick that upin the community, and so for me
that was really good.
I mean, I suppose one thing I'mconscious I've come, you know it
(28:04):
was a hard time, and I'veshared kind of my views on what
it was like, but also,ultimately, I am really grateful
that MDUs exist because I thinkactually for me I can imagine,
particularly when I was unwellthe thought of being forcibly
separated from my son would havejust been horrific.
(28:28):
Yeah, so you know the fact.
Actually he was able to staywith me throughout.
You know, that's something Ithink is so lucky because I mean
, I think, talking to people,for example, in the States, they
don't have MBUs and I think thefact that at least you've been
able to stay with your childprobably makes things easier
(28:48):
than, if you say, had to go on ageneral 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 kindof help with the care of the
baby or kind of run groups.
So I think I'm grateful that itexists, but it's also a very,
(29:12):
very tough thing to go throughand you know I can still
remember little things thatmembers of staff did you know,
that were just just littlekindnesses 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, thelittle things, the language you
use or the little touch orconversation you have, that,
yeah, can make a big, big impact.
I think you're right.
I think we are very lucky tohave mother and baby units, and
I can see what you're saying.
(29:52):
It it's extremely tough.
But it would have been eventougher after you've been
separated and in a completelydifferent environment that isn't
so focused on that mum and babyrelationship.
When you went home.
Sarah (30:11):
So you had community um, parent infant psychotherapist
and presumably then was it thenthe perinatal team took over or
the community mental health teamtook over in terms of looking
after you yeah, I think it wasstill the perinatal mental
health team, you know, hadfollow-ups um with them for
(30:33):
about a year or maybe it waslonger, and so again, like when
I was in the community, theparent infant psychotherapist
was brilliant and just thingslike I think one of the things I
really worried about from kindof you, when you're depressed,
you just feel very disconnectedfrom everyone, and so one of the
(30:55):
kind of ongoing worries I hadwas about how it could have
impacted the bond with my son,and I can remember like one
session um we were new and I'dsat my son down and the
therapist pointed out that he'dlooked at the therapist in terms
of like, oh, you're a newperson, looked at me, looked at
(31:16):
her again and looked back at me.
And she was like this is himseeking reassurance from you,
and it's a really good sign ofbonding, and so it was just such
a helpful way for me to kind ofexplore 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, theolder he, the older he gets, the
better he gets.
So you know, now he's talking alot and he's inquisitive about
the world, which for me is justmagical.
You know, there are silly gameswe can play together.
So like, yeah, I think probablywhat the therapist in the MBU
(32:07):
said about like you might justnot have enjoyed the baby stage
very much, even on the outside,yeah, no, I think we have a
really good relationship and Idon'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 asyou started to talk about all
the lovely things he's doing.
That's so great and, in termsof your husband, that
relationship with your son andmost of you, that you as a
(32:49):
family how do you feel that'sbeen impacted, or do you feel
there's there's not really ahangover 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.
So I was never able to do nightfeeds for my son and I'm on such
a load of medication that Ijust like I mean he didn't
literally have to scream thehouse down for me to wake up
(33:17):
yeah, and my husband's the onegetting up with him, my
husband's the one getting upearly if he gets up early, and
so I think, yeah, the kind ofalmost the societal expectations
that that would be the motherdoing it kind of hasn't played
out.
But then actually I think, youknow, while it's tough for my
(33:37):
husband, I think he also lovesit because he's he's got such a
close relationship with my sonand I think it's kind of almost
also, as time passes, you kindof there's more and more
distance between that difficulttime and actually now it's kind
of more, you know, planning like, oh, maybe we could go for this
(34:00):
day out as a family and thatwould be fun.
And you know, oh, he really,you know our son really enjoyed
going on this little fairgroundride.
You know when can we do thatagain?
And so it's, I think it feelslike we've definitely gelled as
a family unit.
But I mean, my husband waslucky, he was able to flex his
work around when I was in theMBU and so I think he was able
(34:25):
to see more of our son when wewere in hospital, and so I think
there's always been that senseof connection.
Florence (34:32):
Yes, yeah, and I think what you're saying about the
perhaps slightly different fromkind of societal expected roles.
I can see that that builds areally close relationship
between your husband and yourson, the fact that he's stepping
in and doing those bits, andit's kind of partnership working
(34:53):
partnership, isn't it?
You mentioned that you had usedapp for their peer support yeah
.
Sarah (35:06):
So I think, as everyone was getting ready to leave
hospital, we were told aboutthis charity called action on
postpartum psychosis.
It's an absolutely amazingorganization that I think really
kind of punches above itsweight and what it achieves.
So they do a range of things.
They have really helpfulleaflets on their website that
kind of act as education.
(35:28):
But the thing I've found like sovaluable is their peer support
services so you can be matchedone on one with someone who you
can meet up in person and thenthey hold regional support
groups.
So the one I go to they haveonce a month and then maybe
every three months they have onein person and I think from my
(35:49):
perspective it's just sovalidating to be able to talk to
people who've had similarexperiences and kind of process.
What you've been through and Ithink also it's you know it just
helps you feel less alone inwhat you've been through.
And I think also it's you knowit just helps you feel less
alone in what you've beenthrough.
I think they, you know theyalso offer support for partners
(36:10):
and families and it's brilliantbecause you don't necessarily
stay in touch with people froman MBU or you know, even if
you're ill and don't make it toan mbu, it's just it's so useful
to be able to talk to othersyeah, I can.
Florence (36:26):
I can sense that not feeling alone, feeling like this
, is loads of other people thathave been through that sort of
thing really yeah absolutelyperfect, and I will um put a
link in the show notes if peoplewant to know more to the
charity.
I know it's probably a millionmiles from your thoughts, but
(36:50):
having had this experience, doesthat I don't know what you were
intending in terms of does thatmake you re-evaluate whether
you would have another baby ornot?
Yeah, so.
Sarah (37:05):
I mean, I think we we did talk to um, a perinatal
psychiatrist, and I think youknow the advice is you know I am
high risk, I, I think, I don'tknow I think she might have
mentioned 50%, but then I thinkshe also said but lithium lowers
that risk a lot, and so Isuppose there's enough distance
(37:31):
that I think we would thinkabout it and I think also, I
suppose I would just hope itwould get picked up a lot more
quickly.
I mean, oh, for example, youknow, when people have had, like
, say, a bipolar diagnosis for awhile, they kind of know their
way around all the psychiatricmedicines, and so, you know, I
(37:52):
think I'd probably be much moreadvocating, for I need to have a
stash of benzodiazepines pleaseyou know, and I think people
would just know actually we needto jump into action a lot more
quickly.
But I think also the fact that Iwould be staying on the lithium
and therefore not breastfeedingalso makes it a lot easier to
medicate quickly.
So it's I don't know, it'sdifficult because it was an
(38:16):
incredibly difficult time andyet at the moment it's just like
the most gorgeous age with myson, and so I guess realising
and you know I was stilldepressed when I came out of
hospital, it was still hard andactually for me getting back to
work was actually reallyimportant and kind of reclaiming
(38:39):
that as part of my identity,but I don't think I think it was
one of those things.
You know, we're conscious thatactually I wouldn't want to be
going into hospital because of,you know, the impact it would
have on my son now, and I thinkit was one of those things.
But do we think we could addressthe you know, it's that
(39:01):
trade-off of like okay, I feellike, you know, if a second came
along, probably everyone wouldbe 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 supposeit's, I don't know, maybe
foolhardy, but it's difficult.
(39:22):
It's that trade-off between theimpact on your, your child, but
also the fact that actually itcould just be a few months in
the baby's life and so it's.
You know, there's no, I guessthere'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 likezesty bit, a bit that I want
people to remember and that willbe a bit partly for healthcare
professionals, kind of whatwould you like them?
Or or know if, if they werecaring for a woman with
(40:01):
psychosis or a higher chance ofpsychosis, but also whether
there's something for pregnantwomen, because they also listen
to my podcast.
So, yeah, thoughts on what yourkind of zesty bit, your essence
would be yeah.
Sarah (40:18):
so I suppose for professionals, maybe creating a
space where it feels safe totalk about how you're feeling
towards your baby, I think alsojust kind of maybe acknowledging
the person, because I mean, Iknow everyone when you take your
child to any kind of you know,oh, here are the jabs, oh hi,
(40:40):
mum, how are you doing mum?
And it's like actually, youknow, for a lot of us it's
wonderful, but it's not the onlypart 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 nomention of maternal mental
health.
Now I think any responsibleantenatal classes should be
(41:04):
covering a bit.
You know it's, because what isit?
Is it about one in 500 to athousand who gets postpartum
psychosis?
You know that's a lot.
And you know, with all of thisstuff, if you get early
intervention it's much easier tokind of start treating it's
(41:24):
much easier to kind of starttreating.
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 someways, that's almost more
terrifying, certainly for theirfamilies.
Almost more terrifying,certainly for their families,
because they've never seen them.
Well, and they're suddenly likeoh my god what has happened to
(41:50):
my loved one and and and I thinkcertainly the key thing for me
is, if it's recognized, it'seasily properly treatable and
recoverable from, and so whenI've seen women with psychosis,
that's what I've said to theirpartner and family.
It's okay, I know what this isand I know it's treatable and it
(42:12):
will take time and it'll takemedication and so on, but it's
all right yeah we'll get betteryeah.
I think you're right seeingthat person and acknowledging
that actually, mental health isa key part of that transition to
being a parent.
Yeah, definitely anythingparticular you want to say
(42:37):
differently to women, or maybeit's the same message?
Actually to think about yourmental health yeah, I think so.
Sarah (42:44):
I just wish.
I think my main thing would beI wish people would be a bit
more open about the challengeswith having children.
You know, things like this willchange the way your
relationships within your familywork.
You know, I can remember you'llhave people who you don't know
coming up to you givingunsolicited advice and just kind
of yeah, and I think it.
(43:07):
You know, it's just, it can behard when you know all you're
doing is like feeding andchanging nappies and actually,
if you're used to having acareer, this can actually seem a
bit like, oh, my goodness, whathave I done?
Yeah, and I think, talking to acolleague, his, you know, one
of the things he said he alwayssays to people was like it's
okay not to enjoy it, and so Idon't know.
(43:30):
I know everyone kind of go, youknow, I think I had this idea
that I'd be sitting in a coffeeshop breastfeeding while I read
a book.
You know that's not, um, that'snot what happened at all, um,
and so I guess I know everyonewill tell you oh, it's a massive
change, it's a massive change.
But I think, just going into itwith a kind of it's okay not to
(43:56):
love everything, I think that'svery wise advice.
Florence (44:01):
actually, I sometimes feel this at work because I mean
, I'm supporting women throughbirth and sometimes I'll hand
over a baby and there's thatincredible moment of joy and
exceptional, which is wonderful.
And sometimes I go home and Ithink, particularly for
first-time parents oh my god, dothey have any idea what's about
(44:25):
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 mysister and said it's a
conspiracy.
No one tells you just howdiabolical it is.
So whilst I absolutely adore mychildren, and they're now grown
up, I completely relate to whatyou're saying, that people need
(44:47):
to talk a bit more open aboutthe 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 theirbaby's name on the wall and it's
kind of fantastic.
Well, thank you so so much forsharing your story and your
(45:08):
experiences.
It's been absolutely wonderfulto talk to you and I'm so
grateful to you because I thinkthat lots of people will find
your, your experience and yourinsights really valuable.
So I know it's not easy to comeon and talk about and share
what was an incredibly difficulttime in your life, but I'm
(45:51):
immensely grateful.
So, thank you, thanks very much.
Recommending the OBS pod toanyone you think might find it
interesting, there's also tonsof episodes to explore in my
back catalogue from clinicaltopics, my career and journey as
an obstetrician and life in theNHS more generally.
(46:12):
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
(46:33):
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
If you want to get in touch tosuggest topics for future
(46:55):
episodes, you can find me attheobspod, on Twitter and
Instagram, and you can email metheobspod at gmailcom.
Finally, it's very important tome to keep the ObpsPod free and
accessible to as many people aspossible, but it does cost me a
(47:20):
very small amount to keep itgoing and keep it live on the
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So if you've enjoyed myepisodes and by chance, you do
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(47:40):
Don't feel under any obligation, but if you'd like to
contribute, you now can.
Thank you for listening.
Hello, my name's Florence.
Welcome to the OBS pod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:22):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.
(00:50):
Episode 173 postnatal psychosis.
Today I'm joined by a veryspecial guest, sarah um, who got
in touch with the podcast, andwe're going to talk all things
postnatal or psychosis.
So Sarah has experienced thisherself after the birth of her
(01:16):
son and she's very kindly goingto share her views and her
personal experience to give us alittle bit of a feel.
Some of us may have lookedafter women with postpartum
psychosis.
It's relatively rare, but we dousually see a small number of
women every year and I thinksometimes we see a woman acutely
(01:41):
in a maternity ward and then wedon't know that much about what
their journey is likeafterwards.
So welcome, sarah.
Perhaps you could start bytelling us a little bit about
yourself.
Sarah (01:58):
Okay.
So I've had a diagnosis ofbipolar type 1 for about a
decade and so we knew going intomy pregnancy that that kind of
put me at a higher risk ofpostpartum psychosis.
But I was under the care of mylocal perinatal mental health
(02:23):
team.
We had a birth planning meetingand generally I was actually
very well during my pregnancy.
I was on both a mood stabilizerand also an antipsychotic,
which had kept me very stablevery well for the like quite a
few years.
But the circumstances around myson's birth were very, very
(02:48):
challenging.
So he was actually born on thefirst day of my maternity leave
by emergency caesarean section,and then we had the kind of nice
photo of him on my chest youknow new family and all that um.
But straight away staff noticedthat he'd stopped breathing and
(03:08):
so they had to resuscitate himand was whisked away to neonatal
intensive care unit, so NICU,and so that first night.
Actually the pediatricians wereincredibly kind.
They came and saw me a fewhours later and kind of allayed
my concerns about you know,should I have spotted things
(03:29):
sooner or what was going wrong?
And then kind of I'd been toldI'd be able to see him early in
the morning.
I was then told actually he'snot stable enough, you need to
wait a few hours.
The first time they told mehe'd been intubated which kind
of this, was around the time ofCOVID.
So for me this was particularlyterrifying because I kind of
(03:50):
associated it with people dyingof COVID.
So the next morning he wastransferred to an even more
specialist hospital wherebasically it was full of
premmies but he was was term andso that was very difficult and
so, to be honest, all the focuswent on him and kind of seeing
how he got physically better.
(04:13):
And you know, thank God he didrecover quickly, but basically
by the time he was well enoughto be discharged, I wasn't well
enough to be at home, and Ithink one of the things that I
reflect on now was actuallythere were a couple of nights
where I just didn't sleepbecause I had a cough and at the
(04:34):
time coughing like really hurtmy cesarean wound and so I think
, looking back, I'd assume thatthat was a physical health thing
.
But actually in retrospectmaybe that was a mental health
thing that I just didn't thinkof because it wasn't or
certainly to me at the time itdidn't seem to be presenting
with other symptoms.
Um, but I think so over time II just kind of stopped sleeping,
(05:01):
which I know you're a newparent, that I mean, my son was
away in NICU and SCABOO, but Istopped sleeping and then that's
kind of when everything umreally started going wrong.
And I think it was hard becauseI did have insights at the
start.
You know, that I was probably inhypermania and kind of not
(05:21):
wanting to get worse, but Ithink you know the way if you're
a bit ill.
And then there's the weekendand it's much harder for, like
community mental health teamswhich are set up for Monday to
Friday.
Yeah, it's a lot harder forthem to do that wraparound care
because they're just notresourced for that.
Yes, um, and so it took.
Florence (06:08):
So it took a little while.
So then I was, my son and Iwere sent to a mother and baby
unit and yeah, I guess that wasa big next starts in the first
couple of weeks.
How, how old was your son?
How many days had passed beforeyou started?
Sarah (06:13):
that not sleeping and started to notice things.
Yeah, I mean, it's interesting,possibly with hindsight five
days, if that makes sense, basedon not sleeping with the
coughing, but I think maybe itwas the second week after his
birth that, um, things justescalated yes, I definitely
(06:34):
think sleep, not sleeping for meis a big.
Florence (06:40):
It's a really difficult one because it's a big
flag.
But it's also so difficultbecause parents are very sleep
deprived at that point whenthey've had a new baby and
they're adjusting to lookingafter it overnight and, like you
say, recovering from perhaps acesarean or the birth.
So it's really difficult totease out.
So I'm not surprised when yousay you thought it was maybe a
(07:03):
physical thing and then startedto realise maybe it was a mental
thing.
Because I think that's also verydifficult for us when we're
looking after women, to kind oftease out how much of this not
sleeping is.
Apart from the not sleeping,what?
Sarah (07:28):
were the other sort of symptoms or things when you did
have insight that you werenoticing.
So I suppose for me one of mysigns can be overspending.
And so you know, say I wasbuying stuff for like, there's
always a little kitchen in NICUor SCBU trying to buy some food
for people to snack on in there,and you know my husband was
like, but you're, you'respending lots of transactions,
whereas for me it wasn'tactually much money.
(07:51):
Yes, led to what I'd done inthe past and I think you know I
can remember popping to a shopor something with my mom and you
know, for me it was almost likepart of me was like thank God,
my son's not died.
I want to get a few things tocelebrate.
But I'm just trying to thinkwhat else?
(08:14):
I mean, I think, the usualthings like probably, you know,
talking very quickly, yes, um,possibly jump thoughts jumping
around, but those are kind of myusual key tells and I suppose,
for example, having lots ofenergy and wanting to do other
things.
(08:35):
So, for example, when I waskind of waiting in the family
room, um, waiting to be kind ofcalled to feed my son, you know
I'd taken a language textbookand was like, well, this is
great, I'm going to learn alanguage and for me, kind of
having all these projects yeah,those were my other tells.
I mean, I suppose I saw a rangeof other people's symptoms, say
(08:59):
in the mother and baby unit, soI think there were some people
who were maybe paranoid abouthow their child was being
treated or others were treatingtheir child.
So I think it can.
I think it can vary.
I mean, I suppose for me it waskind of similar to previous
signs of hypermania and maniayes, okay and so.
Florence (09:22):
So you were.
You'd been discharged, fromyour perspective, from hospital,
but you were staying in theNICU accommodation with your son
.
Sarah (09:34):
So we were lucky.
Actually, once I'd beendischarged from the maternity
ward, it was, you know, kind ofgoing forward and back in the
city that we live in um visit myyou know, our son over there.
(09:59):
So I think it was almost, um,you know, things like.
I can't remember anything aboutthe recovery from the cesarean,
just because my energies werefocused elsewhere do you think
that I mean as well as perhapstriggering 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 mentalhealth clinic and I see women
like yourself and we'repreparing through pregnancy to
try and keep you well and keepyou stable in the postnatal
(10:35):
period and one of the thingswe'll do is lots of midwifery
support and visits at home after.
But when your baby's in theneonatal unit, that sort of gets
slightly problematic becauseyou're coming up and down to the
neonatal unit and thereforeyou're not necessarily getting
(10:56):
that home support that we mighthave done for the first month
where people are a little bitmore focused on your well-being.
So do you think that that alsokind of maybe slowed people down
in recognizing that you weredeteriorating?
Sarah (11:16):
yeah, I mean, I have to say I've never really thought
about that because, um, I'veonly got one, one child, and so
I guess I didn't know what thenormal experience was.
But I mean, I think by the timehe was in SCBU, staff were kind
of picking up that it wasn'tquite you know, things weren't
(11:37):
quite right.
Florence (11:38):
Yeah, okay, and was it difficult in pregnancy, knowing
I mean, obviously this was allquite 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 thishigh chance, I've got the
right
Sarah (11:58):
So I suppose I mean, maybe slightly naively you know
we've done the pregnancyplanning advice, or you know I
can't remember what the propername is but before you start
trying we'd we'd gone throughthat.
Yeah, yes, in all honesty, Ithink it just came as such a
shock because I'd been so stableon my medication for kind of
(12:20):
many years, and I think also thefact that I had been well
during pregnancy.
But I think I mean I look backand I wonder was I a little bit
hypo towards the end ofpregnancy?
Florence (12:32):
I don't know, because you know it seems like buying
things for your son and likeeveryone's told, well, you know,
you do a bit of nesting at theend of pregnancy and it's kind
of, but what's, if you like,what's outside of normal yeah,
yeah, okay, so you mentioned themother and baby unit, so so my
(12:53):
experience of trying to get awoman a place in a mother and
baby unit- it's complicatedbecause they're national beds
and when we do our pre-birthplanning session with the mental
health team, we always explainthere's the possibility of an
(13:13):
adult bed where you're separatedfrom your baby, or mother and
baby unit, but they're nationalbeds.
You might have to travel, theremight be a wait, so I'm
interested to know from when youwere unwell and you kind of
tried to get support.
How long did it actually takefrom your perspective to kind of
(13:34):
get into the mother and babyunit?
Sarah (13:37):
So I think actually it was quite quick.
I think I was admitted to themother and baby unit about three
and a half weeks after my sonwas born, and I think we were
talking about how you know,maybe it was two weeks before it
became um obvious that I wasunwell.
So actually I think I was quitefortunate it was something that
(14:00):
had been discussed at, you know, the birth planning meeting.
Um also, like we live in anarea where there are naturally
more mbs to choose from, and Iguess the fact that I was
already under a perinatal teammust 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 maniceverything seems great and you
know you've got all these otherpeople to speak to in hospital.
But my abiding memory was I wasjust so grateful that I was
with my son.
I didn't really care where Iwas because, you know, for three
(14:52):
weeks I'd not really been withhim the whole time.
Yes, and so it was kind of likeI'm with him, yes, I'm with him
, yes, I don't know.
I mean, I think quite quickly Iwas detained under the Mental
Health Act and kind of that hadhappened to me before.
(15:15):
So I wasn't, you know, I knewthe process in terms of all that
stuff.
But, um, I think probably youknow everyone heard a room in a
bathroom of their own.
There was common there, butalso it was quite hard.
It was um during Covid and soyou know the staff had to wear
masks, so it was harder torelate.
(15:36):
But I think also the it was alocked ward and so for me that
was quite difficult, because inthe past I haven't been
somewhere with like an airlockto get in and out.
Um, yeah, so I think at firstit seemed fine.
You know it was very sweetthey'd got, I think.
(15:56):
When you got there they hadlike a little box with some
toiletries and hot chocolate orwhatever, to kind of be like
welcome and try and make thingsfeel 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 aperiod at the end when I wasn't
detained, but yeah, for most ofthat I was that's quite a long
journey to get get well yeahyeah, definitely, I mean I have
to say I kind of I think quite alot of us felt lied to.
(16:37):
When, you know, on a mission youwere told, oh, most people are
only here six to eight weeks,and actually that wasn't my
experience at all, anyone whohad a pre-existing diagnosis.
You know, a whole cohort of usseemed to graduate around the
same time and that was betweenfour to six months of being in
the mother and baby unit.
So I think, yeah, that's reallyhard yeah um, I mean, I think
(17:03):
one of the things that I foundhardest was I'd been kind of
getting better under differentthings and I was very keen to be
able to like the medication Iwas already on I could
breastfeed on, and so I think,particularly when you've had
such an ill child, yes, I reallywanted to be able to breastfeed
, but there came a point when Ihad to go on to lithium.
(17:28):
You know I didn't have a choicepersonally or legally, and so
for me that was I kind ofcrashed down afterwards and I
think I kind of struggled withalmost like what's the point of
me?
You know, anyone can give myson a bottle, anyone can look
after him.
You know, the breastfeeding waslike the one thing only I could
(17:51):
do with him.
Florence (17:52):
Um, so, yeah, that was really tough that that does
sound really tough, and I thinkthat's definitely something I
see from some women when they'vehad a particularly difficult
birth or a neonatal condition orwhatever, that they feel that
breastfeeding is that key,bonding with their child.
So I can see how incrediblydifficult that would be,
(18:16):
particularly when your yourchoices are taken away in that
way.
And so you said you had insightat the beginning.
Were there points when youdidn'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 mycare coordinator from the
community was like I've neverseen you like this before.
And yeah, there were times waswhen I thought I'd been kind of
inappropriately detained andthat I was, that I was well, um,
(18:54):
I mean, I would say for quitelike 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 tothe neonatal stay.
Sarah (19:14):
Yeah.
Florence (19:15):
You mentioned when we kind of prepared for this.
You said that the parent-infantpsychotherapist was incredibly
helpful.
Tell me a bit about them andthat sort of treatment.
Sarah (19:30):
Yeah, so parent-infant psychotherapy is like looking at
, say, how you interact withyour baby and the bond, and I
think, apart from medication, Igot this both in hospital and in
the community and it was likethe most important thing in my
recovery, the most importantthing in kind of building that
bond with my son.
(19:50):
And I think, for example, when Iwas in hospital and I'd come
down, you know, because I wasdepressed, there was kind of, I
had, say, feelings ofambivalence towards you know,
yes, I've got a son, but I'velost my freedom, and not in the
kind of metaphorically like Iliterally legally have lost my
(20:12):
freedom, and so I don't know oneof the things.
It felt like in the MBU you'dalways 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 wasreally or like, apart from the
PIP sessions, or like, apartfrom the PIP sessions, the staff
(20:36):
kind of didn't seem to think toask about how you're feeling
more generally.
And I mean, I think also thereality is, when you're held
under section, certainly I'mvery focused on what I need to
do to come off section and so Ifelt like, actually, if I
started expressing thesefeelings of ambivalence, that
wasn't going to help.
(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, actuallyyou might.
You know things like havingyour freedom takeaway.
You might feel like this, likeany new mum.
It's just the fact that you'rehere, it's kind of particularly
acute yes but I'm trying tothink to remember other um
(21:24):
specific sessions.
But I think also I was worriedthat I'd been very affectionate
towards my son at the start andmaybe I'd pulled back, and you
know, what was that going to doto him?
And you know, the therapist waslike no, he's a really young
baby.
He probably kind of you'restill around, he probably hasn't
picked up on this at all.
So yes, I mean, I don't know ifwe'll speak about afterwards,
(21:48):
but certainly the therapist inthe MBU was really excellent
about afterwards, but certainlythe therapist in the mbu was
really excellent.
Um, it sounds like actuallyit's.
It can be quite hard to getaccess to parent infant
psychotherapy in the communityand 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 abouthow you're feeling and
expressing yourself, becausethat feeds into that legal
detention and that can be reallydifficult.
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 youhave a child yeah, see, you
mentioned to me also about theimpact this had on your partner,
so your, your rest of yourfamily, because he'd had first
neonatal and then both of youeffectively removed for four
(22:54):
months.
So what sort of provision isthere 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 afamily room that you could book
for visits.
I think most of the time he wasable to come on to the ward in
visiting hours and spend time inmy room and so things like.
You know, I think we gave ourson his first bath together and
(23:25):
so I think people are reallyconscious of, you know, wanting
dad or the other parent to stillfeel, yeah, still feel involved
, because I mean, yeah, it's,it's not what anyone expects.
I mean, apparently during Covidcomes the spot about um time
outside of Covid.
(23:46):
You know people just come onthe ward and sit in.
You know they've got variousnice rooms or the garden, and so
I think that did impact thingsa bit.
Florence (23:57):
So you're in the MBU and you've been quite hyper, and
then you're low, yeah, andyou'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 thenalso make that transition,
(24:21):
because that's a massive step,presumably then leaving the
mother and baby unit andcontinuing?
That journey, yeah, so.
Sarah (24:31):
I mean, I think it was difficult.
So at the nursing station theyhad, um, a board with everyone's
baby's name written down and,kind of very publicly, what
level of observations the babywas on, which was, effectively,
you know, how well or able isthe mother to look after the
(24:55):
child.
And so I was on that board atred 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 aninadequate mother.
Yeah, um, that was what thenotice board was very publicly
telling me and others on theward.
(25:16):
And you know, in honesty, it'sstill something I struggle with
from day to day, that feeling ofyou 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 leavethe MBU physically, but
actually the experience stayswith 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 alasting 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 ofcare each each you know, mum,
baby, dyad need, but to havethat visible and color-coded and
what that does sound reallyunhelpful.
(26:13):
Yeah, so when you leave, do youstart?
So you, you mentioned detentionwas shorter than your hospital
stay.
So once you're not detainedunder the mental health act and
you're getting better, yeah, goout 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 leavehospital with, like my husband
or family, yeah, and you know Iwas really lucky that people
lived close enough to do thatwith me.
Um, and then, yeah, theydefinitely don't chuck you out,
um, so you know, it started withlike maybe a visit home for a
(26:58):
couple of hours, then for a day,then like a first overnight,
and you know they're very muchkind of wanting you to build up
to it because apparently forsome people, going back home can
actually be a trigger and sothey don't want to rush you out.
And I think also they keep yourbed for like at least a week,
(27:19):
just from when you're meant fromyour kind of quote discharge,
just to make sure thateverything goes okay.
Yes, and you know, again, thisis a discharge planning meeting
with kind of people from the NBU, people from the community team
.
So I think you know a lot ofthoughts given and I mean one
(27:40):
thing that you know myconsultant in the NBU was really
kind in agreeing to was thatactually I could go on seeing
the parent infantpsychotherapist on the ward
until I was able to pick that upin the community, and so for me
that was really good.
I mean, I suppose one thing I'mconscious I've come, you know it
(28:04):
was a hard time, and I'veshared kind of my views on what
it was like, but also,ultimately, I am really grateful
that MDUs exist because I thinkactually for me I can imagine,
particularly when I was unwellthe thought of being forcibly
separated from my son would havejust been horrific.
(28:28):
Yeah, so you know the fact.
Actually he was able to staywith me throughout.
You know, that's something Ithink is so lucky because I mean
, I think, talking to people,for example, in the States, they
don't have MBUs and I think thefact that at least you've been
able to stay with your childprobably makes things easier
(28:48):
than, if you say, had to go on ageneral 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 kindof help with the care of the
baby or kind of run groups.
So I think I'm grateful that itexists, but it's also a very,
(29:12):
very tough thing to go throughand you know I can still
remember little things thatmembers of staff did you know,
that were just just littlekindnesses 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, thelittle things, the language you
use or the little touch orconversation you have, that,
yeah, can make a big, big impact.
I think you're right.
I think we are very lucky tohave mother and baby units, and
I can see what you're saying.
(29:52):
It it's extremely tough.
But it would have been eventougher after you've been
separated and in a completelydifferent environment that isn't
so focused on that mum and babyrelationship.
When you went home.
Sarah (30:11):
So you had community um, parent infant psychotherapist
and presumably then was it thenthe perinatal team took over or
the community mental health teamtook over in terms of looking
after you yeah, I think it wasstill the perinatal mental
health team, you know, hadfollow-ups um with them for
(30:33):
about a year or maybe it waslonger, and so again, like when
I was in the community, theparent infant psychotherapist
was brilliant and just thingslike I think one of the things I
really worried about from kindof you, when you're depressed,
you just feel very disconnectedfrom everyone, and so one of the
(30:55):
kind of ongoing worries I hadwas about how it could have
impacted the bond with my son,and I can remember like one
session um we were new and I'dsat my son down and the
therapist pointed out that he'dlooked at the therapist in terms
of like, oh, you're a newperson, looked at me, looked at
(31:16):
her again and looked back at me.
And she was like this is himseeking reassurance from you,
and it's a really good sign ofbonding, and so it was just such
a helpful way for me to kind ofexplore 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, theolder he, the older he gets, the
better he gets.
So you know, now he's talking alot and he's inquisitive about
the world, which for me is justmagical.
You know, there are silly gameswe can play together.
So like, yeah, I think probablywhat the therapist in the MBU
(32:07):
said about like you might justnot have enjoyed the baby stage
very much, even on the outside,yeah, no, I think we have a
really good relationship and Idon'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 asyou started to talk about all
the lovely things he's doing.
That's so great and, in termsof your husband, that
relationship with your son andmost of you, that you as a
(32:49):
family how do you feel that'sbeen impacted, or do you feel
there's there's not really ahangover 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.
So I was never able to do nightfeeds for my son and I'm on such
a load of medication that Ijust like I mean he didn't
literally have to scream thehouse down for me to wake up
(33:17):
yeah, and my husband's the onegetting up with him, my
husband's the one getting upearly if he gets up early, and
so I think, yeah, the kind ofalmost the societal expectations
that that would be the motherdoing it kind of hasn't played
out.
But then actually I think, youknow, while it's tough for my
(33:37):
husband, I think he also lovesit because he's he's got such a
close relationship with my sonand I think it's kind of almost
also, as time passes, you kindof there's more and more
distance between that difficulttime and actually now it's kind
of more, you know, planning like, oh, maybe we could go for this
(34:00):
day out as a family and thatwould be fun.
And you know, oh, he really,you know our son really enjoyed
going on this little fairgroundride.
You know when can we do thatagain?
And so it's, I think it feelslike we've definitely gelled as
a family unit.
But I mean, my husband waslucky, he was able to flex his
work around when I was in theMBU and so I think he was able
(34:25):
to see more of our son when wewere in hospital, and so I think
there's always been that senseof connection.
Florence (34:32):
Yes, yeah, and I think what you're saying about the
perhaps slightly different fromkind of societal expected roles.
I can see that that builds areally close relationship
between your husband and yourson, the fact that he's stepping
in and doing those bits, andit's kind of partnership working
(34:53):
partnership, isn't it?
You mentioned that you had usedapp for their peer support yeah
.
Sarah (35:06):
So I think, as everyone was getting ready to leave
hospital, we were told aboutthis charity called action on
postpartum psychosis.
It's an absolutely amazingorganization that I think really
kind of punches above itsweight and what it achieves.
So they do a range of things.
They have really helpfulleaflets on their website that
kind of act as education.
(35:28):
But the thing I've found like sovaluable is their peer support
services so you can be matchedone on one with someone who you
can meet up in person and thenthey hold regional support
groups.
So the one I go to they haveonce a month and then maybe
every three months they have onein person and I think from my
(35:49):
perspective it's just sovalidating to be able to talk to
people who've had similarexperiences and kind of process.
What you've been through and Ithink also it's you know it just
helps you feel less alone inwhat you've been through.
And I think also it's you knowit just helps you feel less
alone in what you've beenthrough.
I think they, you know theyalso offer support for partners
(36:10):
and families and it's brilliantbecause you don't necessarily
stay in touch with people froman MBU or you know, even if
you're ill and don't make it toan mbu, it's just it's so useful
to be able to talk to othersyeah, I can.
Florence (36:26):
I can sense that not feeling alone, feeling like this
, is loads of other people thathave been through that sort of
thing really yeah absolutelyperfect, and I will um put a
link in the show notes if peoplewant to know more to the
charity.
I know it's probably a millionmiles from your thoughts, but
(36:50):
having had this experience, doesthat I don't know what you were
intending in terms of does thatmake you re-evaluate whether
you would have another baby ornot?
Yeah, so.
Sarah (37:05):
I mean, I think we we did talk to um, a perinatal
psychiatrist, and I think youknow the advice is you know I am
high risk, I, I think, I don'tknow I think she might have
mentioned 50%, but then I thinkshe also said but lithium lowers
that risk a lot, and so Isuppose there's enough distance
(37:31):
that I think we would thinkabout it and I think also, I
suppose I would just hope itwould get picked up a lot more
quickly.
I mean, oh, for example, youknow, when people have had, like
, say, a bipolar diagnosis for awhile, they kind of know their
way around all the psychiatricmedicines, and so, you know, I
(37:52):
think I'd probably be much moreadvocating, for I need to have a
stash of benzodiazepines pleaseyou know, and I think people
would just know actually we needto jump into action a lot more
quickly.
But I think also the fact that Iwould be staying on the lithium
and therefore not breastfeedingalso makes it a lot easier to
medicate quickly.
So it's I don't know, it'sdifficult because it was an
(38:16):
incredibly difficult time andyet at the moment it's just like
the most gorgeous age with myson, and so I guess realising
and you know I was stilldepressed when I came out of
hospital, it was still hard andactually for me getting back to
work was actually reallyimportant and kind of reclaiming
(38:39):
that as part of my identity,but I don't think I think it was
one of those things.
You know, we're conscious thatactually I wouldn't want to be
going into hospital because of,you know, the impact it would
have on my son now, and I thinkit was one of those things.
But do we think we could addressthe you know, it's that
(39:01):
trade-off of like okay, I feellike, you know, if a second came
along, probably everyone wouldbe 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 supposeit's, I don't know, maybe
foolhardy, but it's difficult.
(39:22):
It's that trade-off between theimpact on your, your child, but
also the fact that actually itcould just be a few months in
the baby's life and so it's.
You know, there's no, I guessthere'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 likezesty bit, a bit that I want
people to remember and that willbe a bit partly for healthcare
professionals, kind of whatwould you like them?
Or or know if, if they werecaring for a woman with
(40:01):
psychosis or a higher chance ofpsychosis, but also whether
there's something for pregnantwomen, because they also listen
to my podcast.
So, yeah, thoughts on what yourkind of zesty bit, your essence
would be yeah.
Sarah (40:18):
so I suppose for professionals, maybe creating a
space where it feels safe totalk about how you're feeling
towards your baby, I think alsojust kind of maybe acknowledging
the person, because I mean, Iknow everyone when you take your
child to any kind of you know,oh, here are the jabs, oh hi,
(40:40):
mum, how are you doing mum?
And it's like actually, youknow, for a lot of us it's
wonderful, but it's not the onlypart 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 nomention of maternal mental
health.
Now I think any responsibleantenatal classes should be
(41:04):
covering a bit.
You know it's, because what isit?
Is it about one in 500 to athousand who gets postpartum
psychosis?
You know that's a lot.
And you know, with all of thisstuff, if you get early
intervention it's much easier tokind of start treating it's
(41:24):
much easier to kind of starttreating.
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 someways, that's almost more
terrifying, certainly for theirfamilies.
Almost more terrifying,certainly for their families,
because they've never seen them.
Well, and they're suddenly likeoh my god what has happened to
(41:50):
my loved one and and and I thinkcertainly the key thing for me
is, if it's recognized, it'seasily properly treatable and
recoverable from, and so whenI've seen women with psychosis,
that's what I've said to theirpartner and family.
It's okay, I know what this isand I know it's treatable and it
(42:12):
will take time and it'll takemedication and so on, but it's
all right yeah we'll get betteryeah.
I think you're right seeingthat person and acknowledging
that actually, mental health isa key part of that transition to
being a parent.
Yeah, definitely anythingparticular you want to say
(42:37):
differently to women, or maybeit's the same message?
Actually to think about yourmental health yeah, I think so.
Sarah (42:44):
I just wish.
I think my main thing would beI wish people would be a bit
more open about the challengeswith having children.
You know, things like this willchange the way your
relationships within your familywork.
You know, I can remember you'llhave people who you don't know
coming up to you givingunsolicited advice and just kind
of yeah, and I think it.
(43:07):
You know, it's just, it can behard when you know all you're
doing is like feeding andchanging nappies and actually,
if you're used to having acareer, this can actually seem a
bit like, oh, my goodness, whathave I done?
Yeah, and I think, talking to acolleague, his, you know, one
of the things he said he alwayssays to people was like it's
okay not to enjoy it, and so Idon't know.
(43:30):
I know everyone kind of go, youknow, I think I had this idea
that I'd be sitting in a coffeeshop breastfeeding while I read
a book.
You know that's not, um, that'snot what happened at all, um,
and so I guess I know everyonewill tell you oh, it's a massive
change, it's a massive change.
But I think, just going into itwith a kind of it's okay not to
(43:56):
love everything, I think that'svery wise advice.
Florence (44:01):
actually, I sometimes feel this at work because I mean
, I'm supporting women throughbirth and sometimes I'll hand
over a baby and there's thatincredible moment of joy and
exceptional, which is wonderful.
And sometimes I go home and Ithink, particularly for
first-time parents oh my god, dothey have any idea what's about
(44:25):
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 mysister and said it's a
conspiracy.
No one tells you just howdiabolical it is.
So whilst I absolutely adore mychildren, and they're now grown
up, I completely relate to whatyou're saying, that people need
(44:47):
to talk a bit more open aboutthe 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 theirbaby's name on the wall and it's
kind of fantastic.
Well, thank you so so much forsharing your story and your
(45:08):
experiences.
It's been absolutely wonderfulto talk to you and I'm so
grateful to you because I thinkthat lots of people will find
your, your experience and yourinsights really valuable.
So I know it's not easy to comeon and talk about and share
what was an incredibly difficulttime in your life, but I'm
(45:51):
immensely grateful.
So, thank you, thanks very much.
Recommending the OBS pod toanyone you think might find it
interesting, there's also tonsof episodes to explore in my
back catalogue from clinicaltopics, my career and journey as
an obstetrician and life in theNHS more generally.
(46:12):
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
(46:33):
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
If you want to get in touch tosuggest topics for future
(46:55):
episodes, you can find me attheobspod, on Twitter and
Instagram, and you can email metheobspod at gmailcom.
Finally, it's very important tome to keep the ObpsPod free and
accessible to as many people aspossible, but it does cost me a
(47:20):
very small amount to keep itgoing and keep it live on the
internet.
So if you've enjoyed myepisodes and by chance, you do
have a tiny bit to spare, youcan now contribute to keep the
podcast going and keep it freevia my link.
To buy me a coffee.
(47:40):
Don't feel under any obligation, but if you'd like to
contribute, you now can.
Thank you for listening.
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