Pregnancy: hopes, fears and interference

Having now become a parent for the first time, Ruth Patrick reflects on her experience of pregnancy as a user of mental health services

Becoming pregnant for the first time almost always involves conflicting emotions, where excitement about the prospect of parenthood mingles with a mounting sense of anxiety and terror. Fears about coping with sleepless nights, breast feeding practicalities and the imminent end of independence battle for room with a growing joyful anticipation about meeting your son or daughter and those special first few days. As pregnancy progresses, women also have to contend with the various physical ailments associated with their expanding size as well as hormonal changes which can make tears, tempers and tantrums more frequent occurrences.

For those of us living with mental health issues, pregnancy can be a particularly challenging time especially where mental health services feel the need for extra interventions and involvement. While I’ve been comparatively lucky with my own first pregnancy in staying morning sickness free and still being able to sleep despite my bump’s seemingly constant kicking, I have faced additional stresses as a result of my diagnosis as an expectant mother with bipolar disorder (BPD).

That diagnosis – with which I’m not sure I agree but that’s another story – has led to my being immediately identified as a “high risk” pregnancy and fast-tracked for additional input from obstetricians and psychiatric services. NHS guidance recommends that those with a BPD diagnosis who become pregnant should receive more regular interventions from psychiatrists and this has certainly been my experience. From a starting point of being well, on no medication, and having no regular contact with mental health services, I now see a specialist psychiatrist every three weeks, have an allocated Community Psychiatric Nurse and am being monitored through the Care Programme Approach pathway.

Arguably, there are good reasons for this extra support. Women with BPD have a far higher risk of developing both post-natal depression and – of particular concern – post-partum psychosis where new mothers experience a psychotic episode almost immediately after giving birth. Further, some medical research argues that suicide is the leading cause of death among new mothers, giving the NHS’s focus on mental health during pregnancy and early-motherhood a convincing rationale. Perhaps I should count myself lucky that medical advice and input is much more enlightened than in the past, when women with BPD were advised simply not to even contemplate having children.

However well-intentioned though, psychiatrists’ involvement during pregnancy can sometimes feel intrusive and overwhelming, particularly where a pattern of regular contact with mental health services did not exist beforehand. In my own experience, it has been hard to adjust to the continual monitoring by mental health professionals while frequent reminders that between one in two and one in three women with BPD will experience post-partum psychosis was both unwelcome and frightening. While it’s important to plan for this eventuality and talk through how myself, my partner and close family would want to respond to any illness post-birth there is a real danger that constant preventative planning interferes with and undermines the simple excitements and pleasures of the pregnancy itself.

Indeed, when the psychiatrist requested that my partner ring them almost the minute I go into labour so they could be by my bedside almost immediately after birth to check for signs of declining mental health I felt they were going too far. Labour and the final arrival of my baby should be a (admittedly painful) special time and I was simply unprepared to have this compromised by my partner having to ring and then give updates to mental health service staff. Luckily, I convinced them that my mum could instead act as their contact point so that the labour itself could be a time just for me, my partner and the soon-to-be-born baby.

There has been one positive to come out of all the extra attention that my pregnancy has attracted: I have finally got access to the talking therapies I have been trying to get my hands on for years. Previously falling between services, I am now such a high priority that I have been fast-tracked for Cognitive Behavioural Therapy and got to the top of the waiting list within weeks. In a time of mental health services cutbacks, I am certainly fortunate to be accessing this extra support. But it makes me sad (and more than a little angry) that it has taken my pregnancy and being placed in a particular target “high-risk” group to access the talking therapy that I’ve been requesting for so long.

This hints at a wider problem with the whole system of mental health services and support which seems to be driven by what the “professionals” think you need at the expense of more consideration of the service user’s own perspective. Access to services is also too restrictive – often as a result of lack of resources and funding cuts – unless you fall into a particular target group as identified by the NHS.

Arguably, mental health service users should have access to more support during pregnancy but this should not be at the expense of accessing the services that the individual herself feels that she needs at other points in the life course. More money needs to be invested in mental health care and more efforts are still needed to make bureaucratic health systems more responsive to individual service users own take on their needs. After all, it is the patient and not the doctor who is often the real expert on their own condition.

The mental health charity, Rethink, is campaigning for “fair treatment now” to improve access to mental health support across the country. I’m already signed up and so too will junior-Patrick be now that she has made an appearance.

• For more details of Rethink’s campaign see rethink.org/how_we_can_help/our_campaigns/fair_treatment_now/index.html