PREGNANCY PLANNING

Dr Olivia Protti MBBCH MRCOG MRCPsych

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Guinness Book of Records

• The greatest officially recorded number of children produced by a mother is 69, wife of Feodor Vasilyev(b.1707), a peasant from Moskow.

• In 27 confinements she gave birth to 16 pairs of twins, 7 sets of triplets and 4 sets of quadruplets…..Almost all survived to their majority.

WORLD HEALTH ORGANISATION Reproductive health, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

WHY?

• Sexual and reproductive health affects social, physical and emotional well being

• Unplanned pregnancy increases risks to mother and baby in women with severe mental illness

• Offer women a chance to take an active role in their reproductive health

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ALL WOMEN OF REPRODUCTIVE AGE CAN GET PREGNANT!! PREGNANCY IS NOT A TREATMENT! ALL WOMEN HAVE A RIGHT TO MAKE AN INFORMED DECISION ABOUT GETTING PREGNANT!

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WOMEN WITH SMI

• Less likely to have a current sexual partner

• More lifetime sexual partners

• More unwanted pregnancies

• Less contraceptive knowledge

• Sex often unplanned

• Rarely delusional ideas about contraception

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WOMEN WITH SMI

• Women less likely to recall a discussion on

contraception in 1st year post partum • May need repeated contraceptive advice as

acutely psychotic women may not be aware of needs

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FERTILITY • Early studies showed ↓ fertility rates pre- 1970

• ↑fertility rates with breakdown of asylums 1970 -1980’s

• Fertility rates remain below general population

– Illness may affect abilty to maintain relationship (Howard 2002) – Role of typical antipsychotic drugs leading to ↑↑Prolactin

• More unwanted pregnancies likely with greater use of atypicals e.g. quetiapine, clozapine

NICE GUIDANCE

• Discuss with all women of childbearing potential who have a new, existing or past mental health problem:

• the use of contraception and any plans for a pregnancy • how pregnancy and childbirth might affect a mental

health problem, including the risk of relapse • how a mental health problem and its treatment might

affect the woman, the fetus and baby • how a mental health problem and its treatment might

affect parenting.

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GENERAL PREGNANCY PLANNING ADVICE

– Diet – Exercise, reduce stress – Drugs and Alcohol – Folate – Rubella Status/Travel – Check for STI – Smear test – Advice on optimising conception success! Ideally both partners

Parent “Infant”Relationship

• Both parents can experience difficulty in establishing relationship with their baby which can commence before conception

• may result from difficulties in their own childhood being relived in relationship with their planned or idealised child

• “Ghosts in the nursery” can appear before the pregnancy!

HOW TO CONDUCT A PREGNANCY PLANNING APPOINTMENT

• TIME!

• LISTEN FIRST – LET HER TELL HER STORY!

• SEE THE PARTNER IF POSSIBLE

• BE HONEST

BACKGROUND INFORMATION

FIRST STEPS

• PREPARE AND REVIEW CASE NOTES

OR DISCUSS WITH REFERRER

BACKGROUND INFORMATION

• PREPARE AND REVIEW CASE NOTES OR DISCUSS WITH REFERRER

• UNDERSTAND CURRENT PREGNANCY PLANNING INTENTIONS FOR THE COUPLE

BACKGROUND INFORMATION

• CLARIFY DIAGNOSIS, SEVERITY OF SYMPTOMS DURING PERIODS OF ILLNESS, RISK HISTORY, TREATMENT HISTORY

• PREGNANCY/GYNAE HISTORY • CURRENT LEVEL OF FUNCTION,

PSYCHOSOCIAL SUPPORT

PREGNANCY PLANNING ADVICE

• NATURE OF ILLNESS IN PERINATAL PERIOD • RISK OF TAKING/NOT TAKING MEDICATION IN

PREGNANCY

• TREATMENT OPTIONS: PRECONCEPTION, CONCEPTION,PREGNANCY, POSTNATAL

PREGNANCY PLANNING ADVICE

• SERVICES INVOLVED IN PREGNANCY

• PSYCHOLOGICAL TREATMENT

• GENERAL PREGNANCY PLANNING ADVICE

PREGNANCY PLANNING ADVICE

• FURTHER INFORMATION TO TAKE AWAY

• MAY NEED FOLLOW UP APPOINTMENT

• SEND COPY OF CLINICAL LETTER AND

CONVERSATION