Thanks Pinky,
That's great information and very insightful.
I didn't know about increasing the lithium - she talked about decreasing
it as it takes 6 months off lithium for her to become symptomatic. It's
so hard to work through all the conflicting research and getting info
from practitioners who specialise in one area only - like the
psychiatrists who want to change her meds so she can breastfeed - surely
we can milk bank or whatever initially to prevent baby's dehydration/
maternal sleep deprivation - the two main problems that I can see - and
meantime keep her on meds that she is confident with and keep her well
balanced.
Any further info or stories would be very welcome,
Sue
Hi Sue -I have vivid memories of a mum who came off lithium so she
would be able to breastfeed- went into psychosis and didnt even
recognise her bub. It was years ago .
According to Hale(Medications in mothers milk. 11th edition) -
lithium is generally increased (dosage) during preg due to increased
renal clearance . After birth, levels need to be closely monitored as
mother's renal clearance drops to normal. Several cases of lithium
toxicity have been reported in newborns. According to Hale,
breastfeeding is not necessarily contraindicated as long as babys
levels are monitored and there are no symptoms of toxcicity but other
anti manic drugs such as valproate may be a better option for
breastfeeding mums. Of course this depends how confident the woman is
re changing meds if the lithium is effective and balanced for her.
Living with a family member on lithium ( male so not giving birth) the
sad thing I have observed is that as people with mental illness become
unwell they lose the insight that would tell them they were becoming
unwell and so tend to blame others around them to rationalise their
symptoms. I would suggest the woman and her partner/ family member
give you a list of 'early warning signs' of her illness before she has
her bub and that she keeps in good contact with her psychiatrist
throughout pregnancy and postpartum. Home birth may be much better
than hospital as she will be in familiar surroundings so will be
monitored by loved ones who know her well and not treated with 'kid
gloves' for what may well be 'normal' postpartum mood changes. Except
of course that severe mania can happen very quickly and be very scary
for everyone around to contain. What would be their plan if she became
unwell? Get them to write this as they woudl a birth plan.
Pinky
----- Original Message ----- From: "Sue Cookson"
<[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Wednesday, January 03, 2007 6:03 PM
Subject: [ozmidwifery] birth and mental health
Hi,
Do any of you have stories relating to the use of Lexapro and Lithium
(two different women) and birth - particularly homebirths.
Would appreciate any feedback re outcomes and neonatal well being.
Also how the women manage their medication both pre and post birth.
As usual there is a lot of info out thereand a lot of it conflicting,
Thanks,
Sue
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