Some women will take or need to remain on medications to maintain their mental health during pregnancy. You and your doctor will have decided that continuing this treatment during pregnancy is safest for you and your baby. Many of medications taken for mental health disorders are passed from expectant mother’s blood through the placenta and therefore the baby is exposed to them.
Following birth, your baby will no longer be exposed to these medications yet they might develop symptoms of withdrawal similar to those experienced by adults who suddenly stop their medications.
It is important to recognise withdrawal symptoms in your baby and understand how to help the withdrawal process.
Reading this page can help you:
· Learn how drugs prescribed to mothers for mental health disorders can affect babies during pregnancy and after birth
· Help you to understand and recognise neonatal withdrawal symptoms
· Help you to understand your baby’s needs during this time
· Provide advice to you, your partner and others caring for your baby
It is vitally important that you remain well in your pregnancy. The effects of deteriorating mental health can be more significant to the wellbeing of your growing baby than a small potential risk posed by these medications.
Do I need to do anything when I am pregnant?
· Make sure you tell the people involved in your care what medication you are taking
· Don’t stop or make changes to your medication without talking to your doctor first
· Take your medication regularly and make sure you don’t run out. If this happens make sure you talk to your GP or psychiatry doctor about what to do
What are the signs and symptoms of my baby withdrawing?
The symptoms usually appear within the first 24 -72 hours after birth.
Your baby may experience some or all of the following symptoms:
· Irritability and continuous crying
· Agitation and restlessness
· Inability to sleep or excessive sleepiness
· Poor feeding, vomiting or loose stools
· In rare circumstances low blood sugars can occur
· Low body temperature
· Breathing difficulty
· Floppiness, shivering or tremors
You should not worry about this – even if babies do develop symptoms, these usually settle down within a few days with supportive care.
If you choose to deliver in hospital, you and your baby can be discharged 24 hours after baby’s birth if they are clinically well.
If you choose to have a home birth a plan of care will be arranged with your community midwife, this may include an appointment with a consultant obstetrician and more frequent midwife visits in the first 72 hours following delivery.
If there are any concerns about your baby’s wellbeing it will be recommended that he/she stays in or is admitted to hospital for further observation.
How can I help my baby?
Breastfeeding: Most anti-depressants are present in too small amounts in breast milk to be harmful and there is some evidence that the withdrawal symptoms may actually be lower in breastfed babies. Hence, we would encourage you to breast feed as this is the best way to reduce the symptoms of withdrawal for your baby
(You will also be supported if you choose to bottle feed or mix feed your baby.)
Skin to skin contact: If your baby is crying, irritable, has tremors or is struggling to relax and sleep, place him/her in skin-to-skin contact. This helps settle your baby’s heart rate, breathing and reduces stress. You or your partner can do this as often and for as long as you like.
Swaddling: Whilst your baby is in hospital if your baby is very unsettled we may teach you how to lightly swaddle with a sheet. This may help your baby feel more secure. If your baby is swaddled someone needs to stay with them until the sheet is gently un- wrapped. Once your baby is at home we advise you not to continue swaddling.
Responsive feeding: Try to feed your baby when they show feeding cues rather than waiting until they cry. Often babies will have small, frequent feeds, please ask your midwife for support. If your baby is frantically sucking and is inconsolable even after feeds, it may help to use a dummy for a short time, please ask your midwife for advice. Always change your baby before feeding so that you do not have to disturb them once they have a full tummy. If you are bottle-feeding, your baby will need frequent winding during the feed.
Discharge home: You and your baby can be discharged once they are clinically well. Some babies will continue to have mild symptoms of withdrawal for up to one month after discharge home. These symptoms are usually milder than the initial symptoms such as irritability; disturbed sleep patterns and continuous crying.
Who should I speak to if I’m worried about my baby’s health?
· If you are worried about your baby, speak to your GP, midwife, health visitor or call 111
· If at any time your baby appears unwell, drowsy or has feeding difficulties you should see your GP or take him/her to A&E
Further information about medications in pregnancy can be found at:
BUMPS (Best Use of Medicines in Pregnancy) www.medicinesinpregnancy.org
Royal College of Psychiatrists: www.rcpsych.ac.uk/healthadvice/problemsdisorders/mentalhealthinpregnancy.aspx