Apologies for the infrequent nature of my blogs lately

I've been pretty busy with one thing and another. There's not long to go until my maternity leave starts and I've got a lot of loose ends to tie up. Then there is the business of getting the house ready.

Last time, I was discussing my visit it to the psychiatrist. The main purpose of this visit was to come up with a plan for my care after the birth.

The psychiatrist warned me that new mothers usually suffer from a degree of emotional liability. That is, they are prone to crying and laughing either at random times or far more than the situation merits. This usually lasts for about 5 or 6 weeks.

So, if I were to feel a bit up and down after the birth, this is not necessarily a sign of a relapse into bipolar disorder. It is most likely just a normal reaction to what is not only a physically draining but also a life changing experience.

However, the protective effect of pregnancy can wear off after birth and this can mean that things catch up with you. Add to that the fact that a disrupted sleep pattern is very likely after the birth of a baby and the risk of having problems is quite high.

Sleep is really the most critical factor. The psychiatrist went so far as to describe bipolar disorder as being as much a sleep disorder as a psychiatric problem. This is often the way I have felt about it, which is why I am so particular about keeping as regular a sleep pattern as possible.

With twins, sleep will be a real luxury, so it will be an enormous challenge to try and maintain any kind of a sleeping pattern at all. Especially when breastfeeding and, even more so, during the early demand feeding phase.

If I were to become ill, then trying to get help as soon as possible is the best thing for me and for the babies. Post-natal depression can be a very serious illness and it can also affect the mental health of the child if there is a lack of bonding.

Anti-depressants, mood stabilisers and other psychoactive drugs are contraindicated during breastfeeding, so if I were to become so ill that I required medication, I would have to switch to formula feeding.

The doctors view was that, although there are those that say you should breastfeed exclusively up until 6 month, the first few weeks are the most important and when most of the benefit is gained and breastfeeding should not be at the expense of your own health. I am inclined to agree. Although I am determined to try breastfeeding, at least for the first few weeks, if I become ill or it becomes too tiring then I'm prepared to take a pragmatic view and switch to bottles.

So the plan, so far is, I will stay in hospital for 5 days after the birth, to try and get some kind of sleeping pattern established (a little optimistic probably, but at least it might give me a chance to recover from the birth itself) and to give the psychiatrist time to come and see me.

Then I will be closely monitored in the weeks after the birth but with the understanding that whatever happens it is likely to be a bit of an emotional roller coaster, so there is no need to get overexcited about the odd mood swing.

If I do start showing signs of illness then I'll stop breastfeeding and start back on medication. If I am swinging towards mania, then mood stabilisers will be the first resort. If it is severe, then anti-psychotics might come into play (as they work faster). If the swing is towards depression, anti-depressants may be prescribed but probably not the Seroxat that I used to take as there are other medications that are considered to be equally effective but easier to come off.

If things have gone really drastically wrong, then I might be admitted, along with the babies, to the mother and baby unit. This allows new mothers who are experiencing problems to get treatment and support whilst still keeping in contact with their babies.

So that's the plan.

The most common advice for prospective mothers of multiples is to try and get as much help and support in place for after the birth as you can.

So far, many of my friends have been very helpful with the house, very useful now that I can no longer climb ladders and much appreciated. My parents have been outstanding travelling down to help out as much as they can and once they get cracking it is really impressive how much they can achieve.

I'm not sure exactly how many favours I can call in, nor what the division of labour will be in the new household. I'll just have to wait and see but I certainly won't be turning down any offers that come my way!

So any visitors who come round should expect to be handed anything from a dishcloth, laundry bag or a mop to a small screaming child. And if I should happen to fall asleep during their visit...shhh don't wake me, please.

Fortnight commencing 10/09/07

I've missed a big chunk here, due to the infrequency of my diary. During that time I have mostly been OK, although I will burst into tears at completely random things and I do sometimes feel, understandably a bit overwhelmed at how much preparation is required.

Medication: iron tablets- no mental health related medicine though!
Exercise: Some swimming 3-4 hours
Alcohol: 1
Anxiety: Low
Anxiety Level (0-10): 1
Number of Panic Attacks:0
Severity of Panic Attack (0-5):NA
Depression: I have been struggling a bit in the last week, partly due to having the cold and partly due to external factors.
Depression Level (0-5): 3
Mania: Occasional bouts of being a bit hyperactive- lots to do, so little time.
Mania Level (0-5): 1

Summary

Sleep is becoming a real luxury- it is very difficult to find a comfortable position and I get kicked all the time. This past week I have been very under the weather with the cold- pregnancy suppresses the immune system so it is much harder to fight off infection.

I'm starting to see some light at the end of the tunnel with the DIY now though. Just as well, as my hands are now quite swollen and sore and I'm fairly worn out.