.. and for the full unedited article..
When I first read about the case of Alessandra Pacchieri I was shocked, we all were, and it naturally threw up some questions about my own situation.
Like Alessandra I suffer from bipolar affective disorder. I’m also pregnant with my first child. I too made the decision to come off medication, to prevent any harm to the development of my unborn child.
Although coming off medication (a cocktail curbing mood swings, depression, anxiety and insomnia) I am under the supervision of the CMHT (community mental health team) who continue to monitor me without meds. I have been strongly advised to take a short term course of antipsychotics on delivery, possibly in a mother and baby unit, as there is an apparent high risk in women with bipolar who suffer post-natal psychosis due to the huge drop in hormones. Another medical professional however told me the risk of this happening is in fact low. Conflicting professional advice does make me feel a little like a player in a game of "What If?".
The decision to become a mother wasn't an easy one, I was always aware of the risks involved; bipolar can be hereditary, certain medications including one I was on can have cardiac effects on the baby, and how would the child feel about his or her mother having a serious mental illness etc.. but I never thought I'd need to address these because I was told by gynaecologists in my mid twenties that I had fertility issues as a result of PCOS (polycystic ovary syndrome). I also have fibroids which can affect a healthy pregnancy, and, I'm in my late thirties, so when I was hit with the shocking news of pregnancy, I didn't think it would last and prepared myself to be one of the unfortunately high statistics that miscarry. Just as I entered my second trimester, the 'safe' stage thereon, the case of Alessandra Pacchieri flooded the press, obviously triggering my own fears and “What if’s?”
Under the umbrella which is the CMHT, I see a perinatal doctor (a specialist psychiatrist who supports expectant mothers during, and for up to twelve months after birth). A standard referral was made by my regular consultant psychiatrist. This is separate to a mental health midwife who plays more of a medical role in the pregnancy. I also have a CPN (community practice nurse) who supports more practical needs. I am not sure if Alessandra had an extensive team allocated to her here in England, the ambiguity she describes says she perhaps didn’t.
Doctors assess me monthly and so far feel I'm doing OK without the meds. Funnily enough, bar a few mood swings in the first trimester that most pregnant women experience, I have felt more stable without the mood stabilisers, but I have had a healthy lifestyle forced upon me. I've developed a healthy routine; I'm constantly hungry and so I'm eating three times a day (at least!) I never used to eat breakfast, often going into mid afternoon before my first meal of the day, and I'm eating super healthy foods and drinking under 2 alcohol units a week, if at all. Getting knackered easily I go to bed earlier and get up earlier, absorbing more daylight. I'm taking recommended taking pregnancy supplements, saving money, working harder, making plans, having a focus.. of course hormones could also play a part, even though we often associate them with mood swings.
However, my team have explained to me that despite all this they have a duty of care to make a referral to child services around the time of birth. Initially I was concerned, would they deem me unfit to be a mother? But I like many were confusing child services with child protection, a different service altogether. Child services offers initial support if, and only if needed. The timing of learning about the referral came at the same time of the hype around the Alessandra case. At 32 weeks pregnant I am expecting a big meeting, a room withed with my CMHT team, social services, my family, partner and baby father, I will feel like I'm under a spotlight being judged, a little like X-Factor, and I understand that decisions will be made for me, but I reassuringly will be present and involved, I will also give my own opinions and suggestions.
Going back to Alessandra's case, although I do understand that if she wasn't mentally stable enough to understand the harm a natural delivery would incur (a uterine rupture is life threatening to both mother and baby) hence the decision was made on her behalf for an involuntary cesarean, I don't yet understand why the child hasn't been returned to a now mentally stable, compliant and well woman.
Temporary care or adoption?
Various press have reported that Alessandra's previous children were taken into care due to neglect brought on by her own temporary mental instability, but what I think is important to highlight is that the children were (and still) permitted to reside with their maternal grandmother and therefore engage in regular contact with their mother, yet her current child is up for adoption. In adoption cases, legally the children are not returned to their natural parents or pursue contact, unless the child decides to do so as an adult. According to national statistics - Children looked after in England (including adoption and care
leavers) year ending 31 March 2013 only 5% of children ‘looked after’ are adopted, others go into foster care, residential care or with families. So what are the guidelines/assessment criteria that determine whether a child placed in care is temporarily placed, or adopted? In other words, what are the chances of Alessandra or any other woman whose child has been removed under circumstances of temporarily instability getting their child back? *Still awaiting guidelines from family lawyer*
Asking for help
One of my concerns is that many mothers or mothers to be with mental health issues who have been following Alexandra’s case will decide to keep quiet about their concerns about any deteriorating mental health they may be experiencing. During a horrific panic attack, Alessandra contacted the emergency services herself, as I myself did during my first trimester when breathing problems got out of control. Fortunately normal breathing resumed and I wasn’t admitted. Prior to this, two of Alessandra three psychiatric admissions were also voluntary. It would distress me to think that having seen the outcome of Alessandra's ordeal a pregnant woman would rather suffer in silence because she now feels that asking for help could result in having her child taken away. I have always been very vocal with my team, when I have recognised my own symptoms, I've made immediate contact with them, engaged with medication and like also voluntarily admitted myself to hospital. I would like to think that these services would recognise this not as weakness, or uncapping, but looking after myself and making positive decisions in regard to my own well being, thus the wellbeing of my child. I wouldn’t discourage this from anyone.
Also I feel that in her defence a few recent articles have pointed out that Alessandra's three children have different fathers: (the first two are American; the father of the baby who was born in England is Senegalese) and I find these facts irrelevant, as she is not under trial for having different partners, and having three or more partners in a lifetime does not indicate a mental health issue.
As a pregnant woman with bipolar myself, if i could take Alessandra to a quiet corner and whisper some advice, I would strongly suggest she sticks to the meds that are currently keeping her well. A trap I have seen many people with this condition fall into, myself included, is that when we feel well we often feel 'cured' and question whether we need to be on meds anymore. Leave the curiosity there. Another thing about this condition is, like with other mental health conditions, 'episodes' as we call them are only temporary with often many months, years or even decades of wellness in-between. Unfortunately for us, we only tend to come into the spotlight, be that in the the press or to the attention of the authorities during the occasions when we are unwell. The focus and decisions that are make for us are based on these. People more often than not, cannot tell if someone has bipolar, be it a friend, neighbour or colleague, because post episodes we too can lead ‘normal’ healthy and successful lives. We do not choose these episodes and like anyone else deserve to be given second chances.