The Blog

When Medical Opinions Differ

More than ever we require an official set of guidelines so that pregnant women with mental health issues are not given conflicting medical opinions which have the potential to cause serious harm.

Among the numerous healthcare professionals I saw during my pregnancy I saw not one, but two psychiatrists.

The first psychiatrist I saw was attached to the local Mother and Baby Unit (MBU) and I was petrified about seeing her. Up until then I'd never been referred to a psychiatrist before and to me seeing one meant that not only was I ill but that things were rapidly getting out of hand.

But scared as I was I still went to see her, determined that I would talk to anyone who could possibly help me with my unstable mental state, no matter how difficult and scary taking to people and admitting that I had problems was.

I saw this psychiatrist at the MBU twice more before I had Squidge and each time I left I felt as confident as I could that, by continuing to take the maximum dose of my medication, I was doing the right thing for me and for Squidge.

Towards the end of my pregnancy my community mental health nurse decided that, although I was already under the care of one psychiatrist it was necessary for me to see the community psychiatrist who was part of her team. I tried to point out that I was already seeing one psychiatrist but she was insistent that I should see this one too.

This psychiatrist had almost the exact opposite effect on me than the psychiatrist at the MBU did. I walked into the appointment looking uncomfortable and scared but at no point did he acknowledge my obvious discomfort and I left the appointment non the wiser as to his name than when I first walked in.

However, there were two things that particularly upset me about this psychiatrist appointment.

Firstly, the psychiatrist told me that the reason the appointment had been arranged because there was strong reason to believe that I would harm Squidge before or after he was born. At no point during my pregnancy had this concern been raised by anyone else and to this day I have no idea where he got the idea from. The CPN who made the referral denied all knowledge but it broke any trust I had in her and I did my utmost to minimise contact with her until Squidge was born.

The second reason was that rather than asking me about any medication I was taking or reading the notes that were sat in front of him. Instead he told me that he 'assumed that I'd stopped taking all my medication' when I found out I was pregnant.

At the time I was too shocked to be angry.

I managed to collect myself sufficiently to tell him that actually I was taking the maximum dose of my pre-pregnancy antidepressants as well as regular doses of sleeping pills and the occasion dose of tranquilisers. I explained that this was the course of action that all the other healthcare professions who had seen me up until this appointment, the MBU psychiatrist included had deemed to be the safest.

This psychiatrist ummed and aahed and eventually conceded that maybe the MBU psyschiatrist was more qualified to advise on medication during pregnancy than he was. As it was I barely listened to him for the rest of the appointment. I gave him enough information to dispel any ideas he may have had about me harming Squidge but I didn't discuss any problems or concerns that I had with him, saving them instead to discuss with the MBU psychiatrist.

I was fortunate in my conviction that taking antidepressants during pregnancy was necessary for me to be able to carry on until Squidge was born. If I had been less sure that my actions were the right ones I could well have left the appointment having reversed my decision and completely stopped my medication that day.

I honestly believe that without regular antidepressants I wouldn't have lived long enough for Squidge to be born safely.

Even today I can't believe that a healthcare professional who was supposed to have my best interests at heart would make such sweeping statements about medication without actually taking a proper history or bothering to read the notes that were available to him. I appreciate that sometimes patients get mixed up but surely it is never appropriate to firstly make assumptions and then tell the patient that you have done so?

I also find it difficult to accept how two highly trained healthcare professions can have such different opinions regarding a situation that is not uncommon in either mental health or maternity care. More than ever we require an official set of guidelines so that pregnant women with mental health issues are not given conflicting medical opinions which have the potential to cause serious harm.