Expecting a baby is an emotional time for anyone, but it can be particularly challenging if you experience a mental health problem like schizophrenia or bipolar disorder which you usually manage with antipsychotic medication. This page covers:
All antipsychotic drugs carry some risks in pregnancy and breastfeeding. Ultimately, you will need to balance the possible risks to your baby against any potential harmful consequences of not taking your medication (such as potential relapse) and then come to your own decision about what's best for you and your family.
What are the risks?
- Risks to your developing baby in the first trimester. All drugs carry higher risks during the first three months of your pregnancy, when your baby is most vulnerable. However, some antipsychotics carry greater risks than others during this period. For example, prochlorperazine (Stemetil) in particular is associated with malformations in the developing baby if you take it during the first trimester.
- Possible effects on the newborn in third trimester. For example, there's a risk that your newborn may experience a temporary muscle disorder if you take antipsychotics in the third trimester. All risks become higher in the last few weeks of pregnancy, when your baby becomes more vulnerable again.
- When breastfeeding, the drug could be passed to your baby through your breast milk, and it's possible that your baby could experience some side effects from the medication. Drug manufacturers particularly advise against taking second generation antipsychotics if you are breastfeeding. If you want to breastfeed while staying on your medication, ask your doctor to advise you on how serious any risks are with the particular drug you've been prescribed. If the risk is low, you might feel that the advantages of breastfeeding whilst taking your medication outweigh any risks. Advantages to breastfeeding your baby for at least part of the time include: better nutrition for your baby, better immunity for your baby against various illnesses, and more opportunities for the two of you to bond.
- Drugs are not clinically tested in pregnant women, so there's not much evidence around how safe antipsychotics are in pregnancy in general. Newer drugs carry a higher 'unknown' risk than drugs that have been around longer, simply because scientists have had less time to gather evidence about them.
For more information about risks in pregnancy with a specific drug, you can look it up in our antipsychotics A-Z.
What can I do to feel more in control?
- Talk to your doctor as early on as you can. The earlier you start talking to your doctor about your options, the more in control you're likely to feel. This means:
- for planned pregnancies – as soon as you decide you want to start trying to conceive
- for unplanned pregnancies – as soon as you think you might be pregnant
- Planning your pregnancy gives you more options for managing risks early on, but it's also a common experience to find out that you've become pregnant without planning it. Whatever your situation, it's important to remember that you have the same right as everyone else to choose whether or not to take medication, and to have your say in decisions about your treatment.
- Seek extra support to help you talk through your options and decide what's right for you.
- If you decide to stay on your medication, ask your doctor how you can reduce risks. For example, you may be able to manage your symptoms effectively on a reduced dose, or consider switching to another antipsychotic which carries fewer risks.
- If you decide to come off your medication, make sure you do it safely. See our pages on coming off medication for more information.
- If you don't plan to become pregnant, use effective contraception.
What extra support can I get?
Coming to a decision you feel comfortable with about what's right for you and your baby can be difficult, and it's understandable to feel conflicted. As well as talking to your doctor or psychiatrist, you might find it helpful to explore these options for extra support:
- Family and friends – if you're able, it can be helpful to talk through your feelings with someone you trust, such as your partner or a close friend.
- Midwife appointments – you can talk to your midwife about how you're feeling throughout your pregnancy. They can also put you in touch with your local Perinatal Mental Health Team (if there is one in your area) and help make sure you receive plenty of support from your Health Visitor after you give birth.
- Online peer support – websites such as Netmums and Mumsnet offer a supportive online network for all parents and parents-to-be. Elefriends is an online community for people with experience of mental health problems, where you can share your feelings in a supportive environment. It can be helpful to talk to other people who've had similar experiences themselves, who can reassure you that you're not alone. (For guidance on using the internet when you're feeling vulnerable, see our information on how to stay safe online).
- Specialist websites such as NCT, the Breastfeeding Network and Action Postpartum Psychosis can provide general information and support.
You might also find it helpful to read our pages on how to cope as a parent with a mental health problem, which includes information on helping yourself, looking after children, and other kinds of support available.
This information was published in 2016. We will revise it in 2018.
