• Reference Number: HEY1057/2024
• Departments: Maternity Services
• Last Updated: 30 April 2024

Introduction

This leaflet has been produced to give you general information about your condition. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor/midwife, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Which medications are included?

This leaflet is particularly for mothers who are taking some of the commonly used medications to treat anxiety and depression. These are known as SSRIs (selective serotonin reuptake inhibitors) and include medications such as fluoxetine, sertraline, citalopram and others.

Is it important to treat anxiety and depression in pregnancy?

It is very important to look after the health of new and expecting mothers. Pregnancy and after the baby of a baby can be a vulnerable time for mother’s with mental health issues. We know that treating depression and anxiety will improve the outcome for your baby, this is why it is recommended that you continue your medication during and after your pregnancy despite the side-effects documented below.

Will my baby withdraw from my medication?

Babies whose mothers are taking medications will be used to having the medication in their systems before they are born. When they are born this supply is cut, and some babies can experience a period of transition in which they require closer monitoring.  This usually happens in the first few days of life.

What are we observing baby for during this period?

During this period of additional observation, we are looking for symptoms including jitteriness, agitation or irritability, excess sleepiness and sometimes difficulty feeding. Most of these are very mild, and your baby will get better without any special intervention. We ask mothers who are taking antidepressant medications to stay in hospital for 48 to 72 hours after your baby is born to ensure that if your baby does show signs of withdrawing from medication they can be closely monitored. Some very serious medical problems also have signs just like withdrawal does, which is why the observation is important.

Are there any serious complications?

There is a very small risk of more serious complications after taking antidepressants when you are pregnant. These include problems with the blood flow to the lungs. All babies have an oxygen saturation test after they are born, which in combination with the observation period should identify most babies with this serious complication.

What are the recommendations?

There are national guidelines for babies born to mothers taking antidepressant medications.

We recommend that:

• Your baby is born in hospital.
• Your baby has the routine oxygen saturation screening test.
• You stay in hospital for a minimum of 48 hours after your baby is born, so that they can be observed for signs of withdrawal.
• You can then go home IF your baby is feeding well, there have been no additional concerns about your baby AND you are able to call for help and have transport to reach the hospital at all times in the few days after discharge (including having access to transport overnight).

Symptoms of withdrawal can be the same as the symptoms of some very serious medical conditions such as meningitis, which is why you must seek a medical review urgently if you have concerns after you have gone home.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact:

Antenatal Clinic Tel: 01482 382623 (during your pregnancy)

Rowan Ward Tel: 01482 605381 (available 24/7)

If you suspect your baby is seriously unwell please call 999

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.