One of the hardest aspects of having Post Natal Depression is the knowledge that in order to add to your family you will have to face the prospect of becoming ill again. If you became ill with your first child this can be particularly difficult to come to terms with because you won't know what it is like to have a child without becoming ill. If it happened after a second or later child, take comfort in the fact that you have already had a baby and stayed well.

The fact is that if you have had a previous epsiode of Post Natal Depression you are at an increased risk of developing the illness with a subsequent baby. The risk is about 50% instead of 10-15%. Therefore if you decide to have another baby you need to accept that you may become ill and plan accordingly. Hopefully it won't happen again but it is wise to be prepared just in case...

Here are a few factors which you are in control of and which will give you confidence should you decide to have another baby:

• Remember every pregnancy is different. It's a cliché but it's true, which means that whatever happens with your next baby IT WON"T BE THE SAME AS LAST TIME
• This time you will be aware of the warning signs and be able to seek help early which means a faster recovery for you
• If you were on anti-depressants last time you know that you have in your toolbox a medication which can make you feel better - that is very comforting
• Try to make this baby's arrival as different to the first as you can so that as little as possible reminds you of last time
• Do NOT read loads of books on babycare; believe in your ability to mother your child - you can do it
• Minimise the amount of 'baby equipment' involved, e.g. water temperature gauges, room temperature guides, etc. You don't really need them and they can make you stressed
• If it helps, remove any items which concerned you last time e.g. sharp objects, so that if you do become ill you know these items are not going to bother you
• If you want to, try planning your baby for a different time of year so that your external world is different next time too
• Sit down with those closest to you and discuss what worked and what didn't last time - write it down and then put it to one side - that way if you become ill your loved ones will know what to say to you to help you - and what not to say!
• Write a note to yourself stating what you would like to remind yourself of if you become depressed again - write it in bullet format so that if you do become ill it is easy to read. Suggestions might be: I will get better, this feeling is temporary, look at this wonderful new life I have created, my baby loves me unconditionally, look down at your wedding ring (or maybe a cherished photo) and remember that time when (think of a wonderful experience you had in the past) - I have more times like this to look forward to, etc.
• Realise that just because it happened with the first doesn't mean it will automatically happen again - it is not predestined!
• Think of the sources of support you will have available to you next time such as friends, loved ones, doctor, health visitor, therapist, etc. All these people have been through it once with you and would know what to do next time
• Consider spending time doing visualisations of a really positive outcome to another baby, perhaps with the help of a hypnotherapist - the idea is that if you can visualise a positive outcome enough the positive side of your brain will believe it and therefore the outcome is more likely to be positive
• Make sure you have discussed exactly how your health care providers will manage the delivery of your next baby so that you all have an agreed plan
• Whilst it is unclear how Post Natal Illness can be prevented, it makes sense to minimise any big stressors such as moving house in the months prior to delivery
• Look after yourself physically - take gentle exercise, e.g. walking, swimming
• Make sure you are eating well - consider seeing a nutritionist if you would like specialist advice. In particular make sure you are taking in enough Omega 3, 6+9 as these fatty acids have been shown to improve general depression symptoms and are often at low levels following birth since the baby takes on board a high concentration prior to birth
• ONCE YOU HAVE MADE YOUR PLANS, PUT THEM TO ONE SIDE, TREAT THIS AS A NORMAL PREGNANCY AND ENJOY YOUR LIFE

Medically, what are my options?
Unfortunately there is no magic answer to this question. It is likely that your doctor will want to see you weekly following delivery and you will probably be offered the choice of either going onto medication immediately following delivery or being monitored and going onto medication at the first sign of the illness - taking medication during pregnancy is not recommended as it can cause withdrawal in infants. In some cases women at the very end of their pregnancies are offered medication if their doctor feels this is necessary.

At the moment hormonal therapy such as progesterone or oestrogen is not recommended though research into this area is ongoing and oestrogen in particular has been shown to have a protective effect in some women. There is however an increased risk of thrombosis with oestrogen therapy and breastfeeding is likely to be interrupted. If you are interested in hormone therapy do raise it with your doctor.

If you do decide to have another baby make sure you have discussed all the options and agreed a plan of action with your doctor and other healthcare professionals - do not expect your GP or others to remember everything about you. You need to take control and make sure they know your history and that there is an agreed plan of action following delivery with which you are comfortable. Do NOT be satisified unless your personal plan of action involves at least weekly monitoring in the weeks following delivery by your GP or Health Visitor. You are too important to slip through the net...

If you have had an episode of Post Natal Depression and gone on to have other children please get in touch if you have any advice to share. This is an area which is under-researched and about which there is little information. Any advice or evidence of positive outcomes you can provide will really help other women who are considering having another baby after Post Natal Depression.