PPD Protocol

Including Post Partum Depression, Post Traumatic Stress Disorder & flashbacks.

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PPD Protocol

Postby IslandDreamer » Apr 10, 2006 1:00 am

Post Partum Plan
EDD ________

Medical Care:
Psychiatrist – evaluation before delivery.
Dr. G. 11/25
Address and phone.

Medication Plan

since 15 weeks pg - 20mg/daily Prozac.
Prenatals and B6 daily

? in case of Panic Attacks–

? in case of OCD–

? in case of PPP– Celexa?

? IT’s

Diagnostic Work:
Thyroid tests–all 4.


Acidity test

Other tests discussed in Osmond’s book.

Emotional Care:
Weekly therapy sessions with N beginning: 12/___

Three postpartum visits from doula.

Limited access for extended family (many of whom don't understand and will be upset)...no more than one week visit for Mom and ILs.

Babysitter: Margaret.
Play dates for older child: be specific who.

Home Help:
Meals: be specific who.
Holidays will be upon us...catalogs or one stop Toys R Us.

Self Care:
Staying/feeling pretty --

Haircut and color, 12/15.

Manicure/Pedicure, 12/15.

Wear the belly band.
Develop physical strength (this will be very very challenging as HG takes a lot during pg, and I also have fibromyalgia and will be limited in any exercise I can do)– trampoline, walking, if ambitious, swimming.

Sears photo shoot with children.

Emergency Plan:

If I am too sick, I will be hospitalized at ________________, under the care of Dr. G.

Dh, doc, and I all agreed on what would send me to the hospital: panic attacks or the inability to sleep 8 hours throughout the day.


Postpartum Doula - $20/hr

Day Help:
M and J

Some questions I asked my ob/gyn before he recommended getting a psychiatrist as back up should I fall very ill again.

1. Should I go up in dosage of Prozac at the end of the pg? (currently 20 mg/day) Or should I go up after delivery? Or wait and see?

2. What prescription can I have at 36 weeks (so it's in my hand at the hospital) for panic attacks?

3. What prescription can I have at 36 weeks for ITs (intrusive thoughts)?
Again, not to take while pregnant but have in hand at hospital.

4. What prescription can I have at 36 weeks for insomnia?

5. What vitamins besides b6 and a prenatal should I start after delivery? (Can't hold down vitamins yet, except b6....hoping to get some in me during third tri.)

6. What will we do if one of the above meds doesn't work or causes an allergic reaction?

7. What hospital in-patient psychiatric program do you recommend if I need to be hospitalized? (I figure, if I need to be hospitalized that I shouldn't be trying to decide where to go after I'm sick.)


After reading what Marie Osmonds doctor wrote (about 2/3rds of the book), I want to line up some blood testing postpartum. I need to study the tests and talk to my ob. I figure a CBC to check minerals, etc. I also want to be sure a thyroid antibody screen is done; I've asked for this FOUR times and still not gotten that specific test...there are four thyroid screens. So I'm adding a new section to my protocol under medication called diagnosis to find the cause. I finally feel hopeful that maybe someone in the world can find the cause of my (and your) PPD, not just treat the symptoms. I've been so frustrated knowing my symptoms are treated but the underlying cause is still there....it's like painkillers for a broken leg but no cast or proper support for the leg. Time for the proper supports for my chemistry.


Things I've added since creating this:
Finding B6 and magnesium along with the Prozac are helping me, and I do still take a Restoril here or there if I get to wound up to sleep.
Last edited by IslandDreamer on Aug 26, 2009 6:49 pm, edited 2 times in total.
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Postby Kadinga » Apr 11, 2006 1:05 am


I'm going to start thinking about my post-partum plans now. I don't think I'll need as aggressive a plan as yours, as my history of depression doesn't include PPD and worse as yours does, and I've always been able to avoid meds (which is important to me on a personal level), but a plan, all the same, will be handy.


2 HG darlings; Heather, September '03 & Henry, May '06
"To understand and be understood makes our happiness on earth" (German Proverb)
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Postby Feathery » Apr 17, 2006 11:00 pm

During the pregnancy for my DS I consulted with a psychiatrist and we made a plan very similar to yours. I was so afraid, after some years struggling with PTSD related to a trauma, that I'd fall totally apart after the birth of my son. I was lucky that I felt prepared and I had a plan to follow in those moments when my head wasn't in a good enough space to make good plans. Sounds like you may have been blindsided with PPd in the past. I'm so sorry.... This time around you can feel more confident. You have a great plan in place and a supportive team. My loving suggestion...don't worry about "when" you'll get off the antidepressants. As long as they add some stability to your life...they are a blessing. That's how I've grown to think about it. Best wishes......
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Postby Feathery » Apr 18, 2006 10:22 am

My PPD Plan is very similar to yours. Small differences are:

My OB checked my TSH (thyroid sending hormone) every 8 weeks during pregnancy and twice after delivery. This is a simple blood test and turns out I did have to adjust my thyroid meds twice during this time. Also, he switched me to a mixture of thyroid meds that are shown to work more effectivley on people who suffer with depression. (I have surgically-related hypothyroidismand take meds for this every day.)

I started Zoloft during my 7th month of pregnancy. I was having worsening depression and the doc felt this would create a safety net for after delivery.

I enlisted a couple friends to come to my house (taking turns) every morning for the first 6 weeks after delivery. They'd come around 10 AM, help with the baby and I'd get some sleep or at least rest for two hours.

I joined a prenatal yoga class that emphasized relaxation and breathing (rather than fat-burning) and included a guided meditation time. This class taught me alot about how to relax (although I'm still no expert :D )

I also read a book called "Full Catastrphe Living" which teaches guided imagery....a real help in combating the negative effects of intrusive thoughts.

This is what I remember....I better get out my pen and sketch a solid plan for this time around, too. Thanks for the inpiration!
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Postby winter-soul » Oct 16, 2006 9:13 pm

im soo glad i saw this plan.....ive been going over meds and such with my pdoc, and have some help for after the baby is born but no comprehensive plan..........the "in case" senarios ive been dreading and hoping dont materialize.......

i think its such a good idea to write it all out, because i know when i get low or off with anxiety that i become irrational and impossible to reason with...i need help from outside, and if i make my own plan, one i am comfortable with then it will be much easier to follow.

thank you for posting this!!.........it gives me a template to start from.
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Postby teddi » Feb 21, 2007 1:25 pm

I'd like to add a couple to bring up or plan with your OB:

1) Talk about a physical therapy referral if needed, to help with muscle tone and atrophy.

2) Make sure they do a CBC and check you for anemia.
Bert , 3/2000 HG#1, wk 6 - birth, GB removed @ 16wks
Chloe & Kaylie, 12/2004 HG #2, wk 7 - birth, pre-E/pancreatitis
~Angel babe~ March 2012
~ Baby Chuckles~ July 2013
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Postby IslandDreamer » Feb 23, 2007 4:58 pm

Those are great, Teddi.

I originally wrote it as a PPD protocol but would not amend and add HG recovery stuff.

-one week follow up to birth
-supplements to return to health faster
-foodment suggestions
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