3 Tips for Navigating Pregnancy With Bipolar Disorder
Bipolar disorder is a challenging, life-long illness. The first year or two of learning to live with it can be devastating and all-consuming. When I was first diagnosed, 10 years ago at the age of 26, I had to resign from a career I excelled at to focus on getting well. It took an entire year for me to work with my doctors and therapist to find medicine and a treatment plan that worked for me. I was able to overcome severe depression and crippling anxiety, and even suicidal thoughts thanks to the vigilance and support of my husband and parents. Once I found stability and was able to maintain it for a year, my thoughts of starting our family began to take root.
Although I was able to taper off my medicine (under the close supervision of my psychiatrist), and had a normal, healthy pregnancy, we were not prepared for what would happen next. Not only was having our first child an incredible shock to my system (I had an emergency c-section after 17 hours of laboring – no pushing, but since the baby wasn’t tolerating contractions and I wasn’t dilating, my OB made the call for surgery), nothing could prepare me for how I’d react to motherhood. On top of all this, I had put enormous pressure on myself to breastfeed. I thought, from all the pregnancy literature I devoured before the baby arrived, that breastfeeding was the only acceptable means of feeding the baby.
I was wrong and learned the hard way.
Even though I knew lack of sleep was a trigger for me, I didn’t realize how little I’d be sleeping once the baby arrived, especially because I was trying to nurse. I barely slept at all in the hospital where the nurses checked my vitals every hour. Exhausted doesn’t even begin to describe how I felt. But I couldn’t take my eyes off our son. We had created a baby. I was in awe of this little person I was holding. It didn’t seem real. Although it could have been partly because I was headed into the throws of mania even before we left the hospital.
I’m certainly not perfect. Nor am I an obstetrician or psychiatrist. I’m just a regular mom who, after finding out she had bipolar disorder, wasn’t going to let it get in the way of her dreams of having a family. These are my reflections, looking back on my experiences of having my two children, now 6 and 4. This is what happened to me, and how I’d do things differently if I were to have a third child.
1. Have a plan for when you get the baby home.
With our first baby, I did everything and wouldn’t let anyone help. I was trying to succeed at breastfeeding and if someone gave the baby a bottle, he might not go back to nursing. Which meant I was always the one getting up in the middle of the night to feed and change the baby.
With our second, we had a plan. For the first two weeks, someone would be available to take the middle-of-the-night feedings. My parents stayed with us for a week, so they took turns during the first week home. Then my husband took over during weeks two to four. This allowed me to get a solid stretch of six to eight hours of sleep a night, critical to my recovery from the birth (a repeat c-section) and to prevent mania from creeping in. I learned to protect my sleep, and because of this, was able to stay mentally healthy once we brought our daughter home.
2. Don’t feel guilty for formula-feeding.
I breastfed our son for the first four weeks of his life, and then ended up in the psych ward for a week because of postpartum psychosis. Stopping breastfeeding was devastating, but on the way home from the psychiatric ward of the hospital, I realized being healthy for him was more important. Without my health I wouldn’t be present as a mother, no matter how I wanted to feed him.
For our daughter’s arrival, we planned ahead of time I wouldn’t breastfeed. Instead, I got excited about picking out bottles and supplies to formula-feed her, and my postpartum time with her was so much more enjoyable. Since I ended up taking antipsychotics and a mood stabilizer during the pregnancy, nursing was never an option, anyway. I accepted this reality.
3. When a medication works for your condition, weighing the benefits and risks is critical.
After experiencing postpartum psychosis after the birth of my first child, we were better prepared to navigate a second pregnancy successfully. Or so we thought. Going off my medicine for the first trimester was my mistake.
From my research, I knew there was a risk of heart defect during the first trimester of pregnancy with the medication I was taking. So I made a plan with my psychiatrist and the high-risk OB-GYN that I’d taper off the medicine when I found out I was pregnant, returning to it once I cleared the first trimester. Only I hadn’t weighed the benefits of staying on the medication against the risk I was taking.
Within a week of very little sleep I was manic and quickly falling into psychosis. Familiar with my manic symptoms before, my husband quickly took action and had me hospitalized. I was five weeks pregnant with our daughter.
When I returned home, medication was required to keep me stable. I went back to the high-risk OB-GYN for a post-hospitalization check-up and was scheduled for regular checkups and monitoring of the baby throughout the pregnancy. Luckily, she was born completely healthy and I had a wonderful postpartum period with no complications. I learned my risk for psychosis due to the lack of medication was far greater than the risk to my baby.
If you’re considering pregnancy or are currently pregnant, I urge you to work closely with your psychiatrist and OB-GYN to monitor and manage your bipolar symptoms. There are great resources available online to help you as you navigate pregnancy: Postpartum Progress, Postpartum Support International, and if you’re in the Washington, DC metro area (Virginia, Maryland and the District), the newly developed DMV-PMH Resource Guide maintains a comprehensive and current regional directory of specialized mental health providers, support groups, advocacy organizations and other relevant clinical resources pertaining to perinatal mental health.
There are resources available. Please don’t hesitate to ask for help. You can be a mom despite bipolar.
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