Managing the Risks of Taking Lithium For Bipolar Disorder While I'm Pregnant

The ultrasound tech said the doctor would explain afterward. The tech would take pictures of the baby, while the doctor reviewed the images in a different room. I watched the tech’s expression while I leaned back on the stiff hospital chair, jelly sliding on my round stomach. She clicked in silence, images froze on the screen. Clouds, a dark blob. The baby’s heart, she said. She only looked calm, and I tried to relax, reminded myself again of the odds that the doctors told us, that everything was fine. 

• What is Bipolar disorder?

I’ve taken lithium off and on for years, along with a couple of other pills tacked on by different doctors according to the swings of my periodic breakdowns. It’s difficult to remember all the medicines I’ve tried. Some have fallen away amid repeated depressive episodes; I’m told these pills did not work. A doctor called a medication “outdated” and threw this one out. Other pills caused mania, weight gain. Since I’m currently in my longest streak of relative stability, almost three years, we say that my medicines are working.

My husband and I met once with a special psychiatrist when we decided to start trying to get pregnant. She was a fellow-in-training, focusing on perinatal mental health, around my own age. She wore a gorgeous sheath dress, her mannerisms precise and elegant. I had an idea that I’d be asked to defend my fitness to have a child. I felt I didn’t have much to recommend myself. Eight hospitalizations, years of struggle with suicidality. I avoided telling people I stayed at home working on a novel since I didn’t know how to explain that I wasn’t an artist, only a sick person trying to fend off psychotic depression.

I read the notes from that visit a couple of days ago. The doctor listed my behavior as “cooperative and guarded.” Not a bad performance. At the time, I hoped she’d believe I’d make a decent mother because I could deliver a monologue convincingly, about psych wards and 13-year-old traumas. I wasn’t trying to seem guarded, but I don’t know any other way to be, in most situations. I usually take about two years to warm up to people, to get to the point where I look forward to hanging out. And, with almost everybody, not just doctors, I’m always trying to convince people of something, that I’m “normal” or inoffensive. As a kid, I used to calculate obsessively whether I was going to hell. Now I reexamine decisions made years ago, tracing the chances of possible negative consequences and despairing over my doom. 

I’m guarded about most things, but somehow I have let myself fall for this baby I’m carrying. I rarely think about doom when I think about her. I see the possibilities for her life, uncertainties that would usually terrify me, and I’m thrilled. Thinking about raising her, I allow myself to believe I’ll be a good mother, that I’ll make up for my bedridden depressions with daily caring. She kicks me hard at night, and I wake up and rub my pregnant belly, resting my hand on the bulge that might be her head or foot. 

The doctor never ended up giving a judgment on whether I should have a child. She asked the standard questions and took notes, her lipstick impeccable while she smiled and typed. I trusted her because she was beautiful and kind. She talked about the risks of my medications, the most significant being lithium’s disputed low risk of association with a fetal heart defect, claimed in some studies and not present in others. She — and two other doctors I met with after I became pregnant — recommended that I stay on my medications. A relapse of my severe illness, if I went off my medicine, could cause the baby harm as well.

I don’t know why I wasn’t more scared of disaster like I am with everything else. I followed the doctors’ instructions, swallowed my pills three times daily, got pricked for blood draws every month or so. Met with my psychiatrist every week. Stayed out of the hospital, stayed out of bed almost every day. And when the ultrasound tech left, before the doctor came in and explained our baby’s heart showed no defects, I didn’t ask myself why I’d gambled, or whether I’d regret having a child. By then I wanted her too badly, her whole life that we’d imagined, as much time together as we could get.

The odds predicted correctly, everything’s been fine so far. But it didn’t need to be. Shouldn’t I have been more worried? Part of me believes I was being selfish, blinded into incaution by my desire to have a child. But I also wanted to know. When can I take a chance? I’ve rearranged my job, my relationships, all to safeguard against the worst possibilities in myself. I want to think, even with a severe mental illness, I’m allowed to hope that I’ll be one of the lucky ones sometimes. That if I meet with enough doctors, and the odds are on my side, I don’t need to feel afraid. I don’t know if I have that right. If anybody does.

What I want: to hold my baby for the first time, with the right mix of hope, and enough anxiety to keep me aware. To throw open the best of my life to her. Somebody, show me how to do it. I’ll try to learn.