3 tips for navigating pregnancy despite a bipolar diagnosis

Navigating Pregnancy Despite Bipolar Diagnosis

3 days before my daughter arrived in 2010.

My blog turns four years old this August. Having come to this little corner of the internet for nearly four years, writing my story of how I’ve navigated pregnancy and beyond despite living with the diagnosis of Bipolar disorder type 1, I tend to get quite a few questions from my readers. The most common ones come from young women who like me, wondered how they would be able to manage their illness and still be able to care for a newborn. A newborn who would grow into a baby with many demands.

I certainly am not perfect, nor am I an obstetrician or psychiatrist. I’m just a regular mom who, after having found 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. (We are 99% sure we won’t be having another one, in case you’re wondering.)

Accepting the diagnosis

Bipolar disorder is a challenging, life-long illness. The first year or two of learning to live with the diagnosis can be devastating and all-consuming. When I was first diagnosed, ten years ago at the age of 26, I had to resign from a career that I excelled at in order to focus on getting well. It took an entire year for me to work with my doctors and therapist to find a medicine and figure out 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 I 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), but nothing can prepare you for how you’ll react to motherhood. On top of all this, I had put an enormous amount of pressure on myself to breastfeed. I thought, from all the pregnancy literature I had been devouring before the baby arrived, that breastfeeding was the only acceptable means of feeding the baby.

I was wrong and I learned the hard way.

Even though I knew that lack of sleep was a trigger for me, I didn’t realize how little I’d be sleeping once the baby arrived, especially due to trying to nurse. I barely slept at all in the hospital since the nurses checked my vitals every hour because of the surgery. 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. Maybe partly because I was headed into the throws of mania even before we left the hospital.

1. Have a plan for once 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 that 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, and then my husband took over during weeks two to four. This allowed me to get a solid stretch of 6-8 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 breastfeed 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. Having to stop breastfeeding was devastating, but on the way home from the psychiatric ward of the hospital I realized that being healthy for him was more important than anything. If I didn’t have my health, I wouldn’t be able to be present as a mother, no matter how I wanted to feed him.

For our daughter’s arrival, we planned ahead of time that I would not 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 didn’t have the extra pressure to make nursing work. I ended up having antenatal psychosis (mania during pregnancy) during the first trimester of my second pregnancy, so I had to take antipsychotics and a mood stabilizer during the pregnancy. Nursing was never an option and I accepted this reality.

3. When a medication works for your condition, weighing the benefits and risks is critical

Having experienced postpartum psychosis after the birth of my first child, we were better prepared, or so we thought, to navigate a second pregnancy successfully. We knew that I needed to protect my sleep, and I planned from the moment we decided we wanted to have another baby that I would formula-feed since I’d be returning to my medicine after the first trimester. Going off my medicine for the first trimester was my mistake.

From my research, I knew there was a risk to the fetus of a heart defect during the first trimester of pregnancy when women took the medication I was taking during pregnancy. 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, and I’d return to it once I cleared the first trimester. Only I hadn’t weighed the benefits of staying on the med against the risk I was taking.

I was closely monitoring things, testing for pregnancy on the earliest day possible following my fertile period. When I finally got a positive test, my excitement over finally being pregnant (we tried for about nine months) took ahold of my body and would not let go. My mind raced with potential baby names as I’d lie awake in bed not able to fall asleep.

Would it be a girl? How would our toddler react when he met his new sibling? What would it be like to be a Mommy to two little ones?

Within a week of very little sleep I was manic and it was quickly leading to psychosis. Having witnessed 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 that my risk for psychosis due to the lack of medication in my system was far greater than the risk to my baby in utero.

*****

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 during pregnancy and in the postpartum period. 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.

We Need Universal Mental Health Screening for Women Having Babies

we-need-universal-mental-health-screening

I experienced both a postpartum mood disorder (postpartum psychosis) and a perinatal psychiatric issue (a manic episode which led to psychosis) very early on in my second pregnancy. I had been diagnosed with Bipolar Disorder two years before my husband and I decided to start a family, and yet I found limited support and information in my quest to have as healthy a pregnancy and postpartum experience as I could. When I think back to that time in my life, I strongly believe that if I had received better screening – particularly after my first pregnancy – much of the trauma and heartache of what I went through could have been avoided.

Before I experienced mental illness on a personal level, my ignorance of the various forms of psychiatric conditions caused me to judge people whose stories were covered in the media. I remember watching news coverage of the Andrea Yates trial thinking HOW COULD THAT HAPPEN? And then it happened to me seven years later. Thank God my outcome was drastically different.

Just this week a pregnant mother and her three children were rescued in Daytona Beach, after she drove the family minivan into the ocean. A family member had called police hours earlier to express concern over her strange behavior, including talk of demons.  On the 911 tapes, you can hear the sister request a well-being check because “she’s like having psychosis or something.”

This woman literally saved her sister’s life, the lives of those three children and the life of her sister’s unborn baby with that call for help.

They were lucky to have avoided an outcome similar to that of the Andrea Yates case. Simply because someone close to the person who was suffering took action.

Now it’s our turn to take action. There is an urgent need for changes in the way we screen women during pregnancy and postpartum in order to stop incidents like these from ever occurring in the first place.

Maybe this woman’s sister recognized what her family member was going through because of the increase of more open dialogue about women’s mental health issues. I can feel the wave of mental health awareness gaining momentum and hope that very soon there will be less ignorance out there and more acceptance. Because together we can make a difference.

Which is why I support this important White House petition to create mandatory universal mental health screening for pregnant and postpartum women. Did you know that suicide is the leading cause of death for women during the first year after childbirth? Or that 1 in 7 women will experience a mood or anxiety disorder during pregnancy or postpartum, yet nearly 50% remain untreated?

We need change. We need to screen every mother, every time to prevent and treat perinatal mental illness.

Recovery is possible – I am a perfect example of this. But wouldn’t it be incredible if in the future we could catch cases like mine before they escalate? Before they lead to suffering and even death? No woman should have to suffer in silence because she’s afraid to admit what she’s thinking or feeling. We need to provide her with the chance to find recovery early. We need to recognize the signs and symptoms and take action.

Please take a moment to sign the petition: Every Mother, Every Time. Creating a WhiteHouse.gov account takes only a minute and there are simple tools to share the petition on Facebook and Twitter once you have submitted your signature.

This movement will save lives. We need 100,000 signatures to get the attention of the Obama Administration. Let’s come together to make our voices heard on this critically important issue.

Every Mother, Every Time.

Tweet about the petition with the hashtag #EMET:

Thank you for helping to spread the word.

Snow and writing

Snow-and-Writing

This week has been full of snow and writing. I haven’t posted anything to the blog this week because I’ve been busy writing for Postpartum Progress since I’m a member of the Warrior Mom Editorial Team. If you haven’t already seen my posts via my social media promos, I’d love for you to check them out. {Postpartum Psychosis Doesn’t Equal Failing as a Mom & Psychosis During Pregnancy and What It Taught Me are the titles of my two posts.} When I hear the song from Frozen it makes me think of that time in my life when I was having babies and not taking medication in order to protect them.

Seems so long ago, but it hasn’t even been four years since my last episode. Back then I worked to hide what I had been going through. I’ve matured since then and I now know – from the tweets, comments and emails I receive from people who have read my words – that I made the right decision. Speaking out helps so many people. I’ll never know how many, but my heart is content with my decision to become an advocate.

It’s been a long week here with Monday being MLK Day and the little man off from school, then the snowstorm on Tuesday which led to school being cancelled for the rest of the week. I’ve been trying not to tear all my hair out from the “I’m-at-the-end-of-my-rope” feeling due to having to entertain a 3 and 5-yr old for four days straight. We’re all getting on each other’s nerves from being cooped up in the house all week. I say cooped up because for the most part I despise winter and only go out in negative wind chill weather when absolutely necessary.

Like for my therapist appointment yesterday. Couldn’t ask for better timing.

I’ve been working on a ton of stuff for the show in May. Hard to believe it’s only four months until we take the stage. Audition slots are starting to fill up and my Association Producer Anne Marie and I are thrilled to see everything coming together. If you know anyone you you think would be fabulous for the show – I’m talking creative, funny, inspirational, energetic – please have them sign up for a spot before they’re gone.

I recently accepted a new writing assignment for an organization doing a tremendous amount of inspirational, educational, critical work surrounding mental health awareness. I’m honored to have been approached by them and cannot wait to share my first post with you. It’s a once-a-month gig, which is definitely manageable and plus, it’s an opportunity I couldn’t turn down. {Sorry I broke my promise, Maria – but this is worth it!}

So yeah, a lot going on. But if I’ve learned anything over these last few months it’s that the work eventually gets done. When the kids are calling for me to get down on the carpet and play “picnic” or board games with them, I listen. I close the laptop and grab hold of the quality time. Or when exhaustion sets in, we snuggle up on the couch and watch a movie together. Life is good. Better than good, actually. It’s pretty damn amazing. (Including the occasional teachable parenting moment, which I wrote about for WhatToExpect.com recently.)

   “If you are always trying to be amazing, you will never know how amazing you can be.”                                                             – Maya Angelou

Maternal Mental Health Month

Courage_BML

In May 2011, Postpartum Support International (PSI) declared May as Maternal Mental Health Awareness Month. Over the past few weeks I’ve been busy writing some pieces in support of the efforts to raise awareness of women’s mental health before, during and after pregnancy. Two were published recently and I’m proud to share them with you.

 

Yesterday was the 5th annual Mother’s Day Rally for Moms’ Mental Health, hosted by Postpartum Progress, the most widely-read blog in the world on postpartum depression and other mental illnesses related to pregnancy and childbirth. It featured 24 letters (one of them was mine!) from survivors of PPD, postpartum anxiety, postpartum OCD, depression after weaning and/or postpartum psychosis. Their purpose is to inform and encourage pregnant and new moms who may be struggling with their emotional health. I was honored to be included again this year.

 

Along those same lines of postpartum and mental health, today a piece I wrote for WhatToExpect.com’s Word of Mom blog went live. (Yes, that’s really me in the picture included in the post!) In it I describe the feelings of guilt and sadness I experienced when I had to quit breastfeeding because I needed to return to my medication. I’ve learned that no mom should put unnecessary pressure on herself to breastfeed, especially if her mental health is at risk.


I hope you have a chance to check out these posts and please share if you know someone who might benefit from the information within. Thanks so much and I hope all those moms out there had a great Mother’s Day yesterday!