June 02, 2015

My Advice for Pregnancy, Postpartum & Bipolar

"Pregnancy and Newborn" by Petr Kratochvil
I read this article this morning about having bipolar and pregnancy. She had bipolar 1, which is more complicated than bipolar 2 with symptoms and medicines. It was nice to see other women with bipolar manage pregnancy, birth and postpartum. It's quite a task that requires a lot of adjustments. I know of one woman who went off all meds to have a child, but I wouldn't recommend that!

Jennifer Marshall included three tips in her article: have a plan when bringing home the baby, consider not breastfeeding, and weigh the benefits of medication versus other medications. I'm including some of her advice with my own advice for handling mental illness during and after pregnancy.

Regular Psychiatrist Visits and Medication Management


I changed meds over the course of four months preparing to have my first child. I struggled during that whole time with hypomania and self-harm, but I knew I wouldn't have access to a psychiatrist after that four month period due to lack of insurance and funds. After two months of pregnancy, I was able to go on Medicaid and see a doctor! I dropped an antidepressant after the first two months of pregnancy, but without the recommendation of a doctor. Luckily, my doctor added a new antidepressant later, which made a huge difference.

Lesson: Have a psychiatrist monitoring meds before, during, and after pregnancy. Don't change meds too quickly or go off without monitoring.

Safe Medication During Pregnancy


I switched medication so I could have children from class D to class C and B medication, but this doesn't work for everyone. Pregnant women should work very closely with a psychiatrist and obstetrician to monitor the mother's mental health and baby's risks. I took a medication without a lot of research on it during pregnancy and third baby probably had mild effects from it. I think it might have slowed his metabolism after being born, but I don't know. My doctor encouraged me to report the effect of the medication to a research, but I didn't. I wish I had now to add to the medical literature.

In the last trimester of my first pregnancy, I went off my mood stabilizer so I could breastfeed. A few days after delivering my son, I had a day of thoughts of self-harm and harm to my firstborn. But that was the only day of those feelings! After eight weeks, I chose to resume my mood stabilizer medicine when I could feel a slight depression coming on.

Lesson:  It is worth being sane even if a medication may be riskier during pregnancy. Be willing to forego breastfeeding for sanity. A sane mother is better than a harmful, depressed, or psychotic mother!

Regular Counseling Before, During and After Pregnancy


I made the mistake of not going to a counselor for two months before my first child, which led to serious self-harm (and changing meds too quickly). Luckily, I had a neighbor who listened to the Spirit and came to talk to me at a critical moment. Even though I had no insurance, I should have sought counseling when I first felt myself slipping. After that, I did seek counseling through my church's social services. From then on, I was more stable during my pregnancy and after. 

I stuck with counseling through my second pregnancy too, but I made the mistake of not going after the eight-week mark. I had moved and was no longer insured. We were on Medicaid a month later, but I still didn't see a counselor because we were only there for my husband's short internship. I didn't seek out a counselor for another two years and while trying to get pregnant a third time, which led to a worse breakdown. Since then, I have been regularly going to a counselor through my third pregnancy and the years after.

Lesson: Counseling is too important to skimp on while you are trying to get pregnant. Hormones and feelings fluctuate too much during this trial period. I chose counseling during each pregnancy, which I'm thankful for. The postpartum period lasts longer than I thought. I needed it for a period of at least a year or more after each child.

Self-care


I cannot emphasize self-care more for the periods before, during and after pregnancy. I ate more than I should have and gained weight, causing greater depression. I also stayed up too late at nights in an attempt to have "me" time. It has backfired into tired days and weight gain. Take care of yourself spiritually, mentally, and physically. I am a much happier mom when I take care of myself first and then my kids.

Hopefully this helps other women with mental illness who are having children. It's a delicate process and you need all the support you can get. Remember to create a support network of family and friends. We are an interdependent species.


Do you have more advice?