3 tips for navigating pregnancy despite a bipolar diagnosis

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

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:

[Tweet "Universal mental health screening 4 every pregnant & postpartum woman http://ow.ly/uho8X. #EMET"]

Thank you for helping to spread the word.

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

Dear New Mama ~ don't ignore PPP symptoms. Please.

Dear New Mama, My son was four weeks old and I was manic out of my mind in October of 2008. I was somehow able to hide it so well from everyone close to me, my parents, my best friend, my therapist, even my husband. No one knew but me. But who was I kidding? I couldn’t go on like this, and I knew it. The week after he was born I had broken down crying to my mom, handing her my cell phone pleading with her to call my OB to ask her what I could take to help me sleep. I had been off all medication (except pain meds from the C-section) since October of 2007. A full year with no medication at all: a recipe for disaster for anyone diagnosed as having bipolar disorder two years prior. But I was doing it for the baby. My husband and I both wanted a medication-free pregnancy, and then I wanted to breastfeed and did not want to expose the baby to medications that would come through in the breastmilk.

The first month, I had slept maybe 2-4 hours a night and it was catching up with me fast. I'd take two Tylenol PM and would get a few hours of sleep, but woke up, as I usually did since the baby was born, in a sweaty panic – I just knew he needed to be fed even though he was usually sound asleep at the time. I was trying desperately to make breastfeeding work, but we were struggling. He had lost weight since we left the hospital and the pediatrician forced us to supplement with formula but I was determined. I was so afraid of failing. My best friend was my cheerleader, urging me to keep going, visiting when she could to offer helpful tips and encouragement. My husband was also supportive and we knew it was risky being off medication in order to breastfeed, but we had decided to try it. My parents had arrived two days after the baby was born and were planning on staying a week before heading back down to Florida. When they realized how little sleep I was getting, they were worried and my mom pushed out her return trip by five days. After nearly two weeks of help from my parents, my husband’s parents, friends cooking dinners for us, and my husband being off from work, I had to learn to do it on my own. It is so foggy, those first four weeks, but we took pictures so I could remember. I did it on my own for two weeks, three days. Then the shit hit the fan.

The statistic was 1 out of 1,000. I never thought I'd be that one person who was dealt the postpartum psychosis card. I mean, what are the chances, right? But I guess I really should have seen it coming, having been diagnosed with bipolar disorder only two years earlier.

So, you may be wondering, how did I know that I was experiencing postpartum psychosis? Well, at the moment I didn't. I just knew that how I was feeling couldn't be right.

I was dead-set on breastfeeding, and therefore, was the sole source of milk for the baby so I had to be up every two to three hours. The process of changing his diaper, changing his outfit if he had leaked, swaddling him back up, feeding him on the boob, burping him, and settling him back down took me about forty-five minutes each time. Therefore, I had an hour or so to try to sleep before he would wake again, but instead of sleeping, despite what should have been my intense exhaustion, I would rush around the house doing laundry or dishes or I'd pump to try to get my body to produce more milk so that I could store it. It was as if my body had surpassed the exhaustion phase, and I was now invincible. I was starting to believe that I didn't even need sleep. I also felt super smart - like my brain was functioning at a superior level. Having never been a stellar student in any stage of my schooling, it was weird, to say the least.

During the fourth week, before I was eventually hospitalized, I started experiencing hallucinations. Mostly things are fuzzy, but one I can actually remember is from the morning that my husband finally realized he needed to commit me. I had woken up several times during the night but just stayed in bed listening to the sounds of trucks driving along the highway not too far from our house, hoping to fall back asleep. When the dawn broke and light started filtering in through the mini blinds, the alien spaceship that was hanging from the center of our bedroom (aka: the ceiling fan) began to spin, illuminate, and hover towards me. I shook with fear. But kept my mouth shut. I didn’t want my husband sending me to the hospital. I had to keep feeding my baby. We had just started to “get it” and he was doing well. I was actually enjoying the bonding time it created between me and the baby.

THANK GOD my husband got help. He had to call 911 because he wasn't able to get me to agree to go in the car to the hospital, let alone take medication. I was so lucky, because he knew the signs to look for from my two previous manic episodes, and he wasn't afraid (or too proud) to admit that I needed medical attention. Specifically, anti-psychotics. Stat. And although I never had thoughts of wanting to harm my baby, who knows if those could have been the next thoughts to enter my mind had we waited any longer to get help.

What I want you to know, mama, is that if you ever experience symptoms similar to mine after the birth of your baby, please don't feel ashamed about it. Don't ignore the signs. Have your husband or partner read about them too, so they can be as prepared as you are. Knowing what you know now about postpartum psychosis is half the battle. The other half is being open to accepting the help you need to get better for you so that you can be there for your baby. I did, and I'm so thankful because it was the best decision my husband and I did for our family, and continue to do, each and every day.

The medication I take keeps me "in the middle", as we in my family like to refer to it. I ended up taking it, under the close supervision of both my psychiatrist, OB-GYN, and high-risk OB-GYN, during my second pregnancy and we were blessed with a precious baby girl who has completed our family. I continue to take my medication, see my psychiatrist and therapist regularly, and lean on the support of my husband, parents, and close friends in order to keep my mental health in check.

I wish you all the happiness in the world as you meet your new little bundle of joy. I know that you'll turn out to be one incredible mama. Just like I did.

Much love,

Jennifer aka BipolarMomLife

The 4th Annual Mother’s Day Rally for Moms’ Mental Health is presented by Postpartum Progress, a national nonprofit 501c3 that raises awareness & advocates for more and better services for women who have postpartum depression and all other mental illnesses related to pregnancy and childbirth. Please consider making a donation today, on Mother’s Day, to help us continue to spread the word and support the mental health of new mothers.

National Pregnancy Registry

My daughter turned 8 months old yesterday. About two weeks ago she started crawling and just yesterday she started babbling non-stop. I am continuously amazed at how quickly she is growing and changing. And I am intensely grateful that she is a happy, healthy baby. I was hospitalized for bipolar mania when I was just five weeks pregnant. My husband and I had been trying to conceive our second child for seven months and it had finally happened, only to cause me such excitement that I couldn't sleep which lead to my mind racing beyond belief forcing him to sign me into a psych ward for four days. I had been working closely with my psychiatrist to come off the Lithium for the first trimester once I found out I was pregnant and then once the mania took over from the excitement of finally becoming pregnant, I continued to refuse medication because I thought I was doing what was best for the baby growing inside me.

Looking back now I know how very wrong I was.

The main risk that the baby faced if I stayed on Lithium was Ebstein's anomaly, a heart defect. The general population has about a 3% chance of this particular congenital heart condition, and the risk increases to around 6% for a person taking Lithium during pregnancy.

In my case the benefit of staying on medication greatly outweighed the risks of me becoming manic and needing hospitaliztion, and I definitely knew this having done a ton of research beginning back before I became pregnant with my son. But with his pregnancy I was able to somehow stay medication-free throughout those nine months and one month after his birth. And I think I was feeling some mommy-guilt in wanting to give this second baby the same drug-free environment in which to grow and thrive. It only seemed fair.

After spending four nights and five days in a psychiatric facility near our house, I was finally released to the care of my regular psychiatrist after being stabilized on Haldol via injections because I was very resistant to oral medications at the beginning of my hospital stay. They also used Zyprexa since historically I responded so well to it. Of course I was scared to death about how these medications were affecting the baby's development, especially because there is so little research out there on the use of a-typical antipsychotics during pregnancy.

This is what lead me to find the National Pregnancy Registry via an online search. They are collecting information from women who have taken certain antipsychotics during pregnancy and after childbirth to hopefully shed more light on the safety of these medications during pregnancy. They also need women who are currently pregnant and NOT taking these medications, to serve as the control. If you know someone who is willing to participate in this on-going study, please direct them to the site to sign up to join.

It is easy to participate - just a series of brief phone interviews and some completed paperwork releasing medical records is all it takes. They do a baseline interview during the beginning of the pregnancy, a 7-month interview, and a postpartum interview. Simple. Once you finish it will give you a good feeling knowing that you are doing something to help improve the quality of healthcare for pregnant women in the future.