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.

The Hospital Badge

yyellowbird via Compfight cc

When I meet other people who live with mental illness, it’s inevitable that at some point the topic of hospitalizations comes up. It’s as if the number of times you’ve been committed is like a badge of honor.

It’s not, but it is at the same time.

When you’ve been in the hospital, you learn how to fight to get well. You learn to have compassion for other people’s struggles. You learn to realize that your brain just doesn’t work like a plain old regular person’s brain works.

And so you learn coping mechanisms for how to manage your illness.

In group sessions you’re taught how to listen and be present in the moment. You're shown how to use art to express your feelings and work through your emotions in art therapy. During the exercise class you might appreciate the calmness that comes from the breathing exercises and stretching of yoga.

But it doesn’t mean that you’ll be fine when you’re released. For me, having been hospitalized for mental illness was... a very traumatic event, each of the four times it happened.

When I came home from the hospital each time, I’d hide my feelings of guilt and shame, not really opening up about what I had been through to anyone but my therapist. It would take weeks to return to stable, and I was constantly desperate to talk with someone else who understood what I had gone through.

Luckily, I have met some friends through support groups and other avenues, who have also been through hospitalizations for mental illnesses, and it’s always interesting to compare notes. But when it comes down to it, those types of stays are all the same. Meds, therapy, paperwork, release. Then you’re on your own.

Through blogging I’ve had the privilege of hearing from some of my readers who've reached out to me via email saying they’re so glad I’m writing because stories like mine are important to share. They’ll sometimes tell me how hard of a time they’re having, and how they wish they could just go to the hospital for a week or two, maybe it would help.

What I want those readers to know is that going to the hospital may help take the edge off momentarily. But when you get out, and you’re back at home, it’s sometimes easy to fall right back to where you were before you were admitted.

Life goes on. The world keeps turning. And we have to keep on learning to lead the dance with our conditions, lest they turn us in the wrong direction.

For me, this means protecting my sleep. Last night my allergies were in an uproar, given the change in the weather this past weekend. My fitbit displayed a horrendous sleep pattern. I went to bed at 9:15pm (the earliest I’ve been in bed for the past three weeks by an hour) but yet it was quite possibly the worst night of sleep I’ve had in that many weeks.

But I won’t give up. I'm working on staying on top of my triggers to ensure I stay mentally healthy. For myself, for my family, and for my community.

And on that note, it’s time for me to hit the sack.

Spring Break Snow

“Mommmmmeeeeeeeee!” I heard her wail from her nursery, the room next to ours.

I pulled my weary self out of bed and found my way through the dark to her door, guided by the soft light of morning creeping in through the miniblinds in our bedroom.

5:45am. Fun.

“What, sweetie?” I whispered gently.

“I wost my paci, Mommy,” she whimpered.

I felt around her crib with my palms, not able to locate the missing pacifier until I ran my fingers into the crack in her crib bumper where it had wedged itself so neatly.

“Here, honey.” I said as I put the rubber nipple back into her mouth.

“I want to sleep in your womb,” she mumbled, paci gripped ever so gingerly between her lips.

Ugh. There goes my last hour of sleep this morning.

I carried my baby girl into our bedroom and placed her in the middle of our king bed. I tried to fall back into my sleep, but it wasn’t happening. The snow that had fallen during the night was reflecting what little bit of sunlight that was emerging from the sky and our room was starting to welcome the morning. I spent the next fifteen minutes caressing her soft cheeks and hands, a sweet luxury I don’t always having during the day when she’s rushing about playing so busily.

I savored those minutes.

“I wan to go downstairs, Mommy,” she declared, after tiring of my affection.

And so I pulled on my fluffy yellow fleece bathrobe and picked her up so we could go downstairs and admire the last snow before spring while we ate breakfast.

 

Rest: Five Minute Friday {2}

This week I've been short on it. My mind shifts into high gear as I settle into a sweet little hypomanic state. Don't freak out parents - I know I need to catch up on my rest. I just had so much to get done before kissing the kids goodbye, hugging my mother-in-law, and giving my husband a bear hug and a sensual "thank you" kiss at the airport as he dropped me off. He encourages me more than he knows. He trusts me with his loving smile.

It was a long day of travel yesterday.

Five hours on a plane, twenty minutes on the lightrail, three hours on a bus.

But I am finally here.

Dinner last night was amazing - so fresh and full of vegetables and fruit. Sleep came easy to me once I shed my traveling clothes and slid into cozy jammies.

Rest was refreshing.

What I need: meds and sleep

My poor husband. Being married to someone who has Bipolar Disorder has got to be a teeny bit nerve-wracking at times. Take last week for instance. I contracted Baby Girl's lovely stomach bug and on Wednesday night (really, the wee hours of Thursday morning) was up puking my guts out from 1am until 4am. It was horrendous. I swore up and down that I don't think I want to have another baby because throwing up is the most awful thing in the world and I know I'd have morning sickness if we decided to go for #3.

The next morning I tried my hardest to get the kids up for Mom's Morning Out but I could barely walk ten feet without my head spinning. My husband had a 9am meeting that he HAD to be at, so I decided that I'd just keep the kids home and would let them watch TV all day until he could come home early in the afternoon.

And then I remembered my wonderful Mother-in-law. She's retired and she loves the kids and they adore her. I called and she said she would of course come over to watch them so that I could catch up on my sleep.

I couldn't even make the kids breakfast. My husband gave Mister Man a bowl of cereal and Baby Girl a sippy cup of milk and he was out the door. They were distracted with the TV until my Mother-in-law arrived and I crawled back in to bed. I didn't even come out until almost 2pm.

By then I only had a few hours until my husband would get home. I hadn't been able to eat anything, but was able to drink apple juice on ice. It tasted like pure heaven but it was bad news for my blood sugar. My husband got home around 4:30pm and I went straight back to bed. He made me a piece of toast and I was able to keep it down, but my body still ached from the heaving the night before and then there were the chills. I couldn't get warm despite two layers of clothes, socks, and a fuzzy bathrobe. Under covers. Eventually I fell asleep again.

I woke up at 9:30pm and picked up my phone next to me in bed to text my husband so he would check on me. He came up and when I was so delirious in the way I was asking him to get my phone charger, he started to get concerned.

Not about the stomach bug I had. He was concerned that I may be manic. I could hear it in his voice.

He tried to force me to take my Lithium, but I refused. I got angry. I called him names for trying to force me.

I realized I had forgotten to call his mom back about the next day and whether she should come help me again, so he offered to call her. He'd stay home with me and the kids.

When he came back up with another piece of toast for me, I took a bite and apologized for my rant. I was just so afraid of the medication making me throw up again like I had the night before. I promised to take it the following night. I know how much I need it.

Just not when my stomach is rejecting anything that goes into it.

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Sleep is my #1 trigger. I know this after years of managing my illness. As much of a night owl that I am, I cannot pull all-nighters like I did in college anymore. I can't even take care of multiple newborn feeding shifts (lucky for me). Because of this, I do everything I can to protect my sleep. If I don't, my health is at risk. Same thing with taking my medication. I may just need a small amount of Lithium every night, but if I go a week without it, I am most-likely going to become manic.

I don't blame my husband for trying to get me to take my medication and for worrying that I could have been becoming manic. He is just doing his job of looking out for my well-being and our family's well-being. I am very thankful that he realized that my irrational behavior was due to my frustration in him not being able to find my cell phone charger and also my haywire blood sugar levels from surviving on nothing but apple juice and a piece of toast all day. He is a wonderful, loving partner and father to our kids who has done a tremendous job of helping me to manage my illness.

Within a few days my sleep was back to normal and my stomach is almost back to normal. I was only off my medication for one night do to this nasty stomach bug (which I wouldn't wish on my worst enemy, btw). This week I am preparing for Daylight savings by going to bed a little earlier each night starting tomorrow. The following weekend (St. Patty's weekend!) I am heading to a memoir writer's retreat in Seattle and this will be a bit of a challenge for me, sleep-wise. But I am well-prepared and I have my trusty sleep-aid to use since the time change will definitely disrupt my sleep. When I get home on the 18th I'll have a good week of work to do on my sleep to get back on schedule, but I know I will be okay.

I am a fighter. I monitor my sleep and take my medication because it is my responsibility to my self, my spouse and my family.

And it's getting to be past my bedtime, so I need to wrap this post up so that I can log some quality ZZZZ's.

Living with bipolar disorder

I don't think a day goes by that I don't think about the fact that I am living with a mental illness. Not because I worry about what other people think of me, it's not that at all. It's because I have to constantly be taking the pulse of my mood so that I can manage my illness to the best of my ability. Over the last seven years I've gotten pretty good at it. I like to describe my experience living with bipolar disorder as a scale of one to ten. A simple ten point scale tells so much for someone like me. Think of it this way: 1 = completely depressed, can't get out of bed; 5 = in the middle, balanced (this is what I strive for every day); and 10 = completely manic, need hospital. I won't lie, I like being in the 6-7 range, but when I do have those times when I creep up to the 8's, I start to crumble. I know that when I get to 8, I need to make time for sleep or else I could tip over to 9 or 10 and that would be incredibly awful. Just because I've been there before. And now we have two kids and I would hate for them to see me in a manic state. Just as I would hate for them to see me depressed. But with my version of bipolar disorder, Bipolar I, my moods swing on the higher side of the scale versus the low side.

Nighttime is the hardest. The kids have been asleep for an hour and within that time I've cleaned up the kitchen and (of late) collapsed on the couch in front of my favorite show right now: XFactor. Some nights I am motivated enough to do a workout and then am filled with so much serotonin that it's almost impossible to turn off the endorphins enough to sleep right afterwards.

I'm trying to curb my evening leftover work/facebook surfing/twitter gazing/blog stalking to a minimum so that I can hopefully join the 10pm bedtime club.

When I do climb into bed, I get super jealous of my husband who, within exactly two minutes of us shutting off the lights, is snoring away happily. I'm a different story. My eyes close, my breathing slows down, and I shift around until I get into a comfortable position to try to nod off. Thoughts pop up and a running to-do list keeps flashing before me. I've learned coping mechanisms over the years so now I am able to turn down those things and find sweet sleep. If ever an hour goes by and I am still not asleep, I know that I must pop a sleeping pill to help me get the zzz's that I need.

I've just been thinking lately about how I live with this each and every day, and will for the rest of my life. Nothing I can't handle, just thought my readers might be interested in knowing a little bit about what it feels like.

Checking in with the doc & Kony 2012

Had a checkup with my psychiatrist today. I brought the kids with me since it's only a 30 minute appointment and it was right at 12pm, so I fed them before we left and brought the ipad to try to keep them occupied. She brought in a few toys for my little man to play with and my daughter sat in the stroller happily tapping away at the ipad. A tiny bit distracting, but nothing a mom of two toddlers isn't used to. I like how my doctor asks about my writing. She knows it is important to me and she supports my voice. My last psychiatrist didn't read my book draft since I became emotional during the one appointment when I told her about it, handing her the draft to read. She told me at the next visit that she hadn't read it since I became so upset. The fact that she didn't read it (or so she said) made me sad. I was handing her a glimpse into my thoughts, feelings, and emotions having lived with bipolar disorder and she turned around and told me what felt like "you're not worth my time outside of paid appointments."

I would have stopped seeing her, but didn't really have a choice since insurance was covering my visits at almost 90%. So I stuck with her until our insurance changed and I was forced to find a new doctor. I was lucky enough to find a very good one whose office is only 5 minutes from our house.

We talked about my mood during today's visit and I admitted I've had some hypomanic periods over the past two months, but they are manageable. I always have a good sense of awareness about my moods and when I feel an elevated period, I know that I need to get more sleep and nap when the kids nap. I take Ambien if my mind is still buzzing when I know it's bedtime. I'm also fortunate in that my husband stays on top of things too and encourages me to get rest when he knows I need it. We work as a team to keep me healthy and I like that.

My doctor and I discussed the recent news of the Kony 2012 movement and how Jason Russell, the filmmaker who was the voice of the campaign, was recently hospitalized in California under a 5150 psychiatric hold. He was trying to raise awareness about a horrible war that was going on which most Americans probably knew absolutely nothing about until news of the viral video his organization created hit the evening news. When I first watched the video two weeks ago, I'll be the first to admit, I was kindof shocked by the message of "Making Joseph Kony famous". But then it hit me. What better way to slap the world in the face to get them to realize how much shear devastation this one person has caused to so many innocent children? The campaign had a call to action too. They want to get the word out to have Kony arrested and put to justice. By the end of the 30-minute video I was a follower. I even shared it on my Facebook wall, encouraging my friends to watch it.

And then the story broke on Friday about Jason's detainment by police after he was found naked on the streets shouting obscenities and pounding the pavement with his hands. The first thing I did was remove the share post of the Invisible Children Kony 2012 campaign from my Facebook wall.

How incredibly narrow-minded and judgmental of me to act in such haste. I immediately didn't want to be associated with the guy just because he had suffered a public mental breakdown? Wow. Talk about needing to have an introspective weekend.

All I could do was think back, all weekend long, about how his story has some similar characteristics to my own. Not nearly on the same scale, of course, but in small part, similar. At the time of my first psychotic episode, I was under a great deal of stress from my career and the goals management had set for me in the coming year, in addition to being in the midst of an emotional affair with a co-worker and mid-way through building a brand new single-family house with my husband. Talk about having a lot on my plate.

I feel so blessed to have had the support I did when I went through that most trying time of my life (and theirs, I'm sure.) My husband did not abandon me, my parents and in-laws wrapped their arms around me in support, and my closest friends were there to listen to what I was going through whenever I needed to talk. I was so lucky that I didn't have to suffer in the public eye like Jason is right now.

I'm sure there were things said behind my back by people wondering what the heck was going on with me. But I didn't have to read about it online or hear about it on the news like his friends and family are doing right now. I pray that they don't read or hear the negative words being thrown about on the Internet and news talk shows, and that if they do, that it only strengthens their defense for him and their efforts to help him get well. I'm praying for him. He's done so much good work. He does not deserve all the hate. Not one bit of it.

I am not proud of my initial reaction to what happened to him. I wanted to write about it here to help teach myself, someone who suffers from a mental illness which caused four psychiatric hospital stays, not to turn my back on someone because they are going through a trying time. Let this be a learning experience to myself and the other 83 million people who watched the video. Don't turn away because I believe that some people come into our lives as blessings, and others come into our lives as lessons.