Jennifer Marshall

I married my college sweetheart at 24 and we have two fun-loving, energetic kids. Diagnosed with bipolar disorder type 1 in 2006, I had to navigate my pregnancies while managing my mental illness. I write at bipolarmomlife.com to share my experiences with others so they realize that there is light at the end of the tunnel.

Mental Illness Didn’t Crush My Dream of a Family

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3347120739_0d840078faPhoto Credit: carf via Compfight cc

I was diagnosed with Bipolar Disorder after experiencing two manic episodes in the same month, each requiring hospitalization. At the time I was devastated and felt as though my dream of having a family had been shattered.

I knew I wanted to be a mom from a young age. I adored babysitting and loved being in charge. In my mind I’d meet the man of my dreams in college, we’d get married soon after, and when the time was right, we’d start a family.

In reality, that all did happen, with one exception.

I met the love of my life while in college. We dated for four years before he proposed. At 24, we said our vows in front of family and friends, promising to love each other in sickness and in health. Little did we know sickness wasn’t far off. We’d have just over two years of health before mental illness knocked the wind out of our nearly perfect love story.

Madness struck me before I’d even had the chance to decide that I was ready to try for a baby. My diagnosis of bipolar disorder left me wondering if I’d ever be healthy enough to be a mother. A year went by as I struggled to keep my chin above water, my depression pulling me deeper and deeper into the ocean of despair. I felt like I had nothing to live for.

My husband and parents fought hard for me. I saw countless psychiatrists, and even a noted doctor from NIMH (National Institute for Mental Health) who told me, as I sobbed in his office with my husband by my side, that I could still have children if I wanted. It was possible, he said. And staying on medication under doctor’s supervision would be a good idea.

After a year of intense suffering, I couldn’t take it any longer and finally agreed to try a medication my doctor had been recommending. It took several months for me to feel the full effects, and for my old, up-beat personality to begin to reemerge. My husband and I took things one day at a time, and when the weeks added up to a full year of stability, the year of hell began to fade into the shadows of our minds. Thoughts of pregnancy began to fill my head, and all of a sudden I was pleasantly distracted from my illness.

I’d accomplish my dream of having a family; it was so close I could taste it.

Looking back now, with two healthy kids and six years of parenting behind me, sure, I’d do things a little differently.

I was medication-free for my first pregnancy and although I did fine and had no symptoms of my bipolar disorder during the 40-weeks, the same can’t be said for the four weeks after my son was born. Postpartum psychosis ripped me from my newborn but I was fortunate it only took a week in the psych ward to return me to my family. In hindsight, part of the problem was the pressure I put on myself to be a “perfect” mom to my new baby. Maybe if I wouldn’t have been so insistent on breastfeeding, I wouldn’t have gotten sick. Maybe if I would have let family help more with the night feedings, my mind wouldn’t have lost control of itself.

Lessons learned, I agreed to do things differently the second time around. I thought I had all the proper precautions in place. I did my research and decided that since the medication I took had the greatest risk to the fetus during the first trimester, I’d work with my doctor to taper off the med once I got a positive pregnancy test. The plan was to go back on the med in the second trimester and remain on it for the duration of the pregnancy.

Unfortunately, the exciting news of the two little pink lines sent me into a manic episode after a week-long battle with elated insomnia. I spent five days in the psych ward at five weeks pregnant battling the most severe mania I’d ever endured. The doctors brought me back from my break in reality with powerful anti-psychotic drugs and I feared I might lose my baby.

Recovery from that most recent hospitalization in April of 2010 was the most difficult. I worked closely with my doctors and my baby girl was thankfully born completely healthy. My postpartum period with her was drastically different than that of my first child, due to the plan I had put in place before she was born. We formula-fed from the start, since breastfeeding wasn’t an option anyway due to my meds. Knowing she’d be a bottle-fed baby from the moment I became pregnant made it easier to get past the sadness over not being able to breastfeed.

Since my husband and I knew that lack of sleep was my number one trigger, he did the middle-of-the-night feedings in her first few months which allowed me to get a solid chunk of quality sleep. We even had my sister-in-law stay with us for the first two weeks since she was home on a break from her job at the time, and she took the night shift. Sleep was still a challenge in those first few months, but luckily she was a great sleeper and we made it through.

One thing is certain: I didn’t let mental illness rob me of my dream of a family. My family is everything to me.

Parenting is no easy task. Throw in mental illness to manage, and it can get intense. Intense, but not impossible. There are resources out there, there is support out there. My kids are worth it all, no doubt about it. I share my story – our story, really – so that other women out there can find hope.

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Perinatal Mental Health Hero

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Perinatal Mental Health Hero

I recently was introduced to a Labor & Delivery nurse who is making a huge impact on the state of perinatal mental health care pathways. I could feel the passion come through in her voice as we spoke a few weeks ago on the phone for nearly two hours about what she was doing to raise awareness and increase access to quality care in our local area (Washington, DC metro area) for women who desperately need it.

I asked Kisha to share her story in a few paragraphs, and this is what she sent me to share with you:

“I grew up in the small southern town of Crowley, Louisiana. After graduating High School, I enlisted in the Coast Guard to see the world. I was stationed in Hawaii for 3 years at a small boat station, then became a USCG Dental Technician Petty Officer 3rd Class. My final duty station was at the Department of Transportation in Washington, DC. Prior to leaving the USCG, I became a Massage Therapist. It was during my 5 year stint as a Massage Therapist, that I rediscovered my heart for nursing. I graduated college, became a Registered Nurse, and a mom at 30 years old. After working as a Mother-Baby and Pediatric RN, I took a chance on Labor & Delivery and found my niche in nursing!  Eight years later, I am still working as a full-time night shift L&D RN.

Being a Labor & Delivery RN is one of the most exhilarating & frustrating experiences. Over the years, I have gained invaluable frontline skills, instincts, and knowledge about calming a woman’s fear in the throes of labor and empowering her to embrace motherhood. I am proud of these abilities and love sharing the birth experience with women and their families, but in all honesty the realization of perinatal mood and anxiety disorders (PMADs) prevalence among mothers and its detrimental impact on families has dramatically shifted my perception and purpose. My heart breaks knowing that over 8 years and countless births, 1 in 7 of those pregnant women and new mothers that I cared for inevitably went home suffering in silence from a PMAD. Maybe some of them already knew they were high risk and had support in place, but for many they went home with an infant and the expectation that their mental health was secondary in motherhood. As I continue to bear witness to the subtle shifts that seem ‘normal’ after childbirth (lack of sleep, lack of self-care, lack of support) that directly contributes to this needless suffering, I have found my life’s work is to destigmatize PMADs, while alleviating the unnecessary suffering of these women and their families.

As a frontline nurse, I believe that we as a profession are key to a long overdue paradigm shift in perinatal mental health. We are well-positioned and equipped to assess the mental health of pregnant women and mothers in the acute care setting, provide them with the first aid emotional support they need, and connect them to the appropriate perinatal mental healthcare providers and resources in their community.”Kisha Semenuk is a mama to two young boys. And as a night shift nurse who recently obtained her Masters of Science in Nursing, Kisha completed her Nursing Capstone Project on the knowledge gap she identified when researching perinatal mood and anxiety disorders and effective postpartum depression screening using the Edinburgh Postnatal Depression Scale (EPDS) among frontline perinatal care providers (OBs,Perinatal RNs, & Mother-Baby RNs).Through her deeper research, Kisha became acutely aware that as a frontline RN she was bearing witness to the silent suffering of so many women and families. Nothing was being done about it on the frontline and Kisha wanted to take action to make lifesaving changes.

She began actively networking with frontline OBs and built a team of fellow perinatal mental health champions who helped her to compile and organize an online resource which will allow women and their families to easily locate specialized, local professionals, support groups and treatment facilities. This resource will be kept at the fingertips of frontline nurses who are often the first healthcare professional to recognize the emergence of a perinatal mood disorder.Kisha’s mission with the DMV (DC-Maryland-VA) Perinatal Mental Health Resource Guide is to develop, disseminate, and maintain a comprehensive, up-to-date, regional directory of specialized mental health providers, support groups, advocacy organizations, and other relevant clinical resources pertaining to perinatal mental health. This directory will assist providers, patients, and their families with obtaining specialized mental health evaluation and treatment during pregnancy and postpartum.

How amazing would it be if we could create a guide like this for every city in our country? I am so energized and extremely appreciative of all the blood, sweat and tears she has poured into this project and I cannot wait to see it take off and bring help and relief to so many families who in the past did not know where to turn.

I applaud Kisha’s dedication and drive for instituting change in an area all of us here at Postpartum Progress care deeply about.

{The DC-MD-VA (DMV) Perinatal Mental Health (PMH) Resource Guide is launching online by November 1 and is a result of an ongoing collaboration between the DMV PMH Resource Guide Team and existing DMV-based PMH Professionals and Perinatal Mood and Anxiety Disorders (PMADs) survivor support network. Team members include: Kisha Semenuk, L&D RN and MSN; Aimee Danielson, Director of MedStar’s Georgetown University Hospital Women’s Mental Health Program; Lynne McIntyre, the Mid-Atlantic Postpartum Support International Coordinator/Mary’s Center Maternal Mental Health Program Coordinator; Helen Conway, Psychology Major (C’15) Summer Intern; and Dina Karellas, L&D RN and Nurse Informatics Graduate Student; in addition to Adrienne Griffen, Founder of Postpartum Support Virginia (PSVa), and Nadia Monroe, Founder of Postpartum Support Maryland (PSMd).}

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Triggers and How They Affect Recovery

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Triggers and Recovery from mental illness

Knowing is half the battle. I found this to ring true in my experience with managing my mental illness during my pregnancies and postpartum.

I was diagnosed with Bipolar Type 1 in 2006. It took over a year for me to find the right psychiatrist, the right combination of medications, and the right techniques through therapy to allow me to begin to manage an illness which had taken me and my family completely by surprise. After months of anguish over what was working and what wasn’t, we finally found a medication that stabilized me and I started to feel pieces of my old self emerging from the darkness.

Once I had been stable for about a year, my husband and I decided we were ready to start a family. I was scared of a recurrence of my illness, but wanted to be a mom more than anything, so we started trying and I was able to get pregnant rather quickly. Unfortunately, our joy was fleeting as I experienced an early miscarriage and had to have a D&C. I was afraid that the medication I had been taking for my bipolar disorder caused the miscarriage, so I convinced my psychiatrist to allow me to taper off the med so that we could try again after I healed from the surgery.

We became pregnant again fairly soon after, and since I was doing so well off the medication and had no recurrance of symptoms, my doctor continued to see me as a patient but allowed me to stay off my medication for the duration of the pregnancy.

This was a terrible decision on both our parts, but I didn’t realize this at the time. Four weeks after delivering my son I experienced a severe episode of postpartum psychosis and had to be hospitalized for a week. It was arguably the worst week of my life, having been ripped from my child, having to abruptly stop nursing, and it took an incredible toll on me both physically and emotionally.

I was stabilized quickly by the team of doctors at the hospital by resuming my course of medication I had been on before my pregnancy. The recovery from the trauma of being taken away from my newborn for a week would take much longer.

I learned through my postpartum psychosis episode that my triggers are: lack of sleep and lack of medication in my bloodstream. These two facts would prove essential to me creating a much more positive postpartum experience with my second child. But not without another lesson first.

Once stable again after my PPP hospitalization, my husband and I began to talk about completing our family with one more baby. Even with my three hospitalizations (two before our first child and the PPP episode), I still didn’t know enough about my illness to know that the benefits of me staying on my medication during the pregnancy and exposing the fetus to the medication, although not the most ideal situation, far outweighed the risks of not being on medication at all given this was one of my top two triggers.

Doctors can advise patients, but it’s up to the patient to follow through with the prescribed recommendations. My doctor had agreed to let me stay off medication during the first trimester due to a heart defect risk, but after week 12 we decided I would go back on my medication for the duration of the pregnancy.

Tapering off my medication in just week 5 of the pregnancy, combined with my excitement and mounting loss of sleep over how excited I was to see those two pink lines on the pregnancy test, landed me in the psych ward again. My baby was barely the size of an orange seed and I had to be hospitalized for almost a week and put on antipsychotic medication to bring me down from the mania I had been struck with.

Because of lack of sleep and lack of medication. Two things I learned I could control.

Recovery from that episode took months; experts say that each subsequent episode is more difficult and takes longer to recover from, and I’ve found this to be true. But I emerged from that setback a much more informed and capable mother, ready to truly manage my illness so that it did not cause me and my family any further pain.

My husband and I talked about how we could handle my postpartum period differently with our second child, and we made plans to take charge over my triggers so that I could stay in recovery long-term. I stayed on my medication for the entire rest of the pregnancy and beyond because my medication kept me stable. We made plans that I would bottle-feed and my husband would take over the middle-of-the-night feedings between 2am – 5am so that I could get a long stretch of sleep at night, keeping my nocturnal clock in check.

I’m not saying it was easy. But my postpartum period with my second child was so much more enjoyable and relaxed compared to my first because I took the upper hand over my triggers. With my family’s support, I made it through. And I continue to keep a firm grip on my dedication to the medication that keeps me stable and getting the appropriate amount of quality sleep each night so that I can stay steady on my recovery path.

Bipolar disorder is a condition I’ll live with for the rest of my life. Learning my triggers and techniques which allow me to stay on top of them so they don’t throw me into a manic episode has been a learning process, but it is one which has empowered me to live well even with a mental health disorder.

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Navigating Your Perinatal Mood or Anxiety Disorder

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8363033986_503c7a47f3As a mom with bipolar disorder who blogs openly about my experiences surviving a postpartum mood disorder, people often ask my opinion on ways to deal with and manage their diagnosis. I am not a medical professional, so I hesitate to even answer these emails. But my heart tells me I need to address their questions.

Having been in the same shoes not long ago, I remember the desperate desire to connect with others who had gone through something similar. Back then, people weren’t talking as openly about mental illness, the stigma was thick and heavy, and I felt as though I was harboring a shameful secret. It wasn’t until I found Postpartum Progress that I truly felt I had found a group of women who understood.

So I get it when other moms, and sometimes dads, write to me about their story, asking for advice on what to do after receiving a diagnosis. They’re looking for the same connection I found. The same searching that led me to join this community.

Here are my suggestions: [Read more…]

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