6 Ways You Can Be an Empowered Patient During Pregnancy When You Have Bipolar Disorder

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The best person on my care team? My OB. Hands down. When we found out I was pregnant (far sooner than we had planned), my husband and I decided right away that no matter what course of treatment  we decided upon after speaking with my doctors, our number 1 priority was my mental health. Still absorbing the shock, I remember my husband standing in our bedroom with his fingers lacing their way through mine, saying, “Health and wellness, Addye. That’s our focus, ok? Your health and wellness. No guilt, no shame, no matter what happens. YOU and your health are what’s most important. We’ll do whatever it takes. We’ll get through this together. I promise. Let’s do this.”  I’m pretty sure I was fighting back tears and a whopping dose of fear in that moment as I high fived him and agreed: We could do this. I could do this.

And I did. I have. I’ll be a year postpartum next month, and as I watch my youngest son crawl into the room he shares with his two older brothers, I think back to that moment in my bedroom and feel proud of that promise we made, and the treatment option I chose.

Given my previous history with PPD, the nature of my illness, and the increased risk of relapse I faced because I have bipolar disorder, we decided staying on two out my three medications was what health and wellness would look like for me…as well as for the baby and the rest of my family.

That was my choice, but I know many other mothers with bipolar disorder who opted to go without their medications during their pregnancies and remained healthy throughout. No matter what course of treatment you and your care team decide upon, the important thing to remember is that you DO have options. There’s nothing I hate more (aside from stigma) than coming across an article on the internet that gives women with bipolar disorder incomplete information regarding their treatment options during pregnancy and breastfeeding, doesn’t point to what resources they can utilize to make informed decisions, and doesn’t tell them how they can navigate the unique challenges they’re faced with.

So let’s talk about how to do that, shall we? (This post is going to a bit long, but bear with me, I believe what I’m sharing with you is important)

1. Build Your Care Team, Create a Treatment Plan

I cannot stress the importance of this enough: You MUST have people on your medical team who have experience in treating pregnant women with mood disorders. Think of this as your Dream Team. People you want on this team are your OB, your psychiatrist, therapist (if you have one), and a pediatrician. It’s possible your obsectrician will also want a reproductive psychiatrist and maternal fetal medicine doctor on your team as well, especially if their experience on this front is minimal. Thankfully, my OB had extensive experience with caring for women with bipolar disorder during their pregnancies and knew pretty much everything that’s out there regarding medication use during pregnancy and breastfeeding. He was up to date on the latest research available and proved to be my most invaluable resource on my care team. Seriously, he’s the one who gave me the confidence that all would be well, and that choosing to stay on at least two of my medications was a safe and healthy choice. Both he and my psychiatrist spent a lot of time going back and forth, weighing the risk vs. benefit of staying on meds or going without, and although they disagreed on a few minute points, they ultimately decided staying on medication would be healthiest for me, and ultimately, baby.

Also be sure to find a pediatrician to consult. You’ll need one anyway after the baby is born, so you might as well find one who knows about medications, postpartum mood disorders, AND does depression screenings at well visits. (Our pediatrician does and it has been incredibly helpful to me this past year.)

Finally, ensure that the team you build has your mental health as their top priority. As soon as a woman becomes pregnant, the focus tends to immediately shift toward the health of the baby and stay there. In the past, I’ve dealt with OB’s who only cared about how I was doing physically and what impact any physical conditions I had would have on my baby in utero. Not once did they focus on my mental well-being, let alone have it guide my prenatal care. Listen: I completely agree that baby’s health is a priority. I do. But I’m going to just come right out with it and say that a mother’s mental health is what’s most important and should be the foundation of her prenatal care, and if no one on your team shares in that philosophy? They shouldn’t be on your team or in charge of you and your baby’s care. Period. Same goes for the person treating your mental health condition. My first psychiatrist through the VA was woefully uninformed and unhelpful when I told her I was pregnant. It took a lot of pushing, but I was finally able to have my care transferred to a psychiatrist with a background in pharmacology and reproductive psychiatry, and it made a significant difference in my overall care.

2. Communicate and Advocate

Everyone on your care team should be in constant communication with you and each other through every phase of your pregnancy and delivery. They should also be able to come to an informed consensus (with you) about your treatment. There is nothing worse than having two of your doctors at an impasse over a part of your treatment plan because they just disagree. It’s incredibly frustrating and the last thing you need to be worried about. If this happens, don’t be afraid to speak up and advocate for yourself, reminding them that they are there to help care for you and your baby, and you need them to work together.

Always be open and honest with your care team about what you’re feeling and experiencing throughout your pregnancy, so they know how to help you as soon as possible. Part of my treatment plan involved staying off of my mood stabilizer during my first trimester, but remaining on my anti-depressant. At 11 weeks, I called my OB and told him my mood was starting to take a nosedive and I was worried about a depressive episode. He moved my NT ultrasound scan up to the start of week 12, and as soon as he reviewed the results, gave me the all clear to start back on my mood stabilizer.

3. Do Your Own Research, Knowledge is Power

There are books out there on  medication use during pregnancy and breastfeeding and the variety of treatment options available for women in our situation-get your hands on them and read as much as you can, being sure to talk with your care team about what you learn as you do. When researching my treatment options and discussing them with my team, books I read included Pregnant on Prozac by Dr. Shoshanna Bennet, Medications and Mother’s Milk 2012: A Manual of Lactational Pharmacology by Dr. Thomas Hale, and The Complete Guide To Medications During Pregnancy and Breastfeeding: Everything You Need to Know To Make the Best Choices for You and Your Baby by Carl P. Weiner MD and Kate Rope.  I also read everything I could on the MGH Center for Women’s Mental Health blog, which has a wealth of information on research studies and how to use their findings to make informed treatment decisions with your clinician.

4. Create a Birthplan That Takes Your Mental Health Into Account

Initially, I considered going without pain meds for my delivery. I read all I could about natural child birthing methods, and had it in my mind that I’d hypnobirth my way through labor and delivery, even if  I wound up crying uncle and utilizing some form of pain medication. But at 28 weeks, I landed in L&D with contractions that wouldn’t stop without magnesium. In fact, they didn’t really stop the rest of my pregnancy. I contracted every day of my third trimester without ever dilating more than 2 centimeters. Previous experience reminded me that neither of my labors with my older two progressed without intervention, despite having intense, painful contractions that were off the charts for a week. Looking back, I’m positive this contributed to the panic and anxiety I had during both deliveries and afterward. With this third go around, I was miserable, exhausted, starting to have anxiety attacks, and was starting to cycle between nesting induced hypomania and depression.

At week 38 I told my OB I was done and worried that continuing would put me over the edge and trigger a depressive episode-and I hadn’t done all of this preventative health and wellness work to be in a dark place when my baby boy was placed on my chest. I knew my limits, and wanted a bit more control. I wanted an induction. He agreed, and a week later I was in the delivery room smiling and laughing as I stared lovingly at my newborn-100% anxiety free. It was a calm and beautiful experience and in my opinion, gave me the strong start postpartum I needed.

Whatever your birth plan is, make sure it’s flexible, realistic, and compliments your treatment plan.

5. Have a Support Network

Having the love and support of friends, family, and your partner is so important. Lean on them when you need to, and don’t be afraid to ask them for help. Inform them of ways they can be a support to you. My friends (fellow Warrior Moms) and my husband did an amazing job of supporting me during my pregnancy and this past year. I couldn’t have made it without them to call, text, and share this experience with. A therapist can also be an invaluable resource to you during this time; they can help you process all you’re experiencing and develop coping strategies for managing your postpartum period. Consider finding support online in a private forum for pregnant and new moms with mood disorders (like Postpartum Progress’ Smart Patients Forum or the #PPDChat private group on Facebook), or find what’s available to you locally through organizations like NAMI or DBSA.

6. Self Care

Try to find ways to incorporate rest into your day as much as possible, even if you already have other children. Do not go without sleep. Create manageable to-do lists, and reconstruct your expectations about how much you can get done each day-especially if you’re working. Practice deep breathing exercises, and engage in physical activity that is both safe for you and baby and feels good. Engage in activities that are calming and nourish your soul-even if it’s binge watching your favorite show on Netflix. Keep track of your mood either in a journal, or with a mood tracking app on your phone; this will help you be able to communicate to your care team and support network how you’re doing. (I use iMood Journal) Prenatal massage, mani/pedis…whatever self-care looks like and is for you, be sure you do it and do it as much as possible.

 

I hope this is helpful and gives you a good starting point for creating a plan that works for you. Remember-You have options when it comes to treatment. You can do this. I promise. You got this, mama.

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Let’s Rewind: The Isolation of Motherhood pt. 2

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My family and I headed to a castle. No big deal.

My family and I headed to a castle. No big deal.

Parenthood is, in a lot of ways, just a bunch of sleepless nights bleeding into long days. That sounds kind of bleak, but I’m not sure there’s a more complex state of being than that of being a parent. You’re always being pulled in multiple directions and overcome with conflicting emotions. And, honestly, I’m not sure that it’s ever as hard as it is in the first gritty-eyed months of having a freshly baked baby.

Throughout Archer’s first year, inertia carried me. Once I went back to work, the force of my footsteps was the only thing that propelled me forward. Daycare. Work. Pump. Coffee. Pump. Lunch. Pump. Daycare. Home.

And through it all, I felt alone.

Physically, distance crushed me. I was half a continent away from my family. Emotionally, disconnect destroyed me. Most of my friends did not have children of their own. If I could have articulated how abandoned I felt, my words would have been scarcely a whisper.

But, again, let’s rewind.

Breastfeeding came easily to Archer and me. Despite his time in the NICU, he latched quickly and nursed like a champion. The emotional trauma of his tumultuous birth experience was healed by our outstanding nursing relationship.

Nursing sustained us. It bonded us. It provided just the right dose of feel-good hormones to shield me from the undercurrent of isolation that tried so insidiously to steal my joy. When we weaned, the loneliness reached up from the deep below and quietly pulled me down.

Without realizing it, my body and mind were being realigned as Archer nursed less. The chemicals in my brain like tectonic plates, slowly and imperceptibly shifting to create entirely new and unrecognizable continents within my psyche.

I left my job to pursue a freelance writing and marketing career and I spent each day deafeningly alone. Just me and my deadlines and – I know now – my depression.

Despite having solid support systems and amazing friends, I was borderline non-functional by the time I admitted that I needed help. Depression is a liar and she told me that no one knew my plight – that such loneliness was the result of being undesirable by friends and family alike.

In my first postpartum counseling session, I sat across from my psychiatrist and psychologist – both specially trained to work with mothers with mood disorders – and told them how impossibly isolating motherhood was. My doctor pushed up his glasses, looked me in the eye, and said, “Liz, I am not here to belittle your experience, but I want you to know that every mother who has ever sat in that chair has said those same words.”

Now, let’s fast forward.

With a diagnosis of “post-weaning depression,” I restarted on my Lamictal and recovered, once again, quickly. And, again, we reveled in my stability.

Archer became our co-pilot on a new adventure and we moved from Baltimore to Germany for a three year assignment with my husband’s job. In our time here, the isolation of motherhood combined with the isolation of ex-pat life to create a sort of mecha-loneliness that has tried to cut me down many times. If I’m being honest, sometimes, it has succeeded.

Enduring a rough pregnancy an ocean away from family and friends did little to quell the rising tide of lonesomeness. Late night nursing and long days working ignite sparks of heartache that occasionally rekindle the flames of alienation.

But, in my worst days, I rewind to my psychiatrist’s office and remember that my isolation is not a unique condition of my experience with motherhood.

You see, motherhood is a weird thing in that many mothers experience the same things, but in different ways. There are times when all of us feel alone. Motherhood, on some level, breeds some amount of isolation. But, in that isolation, we are – in a twisted way – brought together.

 

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Reward and Risk: My Decision to Stay On An SSRI During Pregnancy

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postpartum depression medicationNearly two years to the day after my overdue diagnosis of postpartum depression and anxiety, I found myself pregnant and still on an SSRI antidepressant. We had been trying; I had done my research, consulted my OB and my Pediatrician for their thoughts on wether or not I should taper off of my medication prior to becoming pregnant again. They both agreed that the risk was outweighed by the reward-a healthy me was the best way to guarantee a healthy baby in the long term. When I specifically asked my pediatrician about the increased risk in heart and lung defects, she stated that we could handle it on the back end, IF it needed to be handled.

Fast forward three weeks. To our complete surprise, we discovered we were expecting not one baby, but two. Fast forward a few more weeks, a lot of tears, panic, a couple of therapy sessions, and dozens of honest conversations with my husband, doctors, and some other Warrior Moms later, and I had decided that the best thing for me and my babies was to remain on my Celexa until the third trimester of the pregnancy.

SSRI antidepressants do cross the placental barrier during pregnancy. This means that the fetus will be exposed to the medication while in utero. My doctor suggested that I wean off of the medication during the third trimester because some babies exhibit “‘withdrawal’ symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (Psych Central, 2006).” However, she stressed that many of these symptoms, specifically irritability and trouble feeding, are normal for newborns and would likely be hard to discriminate from the normal behavior of newborn twins. [Read more...]

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Educating mamas-to-be one story at a time

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I think of mental illness the same way I view cancer. It can strike anyone at anytime. For me, the time came at the age of twenty-six. I was blindsided. Two manic episodes two weeks apart; two stays in two different psych wards at the end of 2005.

If the first time was a complete and utter shock, the second reinforced what I guessed was happening to me. My family and I were in denial after the first incident, totally unprepared for the road ahead. The second bout of mania solidified the fact that this was real.

Even after living with bipolar illness for two years, I had yet to fully understand the disease. When my husband and I reached a point where we agreed I was stable enough to try for a baby at the end of 2007, I read everything I could get my hands on about postpartum depression, the only postpartum mood disorder I knew about. I had lived through a year of debilitating depression following my diagnosis of bipolar type one, and was terrified of falling into the darkness again. Especially with a new baby who would be depending on me for survival.

Impressed with what I thought was a great job preparing for my postpartum experience,  you can imagine my confusion when instead of the intense case of the baby blues I had expected, mania began taking over my mind in the weeks following my son’s birth.

The pressure I had placed on myself to succeed at breastfeeding made everything worse. Instead of turning over my sweet, swaddled little boy to my husband so he could give a bottle of formula and I could get some decent rest, I pushed my body further than I ever have, on top of having just given birth via emergency C-section after a sixteen-hour labor. I was not allowing others to help me care for my baby, which in turn contributed to the swift deterioration of my mental health.

It was only the third time in my life that I had felt full-blown mania, and now having been there four times I can easily say that it’s like an out-of-body experience. You have the strangest thoughts, such as the time I believed every song that came on the radio was a sign specifically meant for me and my life. Sleep and food became things I needed very little of to function, my energy level soaring through the roof. I felt invincible.

Until everything fell apart and I spent the fourth week of my son’s life in a psychiatric ward of our local hospital suffering from postpartum psychosis.

I’m very lucky in that I respond well (and fast) to medication, and so I was back at home before I knew it, returned to my precious baby who had no idea I had gone away. My recovery was slow and steady, and within a few months I felt like myself again, and was settling into my new role as a first-time mom.

These days I am so glad that Postpartum Progress is a community of women who share their experiences. I know there are people out there who have read these stories and who have become more educated about postpartum mood disorders (PPD, postpartum anxiety, postpartum psychosis, postpartum OCD, postpartum PTSD) from visiting the site. By sharing to educate and to inspire, we can prevent or minimize the occurrence of postpartum mood disorder hospitalizations by catching the symptoms early. Keeping more mamas and babies together by sharing one story at a time.

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