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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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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It’s Harmful to Pretend to be Supermom

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I remember all the feelings from when I had my first baby almost six years ago. Joy, utter disbelief at how we created something so freaking amazing, relief, exuberance, nervousness, exhaustion. But none was more harmful than the feeling of being invincible.

This feeling of invincibility is actually a symptom of postpartum psychosis, but I didn’t know it at the time.

I was now in charge of a new, helpless little baby. It was as if my ego grew tenfold in the moments he was extracted from my belly and the only person who could do things right for this tiny person my husband and I had brought into this world was me. Because I was his mama, of course.

He liked how I swaddled him best, how I rocked him just right, how I fed and burped him. I was trying to breastfeed exclusively which, looking back now was a mistake given how lack of quality sleep is a trigger for mania in my case, but I was putting the baby first, not my mental health. I never gave myself a break because I thought if I did, I’d be failing as a mom.

What I know now, after experiencing postpartum psychosis when my son was four weeks old, after recovering and going on to have a second baby, is that pretending to be supermom is harmful. It’s probably one of our worst habits as moms – pretending everything is fine when it’s not. This type of facade hurts everyone in the family, especially the mom. [Read more...]

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What If You’re Still Fighting PPD?

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winding path through trees Last week was a big week here at Postpartum Progress. It was the site’s 10th anniversary, and therefore the 10th anniversary of Katherine’s start as a powerful advocate for women with postpartum depression and similar mood disorders. In celebrating that anniversary, you may have seen stories from a whole list of women who credit Katherine and her work with saving their lives and getting them to where they are today.

But what if you’re not better? What if you’re still fighting PPD?

Being exposed to a slew of stories from people who did recover and who are better while you’re not can leave you with questions of, “Why me?” Or, “Why not me? Why are they better when I’m not?”

You may feel as though you have done everything you’re supposed to and it hasn’t worked. You might wonder why it’s seemingly easy for some people but not for you. And you might look at all that celebrating and feel like giving up.

What I want you to know is this: You will get better.

[Read more...]

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