Should You Have A Baby If You Struggle with Serious Mental Illness?

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mental illnessLet’s say you are in the high-risk category for developing a postpartum mood or anxiety disorder like postpartum depression.  You have battled depression, anxiety, OCD, or bipolar throughout your lifetime, and you have been told that the major hormonal and identity shifts that occur during pregnancy and childbirth are likely to push you out of remission, aggravate your symptoms, or lead to even more mental health challenges than you have already faced, like psychosis perhaps.  Maybe you are currently taking medicine and maybe you are not.  Maybe you are willing to continue your medication while pregnant, and maybe you are not.  Maybe you have already had a child and suffered with severe postpartum mental illness including psychosis and maybe you have not. But one thing is for sure: you desperately want a baby and you are scared to death about what this might mean for you.  And for your child.

These are tough questions, and anyone who identifies with the above snapshot can attest to how unbearably complicated all of this can feel.  Struggling with a perinatal mood and anxiety disorder when you didn’t see it coming is like a blow to the head that knocks you flat for a while.  Thinking ahead and knowing that you are likely to struggle gives a mom the chance to plan ahead for support, but can also be downright terrifying.

Perinatal mental illness awareness is increasing, but the fact is that there are many highly skilled medical professionals out there who still are not up to date, informed, and knowledgeable about the many elements to consider when it comes to perinatal mental health.  Women are told to not even consider having children due to mental illness when there may be safe ways to do so.  Women are told to stop taking their medication during pregnancy when this is neither necessary nor safe.  Women are given wrong information all the time, and life-changing decisions are made without adequate information.  And this is a problem.

This is what we know, in no particular order:

-       Moms who have struggled with depression, anxiety, OCD, bipolar and psychosis are more likely to struggle with mental illness postpartum than mothers who have not.

-       Moms who have a history of bipolar are 25-30% more likely to develop postpartum psychosis than moms who do not.

-       There is no concrete evidence that pregnancy prevents mania or depression in women with bipolar.

-       Discontinuing medication during pregnancy opens up the possibility for relapse in women with mental illness.

-       The first 4-8 weeks after delivery is the most critical time for women with bipolar, as this is when most cases of psychosis become evident.  During this period it is IMPERATIVE that moms get adequate sleep, nutrition, and exercise.

-       Under the attentive care of a trained and appropriate medical provider, a mom who suffers severe mental illness can become pregnant and go on to deliver a healthy baby and be symptom free.

-       Whether or not to take medicine to treat symptoms of mental illness while pregnant is a question best answered under the direct care of a trained and appropriate medical provider.

-       Most moms with severe symptoms of mental illness, including bipolar, will require medication support during pregnancy in order to manage symptoms and/or remain symptom free.

-       Many medicines required for the treatment of mental illness including depression, anxiety, OCD, and bipolar are known to be safe enough for pregnant moms when weighed against the known risk to both mom and baby of untreated or undertreated symptoms.  Many, many women take these medicines while pregnant and go on to deliver healthy and thriving newborns.

-       Current research tells us that, in most cases, moms can absolutely have healthy pregnancies if they are suffering from mental illness, including bipolar.

-       Postpartum bipolar and psychosis are both temporary and treatable with adequate professional help.

There is no doubt about it that women who suffer from more severe mental illness are much more likely to develop perinatal mental illness than women who do not… and without appropriate medical care, many of these women will be at a very high risk for psychosis and hospitalization.  And so, what to consider if you are one of these mamas?

  1. How severe is your mental illness, and are you willing to do the work required to both prevent and treat symptoms?
  2. Do you have adequate support lined up including a reproductive psychiatrist, therapist trained in perinatal mental health, understanding partner, and OB who is knowledgeable and supportive of women who need to take medicine while pregnant in order to be well?
  3. Will you be able to maintain adequate rest/sleep, nutrition, exercise, and stress management while pregnant and into the postpartum year, and do you have the imperative support lined up to do so as to prevent the aggravation of symptoms?
  4. If you have had a child before, are there supports that you are able to put into place that may help to reduce symptoms the second time around?

This is all very personal, and while some families may decide not to get pregnant because the risk of mental illness relapse or psychosis is too high, others may feel strongly that they are willing to take these risks and do the work in order to be healthy while pregnant and caring for a baby.  No matter where you are with this, the one thing that is certain is as follows: When making the decisions about whether or not to have a child if you suffer from current or previous mental illness, it will be important to understand the very imperative role that medical, therapeutic, and community support will play in your journey.  Moms who have this history cannot to it alone.  Nor should they need to.

To find a trained Perinatal Mental Health provider in your area, visit our postpartum depression treatment resource page or check out  http://www.postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators.aspx

~ Kate Kripke, LCSW

Editor’s note: RELATED, here’s a recent story from MGH Center for Women’s Mental Health: What’s worse for pregnancy, bipolar disorder or the medications used to treat it?

Photo credit: © freshidea – Fotolia.com 

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About Kate Kripke

Kate Kripke is a Licensed Clinical Social Worker (LCSW) specializing in the prevention and treatment of perinatal mood and anxiety disorders. She is also a Colorado state coordinator for Postpartum Support International. Kate lives in Boulder with her husband and two daughters and writes an eponymous blog.

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  1. I’m so grateful to see something in print about Moms with mental illness (bipolar in particular). I am fortunate to have a wonderful psychiatrist who has been supportive of me throughout my pregnancy, but I have encountered medical professionals who chided me for staying on my medicines. I was pretty shocked when this happened, but simply let it go. I’ve had a fairly stable pregnancy so far, with only a few periods of mild blues and no hypomania, and I’m hoping I can avoid any episodes after the birth. With my first son, I did end up hospitalized a couple times within his first two years, so I know it’s absolutely crucial that I maintain my med routine and get enough rest and stay in touch with my providers. Thanks so much for acknowledging that bipolar illness and other mental illnesses do not necessarily make you unfit to be a parent.

    • Absolutely! Mental illness definitely does NOT make one unfit to be a parent. It’s a factor in who we are as people, certainly, and as responsible parents it’s our job to make sure we are under the care of professionals and following our treatment plans, whatever they may be, so that we are as healthy as possible. But mental illness does not and should not preclude becoming a parent.

  2. Excellent article! I am there right now, pregnant with a history of severe PPD/PPA and was advised not to have any more children. But, we wanted another child desperately. Along with my OB, Psychiatrist and Therapist, I am doing everything in my power to ensure all resources are assisting me. Lately, I have begun to worry about my decision. I pray that all will be fine.

  3. Thank you very much for highlighting this issue. It’s exactly what’s on my mind right now. I’m burning to have more children but hesitate to put the good place that my daughter and I have finally reached in jeopardy. We had desperately wanted to adopt children, but sadly cannot afford to do so.

  4. I’d like to reiterate what Katherine mentioned in a reply here… Mental Illness does NOT make someone unfit to be a mother (and a fabulous one at that!)- My hope is that both families and doctors understand that there are safe (and important) ways to support women with mental illness when they do want to become pregnant and have children. And that when these women are supported appropriately, they can go on to carry babies and have early mothering experiences that are healthy and embowering.

  5. Does anyone know if pregnancy and delivery can actually cause bipolar disorder or is it just a trigger for someone that already has the illness? I keep reading all of these blogs and comments from women who find out that they have bipolar for the first time after pregnancy. So is pregnancy the cause of it for some of these women?

  6. This is a great question, Katy.. and my guess is that you are not alone in your uncertainty about this. The short answer is that, no, pregnancy and delivery are not known to be an isolated “causes” of bipolar disorder- meaning that a woman who has never shown symptoms of depression anxiety, mania, or hypomania (mild mania) will not suddenly develop this mental illness simply due to pregnancy or childbirth. What we do know is that pregnancy and childbirth can both magnify and, yes, also “trigger” symptoms in someone who is predisposed to this illness (personal or family history, for example). Bipolar II- a more mild type of bipolar disorder that is often undiagnosed or misdiagnosed- has been called the “postpartum depression imposter” because the mania is missed (hypomania is not always detected because it is not usually a mania that interferes with someone’s life), and the depression is misdiagnosed as simple unipolar depression. The stories that you read are not uncommon- many women will not be diagnosed with bipolar until after they give birth because A) their symptoms that were once manageable and undetected will be heightened at this time (irritability, impulsivity, heightened energy for no apparent reason followed by lower mood suddenly become rage, destructive impulsivity, and/or mania followed by deeper depression) or B) these moms who have an undetected bipolar disorder will be treated for their depressive symptoms with an SSRI antidepressant and may, because of their bipolar, be pushed into a manic state through the antidepressant use…. It is important to note here that women who are being treated by appropriate providers will- hopefully- be supported if this happens and will be appropriately treated for their bipolar with the correct medicine. Like any other mental illness, bipolar is absolutely treatable and managed well with medication and life style support.

    • Thank you for this thoughtful and informative article.

      I had been diagnosed with depression many years before becoming pregnant, and I never considered my depression as a factor in whether or not I’d get pregnant. I took meds for depression through both of my pregnancies. The meds didn’t work so well during my second, and I was severely depressed. I was diagnosed with bipolar disorder about six months after my second daughter was born. In many ways, it’s amazing that I survived my second child’s first year. I was fortunate to have a lot of support on many different fronts.

      Because of my (physical and mental) situation, I would never consider having another child.

      I am diligent about my mental health, communicating with my psychiatrist, and managing my moods so that I can be the best person and parent possible.

      Having said all that, I would not change either of my pregnancies. My daughters are the light of my life. I am a great mother, absolutely the best mother my children could have.

      I’m so fortunate that all this happened during and after my second pregnancy. If it had happened before my first pregnancy, I may have decided not to have any children at all. That would have been such a huge loss to my family and extended family.

      I worry that doctors strong-arm women who have a lot of support, who have the potential to be wonderful mothers into avoiding pregnancy because of their mental health. That is such a travesty.

      I also worry for the women (like me) who have doctors who are reluctant to use the psychiatric medications during pregnancy. That’s something you don’t know until you’re sitting in the office, crying and begging him to help you.

      We and those close to us have to be prepared to advocate to get the help we need, no matter what situation we’re in.

  7. Thank you so much for this article. This website has been such an amazing resource. Personally, I have been dealing with episodes of depression on and off since college. I am 34 now. I married my best friend when I was 23. He has been with me through it all, knowing that the depression is something horrible that is happening to me, but not the thing that defines me. I have always been so ecstatic to think about having children, but in the last couple of years my excitement has turned to fear. Yes, I am afraid to have a relapse and experiencing PPD or worse, but the issue I am most afraid of is passing on the depression to my future child. Does anyone else struggle with this? I never want someone I love to experience what I have. I don’t want to pass on the hurt, being told that depression can be genetic. But it just breaks my heart to think of not having any kids. I feel so much guilt and am so conflicted.

    • What you’re struggling with is a very personal choice, but let me offer my perspective from thinking about the same question. It would also break my heart if one of my kids turned out to inherit my bipolar. But knowing what I know now about managing bipolar and the signs and symptoms, I hope I would be better armed to help them deal with it and catch it early on before it has a chance to devastate their lives. I think it’s worth the risk, but as I said, this is a very personal question. I would encourage you to talk to someone about it, especially since you are feeling a lot of guilt. You certainly don’t deserve to feel that at all – you have nothing to feel guilty about, you’re just struggling with a difficult issue. Hugs to you!

      • Jane and Lisa, I too feel wary of having children, for several reasons, but mostly for fear of relapse. I haven’t especially been passionate about having kids, and I worry that my lack of desire to have them will contribute to depression if I do become pregnant. Has anyone felt this way? I feel conflicted as well about what family and friends would think of a choice not to have children at all. I have experienced depression as a preteen and teenager, as well as these past two years, but now I am okay. I am 28. I too have a wonderful husband who has been with me to help. I have had moderate, not severe, depression. We are Christians. What does everyone here think about not being “desperate” to have children and how that would influence PPD? Should I wait until I want children more to have them? I know this is a personal question, but I am eager to hear people’s thoughts to inform my decision. I feel comfortable asking this community of women, and I am of course praying about it. I want the best for my family.

    • Jane, I definitely struggle with the fact that my kids are both more likely to have mental illness, as both my husband and I have it in various forms. It’s likely my parents passed their heredity on to me and yet, I’m glad I’m here. I am able to contribute, and can look at my life overall and feel that there’s been more good than bad, despite mental illness. So, while I worry that they will struggle in some ways, and I have some guilty feelings over that, I’m still so glad I had my babies and I believe in my heart (have to believe) that they will be okay.

    • i really struggled with this fear while i was pregnant. so far, he shows signs of being a resilient baby. i look at it this way: i’m in an excellent position to teach him how to deal with his feelings in the healthiest way possible. i know what to look for, how to help, and when to get help. and i’m inspired in my own care so that i can lead by imperfect example.

  8. Wow, I clicked this link thinking I was going to get info on tying my tubes due to OCD. (Because I don’t want to pass this awful illness to my child. That would be selfish.) But no I click it only to read one of the most selfish things I have ever come across. And people are calling me selfish for not wanting kids.

  9. I have a traumatic brain injury and depression and I have wanted to have children since I was a child myself and plan to have my first within the next two years so I have started planning! lol! I want to be as prepared as possible because I know with a TBI and depression I will face extra challenges especially with the lack of sleep.

    Thank you for this :)