Monday, October 14, 2013

Bipolar and Pregnant (Part 1)

Even if you are not bipolar, deciding to have a baby is a major life event. But at least bipolar women are not told categorically that they must not become pregnant, which is what happened until a decade or so ago.

When I got pregnant I didn't know I am bipolar. But I had a trouble-free pregnancy with no morning sickness, and I felt terrific until I went into labor. My natural delivery with no anesthetic was naturally painful, and in retrospect, I wish I'd had a spinal. But all in all, I was lucky.

If you are a bipolar woman who wants to have a baby, consult your psychiatrist and obstetrician about medication options. Ideally, of course, years earlier you will have got medical advice on how being bipolar factors into your contraception decisions.

If the prospective father is the one who is bipolar, he and his wife would be wise to discuss with his psychiatrist how fatherhood may affect him. If both people in a couple are bipolar, they should both consult their doctors, perhaps together.

Pregnancy has never been restricted to those who choose it. Bipolar women who accidentally become pregnant had better continue to take their usual meds and consult with their doctors and the prospective father about whether to continue with the pregnancy.

If you are bipolar and pregnant or planning to become pregnant and you plan to take bipolar medications before and during pregnancy, make certain the meds have not been shown to cause birth defects. And if you do not want to continue taking meds while pregnant, be alert to the risk of self-medicating with alcohol and tobacco, which also can cause birth defects. 

A further risk is that if a bipolar woman takes no medication and becomes depressed during pregnancy, her depression can have a negative impact on the baby. Yet another key factor is that statistically, a bipolar woman who ceases taking her meds before and during pregnancy is at risk for the return of symptoms.

There is no one answer that fits all bipolar expectant mothers and their medications. Consultations with your psychiatrist and OB-GYN can help with a decision about what, if any, meds to take while pregnant.

I was surprised to read that electroshock therapy may be safer for a pregnant bipolar woman than drugs. Of course, electroshock should only be administered by a doctor knowledgeable about bipolar disorder and pregnancy.

Given the emotional nature of pregnancy even for women who are not bipolar, bipolar women can help themselves and their baby by having talk therapy regularly with a professional they like and trust. If you are one of these women, you might want to discuss with your therapist whether the baby's father should join you in at least some of the sessions.

It is a good idea to arrange well in advance of the birth to have someone who can take care of the baby if you are unable to do so until your postpartum bipolar disorder stabilizes, because a bipolar woman who is pregnant or has just given birth is at increased risk for a manic episode that may require hospitalization, whether or not she has been taking her meds.

Another key consideration after giving birth is whether or not to breast feed your baby, and if you do breast feed, whether to take medications, and if you do take medications, which ones are safe for your child? Again, find a doctor well versed in answering such questions.

Whatever you decide about having a baby, I wish you all the best. With the support of your partner, your families, and your doctors, you and your baby, if you choose to give birth, can be off to the best possible start.

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