BiPolar-II Disorder And Family Planning

*This post was originally written back in 2018. 2021 update–we are expecting!*

Being diagnosed with Bipolar-II Disorder at age 29 is something I didn’t expect, but I would be lying if I said it was a surprise. I had lived with a previous diagnosis of generalized anxiety disorder and depression all my life, and it wasn’t until I received my Bipolar diagnosis that everything finally felt like it made sense and fell into place. 

That is, except for the area of family planning. 

My chosen course of treatment for my Bipolar disorder is medication coupled with therapy. I recognize that the choice to take medication is not for everyone, but for me, it is the best treatment option. A low dose of a mood stabilizer takes the edge off my mood swings and helps me keep a more even and predictable keel. 

When my husband Daniel, and I began serious conversations about family planning, they were after my diagnosis. If I’m being honest, because my diagnosis was so new, how my mental health would affect our choices around having children was not something that I even thought to consider. I was preoccupied by concerns around infertility, social pressure, and timing (click here to read) 

  • Yes, my medication can cause birth defects. However, the risk is around 13% –a number that is significant, but certainly not definite. Despite these risks, my medication falls in the middle to low tier of mood stabilizers that cause pregnancy complications. 
  • Just because I might not want to be on my medication does not mean that I can’t be on any medication. There are other mood stabilizers that carry and even lower risk. 
  • As a precaution, I should take 400mg (not mcg) of folic acid in addition to a prenatal vitamin for at least 6 months to a year before trying to conceive. This minimizes the risk of spinal defects. 
  • The only way to completely minimize risk from medication is to stop taking it completely even before contraception. This is because like alcohol, the most damage is done in the early weeks before you might even know you’re pregnant. 
  • If I chose to forego my medication, a good OBGYN would have me immediately resume taking it (obviously at the lowest dose to be titrated back up) as soon as the birth was over. This does however, mean that I would not be able to breastfeed. 
  • Sometimes the hormone levels changing during pregnancy can naturally minimize or even eliminate Bipolar-II symptoms. 
  • Given my history, I would be monitored extremely closely for signs of postpartum depression. Precautions regarding support systems and assistance would be set up long before the birth. 

It was my husband who suggested that I broach the subject with my gynecologist because being the analytic thinker he is, he was already wondering how my diagnosis would play a role. 

When I spoke to both my gynecologist and my psychiatrist about the fact that we were thinking about trying to have a baby, I was not prepared for the information that I received. Both women seemed far from optimistic about my ability to be pregnant while on my medication. The phrase “significant rate” preceded the words “postpartum psychosis,”  “birth defects”, “cleft palette,” “premature birth,” and  “microcephaly” were delivered at rapid speed paired with lots and lots of statistics. Their perspective was that it was better to be safe than sorry and stop taking my medication for the duration of trying to conceive and while pregnant. After a few minutes I couldn’t even focus on what they were saying because it took every ounce of my concentration to not run out of the room. I think both doctors could sense my alarm and frustration because they immediately started to backpedal and tell me that “Things may have changed. There are some new studies.” By the end of each appointment, they both recommended that I call Mass General to set up a consultation with a doctor in the high-risk pregnancy department because that was where I could get the most up-to-date and accurate information. 

I came home and updated my husband. I was a mix of emotions. Part of me was sad because I felt like this meant I couldn’t have children. The other part was furious because I felt like there had to be more to the situation than what I was told. Daniel was somber and didn’t say much aside from that we should follow through with the consult. 

The earliest consult we could get was several weeks out. In the meantime, my feelings on the circumstances continued to flip-flop, and Daniel’s did too. On any given day, one of us would be confident that I could go without my medication and not grapple with my symptoms while the other said there was no way. Additionally, we struggled to understand how the statistics presented by my doctors would translate from a number to real life. 

Personally, I started to doubt my own ability to even be a mother beyond just bringing a bundle of joy into the world. 

What happens if I am too depressed to care for our child? 

How will having a mother with Bipolar -II affect our child’s well-being? 

What happens if I lash out at our baby? 

Will our child resent me if due to my symptoms, I need to miss some of their activities? 

What happens if for some reason I need to be hospitalized? 

In the midst of all my doubts, a couple that we were friends with had an upcoming baby shower –I did not feel like I could bring myself to attend. Of course I was happy for them, but the last thing I felt I could do was publicly celebrate someone’s pregnancy. Feeling horrible about this, I reached out to her husband (my friendship with him is how we all started hanging out), and I briefly explained what was going on. 

I am so glad that I shared our situation with him! He responded that they completely understood because they actually had to face the exact same circumstances and decisions in their own journey to parenthood. I was so relieved to know that someone else knew and understood all of the feelings, questions, and doubts swimming in my head. 

The morning of the consult I was numb. I had been carrying the weight of the unknown for weeks, and I really didn’t have it in me to muster up any optimism that we would hear anything different than what we were already told. We went to MGH, sat in a waiting room filled with expectant mothers, and waited for my name to be called. 

Much to my surprise, the woman with whom we consulted was warm and friendly — a much different disposition than my gynecologist and psychiatrist. She listened to our reason for being there, asked about my medication dosages, and proceeded to give us information in a comprehensive, knowledgeable, and calm way. Through listening to her, we learned the following: 

Out of everything the doctor said, the biggest thing that stood out was this: 

“All doctors have their own professional opinions and ultimately it is up to you. But regarding whether or not you should stay on your medication, I believe that in order to have a healthy baby and pregnancy, you need to have a healthy mother. This encompasses both her physical and mental health because in the long run, that’s what a baby needs.” 

Granted, in the moment I was hung up on the fact that we’d have to wait 6 months to a year, but when all of the emotions settled, what she said last was the most valuable piece of information she gave us that day. My own health is paramount. If my best option is to stay on some kind of medication throughout the process of starting our family, that’s ultimately okay–not ideal but OKAY. 

We have since put a hold on any immediate plans to start having kids because we have a million other things going on (holla at moving across the country and me finding a new job), but when we do actually feel ready to try, I need to remember that having Bipolar-II is not a death sentence to the prospect of having a child, and all hope is not lost.  

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