3 tips for navigating pregnancy despite a bipolar diagnosis

My blog turns four years old this August. Having come to this little corner of the internet for nearly four years, writing my story of how I've navigated pregnancy and beyond despite living with the diagnosis of Bipolar disorder type 1, I tend to get quite a few questions from my readers. The most common ones come from young women who like me, wondered how they would be able to manage their illness and still be able to care for a newborn. A newborn who would grow into a baby with many demands.

I certainly am not perfect, nor am I an obstetrician or psychiatrist. I'm just a regular mom who, after having found out she had bipolar disorder, wasn't going to let it get in the way of her dreams of having a family. These are my reflections, looking back on my experiences of having my two children (now 6 and 4). This is what happened to me, and how I'd do things differently if I were to have a third child. (We are 99% sure we won't be having another one, in case you're wondering.)

Accepting the diagnosis

Bipolar disorder is a challenging, life-long illness. The first year or two of learning to live with the diagnosis can be devastating and all-consuming. When I was first diagnosed, ten years ago at the age of 26, I had to resign from a career that I excelled at in order to focus on getting well. It took an entire year for me to work with my doctors and therapist to find a medicine and figure out a treatment plan that worked for me. I was able to overcome severe depression and crippling anxiety, and even suicidal thoughts thanks to the vigilance and support of my husband and parents. Once I found stability, and was able to maintain it for a year, my thoughts of starting our family began to take root.

Although I was able to taper off my medicine (under the close supervision of my psychiatrist), and I had a normal, healthy pregnancy, we were not prepared for what would happen next. Not only was having our first child an incredible shock to my system (I had an emergency C-section after 17 hours of laboring - no pushing, but since the baby wasn't tolerating contractions and I wasn't dilating, my OB made the call for surgery), but nothing can prepare you for how you'll react to motherhood. On top of all this, I had put an enormous amount of pressure on myself to breastfeed. I thought, from all the pregnancy literature I had been devouring before the baby arrived, that breastfeeding was the only acceptable means of feeding the baby.

I was wrong and I learned the hard way.

Even though I knew that lack of sleep was a trigger for me, I didn't realize how little I'd be sleeping once the baby arrived, especially due to trying to nurse. I barely slept at all in the hospital since the nurses checked my vitals every hour because of the surgery. Exhausted doesn't even begin to describe how I felt. But I couldn't take my eyes off our son. We had created a baby. I was in awe of this little person I was holding. It didn't seem real. Maybe partly because I was headed into the throws of mania even before we left the hospital.

1. Have a plan for once you get the baby home

With our first baby, I did everything and wouldn't let anyone help. I was trying to succeed at breastfeeding and if someone gave the baby a bottle, he might not go back to nursing. Which meant that I was always the one getting up in the middle of the night to feed and change the baby.

With our second, we had a plan. For the first two weeks, someone would be available to take the middle-of-the-night feedings. My parents stayed with us for a week, so they took turns during the first week home, and then my husband took over during weeks two to four. This allowed me to get a solid stretch of 6-8 hours of sleep a night, critical to my recovery from the birth (a repeat c-section) and to prevent mania from creeping in. I learned to protect my sleep, and because of this, was able to stay mentally healthy once we brought our daughter home.

2. Don't feel guilty for formula-feeding

I breastfeed our son for the first four weeks of his life, and then ended up in the psych ward for a week because of postpartum psychosis. Having to stop breastfeeding was devastating, but on the way home from the psychiatric ward of the hospital I realized that being healthy for him was more important than anything. If I didn't have my health, I wouldn't be able to be present as a mother, no matter how I wanted to feed him.

For our daughter's arrival, we planned ahead of time that I would not breastfeed. Instead, I got excited about picking out bottles and supplies to formula-feed her, and my postpartum time with her was so much more enjoyable since I didn't have the extra pressure to make nursing work. I ended up having antenatal psychosis (mania during pregnancy) during the first trimester of my second pregnancy, so I had to take antipsychotics and a mood stabilizer during the pregnancy. Nursing was never an option and I accepted this reality.

3. When a medication works for your condition, weighing the benefits and risks is critical

Having experienced postpartum psychosis after the birth of my first child, we were better prepared, or so we thought, to navigate a second pregnancy successfully. We knew that I needed to protect my sleep, and I planned from the moment we decided we wanted to have another baby that I would formula-feed since I'd be returning to my medicine after the first trimester. Going off my medicine for the first trimester was my mistake.

From my research, I knew there was a risk to the fetus of a heart defect during the first trimester of pregnancy when women took the medication I was taking during pregnancy. So I made a plan with my psychiatrist and the high-risk OB-GYN that I'd taper off the medicine when I found out I was pregnant, and I'd return to it once I cleared the first trimester. Only I hadn't weighed the benefits of staying on the med against the risk I was taking.

I was closely monitoring things, testing for pregnancy on the earliest day possible following my fertile period. When I finally got a positive test, my excitement over finally being pregnant (we tried for about nine months) took ahold of my body and would not let go. My mind raced with potential baby names as I'd lie awake in bed not able to fall asleep.

Would it be a girl? How would our toddler react when he met his new sibling? What would it be like to be a Mommy to two little ones?

Within a week of very little sleep I was manic and it was quickly leading to psychosis. Having witnessed my manic symptoms before, my husband quickly took action and had me hospitalized. I was five weeks pregnant with our daughter.

When I returned home, medication was required to keep me stable. I went back to the high-risk OB-GYN for a post-hospitalization check-up and was scheduled for regular checkups and monitoring of the baby throughout the pregnancy. Luckily, she was born completely healthy and I had a wonderful postpartum period with no complications. I learned that my risk for psychosis due to the lack of medication in my system was far greater than the risk to my baby in utero.

*****

If you're considering pregnancy or are currently pregnant, I urge you to work closely with your psychiatrist and OB-GYN to monitor and manage your bipolar symptoms during pregnancy and in the postpartum period. There are great resources available online to help you as you navigate pregnancy: Postpartum Progress, Postpartum Support International, and if you're in the Washington, DC metro area (Virginia, Maryland and the District), the newly developed DMV-PMH Resource Guide maintains a comprehensive and current regional directory of specialized mental health providers, support groups, advocacy organizations, and other relevant clinical resources pertaining to perinatal mental health.

There are resources available. Please don't hesitate to ask for help. You can be a mom despite bipolar.

We Need Universal Mental Health Screening for Women Having Babies

I experienced both a postpartum mood disorder (postpartum psychosis) and a perinatal psychiatric issue (a manic episode which led to psychosis) very early on in my second pregnancy. I had been diagnosed with Bipolar Disorder two years before my husband and I decided to start a family, and yet I found limited support and information in my quest to have as healthy a pregnancy and postpartum experience as I could. When I think back to that time in my life, I strongly believe that if I had received better screening - particularly after my first pregnancy - much of the trauma and heartache of what I went through could have been avoided.

Before I experienced mental illness on a personal level, my ignorance of the various forms of psychiatric conditions caused me to judge people whose stories were covered in the media. I remember watching news coverage of the Andrea Yates trial thinking HOW COULD THAT HAPPEN? And then it happened to me seven years later. Thank God my outcome was drastically different.

Just this week a pregnant mother and her three children were rescued in Daytona Beach, after she drove the family minivan into the ocean. A family member had called police hours earlier to express concern over her strange behavior, including talk of demons.  On the 911 tapes, you can hear the sister request a well-being check because "she's like having psychosis or something."

This woman literally saved her sister's life, the lives of those three children and the life of her sister's unborn baby with that call for help.

They were lucky to have avoided an outcome similar to that of the Andrea Yates case. Simply because someone close to the person who was suffering took action.

Now it's our turn to take action. There is an urgent need for changes in the way we screen women during pregnancy and postpartum in order to stop incidents like these from ever occurring in the first place.

Maybe this woman's sister recognized what her family member was going through because of the increase of more open dialogue about women's mental health issues. I can feel the wave of mental health awareness gaining momentum and hope that very soon there will be less ignorance out there and more acceptance. Because together we can make a difference.

Which is why I support this important White House petition to create mandatory universal mental health screening for pregnant and postpartum women. Did you know that suicide is the leading cause of death for women during the first year after childbirth? Or that 1 in 7 women will experience a mood or anxiety disorder during pregnancy or postpartum, yet nearly 50% remain untreated?

We need change. We need to screen every mother, every time to prevent and treat perinatal mental illness.

Recovery is possible - I am a perfect example of this. But wouldn't it be incredible if in the future we could catch cases like mine before they escalate? Before they lead to suffering and even death? No woman should have to suffer in silence because she's afraid to admit what she's thinking or feeling. We need to provide her with the chance to find recovery early. We need to recognize the signs and symptoms and take action.

Please take a moment to sign the petition: Every Mother, Every Time. Creating a WhiteHouse.gov account takes only a minute and there are simple tools to share the petition on Facebook and Twitter once you have submitted your signature.

This movement will save lives. We need 100,000 signatures to get the attention of the Obama Administration. Let's come together to make our voices heard on this critically important issue.

Every Mother, Every Time.

Tweet about the petition with the hashtag #EMET:

[Tweet "Universal mental health screening 4 every pregnant & postpartum woman http://ow.ly/uho8X. #EMET"]

Thank you for helping to spread the word.

Snow and writing

This week has been full of snow and writing. I haven't posted anything to the blog this week because I've been busy writing for Postpartum Progress since I'm a member of the Warrior Mom Editorial Team. If you haven't already seen my posts via my social media promos, I'd love for you to check them out. {Postpartum Psychosis Doesn't Equal Failing as a Mom & Psychosis During Pregnancy and What It Taught Me are the titles of my two posts.} When I hear the song from Frozen it makes me think of that time in my life when I was having babies and not taking medication in order to protect them.

Seems so long ago, but it hasn't even been four years since my last episode. Back then I worked to hide what I had been going through. I've matured since then and I now know - from the tweets, comments and emails I receive from people who have read my words - that I made the right decision. Speaking out helps so many people. I'll never know how many, but my heart is content with my decision to become an advocate.

It's been a long week here with Monday being MLK Day and the little man off from school, then the snowstorm on Tuesday which led to school being cancelled for the rest of the week. I've been trying not to tear all my hair out from the "I'm-at-the-end-of-my-rope" feeling due to having to entertain a 3 and 5-yr old for four days straight. We're all getting on each other's nerves from being cooped up in the house all week. I say cooped up because for the most part I despise winter and only go out in negative wind chill weather when absolutely necessary.

Like for my therapist appointment yesterday. Couldn't ask for better timing.

I've been working on a ton of stuff for the show in May. Hard to believe it's only four months until we take the stage. Audition slots are starting to fill up and my Association Producer Anne Marie and I are thrilled to see everything coming together. If you know anyone you you think would be fabulous for the show - I'm talking creative, funny, inspirational, energetic - please have them sign up for a spot before they're gone.

I recently accepted a new writing assignment for an organization doing a tremendous amount of inspirational, educational, critical work surrounding mental health awareness. I'm honored to have been approached by them and cannot wait to share my first post with you. It's a once-a-month gig, which is definitely manageable and plus, it's an opportunity I couldn't turn down. {Sorry I broke my promise, Maria - but this is worth it!}

So yeah, a lot going on. But if I've learned anything over these last few months it's that the work eventually gets done. When the kids are calling for me to get down on the carpet and play "picnic" or board games with them, I listen. I close the laptop and grab hold of the quality time. Or when exhaustion sets in, we snuggle up on the couch and watch a movie together. Life is good. Better than good, actually. It's pretty damn amazing. (Including the occasional teachable parenting moment, which I wrote about for WhatToExpect.com recently.)

   "If you are always trying to be amazing, you will never know how amazing you can be."                                                             - Maya Angelou

Maternal Mental Health Month

In May 2011, Postpartum Support International (PSI) declared May as Maternal Mental Health Awareness Month. Over the past few weeks I've been busy writing some pieces in support of the efforts to raise awareness of women's mental health before, during and after pregnancy. Two were published recently and I'm proud to share them with you.

Yesterday was the 5th annual Mother's Day Rally for Moms' Mental Health, hosted by Postpartum Progress, the most widely-read blog in the world on postpartum depression and other mental illnesses related to pregnancy and childbirth. It featured 24 letters (one of them was mine!) from survivors of PPD, postpartum anxiety, postpartum OCD, depression after weaning and/or postpartum psychosis. Their purpose is to inform and encourage pregnant and new moms who may be struggling with their emotional health. I was honored to be included again this year.

Along those same lines of postpartum and mental health, today a piece I wrote for WhatToExpect.com’s Word of Mom blog went live. (Yes, that’s really me in the picture included in the post!) In it I describe the feelings of guilt and sadness I experienced when I had to quit breastfeeding because I needed to return to my medication. I've learned that no mom should put unnecessary pressure on herself to breastfeed, especially if her mental health is at risk.

I hope you have a chance to check out these posts and please share if you know someone who might benefit from the information within. Thanks so much and I hope all those moms out there had a great Mother's Day yesterday!

A promise

There have been many ups and downs in my life since being diagnosed with Bipolar Disorder six years ago. Thankfully, the past few years have included significantly more highs than lows, mainly because I've been stable and have made a commitment to myself and my family:

I promise to always take my medication, see my doctor and therapist, and get good sleep.

This promise stemmed from the fact that, at 5 weeks pregnant with my daughter, I spent almost a week in a psych ward to bring me down from the most extreme psychosis of my life. It came about because I was so incredibly happy - over the moon, really - that we were pregnant after trying month after month for almost a year that I didn't make sure I was getting enough sleep. I remember the nights leading up to the hospitalization where I would just lie in bed wide awake, my mind racing with baby names while my husband was sleeping soundly beside me. You see, when I knew I was ready for another baby, I wanted it like, that second. To have to live my life in two week increments for so long, and to have waited almost a year to see those two pink lines, both of those realities had driven me mad. Quite literally.

I count my lucky stars that I was able to get help. I took the medication I needed with my doctor's close supervision, in order to make it through the pregnancy. And my wonderful husband took over many a night feeding during the first month or two so that I could get the sleep I needed at night and the naps needed to catch up during the day.

In the waiting room before my trial to be released from the hospital {yes, there was a trial due to the fact I was involuntarily committed}, my husband and my dad sat with me. I was in handcuffs. Don't ask - we have no idea why they would cuff an almost 6-week pregnant woman who wouldn't hurt a fly - but we think it was because they had to treat all the patients the same. My hair was a disaster, I had on mismatched sweats and the sticky-bottom hospital socks and I was just dying to get out of there. I can't remember why I didn't have shoes on.

This is where the promise occurred. My dad took a picture on his phone of me sitting on the small sofa in that tiny room. With cuffs on.

So I would always make good on my promise to keep taking my medication.

That was two years ago. And I have no intention of ever breaking that promise.

My family means too much to me to ever put them through that again.

Thank you to my dad, for thinking to take that picture. Now, Dad, it may be on your old iphone which has a shattered screen, but maybe you could find a way to email it to me so that I can crop it and Instagram-it so that I could add it to this post?

{Don't hold your breath since he's not that great with computers and he's presently on a golf trip in South Carolina. But I'll try to add it. For posterity.}

Two years ago today

It's been two years to the day today that I was last hospitalized for a manic episode.

And what a storm it was. I had just found out I was pregnant and thus was so excited I couldn't sleep for a week. You see, it had taken us ten months to conceive the little lady and being the impatient, total Type-A person I am, that was just way too long.

When I don't get enough sleep, it leads to mania. My thoughts race out of control, I start talking in circles, and I lose touch with reality. My husband knew the signs all too well. He knew what needed to be done.

Within thirty minutes, his mom was here to help with our 18-mo old son, and the EMT's and two police officers were standing in our bedroom trying to talk me into going with them to the hospital. When I wouldn't consent, my husband signed some papers, and they cuffed me and put me in the squad car. Luckily this time it was pitch black outside and they didn't have their flashing lights on. So hopefully the neighbors didn't see and think I was being arrested.

Crazy how far I've come in those two years. I've learned so much over these past six years living with bipolar disorder. I've learned how important my family is to me, I've learned which friends care enough to actually talk with me about what I've been going through, and most of all I've learned that I can overcome this "mental illness" to make my dreams a reality.

Six years ago I was so crippled by depression and anxiety that at times I didn't want to go on. I was being so selfish, but I saw how my condition was affecting my family and I hated that I kept bringing everyone around me down because of my mood. I felt like I had lost my identity because the career I had worked so hard to build over the past four years came to a screeching halt after my second hospitalization. I couldn't handle the pressure at work any longer - the pressure that had pushed me to work harder and smarter over the years was now causing panic attacks and driving me deeper and deeper into depression.

Ultimately, I had to resign from my job and with that I felt like I was a nobody. I was worthless. I was sad. I didn't feel like there was anything worth living for.

Looking back, it basically took me all of 2006 to pick myself up again. I went through so many weeks of crying hard every.single.night. It's hard for me to think about what my parents and husband went through during that year. I don't know if I would have been strong enough to stay positive and supportive to someone who was so incredibly sad.

But they did. And Thank God they did. I am eternally grateful to them.

I never would have imagined that I would be where I am today without the love and encouragement of my dad, mom, and husband. Along with my in-laws, brother, two sisters-in-law, and a handful of close friends, I trudged through 2006 and made it into 2007. I made it to see another day.

And now I know that there is so much to live for.

I am so thankful to have found a medication that works for me. I know that I am lucky. I take my medication religiously and stay on top of my moods to make sure I continue to stay stable. I have too much going for me to end up in the hospital again. I don't want to miss a second of this life.

Because it really is too short when you think about it.

A risk worth taking; a list worth making

Back when I was first diagnosed my dad had what turned out to be a genius idea: to journal about my illness. Every day he wanted me to write down four things: the date, how I was feeling, what meds I took that day, and any side effects I was experiencing. He was determined to figure out what the heck was happening to his little girl, and this little idea was one of the only things he could get me to do which in the end would help in more ways than we knew when I started. After my most recent hospitalization (which was right after we found out I was pregnant with our second child) I had a very hard time bouncing back. It is true that I respond very well to Lithium, but at the time I was adamant about not going back onto Lithium until I was past the first trimester because of the risk of Ebstein's anomaly. In reality, my risk was only about 6% if I had used the Lithium during the first trimester, but I refused. And I am very stubborn. And determined. And I got my way.

But looking back I wish I would have just used the medication which I so desperately need flowing through my bloodstream each and every day. Lithium to me is like insulin is to a diabetic. I know this now.

So instead of using Lithium during the first trimester, my psychiatrist agreed to use Haldol to treat my mania. It is the drug that they inject into my backside when I am hospitalized because I reject all oral medications when I am manic. Lucky me. They would have to use three people to hold me down while the fourth administered the drug. It would start working within fifteen minutes - by that point I'd have been walked back to my room and tucked into bed to sleep and let it work its magic. Once I was discharged from the hospital, I had my oral prescription for Haldol filled and continued on it for a few weeks.

Those weeks were such a huge struggle for me. Mentally I felt as though I could not put my thoughts together in sentences. Simply speaking a basic sentence was so incredibly difficult. I barely went out in public for three weeks because I was so afraid of not being able to hold a basic conversation.

I also had a very hard time writing. I found it hard to journal then, mainly because it was so hard to think let alone use a pen to write down those thoughts on paper. My family blog which was normally filled with descriptive paragraphs of what I had been doing with our son each day, were now filled with just little video clips and some pictures here and there. I felt paralyzed to an extent. It was almost as if I could feel the neurons straining so fiercely to fire off some kind of signal. But the neurons were back-firing. Badly.

The chemicals in my brain were so completely off and I wanted more than anything else to just turn them back on.

My dad had another brilliant idea during this difficult time. He told me one morning when we were talking, to make a list of 10 things I wanted to accomplish that day. They could be as simple as unload the dishwasher, make the bed, fold the laundry, or bake cookies with my little man. This way, I could look back on my day and see all the things I was able to get done. This simple method of goal-setting worked like a charm for me.

I still use this tactic to this day. I love to sit down in the morning and jot down the things that I want to accomplish that day. The weeks that I do it, I feel like I get so much more done around the house. For my family and myself. It's such a great thing to build into your daily routine.

Around week 10 of my pregnancy, fed up from the daily struggle with my malfunctioning brain, I decided to do something about it. I distinctly remember the day I called my high-risk OB-GYN to ask him if I could just go back on the Lithium right then, instead of waiting until the end of week 13. I was pretty much in tears on the phone and he said that I needed to do what was right for me. And that it seemed like I needed it. It being the Lithium. I said yes, and felt an enormous weight lifted off my shoulders when I hung up the phone.

After about a week back on Lithium I began feeling like myself again.

It was a well-calculated risk and one that I was glad that I took. Having to choose between taking a medication while pregnant or struggling with a mental illness that causes you physical stress and trauma is one that I wish no woman would have to make. But sometimes we have to make hard decisions. I was very scared and felt an enormous amount of guilt for having to subject my unborn child to a potentially harmful substance while she was growing inside of me, but if I had to do it over I would do exactly the same thing.

I'm forever grateful that she was born healthy and today is a thriving toddler who pushes the limits every single day. And I'm thankful that I have such a supportive husband and parents who were right there with me every step of the way encouraging me to make the best decision for me at that moment.