Making the Choice to Get Pregnant if you Struggle with Severe Mental Illness

By Kate Kripke, LCSW

Let’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