"Don't Have Children!" Busting Myths About Bipolar Disorder and Motherhood

Tuesday, June 07, 2016 by Meg   •   Filed under General

It starts as soon as we get married, sometimes at the wedding reception.

“When are you guys going to have kids?”

It’s like a cult, this motherhood thing that we are pressured to join at the first possible opportunity. We’re told that we will forget the pain of childbirth, that we won’t even miss our old activities. 

LIES! ALL LIES! I’d love to see the day I completely forget squeezing a wriggling, screaming  turkey out of my vagina. 

But there is a division between this outside pressure and the experience of some women, particularly in the case of bipolar disorder. While we hear, “Come join us,” peppered into even the most mundane conversations, these women often hear, “Danger!” because their physician told them they should avoid pregnancy.

And it tears them apart.

Barring extreme examples, this is usually outdated information, often laced with stigma and misunderstanding. Having bipolar disorder is not a sentence of childlessness. You can still join the club of baby wipes, sleepless nights and incessant harmonica playing. Just make sure you’re certain about that because harmonicas are only cute until they whip them out at five in the morning. 

Make sure it’s a goal. Then understand that it is a viable choice in most cases, one that I firmly believe women are capable of making.

Then why all the fear? 

The surge in “Don’t have kids!” came at the heels of research showing that while severe postpartum depression effects up to 10 percent of women across the board, postpartum psychosis—an illness associated with delusions and infant harm— is another matter. Postpartum psychosis occurs in about 1 out of 1000 births and may occur at rates of up to 100 times higher in the bipolar population than it does in the general population (though less than 4 percent of those with postpartum psychosis actually harm their kids)1

“What the what? I thought you said it was safe to have kids even with bipolar!”

I know those numbers seem scary, but even at higher rates of prevalence it isn’t as common as it might sound. The main concern for practitioners is the potential for symptom relapse during pregnancy and in the postpartum period, because women with bipolar disorder seem to be especially sensitive to the severe hormonal shifts that come with growing another human.

But this doesn’t meant that they shouldn’t use their uterus like an easy bake oven. It means that they have to be aware. Because if you are not getting the assistance you need, either due to lack of affordable mental health care, familial pressure or stigma, you run a much higher risk for severe symptoms. 

Herein lies a part of the issue, because misdiagnosis is now, and always has been, rampant. And the women who end up engaging in infant harm or other scary behaviors are often the ones who are misdiagnosed or under-treated. This is especially difficult because there is some research to indicate that many women with histories of depression may convert to bipolar disorder after birth. One study found that the rate of switching diagnoses was 11-18 percent higher in the postpartum period than at other times2. So with those high hormone levels, not only do women have a higher risk for all manner of psychological distress overall, but they may have a higher risk of triggering manic episodes and bipolar conditions even if they’ve never had them before.

In another study, inpatient women who had harmed their children were monitored and diagnosed3. On admission, 75.6 percent were diagnosed with major depression and 24.4 percent with bipolar disorder. At discharge, 73.3 percent had been rediagnosed with bipolar disorder because physicians were able to see the manic cycles during their hospital stays. This is too high to be a simple diagnostic switching phenomenon. These women were misdiagnosed and mistreated during pregnancy and early postpartum, if they were treated at all. 

Obviously things like this mess with numbers. You have more of a chance that someone will have severe symptoms if you wait until the aftermath of a severe episode to diagnose and treat them appropriately. And for every one bipolar woman with infanticidal urges we hear about, there are hundreds more who are riding beneath the radar because they are doing just fine. 

It isn’t that the risk isn’t real. Sleepless nights and hormones wreak havoc on our bodies and can trigger more symptoms. This is something that every women should be aware of when making these decisions. According to some studies,  71 percent of women with bipolar disorder will experience a resurgence of their symptoms during pregnancy, though the risk is two times greater for those who forgo drug treatment4

Mother nature is a huge jerk. Understanding the possibility that she may try to bitch slap you during this time period is a good way to make sure any symptoms get addressed early and effectively.

While many treatments come with some level of risk, the condition can usually be managed with correct diagnosis, balanced treatment and careful monitoring. Make sure you have a good shrink at the ready, a medication plan and social support structures who understand your condition. Telling a functional woman with a bipolar diagnosis who is receiving treatment that she should not have a child due to her condition is often unfounded and it is sometimes a downright dick move. Stress can trigger all manner of psychological issues even in those without bipolar disorder. None of us need more stress in pregnancy thinking that something is going to go wrong. 

Awareness matters. If you’re bipolar and reading this, you already have a leg up on the situation. Accurate diagnosis and a plan for pregnancy and postpartum allows every woman to weigh her odds and make informed decisions about her body, for better or worse.

It might not be easy, but it might be worth it once you get past the harmonicas. And only you can decide whether it is a path you want to take. 

 

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Citations
  1. http://dsm.psychiatryonline.org/article.aspx?articleid=100698 
  2. http://onlinelibrary.wiley.com/store/10.1111/bdi.12140/asset/bdi12140.pdf;jsessionid=F2AFE13F6F972572343BDF70825EDA66.f03t03?v=1&t=hwnu3rb1&s=92a9a5eabad5d7be1d895f61e55c3a69d00efa84
  3. Kim J-H, Choi SS, Ha K: A closer look at depression in mothers who kill their children: is it unipolar or bipolar depression? J Clin Psychiatry 2008; 69:1625–1631
  4. http://www.ncbi.nlm.nih.gov/pubmed/18056236



Topic-Relevant Resources

The Bipolar Workbook: Tools for Controlling Your Mood Swings
Tips and tools for addressing mania and depression.

The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know
Good breakdown of what to expect from bipolar disorder and tools to cope with symptoms.

The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers
More detailed answers to common questions about bipolar disorder.

This Isn't What I Expected [2nd edition]: Overcoming Postpartum Depression
A great guide on combatting postpartum depression. You're not alone.

The Postpartum Husband: Practical Solutions for living with Postpartum Depression
A concise, practical guide full of useful information for the loved ones of those suffering with PPD



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