Having a baby is a major event in the life of any woman. For those with bipolar disorder (formerly called manic depression) there are even more issues to think about.
When considering having a baby, women with bipolar disorder and their families have many questions but can find it difficult to get the answers they need.
The risks of severe illness after childbirth are extremely high for people living with bipolar disorder. Episodes of postpartum psychosis occur after approximately 25% of births to women with bipolar disorder. Postnatal depression follows a further 25% of births.
This means that about half of women with bipolar disorder stay well after having a baby and about half may have an episode of illness.
Two groups of women with bipolar disorder may be at higher risk: those who have had a previous severe postpartum illness, and those with a mother or sister who have suffered a severe postpartum illness. For these groups the risk of suffering postpartum psychosis may be over 50% (greater than 50 in 100).
It is there important for women with bipolar disorder to think very carefully about these risks.
Many women with bipolar disorder are very glad that they have had a family and make excellent mothers.
Indeed, most women with the illness thinking of starting a family, when presented with all the relevant information, make the decision to try for a baby.
What makes some women ill at this time?
Research has learned a lot about the causes of bipolar disorder. We know that it can run in families, and that there are lots of factors that can trigger episodes.
But while we know that women with bipolar disorder are particularly vulnerable to becoming ill following childbirth, we don’t fully understand what it is about childbirth that triggers the illness.
It may be related to hormones, sleep disturbance or simply the fact that the arrival of a new baby is a major life event.
But while we know that women with bipolar disorder are particularly vulnerable to becoming ill following childbirth, we don’t fully understand what it is about childbirth that triggers the illness.
It may be related to hormones, sleep disturbance or simply the fact that the arrival of a new baby is a major life event.
By doing further research, we can learn more and use this knowledge to help with prevention and treatment. This is why it is helpful for pregnant women with bipolar disorder to get involved with research.
What can I do to lower the risk of becoming unwell?
Ideally, it is best to discuss your thoughts about getting pregnant with your GP and psychiatric team before trying for a baby.
Some psychiatrists and other mental health professionals have a special interest in pregnancy and childbirth (sometimes called Perinatal Psychiatry).
In the UK there are several excellent perinatal mental health teams but unfortunately many areas of the country are not covered.
Ask if you can be referred to a perinatal mental health team – they would usually prefer to see you as early as possible, ideally before you become pregnant, and not just if you become ill.
Many perinatal mental health teams are attached to mother and baby units (MBUs), which can admit unwell mothers with their baby.
If there is no local service, it may be possible to see a perinatal psychiatrist further away or there may be a specialist mood disorder service in your region.
Even if these options are not available, all women with bipolar disorder should ideally see a psychiatrist for advice if they are planning a pregnancy, even if they are not currently under the care of psychiatric services.
You can discuss:
- how to make sure you are as well as possible when starting pregnancy
- your risk of developing postpartum psychosis or postnatal depression
- risks and benefits of medication in pregnancy and after birth – this will mean you have the information you need to make decisions about your treatment
- the type of care you can expect in your local area e.g. how professionals will work together with you and your family
- whether there is a perinatal mental health service, a specialist midwife or a mother and baby unit near you
Creating an ACD during pregnancy or after-birth
The organisation Advance Choice provide guidance on creating advance choice documents (ACDs) to help you state your wishes and instructions about your treatment and care during potential future episodes of illness.
Video resources are available with specific considerations for women around pregnancy when making an ACD.
Resources
- NCMH leaflet: Bipolar, pregnancy and childbirth
- NCMH leaflet: Bipolar disorder
Piece of Mind podcast: Have your voice heard in mental healthcare decisions
Advance choice documents (ACDs) give people living with mental illnesses an opportunity to state their wishes and instructions about their treatment and care during future episodes of illness.
We chatted with Professor Tania Gergel about her work to raise awareness of this vital tool for people with severe mental illness.
Piece of Mind podcast: postnatal depression
Listen to our episode about postnatal depression with Laura Dernie, who experienced postnatal depression, and Professor Ian Jones, former director at NCMH.