Risk. If Only I was Writing a Guide to the Board Game…

Making the decision to get pregnant was not an easy one, nor was it one that my husband and I took lightly.  Many mental health disorders have been diagnosed in my family, including my father, and relatives on both maternal and paternal sides of the family.  And obviously, I myself have bipolar disorder.  In addition to the genetic predisposition for mental illness that I bring to the table, my husband has type 1 diabetes, which is also linked to likely genetic components.  I have joked that my husband and I having a child is like playing Russian roulette with our genes.  Could I live with myself if I passed on a severe mental illness to my child, when I knew ahead of time that it was a possibility?  Is it irresponsible to have a child knowing this information?  What if I had a child with both mental illness and type 1 diabetes?  That sounds like a deadly combo— a physical condition that requires daily, vigilant care combined with an illness that can make even the most basic self care extremely difficult. 

Taking medications for mental illness can pose risk to a fetus.  Unmanaged depression/bipolar disorder poses risk to a mother and fetus.  A woman with a mental illness is forced to weigh these risks—risk to herself and risk to her child—to make a decision that feels impossible and scary.  After working with my psychiatrist, we agreed that the risk to myself and fetus would be greater if I came off of medications for my bipolar disorder, due to having historically severe depression episodes.  Telling my gynecologist that I needed to stay on both my anti-depressant and mood stabilizer won me an automatic referral to a high-risk gynecological specialist, should I become pregnant, an additional prescription for even more folic acid than I was already on, and the looming fear that medication that I chose to stay on, knowing full well the risks to the fetus, could cause harm to my child.  Could I live with myself if I knew I was the cause of my child’s birth defect?

I have to think about myself too.  Will I be able to survive nine months of pregnancy—with the addition of pregnancy hormones to the anxiety and depression symptoms I already have?  My depression already makes me really tired a lot of the time; can I handle adding the fatigue of pregnancy onto that?  I can’t take most of the anxiety medications I typically use when my panic disorder flares up while pregnant—will I be able to get through an intense anxiety episode?

What will it be like after I have a baby?  Will I be able to manage sleepless nights of baby cries and feedings?  Will I be able to be the mother I want to be?  Sometimes I can barely take care of myself—can I really take care of another human being?

These questions will lead you down a road filled with self-doubt and criticism real fast. I sought support from my Facebook group of people with depression or bipolar disorders.  I wanted it to be helpful.  But ultimately the responses were not comforting.  There were inconsistencies in recommendations between my provider and others: “I decided not to have children, but one psychiatrist suggested going off all psych meds before getting pregnant. He believed that it wasn’t safe to take any psych meds while pregnant.”  There were decisions made by other women that made me second guess my own: “I decided against children because my mood is too unstable without meds and I also don’t want to potentially pass BP onto a child.” And there were women who experienced some of my worst fears with becoming pregnant: “When I was pregnant and stopped my meds, I became dangerously unstable. If I had to do over again, I would adopt.”  Ultimately my question sparked some heated debate between other members of the group regarding adoption versus having children due to risks of genetically passing on mental illness.  While I respect each woman’s opinion, I was left more torn and confused than ever.

I haven’t been able to find many supports for women with mental health disorders that consider our unique needs, including parenthood considerations, pregnancy, menstrual cycles, menopause, etc.  After hours of searching, I could not find a single support group related to this topic, other than for postpartum depression. When it comes to finding reliable information to aid decision-making, there is accessible information on medication use, but little else. And even the information available on medication use reports how there is really not enough information to confidently declare which medications are presumed safe versus not safe for pregnancy.  One of the most informative articles I read concluded, “Although data accumulated over the last 30 years suggest that some medications may be used safely during pregnancy, knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete.” Why do so many research studies have to end with the conclusion that more research is needed to make a better conclusion?

Even though I didn’t find the kind of peer support I was searching for, I was able to discuss things with my mental health support system, my husband, therapist, and psychiatrist to come to a decision. After weighing all of these factors, assessing the risk versus reward ratio, we decided yes! Having a family was an important value for each of us and we were willing to take the risk.  We felt at peace with this decision.  Then we found out there was still plenty of time to re-think every decision that had already been made because it turns out deciding to have a baby was the easy part…getting pregnant was the hard part.

In a future post, I’ll share more information about our journey thus far with infertility and how it has taken a toll on our mental health, especially as it relates to our dwindling confidence in the decision to pursue biological parenthood.   I want to end this post with words of encouragement and hope, but the word risk continues to taunt me with uncertainty.  The best I can do is to continue to search deep within for strength, perseverance, and acceptance of whatever uncertain outcome is waiting for us at the end of this journey.

Everything will be okay in the end. If it’s not okay, it’s not the end.

-John Lennon

Please comment below if you are aware of any resources specifically for the unique needs of women with mental illness.  And as always, thank you for reading.

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