This week, I am publishing the second of a two-part interview with Dr. Amanda Itzkoff, MD, covering the subject of living with bipolar disorder and pregnancy. I’m often asked about this and, since I am not a doctor nor a woman, I decided it was a good idea to seek the knowledge of a trained medical professional. (Part one can be found here: Bipolar Disorder and Pregnancy)

How do most bipolar women handle forty weeks of pregnancy?

They’re pretty motivated to have families! They work closely with their psychiatrist and obstetrician/gynecologist. They accept as much family support as is available when it’s helpful. (Expectant mothers should not accept family “support” that isn’t helpful). They have back up plans.

Do women come to you specifically to deal with their pregnancies when they are bipolar?

Yes, and also with depression and anxiety! It’s very rewarding working with these cases. Many women have been misinformed and do not know their options. They may have been told that they cannot have children, or that they cannot take any medication during pregnancy. It’s incredibly important to work closely with a knowledgeable reproductive psychiatrist who can walk you through the risks and benefits of all of your available options, and work closely with you throughout the process. Women who have bipolar disorder and want to expand their families can absolutely do so.

We all know about postpartum depression. Is there an equivalent complication for women with bipolar disorder once they give birth?

Yes, some women may become depressed, manic, or develop a new symptom. Psychosis, fortunately, is decidedly rare in patients without histories of psychosis.

In general, do women who have bipolar disorder need extra attention during pregnancy and postpartum?

Yes, they absolutely do.

Do women who have bipolar disorder have any complications with breastfeeding and the fatigue associated with caring for a baby?

Yes, they can. Some issues relate to medication that will be passed to the baby in breast milk. If breastfeeding is safe with current medications, it can be a challenge to do it, if you’re up many times per night. Some women handle this with pumping and help overnight, others may want to consider bottle feeding. Woman who are very attached to breastfeeding but are struggling to do so because of more severe latching problems, for instance, often experience exacerbations of anxiety, depression, and mania. Close monitoring, discussing plans and possible challenges while planning pregnancy, and bottle feeding if necessary are all worth considering here.
How can a partner, family members, or friends be of help to a bipolar woman during her pregnancy and after she has given birth?

Bipolar and Pregnancy

Dr. Amanda Itzkoff, MD

They should ask what the mother may need or want specifically. A partner should attend at least one psychiatrist appointment prior to pregnancy. Talk about how you are going to talk about symptoms, should they emerge. Be involved in a backup plan, or Plan B. Forge a Plan A for nights. Can your partner do most up this? Staying up nights is not well tolerated by most patients with bipolar disorder. How will you do this? Pump? Formula? Can you afford hired help? Can family help with nights? How important is breastfeeding or exclusively breast milk to you? Then forge a Plan B for nights. For partners, friends, and family, offer to help by asking, “What can I do to help?” and then do that.

Do not just call and ask to stop by someone’s home who has a new baby to ooh and ah over the baby. These people are likely exhausted (mother and baby, and likely dad). Do chores that don’t necessarily need to be baby related. Help clean up the home, do laundry, bring a meal, care for older children if this isn’t a first child.

Do you ever have cases of women who have bipolar disorder to whom you suggest they do not become pregnant?

I have not. It’s not typical in my practice, anyway, that patients who are quite unstable actually want to become pregnant. I have patients for whom third-party reproduction is clearly the best option (they believe so and I absolutely agree). There are many options that can allow a mother to remain in good health. It may take work, but there are many options. Certainly, if I did see a patient who did not seem stable enough to undertake pregnancy, I would be honest in my opinion.

Have you ever seen women with bipolar worsen during pregnancy?

Unfortunately, I have.  It’s important to be stable before pregnancy, discuss and plan and make any medication changes that would be desirable before pregnancy and establish stability on these for a suitable period prior to pregnancy, make a backup plan, stay in close follow up. I stay in touch with these patients weekly, even if they are feeling fine.

Gabe Howard is a professional speaker, writer, and advocate who lives with bipolar and anxiety disorders. He has made it his mission to change the way society reacts to mental illness. He is an award-winning blogger and the creator of the official bipolar shirt. (Get yours now!) Interested in working with Gabe or learning more? He can be reached on Facebook, via email, or on his website, www.GabeHoward.com.  Don’t be shy — he’s not.