Blog series: Bipolar pregnancy, birth and beyond

So, at the moment, there’s a storyline on Eastenders where Stacey Slater, who has bipolar disorder, develops postnatal psychosis after the birth of her child.

You might have found this blog searching for bipolar disorder and pregnancy. Or you may be watching Eastenders and feeling quietly terrified. Or relieved. Or confused. Or even disgusted.

From finding out I was pregnant, to having my babe, I’ve been blogging about what my experiences of having bipolar disorder and being pregnant and under psychiatric care have been like, including the good stuff, the shit stuff, the triumphant stuff and the angry-making stuff. And on how my having a mental illness has also not defined my pregnancy, or my parenting, as much as I feared it would. I’ve collected those posts as a series, which you can read here.

The Beginning: Pregnant, Mental and Fat

My Big Fat Bipolar Pregnancy: featuring the perinatal team, the birth plan and the Fear

My Birth Story, Why Birth Plans are Bullshit and the Stigma of Mentalist Mums

Musings on Mumhood: Feminism, Love and Grief

Therapy Tales Part 1– when I started therapy for death and postnatal anxiety

Therapy Tales Part 2 and 3

Therapy Tales Part 4: Trauma

My Body Has a Trigger Warning: Self harm and stigma

Stopping psychiatric medication after 16 years: My Drink and Drugs Heck

The Beauty of Babyhood

And if you don’t have time to read, here’s my video which talks about how my diagnosis shaped my care:

But if you’re already in the trenches of depression or more and want some support and real life stories, then you can check out PNDandMe on Twitter.

Hope this helps someone.

Therapy Tales No. Etc- Death and Trauma. Fun.

Therapy is ending soon.

Losses, fears, love- that’s basically it. Losses of things I loved- including animals (I know pets die, but mine in sudden, cruel ways I can’t go into here but which haunt me) and people. They all died lonely, premature, unfair, painful deaths. As soon as I really understood what death really was (which happened when I had another loss- my friend who killed herself when I was 15), I have been completely heartbroken ever since. Of what life is. Of feeling. Of finality. Of memory. I can’t bear it, any of it. That’s when the fear really started. I’d always been afraid of my parents’ death, i obsessed over it. But that was my first big loss, of someone I’d seen so recently, so young, so similar to me. We were all steeped in bullshit pop music mythology, playing with self harm. But she died. Alone. And I was unforgiven for something. I never got to explain or say sorry. And she died. Died. Death. Forever. My first cremation, too.

Memory is important to me. Memory is evasive to me. I have convoluted memories of my own childhood.  Different from my siblings’ because we’re different people. Everything is kind of mixed up, muddy. Then my own brain conspired against me, and I don’t remember a lot of my periods of illness, or the life that existed, inevitably, as life does, within them. And I had my own fractious relationship with the truth when I was young.  When I look back I realise it was because I found it so hard to be living the life I had, so created another, not even one that was easier, but one I felt could justify the pain I was in without ever being honest about what was really causing it (it still feels churlish and trivial, and now I am at the other extreme of exposing honesty).  Other people have memories I don’t, largely negative and embarrassing. My own bad behaviour haunts me not just because it hurt those it was directed to (or caught within), but because I know it has become part of the memory arsenal, that chorus always waiting to be summoned, or to butt in, uninvited, and to hurt. And I hate that. I don’t want to be someone’s bad memories. Maybe if I can be better now, I can replace it or erase it? And all I want is to give my son happy memories. Robert says I’m morbid, which is true. He keeps us in the present- he thinks, “experiences”, I think, “memories”. Already living in the past tense.

Memory is all we have, really. In the end, if we’re lucky, that’s all we have. Since my dad died I have dug deep and cling to the good memories I have of him. Further and further away. It’s hard to remember happiness. It’s not the visceral gut punch of despair, more the balloon in your hand that drifts away, bright and then small and smaller. Physical pain is hard to remember (I couldn’t describe now what my contractions felt like, even though I know they hurt), but emotional pain recalls itself constantly. So I often only remember the bad things clearly (and how bad they were), and it feels like they just happened. How jealous I am of people whose parents weren’t like mine and who they went out to lunch with and they didn’t die like my dad did. Even those who did die but in ways that people had some sympathy for (alcoholics dying, lowest of the low, fuck their children, the way we were treated by the medical staff, my baby brother and sister, fuck them forever and forever for it, for every person afterwards who turned their face away from me),  I have to unfollow people on Facebook posting happy pictures with their parents. Out at lunch! Having drinks! Doing normal things.

Memory is the twoheaded monster. My memories of my dad are awful, Sometimes they engulf me and I feel like tearing my skin off in agony that I can’t go back, can’t change something, can’t intercept this awful image and make it different. That was it. And his memories. I think that’s perhaps worst. HIs life which he didn’t deserve. That he was so desperately unhappy. That he died like he did, and that I knew he was afraid of it. And there are tears pouring down my face as I write this. To be afraid without comfort. Without hope. I wanted to be there when he died to be a hand or a face or a word, and I wasn’t.

Me being there wouldn’t have changed the outcome, he would have died anyway. But I wanted to do something, anything.

My friend Brendan died not long after my dad. He was an alcoholic too, was trying to recover. He died of an accidental overdose and my last communication with him was a voicemail he left on the Monday before he died asking me to meet up, saying he was nearby, just passing, are you in? get in touch, and I was so up my own fucking selfish arse I never did and then he died.

In therapy we talked about safety behaviours and my big one is having my phone on me and being always contactable. I have a three hour commute to and from work and most of it is underground. I went for a rare night out on Tuesday and had a panic attack on the train as I visualised (fear not feelings etc, but it felt like a promotion, it felt like destiny), Robert screaming over our baby, screaming and screaming and I wasn’t there. That if he died I wouldn’t be there. What would his last memory be? Be held, be there, be loved. Not alone.

(Howl)

This is hard to write. I’ll come back to it.

It’s also about fear. I used to have nightmares about my dad dying from his drink. But he did anyway. It happened even worse than I screamed about. So why should I trust my fears aren’t real? That the worst won’t happen? It did. All the worst fears I have (dying myself is a worst fear that will inevitably be true, but I fear dying young, leaving my baby, Robert dying, my baby dying, my mum being unhappy and dying) came true so why not these? It’s hard not to take my anxieties as facts. They happened.  And with Robert and my baby in particular, who are my husband and my son, I love them so fiercely, I think, my love must insulate them from suffering, from death. But it doesn’t and it won’t. How can I ever accept that? I know it’s a childish and possibly a bit narcissistic but there it is. When Robert has the slightest bit of discomfort, my refrain is, “What can I do? How can I fix it?”

We talked about my intrusive thoughts which often take the form of, when I’m speaking to someone, imagining them dead. And realising they have the same expression, that I am just superimposing my dad over everyone’s faces, just reliving it constantly.

We didn’t even get on that well when he was alive. We had some beautiful moments, a lot of understanding, and he was a good person. But I often hated him for what he put us through. I used to fantasise about him falling downstairs and breaking his neck just so he’d shut up. Stop shouting. Stop drinking. Then we’d be free. (I hate this freedom. I hate myself).

So the therapist talked a bit about trauma and how events can be too big for the brain to process so they never become memories. They’re always happening instead. A sort of PTSD. And how if you break them down they can be processed and become memories and stop being so present. I’m skeptical. I have some extra sessions before we quit but feel like we’ve pulled a thread and I want the jumper back. And I don’t want to do the homework. I don’t want to write it all down. I want to keep pushing it all out. I don’t want to break it down. I don’t want to break down.

I cried a fair bit after that session and Robert gave me a lot of hugs when I came home. And then abruptly I just stopped talking about it, as I do, Silly, trivial, depressing.

Yeah.

(Stay with the feelings)

My Big Fat Bipolar Pregnancy- feat. the perinatal psychiatry team and The Fear

Mental illness isn’t the bogeyman.

I’ve been quite quiet here. It’s not as though I haven’t been trying.

See?

See?

Those drafts were mostly interrupted by bouts of exhaustion and blankness. I’d tried to write something funny and light, but it felt quite forced.

What’s prompting me to write today is the heartbreaking death of Charlotte Bevan and her four day old daughter, Zaani.  What’s known is that Charlotte had a history of mental health issues- namely schizophrenia and depression, according to her family- was severely sleep deprived and had stopped taking her medication as she wanted to breastfeed. She left the hospital in clinical slippers without a coat, her baby wrapped in a blanket.  They both died, in this freezing December, near the Clifton Suspension Bridge, a common suicide spot.

I’m not going to speculate. I’m not going to say that I recognised- viscerally- the hollowness in her eyes as she walked past a series of CCTV cameras. Nor wax, too much, about my own terror of visiting that lonely place.  I’m not going to pontificate on mental illness or womens’ agency, paternalistic attitudes or breastfeeding.  I’m not even going to post a screed on the woeful provision of perinatal mental health services in this country.

Hint: areas in the red have no perinatal mental health provision. I live in an orange bit.

Services and support which should be available everywhere- to every woman- who is pregnant or has given birth. I’m not going to talk about the senselessness of this when a woman’s risk of suicide is highest in the year postpartum. Nor that it’s any woman- not just a woman with a known history of mental illness.

So what I’m going to do instead is tell you- maybe selfishly- about my own experiences of being a pregnant woman with bipolar disorder, whose mother had postpartum psychosis, who is therefore under the perinatal mental health and considered a high risk pregnancy.  I’m going to explain how that feels for me, and about the kind of choices I’ve had to make.  I’m going to talk to you about what’s happened to me since I peed on the stick and found out I am expecting a son (not a daughter- that was a bit of surprise at the anomaly scan. I have grown a penis. Whole other blog in that and how I shamefully have far more gendered ideas than I thought I had).

One of the reasons I’ve kept my pregnancy related bibblings confined to my Twitter and Facebook is because this blog is, and always has been, a mental health blog.  And my mental health has governed my life for the past decade. Every major life event has been impacted in some way. I only got 7 GCSEs because I had a breakdown. I was then kicked out of college because I was a rambling, nonsensical whirl of mania. I moved to London in its midst. My father’s death was followed by my admission to hospital. A series of job losses, four years on benefits. I dropped out of my mental health nursing degree partly because I had become suicidally depressed. The good stuff, too. I won an award for a play based on this blog. Not me, and not my life, but my own fractured narrative of mental illness. I’ve had writing opportunities because I write about mental health in a way that people enjoy and relate to (thank you). But that’s all anyone has ever really been interested in about my writing. Or about me.

Here I am, pregnant. And it’s such an abstract thing, though increasingly less so over the weeks. 29 have passed- from a feeling, a line, a long stretch of sickness (which is also why I have been more comfortable with the microblogging of Twitter- constantly vomiting and general exhaustion doesn’t render you the most capable of stringing together a….se), to now experiencing flutters and rolls and bumps. It’s still so strange to me that this “being pregnant” will become, “giving birth” (argh!), to a newborn, a tiny little stranger, who will become my son, and I will become their mother. And they’ll have words, mannerisms, be a sovereign human being in their own right, have memories of me, and I’ll have memories of them. Hopefully one day we’ll talk about them together. And they’ll have a name.

And this is mine. It’s all mine.

It doesn’t belong to a doctor, it doesn’t belong to a CPN, a diagnosis, a theory, a plan, a pathology, a movement. It belongs to me, and to my husband, and to the people we love who are sharing in this with us.  Of course, it’s pregnancy, a highly medicalised event. It has its own language, it’s own pathology, its own plans. But they have been so reassuringly, wonderfully, vividly familiar to me. Here is a path my mother walked down. And you. And you. As disempowering as the experience can be, as lonely, as radicalising to my feminist ideas of myself as a woman and a female, it is ordinary.  It is so ordinary that when I vomited my breakfast in a yellow arc onto the black and white tiled floor of my local cafe, the women who worked there didn’t flinch. “It’s okay, we’ve been there, we remember what it’s like”. I felt part of some great tradition, and here was the initiation ceremony.

But Charlotte Bevan’s tragedy can’t help but make me think of my fear of the future.  I haven’t been the perfect pregnant woman by a long stretch. She is slim, she eats organic food (except eggs, cheese and raw fish), she doesn’t drink, nor smoke, nor get stressed. She does 30 minutes of gentle exercise a day (maybe yoga or pilates), she doesn’t dye her hair nor pet her cats.  She doesn’t take any medication, not even for one of the numerous headaches she’s likely to have. She does all this not just because she is told to, nor because she is “good”, but because she became a mother at the moment of conception. She’s the selfless mother, the ideal woman. She’s not a person but a habitat from when sperm meets egg.  That’s the perfect pregnant woman, and she’s still not perfect enough.

I am so far from that ideal that it’s hard not to feel like a failure already. I’m obese from years of psychiatric medications. It doesn’t matter that I have no weight related problems (as rigorous testing, hypotension and seemingly endless urine and blood samples will confirm). It was enough for me to be told, almost accusingly, that I WILL get gestational diabetes and pre eclampsia and that they’ll need to keep an eye on what I eat (which was pretty easy- just check the floor of the train at Tulse Hill station).  I smoked and drank, I drink more caffeine than recommended because for half of the day I am in a fugue from the antipsychotic medication I’m still taking. I get stressed and more than that, I have a diagnosis of mental illness, I am struggling to exercise due to exhaustion and I cuddle my two silly, wildly affectionate cats. I don’t feel like a mother yet, and I wonder when I will. I don’t think in terms of, “little angel”.  I didn’t undergo some sort of transformation as soon as I became pregnant. I still haven’t.

I have been reminded so frequently of my own imperfections as a woman that I have felt that my, “maternal habitus” is a cesspit. I have, at every stage, thought, “This is when I lose it”. Blighted ovum, then miscarriage and now I’m petrified of stillbirth, after that, it’ll be SIDS. So I’ve been afraid to bond with the little Bean in there, even though he’s growing wonderfully, booting away and, usual pregnancy niggles aside, I’ve had a pretty easy go of it.  The anxiety has at times been so bad that my psychiatrist has added a brand new diagnosis to my pregnancy notes- generalised anxiety disorder.  The anomaly scan was supposed to be a turning point, and it was.  It looked like they had a rare and serious birth defect called esophagal atresia. We spent the next few days, waiting for a rescan, in a fog of terror. My husband ran ahead from me as we returned from hospital to hide the little leopardprint coat we’d bought them and to put away the box of baby stuff that had been donated to us.  All our images of taking our baby home after the birth, the mundanity of feeding and changes, were replaced with immediate operations, long stays in the NICU and a possibility our baby would have a potentially life-ending chromosomal disorder. (The rescan was clear. Subsequent ones have been, too, but we still can’t relax).

As much as this does not belong to mental illness, mental illness does belong to me. I can’t, as much as I want to, separate that from the seismic physical and emotional changes I’m going through right now.  The problem with being in the mental health system for a long time is you’re told so many different things are wrong that eventually, you believe nothing is. And you can be a bit shocked when others don’t share that belief.  Initially, I resented their intrusion. Imagine what I would be writing if they didn’t exist in my area.

In the beginning

Due to the, “holy fuck, what is this, am I dying” nausea I experienced until 23 weeks, I knew i was pregnant pretty quickly. I got a positive test at 5 weeks. The first thing I was worried about was my medication- I had no idea if it was safe to take, but also no idea how I’d cope without it.  The first few weeks were the hardest emotionally. We’d just been told we were being evicted and had to find somewhere else to live. That stress coupled with the (happy) shock of being pregnant and the hormonal surge meant I spent the first month oscillating wildly. But it wasn’t really anything unusual- it was a reaction to the situation we were in and biological fuckery. (What is unusual for you? Write that shit down now. Give a copy to the people close to you).

I went to see my GP, who congratulated me, said she couldn’t definitely advise me on my medication and referred me to the perinatal psychiatry team.  She told me to continue to keep taking my medication, and so I did (and still do).  At the moment I’m only on Quetiapine, which is an antipsychotic.  She didn’t seem fatalistic or concerned, which cheered me up. I’ve written before about some of the fears I had about pregnancy. Mostly, they’ve been unfounded, but I’m still afraid. 

The perinatal psychiatry team

Midwife number 1

Risk, risk, risk. You have a high risk pregnancy.  No fancy home birth for you (fuck that, I want TEH DRUGS). Your BMI is over 30, you’ve smoked and you’re mental. The midwife took my history as I shrank into my chair. She wrote, “SLASHES ARMS SINCE AGE 14”, something which shocked me so much I asked her to correct it. It’s inaccurate- I haven’t self harmed in 5 years- and the word, “slash” is such an ugly, deforming word that I didn’t want associated with me, or my pregnancy. She apologised and changed it, saying she wanted me to be comfortable.

A few weeks later, wearing my Baby on Board badge with my sleeves rolled up in the sweltering heat on the tube, I saw people clock- with disgust- my scarred arms and the badge. And realised that I now have the rest of my and my child’s life with this. Flashes of bringing them to the swimming pool and being stared at. School gates. Grief.

Fuck ’em.

The perinatal nurse 

I had to give a different history to the perinatal nurse who came to visit me at home. This was the story of my life, told, lightheaded from nausea, in my garden. It was summer then, and we were just getting settled into our new flat. Robert was asleep upstairs after a nightshift.  I offered tea, which she refused.  She has that light, almost incredulous way of speaking that some mental health nurses do. I’m already familiar with them- I did a few days with the perinatal nurses when I was a student, and they seem altogether more gentle than their CMHT counterparts. She said, “Oh, what a lot you’ve been through. It’s no wonder you’re so anxious and worried about getting attached”. At this point, I was correcting people who said, “You’re having a baby!” with, “No, I’m pregnant. It’s different”.  I wasn’t really sure what to say to that. I know people mean well, but my life hasn’t been that bad and I don’t like it when people head-tilt (the IRL version of italics) or feel sorry for me.

She taught me some breathing exercises for panic attacks (my panic attacks abated somewhat for a while. Being so busy does that. They’ve returned a bit lately) which don’t seem to come close to controlling the death terrors I experience at night, and made an appointment with the psychiatrist for me.

Before she left, I felt like I needed to ask.

Will I be referred to social services?

Midwives can sometimes be a little cautious with women who have mental health issues, she admitted. But no, the midwife hadn’t made that call. “Are you planning to?” No, not at the moment. If we’re worried that you might need more help in coping then it’s something we can talk about.

I still haven’t been referred, though my psychiatrist admitted that when I called them (having to reschedule that first appointment as I didn’t receive the letter with the date), they had considered doing so.  But I am coping, and if I continue to, good. “Will they take my baby away if you call them?” No, that’s not what they’re there for. Sometimes, we can need a bit of practical support.  We want to keep you and baby together, not separate you. It’s usually better for both mum and baby to stay together. We’re here to support you in staying well.

While I’m glad I didn’t get an automatic referral, I know this may be partly due to my diagnosis. My perinatal psychiatrist believes that bipolar I disorder is the right diagnosis, and that’s what we’re working with. I tend (these days) to be okay for ages, then get kicked right up the hole with it. That’s where the, “risk” largely is- bipolar disorder has a high relapse rate during pregnancy, tricky management and is more likely than depression to lead to postpartum psychosis. My mum also experienced psychosis after birth, which kicks my risk up past 50%. So, it’s a pretty shit diagnosis to have during pregnancy. It does have an advantage- throwing medication at it can work quite well (as long as you aren’t stupid enough to throw just an antidepressant in there) Everyone’s different, but depression, mania and psychosis generally have quite obvious triggers, and well tested treatments.  It’s not more or less “real” than other mental health issues. There’s no, “real” one, really. We still don’t know what causes any of them, but some are viewed as more biologically based than others, and that makes them, if not easier, then more predictable to doctors..

Some women I know who are as functioning as I am, but who have a diagnosis of personality disorder, have been referred to social services.   This isn’t fair, and I think it’s partly to do with the stigma surrounding it, and partly because it might be viewed as less predictable than bipolar disorder. It could also simply be their trust, doctor and nothing to do with their diagnosis. I did actually have borderline personality disorder as a diagnosis in the past, but it hasn’t been one I’ve ever been treated for. I don’t believe I have it, nor does the perinatal mental health team, who noted it was historical, not a concern and that I seemed stable. I felt like an arse for being glad about this. It’s partly due to the fact that when it’s flashed up on the screen in the past, I’ve had a lot of irrelevant, tedious questioning about self harm (not in years) etc. You may as well be asking me about a decade-old leg break.

But these means that women who have been referred and monitored very closely might have a different story to me. I’ve been largely okay so far, but that’s the shitpantsingly scary thing about mental illness and particularly mental illness in pregnancy- it can descend with terrifying swiftness and brutality.

The mental health midwives

When I was referred to perinatal psychiatry, my care was transferred from the community midwives to a specialist team called the Brierley midwives. They’re 8 community midwives who specialise in two things:

1) Home births

2) Women who have a history of mental health issues

I felt pretty smug as half the yummy mummies in East Dulwich want the Brierley midwives and I got them automatically for being mental! Some perks of the job, eh.

They’re a small team, split in two. So I essentially have 4 midwives. I have my named midwife, my first port of call. Throughout my pregnancy, I’ll meet all the rest in the team of 4, so when I go into labour, the midwife won’t be a stranger to me. That’s pretty good and a relief for someone like me who has been struggling with anxiety and likes to know things in advance.

I have the normal midwife appointments with them, but can also have a few extra if I’m nervous. They’re not trained in the same way mental health nurses are. They’re more holistic in their approach, and take care of your emotional health as well as the health of the pregnancy. They’ve been great, and are always very keen to let me listen to that lovely little horsehoof heartbeat sound. They’re not hugely different from ordinary community midwives.

The perinatal psychiatrist

The perinatal psychiatry team are situated in the same hospital as the maternity unit. It’s a rather unpleasantly long walk down a thousand blindingly shiny corridors that seem to swim and shimmer to the exhausted, teary-from-vomiting eyes. The reception area has always been empty when I’ve arrived. There’s only about six seats and my burgeoning behind means I need two.

I’m instinctively, defensive around psychiatrists. I’ve worked with them professionally so I know they’re human beings. Mostly, they’re also compassionate human beings. As doctors, though, they are drawn to the mechanical and the explainable. It’s sometimes disturbing to feel you’re a puzzle to be solved rather than a human being, too. They have so much power over the lowly mental that it’s extremely hard to let your guard down.  This time was, at least, quite different from when I’ve seen psychiatrists attached to the CMHT. I hadn’t been summoned there like a naughty child to the headmaster’s office. I was well and there to take advantage of their support- conversely, it meant I was also a little resentful of having it forced upon me.

Alongside quite a few leaflets. I keep them in the living room for easy reading for us both. Got a spare minute with a cup of tea and want to terrify yourself?

Ta-da!

Ta-da!

Can I take psychiatric medication throughout pregnancy? Can I breastfeed?

When talking about medication, I told her that I’d tried to come off it numerous times but suffered such awful withdrawal (insomnia, itching, eventual quasi psychosis from sleep deprivation) that I’d always returned to it.  She frowned and said Quetiapine didn’t have any withdrawal symptoms. As I tried to elaborate, she picked up a copy of the BNF and began flicking through it to disprove me. That was a strike.

As fat as I am due to it (Quetiapine doesn’t cause weight gain, she said. Strike 2! Tell it to the people suing the company that makes it for their diabetes), it’s the one medication that has helped me stay sane, and largely because it means I can sleep. I am a natural insomniac and very prone to hypomania and hyperactivity because of it. Getting regular sleep has been the lynchpin. Although I went into the appointment to argue my case for coming off it, I was secretly hoping she’d tell me it was okay and I should stay on it, as the thought of going through withdrawal and insomnia was unbearable.

She did.  Quetiapine is a category C medication in pregnancy. It means risk can’t be ruled out, and it can’t be ruled out because it’s unethical to test on pregnant women.  Case studies so far indicate the risks are gestational diabetes and diabetes 2 (I have been tested twice for GD- I don’t have it and won’t be tested again) which can cause a high birthweight.  Confusingly, the consultant obstetrician (I get one of those due to being a high risk pregnancy), says it can cause low birth weight. So go figure.  There’s also evidence that it can cause slight respiratory problems after birth, sedation and babies may be a little behind developmentally for a few months, but catch up. Their APGAR score is generally 9 or 10, which is great.

These are all scary sounding things and I’m still scared of them. I do feel a sense of failure and wish I was, “normal” and didn’t take psychiatric medication. I think about how sedated and dopey I am and feel a huge sense of guilt for what it might be doing to my baby. And because there’s no long term studies, I also have no idea what it’s doing to their developing brain.

But. I have to try and put my faith in…something. Myself to keep well, which cannot be done by willpower alone and especially not now.  In the perinatal team.  As much as she initially rubbed me up the wrong way (I warmed to her a lot in subsequent appointments. It’s never easy to go in and tell your whole life story to a stranger), she is the consultant and I trust her opinion. Most importantly, I’m being closely monitored- and so will Bean when they’re born and afterwards.

So, breastfeeding.

Breastfeeding is great. Boobs make milk! How mad is that? You’ve had them your whole life and then, when you’re pregnant (or taking Risperidone), they inherit this magical superpower. MILK! It’s food! Holy shit!

But some women’s boobs don’t make milk. Some women find it too uncomfortable, painful or downright weird to breastfeed. Some can’t, some don’t want to, and that’s all fine. Because you know what else is great? Making our own choices about our own bodies. Breastfeeding is not the be all, end all, and the medical establishment- and frankly, other women- have a lot to answer for in downright shaming women about breastfeeding.

It’s better than formula in some ways (and not as good in others- formula has added vitamins our bodies don’t make, formula is very convenient too). It does help with things like shrinking your uterus back (ping!) and as for bonding, I don’t know. You can still do skin to skin contact with a bottle and bond that way. Breastfeeding doesn’t give you nor your baby immortality. But I can understand why women- even if you sort-of discount that intense societal and medical pressure- really want to breastfeed. I do. I want to do to it because I haven’t done it before and it’s a new experience. I want to do it for the benefits it does have.  I want to do it because it’s cheap and we’re skint. I want to do it because boobs, milk, weird.

The general blanket advice for women taking medication, particularly psychiatric ones, is don’t breastfeed. Please get a specialist opinion on this if you can. Some resources include Drugs in Breastmilk from the Breastfeeding Network.  If you know someone who is facing this question who isn’t getting good advice, try to help them find it. Because it’s a big one. Women are being encouraged- and deciding themselves out of pressure, desire, guilt, complex, personal reasons I would never want to judge or belittle in any way- to stop taking medications which are potentially keeping them safe and stable so that they can breastfeed. This is wrong. I don’t mean medically, I mean morally. Women should be encouraged to put their health first. Believe me, I understand that, especially when you’ve struggled with your mental health, you so want to do the, “right” thing, the, “natural” thing, the thing to bond and connect. But formula is not going to kill a baby, whereas a relapse could kill the mother. That’s as brutal as it gets, but it’s true.

I got specialist advice from my psychiatrist who says I can breastfeed. A very tiny concentration of the medication will be in the breastmilk. This study reports 0.1% of my dose and no adverse effects. I’m on the lowest dose of quetiapine I can get away with, but it’s likely that’s going to increase as it’s working less effectively as time goes on. So again there is a little risk with breastfeeding. I’ll be monitored (awful word) and if it’s having effects on the babe, then I’ll switch to formula. Will be upset and disappointed? Probably. But what I am repeating to myself, in my rational mind, is my health first.  I can’t look after my baby if I’m unwell.

The Birth Planning Meeting- making a mental health advance directive

I last saw my psychiatrist about 10 days ago.  I’m doing pretty well so we won’t have any more appointments individually, nor will I be seeing my perinatal nurse again unless I ask to. I will be seeing them on the 15th of December to have a birth planning meeting.

This is essentially where your whole “team” (including your future health visitor) gets together to talk about your birth plan and what you want to happen afterwards, especially if you become unwell.  As rationally as I’m writing this, as ticking-along as it’s been, that’s a possibility. What do I want to happen, what do I not want to happen? Would I be okay with an increase in antipsychotics, and if so, are there ones I don’t want to take? (This may largely be out of my hands if I do get sick, but my wishes will be taken into account).  We’ll also discuss treatment options should I get sick, such as the mother and baby unit. There will also be general discussion about labour, like with any woman.

I’ll know more about this when I actually attend it, but I feel quite reassured by it. Robert will be there too, and no doubt find it all quite bizarre.

What will be happening is that I will continue taking medication after the birth. And there is a huge concession here- it means my husband has to give up work when the baby’s born. You can imagine how financially shattering this will be, it’s maternity leave (I can only take 6 months at the very most, and that’s a huge struggle) on one salary. But he works nights exclusively, and hasn’t been able to find a day job. I work full time and want to return to work. The “team” agrees that although I’m likely to have sleep deprivation like any new parent, it is completely essential that I get as much sleep as possible to stay well, and this means Robert will have to stay at home with me and do nights with the baby so I can take my medication and sleep.  My doctor and midwife are pretty worried about me going back to work so soon, but I don’t really have a choice as we can’t afford otherwise. I only get 3 months maternity pay and have been saving up otherwise.

The Fear

When I got home from work tonight, I broke down crying for the first time in months. Despite all this planning and all this support, I am terrified of becoming unwell after the birth, terrified of it happening now, too. It does feel so frighteningly out of control, even after writing 5000 words as to how it isn’t. I feel like I don’t really have control over anything.

I am scared of how quickly women become ill after pregnancy and scared it’ll be me. Scared I won’t be able to ask for help, scared I’ll be beyond even recognising I need it. Scared Robert won’t be able to cope, scared of being alone (it is the loneliest place in the world), scared of not being able to care for my baby. Scared of being a failure. Scared of not being able to bond. Scared of feeling trapped, scared of what I’d do if I did.  Scared of the fact I have made the one irreversible decision of my life.  Scared of a lot of things a lot of women are scared of.  That spiky sea urchin in my brain is a saboteur and a liar and I make a conscious effort not to listen to them.

But having support does help. It does make a difference. I have a partner, which is support a lot of women don’t have. I have an understanding workplace, too. I have the perinatal team. I have these clear things in my head, here, and in my notes. It isn’t the quivering inarticulate terror of when I became pregnant. It isn’t the kind of fear and uncertainty I imagine many women who don’t have support feel. I don’t know what support Charlotte Bevan had. I hope her family have some support right now for what they’re going through.

All women need and deserve support when they’re pregnant and afterwards.  A check up at 6 weeks is not good enough. A questionnaire will not cut it when we are so ashamed of how we’re feeling and so afraid. Feel free to ask me anything here or on Twitter- ms_molly_vog. If you’re pregnant right now, or thinking about it, please reach out if you’re struggling. To someone- your GP, your midwife, a friend, even a forum or Twitter if you need to talk.  I apologise for you in advance if your GP or midwife are shit, if your mental health provision is shit. It’s not right, it’s not fair, and it’s not how it should be.

It’s 1am now. Tears largely dried. Time to sleep, if searing heartburn allows. I am feeding Bean a fine selection of curries when he’s 18. Sweet revenge. Night.

*bump*

*bump*

Pregnant, Mental and Fat

Bloody hell. It’s taken me 18 weeks to write this post. I imagined a dam would burst when we told everyone at week 12. And I, who diarises everything and have done since I was a child. Anyway- better late than never. This is my news…

Whomp whomp whomp she says

Whomp whomp whomp she says

I found out I was pregnant on the day Rik Mayall died. My already not inconsiderable boobs seemed to have become zeppelins of ache, so I decided to grab a pregnancy test on my way to work to  wee upon in the peaceful surroundings of the disabled toilet. I yawned as I waited for the results, expecting it to be negative like all the others had been. It wasn’t.

The first person to find out wasn’t my husband, but my much beloved friend at work, Ellie. Robert had just gotten off his week of nightshifts and as I’d left for work, had been barbecuing in the garden with his friend Ben.  As I waved goodbye there was the, “hhsssstt” of an opening can and a peal of already-rather-drunk laughter. (In fact, this was him that very morning:

I bumped into her as I was dashing across to the Superdrug to buy another four pregnancy tests. I’m one of those incredibly unlucky (or lucky, depending on how you see it) people to have gotten a false positive pregnancy test (two in fact- fuck you Sainsburys own brand). That positive test was met with jubilation, calls to buy fizzy wine, shock. This time it was rather different. I got home from work, having sent Robert a few subtle, “Hey, you sober now? Wow, about that Rik Mayall eh?” texts throughout the day. When he texted back to tell me that he was turning into an otter, I thought it was best to break the news in person. Which I did by shaking him awake at 7pm and quietly telling him the news. It took him a while to shake off the alcohol haze and for the news to be understood.

We had approximately 19 hours with which to enjoy the news and to imagine a future with a child. The next day, our bastard landlord. the criminal scumbag Gabriel Edun whose negligence could have killed us in the house fire it caused, was heard casually talking over the garden fence with the landlord next door about their offer on the flat. He was selling. We confronted him and he admitted that he would be serving us with a section 22 notice of eviction. We’d only lived there 3 months, and those 3 months we’d lived in a sooty, fire damaged whole, taken days and days off work, not just for hospital treatment after the fire but to sit around waiting for this lazy piece of shit to come and make the flat breathable again. We’d only endured it because the flat was very cheap and he had assured us, repeatedly, that he wouldn’t be selling and we could finally have somewhere to make a home.

Fucker. We left him this as a present.

Sincerely, motherfucker.

Sincerely, motherfucker.

(The shitbag scumlord couldn’t had evicted us legally anyway- he didn’t protect our deposit and I got it back when I threatened him with court. I had spent the day cleaning his shithole and as I left, he offered to carry the hastily packed bags of an unwanted house move to the bus stop because of my “condition”. I declined).

We could have waited three months until he served the eviction notice, but in the three months since we’d moved to Lewisham, we’d already been priced out of it. We had to move quickly. The next weeks I could barely sleep, and could barely eat because I was throwing up everything that passed my lips (“morning sickness” my HOLE. All day sickness.  All 15 weeks of endless dizzying sickness). We were both hysterical, me crying often, totally screwed financially having spent everything we had on moving three months previously.  It absolutely ruined the first month as all I could think about was where we were going to live and what we were going to do. We ended up having to borrow money, and kind friends helped, too, and finding a place in Streatham, far, far more than what we were paying but still below market rent. What a fucking joke London is. (Incidentally, we moved to Streatham to be close to Robert’s family, who are now all moving out of fecking London).

Having to move also meant that I had to end therapy. I had *just* started therapy (finally) for panic disorder.  I was struggling to get to appointments on the bus due to sickness, so she said she thought I’d be better referred to Lambeth, which I agreed with. Couldn’t transfer, had to do a new referral. Which I’ve yet to do.  Because…

This got long. In the next entry, I’ll discuss the NEVERENDING APPOINTMENTS you can expect if you’re both pregnant and mental! 

And I’ll also talk about how GREAT it is being FAT and how you’re basically told you’re KILLING YOUR BABY just by EXISTING WHILE FAT! 

MARVEL as you VOMIT for 15 weeks! 

To be continued… 

Mentalism and Motherhood

I get emotional over the tree in our tiny garden in Peckham.  Which is silly.

But I watched it bloom into beautiful blossom in the spring…

and drizzle pink flowers every time the breeze blew…

…and, to my surprise, the delicate butterfly-blossoms became apples, which twatted me on the head every time I went to hang the washing up…

Not pictured: me swearing.

Not pictured: me swearing.

…and grew big enough to be picked (or picked up, as in this case) and eaten.

And the apples will disappear, and the tree become bare and anonymous like it was when we moved here last year, then it’ll blossom again and, again, become laden with fruit.  And the cycle will repeat. We didn’t do anything to make it happen. I thought the tree was dead when we moved in. All it’s had is rain and sun, and it lives on.

My friend Ben insisted it was just a useless little crab apple tree, but it wasn’t. (And crab apple trees aren’t useless anyway). 

I want to be part of a cycle.  Of that cycle: of renewal and birth and endlessness.  Even though I have PCOS, I just assume it’ll happen. Granted, those aren’t great reasons to have kids. But recently, I’d been broodier than usual (as has my husband). Awwing at the photos of babies my friends post on Facebook, wanting to be part of that seemingly perfectly imperfect life. My friend, a mother of two, wisely told me, “Having kids is like a bomb going off in your relationship”. But I want to be standing in that wreckage. Not the sometimes-inconsequential feeling neatness of now.

If you follow me on Twitter (I am there as brain_opera), I probably depressed you the other day by posting the heartbreaking Daksha Emson inquiry. Daksha Emson was a psychiatrist who committed suicide, in the violent way horrifyingly typical of women with postpartum psychosis, by stabbing herself and her baby daughter, Freya, then immolating both of them.  Daksha survived for 3 weeks before succumbing to her injuries, and Freya died at the scene. They were both found by her husband, David.

Daksha died in the perfect storm.  A psychiatrist, she worked in a profession with stigmatises their own having mental illness.  Whose illness was downplayed, “doctor to doctor”. Daksha had bipolar disorder, and, although she experienced periods of unwellness where she was hospitalised (and had ECT, on one occasion), she managed to excel in her field. She took medication and didn’t have a relapse in the 8 years she and her husband were married until she became pregnant.

When I was a nursing student, I attended a conference on perinatal psychiatry.  If I’d stayed in nursing, it’s where I’d have liked to specialise. It was a fascinating day.  Firstly, we looked at how infants develop, and how vital those early attachments are.  It’s why mother and baby units, which keep them together and help support the mum and partner, are better than just chucking the mother into a psychiatric ward.

We watched a video of some mothers who were experiencing psychotic and depressive symptoms while caring for their children in a mother and baby unit.  We saw the baby’s increased agitation due to the lack of reaction from the mothers.  The Still Face experiment illustrates this:

Then, we saw the improvements, in both mum and baby, a few months later when the women had recovered.  We learned (or at least, I did), how peri/postnatal mental illness can often strike those who one would least expect; first time, middle class mothers in their thirties. And this in itself is where women like Daksha were let down. How could this high-achieving psychiatrist and mother become mentally ill?  As the inquiry says, isn’t mental illness for, “the great unwashed”? And when the great unwashed do get pregnant, they don’t experience the trauma those professional women do of becoming a mother, the role that’s been created for them since the universe began, which they must now inhabit fully, and which everyone is else is watching you shape yourself into. Surely?

Dr Margaret Oates (who has a mother and baby unit named after her) was there. She spoke acidly of cases where women, clearly unwell, were discharged from services with the label, “personality disorder”. One mother, who was previously diagnosed with bipolar disorder, was deemed to instead have a personality disorder and sent home with antidepressants.  “And what happens to a woman with bipolar when you just give her antidepressants?”, she snapped. She got worse, walked into incoming traffic and died.

Daksha Emson had bipolar disorder.  Postpartum psychosis is so closely linked that it’s sometimes called postpuerpal bipolar disorder. The inquiry into her death states that doctors must assume one will become ill, not the other way around. Therefore, it’s all about that lovely phrase we all know so well as patients and practitioners; risk management.

But that’s complex in itself. A woman who becomes unwell in pregnancy, or who was already taking medication for a pre-existing mental health problem, might be limited in her choice of treatment.  Then they may have to- or want to- stop taking medication so they can breastfeed their child. They can become unwell astonishingly quickly.  There’s also the shame factor. The shame factor that permeates all mental ill health, but especially mental ill health when it’s supposed to be the happiest, most wonderful, shiny, Mothercare advert time of your life.  Where do you even start with that? We’re shamed anyway for having mental health problems, then further shamed for being women- how much shame and guilt must a new mother feel?

Then the father of the child, if he’s employed and you’re with him, might have to go back to work after two weeks.  It becomes easier to hide how bad things have become. In the shadows, they disintegrate. And the stress of looking after a new life, utterly dependent on you, would take its toll on anyone- lack of sleep, worry about the infant, recovering from childbirth, financial implications, everything.

Afterwards, I asked to spend the day with the perinatal psychiatry team at a local hospital.  The nurse explained who was referred to their team.  I felt the blood rush to my head as I read:

Referrals are essential for women with:

  • Bipolar Affective Disorder
  • Schizophrenia / Schizoaffective disorder
  • Previous Postpartum Psychosis
  • Severe Depression
  • Other psychotic illness
  • Family History of Postpartum Psychosis

I have (or probably have, I haven’t had a hypo/manic episode for 2 years and my recent psychiatrist who has only seen me well and heard me speak with a very, “I’m okay” now spin on things) bipolar disorder and my mum had 2 episodes of postpartum psychosis. It was strange to see it in black and white.  Here is your future.  This is what your pregnancy is going to look like.  Someone asking you questions.  Somewhere, you’re going to be a file and they’re going to be watching you. Someone’s going to come and visit you and someone is going to know more about you that you’re comfortable telling them. They might take your baby away. They might take your baby away. They might take your baby away.

I should have felt relieved.  Isn’t for the best that I’d be referred if I was pregnant?  Isn’t it good I’d be looked after and had some support? But it still scares me because it feels like an intrusion- another intrusion in a lifetime of intrusions- by mental health services into my life.  Resenting bitterly that mental illness may steal another part of my life, that mental health services may be the ones who define it at all.

When I was initially diagnosed, I was advised to think twice before even becoming pregnant. I did, briefly, a few years ago and I did become unwell, first with depression, then with hypomania, but that could have been the circumstances of the pregnancy rather than any sort of organic reason. What would happen now?  No matter what has gone before, I have imagined myself pregnant and beaming with a wanted child. Well, happy, blooming then fruitful.  I blot out the fact that pregnancy and having children is one of the most stressful things a couple can do and that a quite shocking amount of partners have affairs during these periods.  And that my husband isn’t great at coping with me when I’m not very well (but he’s getting better, and I know he’d be an amazing dad).  And that I live in a tiny flat and I’d have no money and wouldn’t be able to cover the rent on SMP. And that I take antipsychotic and antidepressant and mood stabilising medication and have tried to kill myself. And suicide is the leading cause of maternal death.

Oh, that.

But then I wish someone had been there when my mum was suffering when she had my brother and sister. I can’t remember what happened (particularly when my sister was born, because I was still a far-off idea at the time), but I do remember she thought there were rats in the bath, blood, that my brother was some sort of god and that she was mad for years after- still is, really- and that my dad’s drinking got worse and worse until it killed him.  I try to tell myself that just because it happened to her, it doesn’t mean it will happen to me.  I’m not married to my father, and my father was an alcoholic, and I’m not. I’m not living her life, in her circumstances. I’m not her. I’m not her.

And even if I was, how badly did having two parents with a mental illness affect me?  On a good day, I’d say, “Ach, hardly at all”. On a bad, I’d be flung back into a cobwebby corner of my memory where I’m hiding behind a door with my hands over my ears listening to my parents scream at each other, and the years that followed where I spun in my mother’s confused untruths, not sure what was true, not sure what wasn’t and remember my joyful time in CAMHS.

I have my brother and sister, though. I have them.

On balance, though, I think my experiences have had a positive impact on my personality rather than a negative one. I grew up to be compassionate, to want to help people, to be independent since we largely had to look after ourselves, to value creativity as a way to express myself when I lived with people who could be wordless, and to be someone who stands up for themselves and for others. On the downside, I’m one of those people who struggles to make close relationships (and this scares me about having kids- who would help me? Who could I ask?), who runs away when people try to get close to her, who is super-sensitive, who seeks validation too often, who feels overburdened with a sense of responsibility and guilt for things I can’t control, and who shuts down if someone shouts at me as it throws me back into the centrifugal force of my parents rage. (And yes, I’m aware that my traumatic upbringing and subsequent traumas have probably contributed a fair bit to me being mentally interesting. But I certainly don’t blame my parents for that. They’re people, first). But those things don’t hold me back to any huge degree and the slightly reclusive part of my personality is one I’d miss having, too.

And they weren’t always like that. Sometimes, my parents were wonderful.  It was something I was wildly jealous of when my dad died- other peoples’ memories of their parents. I had friends who lost their parents to cancer at similarly young ages to when I lost my dad.  But their parent, “battled”, was, “brave”. Was proud, was strong, had friends, were blissfully and memorably ordinary. They had coffee with their parents and bought them places, to events that didn’t end with them screaming at them to stop, slumping into sobs.  I was so jealous that, then, all I had left of my dad were horrible memories.  They were the ones that floated to my mind when I thought of him. Memories that drenched me in shame and regret, regret of such a short, wasted life, and shame that we weren’t enough for him to want to live for.

But as time has passed, I remember more good about him.

I understand he couldn’t, “just” stop drinking. I thank him for the good influence he had on me. To be silly, to be strong, to read. I mourn that my children won’t have him as a grandad, to be bounced on his leg like he used to do me.  Now whenever I talk to my somewhat transformed mum on the phone, I ask her to think about getting herself a wee fella.  I hate the thought of another life not being lived, being wasted without love, without someone, even a good friend, to share with.

And on the plus side of me not really being close to many people, I have a lot of love.  Tons of it, pouring out of me, for anyone to have if they want it.  So that’s something.

But my parents were never really helped for their problems.  No-one really supported them when they needed it, when we needed it. How different things might have been if someone had recognised they needed help. These somewhat self-regarding entries are a protection.  A way of acknowledging what could happen.  Save yourself by being self-aware in case there comes a time when you can’t be.  So it doesn’t come.

So I think I need to give up any expectations I have of pregnancy or motherhood, both good and bad. I may not suddenly have a giant gleaming kitchen and long, russet hair (it’s purple right now, but for some reason, when I think of my hair when pregnant, it’s long and not falling out like it does during pregnancy and russet and smells of apples, the latter being a probability considering we are currently buried in them) and have that kind of flattering slimness that accentuates my bountiful bump (I’m newly obese again, so that’s not going to happen anyway).  I may not have a husband who’s endlessly patient with me and who listens to my stomach like a shell for the sea and sings to me (I fucking hope not- he’s the most effortfully bad singer I’ve ever heard) and keeps everything clean and is never bad tempered and never misses sex or the nights out with his previously young wife and the nights in with his previously girlfriend. He won’t become depressed himself and will continue to bring me coffee and breakfast and call me beautiful.

Likewise, I may not go mad and may not end up struggling to bond with my baby, and may not be like my mother, and may not spend every waking minute thinking I’m a shit mother and a shit person and shit feminist, and may not have to come off my medication and if I do, I may be fine, and it may, may be, just a gloriously ordinary time of my life, like it is in the lives of lots of women, like it is for lots of women with mental health problems, too. Apart from panic attacks, I’m fine now. I may continue to be fine. And even if I wasn’t, it’ll all be worth it in the end.

I hope so.

P.S: I’m not pregnant, don’t worry.

P.P.S: Daksha Emson is an exceptional case, hence the inquiry.  Although women can be so unwell they commit suicide and take their children with them, it’s incredibly rare.  And what has changed since they inquiry?  Not much.

P.P.P.S: If I’ve depressed the shite out of you with this entry, here’s some Eddie Izzard:

The Kick Inside

Now, I’m 21 and not planning on getting pregnant anytime soon. Yet, since the day I began treatment, doctors have been protecting my phantom baby. A typical exchange in my psychiatric appointments follows this general structure:

Me, in a whiny voice: “I don’t want to take my Lith-iiiieee-ummmmmm, it makes me feel sick and I have put on tons of weight”. *sad face*


Doctor, in stern, teacherish voice: “If you don’t take your Lithium with your antidepressants then you will have to go to hospital again. And this time for much longer. Months. You will go sky high again”.

Sullen me: “I have already gone sky high even as I was taking Lithium”.

Doctor, exasperated: “Look, Lithium is the safest mood stabiliser for women of your age“.

By “my age” he means of “childbearing age”. Yet apparently Lithium should be avoided during pregnancy as it cause prenatal defects. Which begs the question- just how dangerous are other mood stabilisers to the unborn child?

The Valproate Family

Well, sodium valproate also carries a risk of foetal defects. Read the whole article on valproates, but this in particular is quite sobering:

Of 403 pregnancies in women taking antiepileptic drugs (AEDs), 87.8% resulted in a healthy live birth and 5.2% resulted in a live birth of a child with fetal malformations, ranging from neurologic to genitourinary to skeletal abnormalities. The remaining pregnancies ended in spontaneous abortion or premature death in utero.

The fetal malformation rate was significantly greater in pregnancies exposed to valproate in the first trimester, compared with those exposed to all other AEDs in the first trimester. (16.1% vs. 2.4%). Additionally, the incidence of fetal malformations was significantly higher in women taking valproate than in those taking no AEDs (16.1% vs. 3.1%).

The higher the dosage, the greater the risk according to Diana Mahoney. Reading around, statistics quoted are much the same.

Valproates and Lithium are the two most commonly prescribed true mood stabilisers used to treat Bipolar 1 in the UK.

Lamictal

Bipolar II is often treated using Lamictal. It’s also approved to treat Bipolar 1, but only when stable on other medications. As for Lamictal and pregnancy, there’s little information out there. Best I can find is this from the FDA, which says that babies born during Lamictal treatment are at higher risk of cleft palette.

So, the two “true” mood stabilisers are harmful when pregnant. Information surrounding Lamictal is shady. What can you take during pregnancy, then?


The Talk: The Doctor Will Always Discourage You Ever

Getting Pregnant

I had “The Talk” with my doctor regarding pregnancy. I have always wanted children, loving my little siblings like they were my own, in that freakish big sister way. However, I also have PCOS, meaning my periods come when the damn well want to, which reduces my chance of conceiving and heightens my chance of miscarriage.

When I told my psychiatric doctor this, he was almost relieved. “The Talk” considers the risks of pregnancy to the manic depressive woman.

I’ve been told that if I get pregnant, I can continue Lithium but need to know the risks. Problem is, Lithium is really not that effective for me. It only has a 40% success rate, and Lithium is the first line treatment for mania. So the 60% whose doctors won’t let them switch- where does that leave us?

I’ve also tried Tegretol and Zyprexa, both extremely unsuccessfully. So if I want to reduce the risk to my unborn child (note: not eliminate it), I have to continue taking the ineffective Lithium. Tegretol is also harmful to foetus’.

Another option aside from Lithium is taking an old-school antipsychotic like Haloperidol. Haloperidol is an extremely blunt tool when dealing with complicated mood episodes and carries risks such as tardive dyskinesia. See your neighbourhood schizophrenic who creeps you out because their tongue moves in their mouth like a blind worm? It’s likely they have tardive dyskinesia induced by old school antipsychotics.

Haloperidol and its cousin Thorazine are both pills I have taken and I wouldn’t trust myself on them in pregnancy.

So, that was one part of the talk.

I then got the lowdown on the risks of becoming pregnant. The National Alliance of Mental Illness articulates it pretty starkly:

Because bipolar disorder emerges during young adulthood and persists throughout the lifespan, women of childbearing age are at risk for this illness. Pregnancy and delivery can influence the symptoms of bipolar disorder: pregnant women or new mothers with bipolar disorder have a sevenfold higher risk of hospital admission and a twofold higher risk for a recurrent episode, compared with those who have not recently delivered a child or are not pregnant.

Basically- we might go absolutely nuts.


Tammy

I witnessed this first hand in hospital with a heavily pregnant bipolar woman called Tammy. Tammy was extremely violent and suffering from psychotic delusions. She believed her child was eating her from the inside and would call every day for the nurses to abort it. It was shocking to witness. She was being medicated with Haloperidol and various sedatives and would be quiet every few hours before the halls would rattle with her petrified shrieks.


Shite

Thing is, I have to listen as I know I have a history of psychotic mania and psychotic depression. So it frightens me to know that that most happy of events- carrying a baby- might make me so ill that I could hurt myself or my child.

The doctor was gentle with this information. He’s blunt like that. He wasn’t mean. He was nice but a matter of fact.

I had always feared post-natal depression but I know that in my depressions, save for the bleakest I have experienced, I can always be reached. Some anchor is dropped, some voice is faraway above the well’s mouth, but I can hear it. It’s a whisper, but I can hear it.

Psychosis is not the same. Psychosis is unreachable, unreal, uninhabitable and unimaginable for anyone other than the person locked inside it.

It horrifies me that I might become psychotic while pregnant. That all us manic depressive ladies out there might fear the thing inside them. Or adore it, too much.

If that wasn’t enough to put me off…

Manic depression is hereditary

Mental illness giveth, mental illness taketh away…

While I can see some valuable things I have gained from being a Mentally Interesting Girl diagnosed young-ish, that isn’t something I’d ever want to pass on.

I do have some insight into things I would never have even thought about otherwise. Things like psychosis, mania, depression, suicide and oh, positive things too. Like how people endure and carry on. And how they recognise- by and large- that mental illness sucks, it could be worse. Granted, I only had this sort of self-awareness very recently, but those clear times are quite valuable. My illness is now a part of me. Not the whole of me, but it’s part of my identity because it affects everything at the core of who I am- my moods, my emotions, my energy, my creative abilities.

But, that said, I would never want to pass it on. Manic depression is hereditary. And as well as giving me some insights, it’s taken me on hell-rides, severely truncated what I’m likely to achieve in life and removed a modicum of control from my moods and emotions, on who I could have been.

What we have to ask ourselves then, when we think of getting pregnant or getting someone pregnant- do we want to pass this on?


Crap Poetry Aged 15

When I was 15, I wrote a really shit poem called, “The Heirloom In my Family Is Mental Illness”. Oh woe! I hear you cry. While the rest of the poem was as teenage wankish as you could get, the title did hold truth.

Mental illness runs in my family. There is a vein coursing through us, from my great-grandmother, to her daughter, to my mother, to me. Sadly, it runs thus on the other side too, but that side bred alcoholism, which eventually stole my father from me.

Mental illness can come from nowhere and it can be caused by traumatic life events. But of all the psychiatric illnesses, bipolar disorder seems to have the strongest genetic link.


Sigh

So, I had that merry onslaught chucked at me when my pregnancy questions peeked above the parapet.

Becoming pregnant when you’re manic depressive is tough. It’s not impossible, though. Pregnancy is tough to deal with whatever the circumstances. It’s just that much harder when you suffer from a mental illness. And if we were all afraid of passing on the “faulty gene”, we wouldn’t be here, us Mentally Interesting folks, and that would be a loss.

I’m going to take the advice of Generic Wise Man and wait and see. You never know.

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