Bipolar - to have a second child?

[Georgia324]

Hi everyone,

My son is 2.5yo now and after a horrendous year of postnatal depression from 6 months - 18 months, with a year of clear health now, my husband and I are thinking of having a second child.

It's much more complicated because I have bipolar, which makes it highly likely (c.60%) than I will get unwell again. I'd hope that with better meds management and recognising early signs of a postnatal high, it wouldn't be the same as it was with my son. However, we can't be 100% sure.

Is there anyone else out there with bipolar who already has a child - and who went through a severe postpartum episode - who has had another (child or episode )? Or anyone who decided that it wasn't worth the risk? And do you have any advice? This is eating me up inside...

It's not just the postnatal period either. Parenting with bipolar is hard - no control over your sleep and limited "selfish" time for self-care that we so desperately need to stay well - so that's also on my mind...

Thanks,

Georgia

[SiouxsieSiouxStiletto]

So sorry that you haven't had any responses to this @Georgia324.

I haven't got bipolar so can't help you but from what you've said about PND, alone time and lack of sleep I think you're wise to give it a lot of thought before getting PG again

[Sweetladyjane]

I have bipolar and struggled after my first child and went very low followed by quite a bad high. With my second my care was much more planned and I had regular reviews with my care coordinator and rapid access to the psychiatrist if my mood was changing for a mess tweak. I did dip after my second was born but they team around me were great and did regular home visits and encouraged me out of the house for walks and generally held my hand through it.

Are you still under the mental health team? If so it could be worth speaking to them about what your care would look like if you had a second.

[Georgia324]

Thank you both so much for replying. I'm relieved to hear @Sweetladyjane that your second experience was so much better. Realistically I'd have to expect a degree of illness - I just don't want it to last 10 months...
I was under the perinatal team who were incredible but my hypomania was missed - probably in part due to lockdown so no f2f appointments and it wasn't very structured. Once I was depressed they were brilliant, and I know there would be lots of things to do differently next time if we did decide to go ahead.

Did you do anything differently with your medication (TTC, pregnancy & postpartum)? I'm on lithium & lamotrigine now. They said to me that 2 meds isn't a good idea and better to pick one. If I came off lithium I think I'd go back on immediately after giving birth as lamotrigine didn't stop the high postpartum for me.

[Sweetladyjane]

I went onto Lamotragine and aripiprazole and have stayed on them ever since. They seem to be working for me.

[Georgia324]

Was that throughout? What did you take before that/did you have to come off anything? I know meds are only one part of the puzzle. How old are your children now? I hope that I have a similar experience to you.. it sounds like you did all the right things.

[hylian]

Hi OP.
I am a child of someone with bipolar.
I think realistically you have to think about how much you are able to give.
If you already have one child and are struggling, then having another child is only going to make things harder and add more challenges to your life. There is a risk that what happened with your first would happen again, so you have to be honest with yourself if you can go through that again, and the impact it might have on both children, your husband, and yourself.
Personally, as a child, having a parent with this was very difficult for me. My parent was well supported but it still had an impact. I love them very much of course, and they did their absolute best, but it's a very confusing thing to see as a child. I wouldn't really wish it on others, but also bipolar isn't a homogenous illness - you may be affected very differently.
Only you can really make the decision.

[Rudeface]

I had bipolar and I was doing well when I got pregnant. Pregnancy went well and I didn't get unwell after birth. But when I got pregnant again I got depressed straight away. I was under antenatal mental health care the whole pregnancy. After birth that support stopped and I got hypomanic for couple of months and then mixed. I ended up to hospital and I also got psychotic symptoms. I was pretty unwell for several years and my diagnosis is now schitziaffective. I am on loads of medication but last couple of years I have been stable.

[Georgia324]

Hi @hylian I'm sorry you had a difficult time as a child. It's not easy for kids though I do think there's a huge range. I have BP2 so luckily have never lost touch with reality or been scary in that way. You may not want to share your own experience but I'd be really interested to hear what you saw, heard and felt as a result of one of your parents having bipolar, so I can work to ensure I do the best for my son, whether or not I have a second.

[Georgia324]

Hi @Rudeface thank you for sharing your own experience. It sounds extremely difficult, certainly the second time round. How are your two children now that you're stable? I'm glad you've found the right meds mix to keep you stable. I guess it shows there's so much variance in individual experiences- some are fine first time and bad the second, and others vice versa. Would you say you did anything differently with meds / aftercare?

[hylian]

@Georgia324 I'm not sure me sharing that will be particularly helpful to your situation, because as you say, you are a different person. I also don't really like to ' air my laundry' online as it were, and it's about you.

You know yourself how bad you are when you are unwell and what the risks are for you potentially caring for children. Realistically, with this diagnosis, you are very unlikely to be well for the next 18 years. That's a long time. You will most likely have periods of illness again before your child/ children are adults.

You already have one child, so really you just need to think about how things are/ have been over the last 2.5 years, how you cope when you are unwell, and whether you want to add another child into the mix.

What is the plan be for your children if you were to get unwell again for a sustained period? Would their dad be able to manage?

As hard as it is, I think you do just need to think about these things. Think about the worst case scenario e.g. if you are ill for 10 months again or longer - because you could be. What would happen and what impact would it have on you, the children, and your husband?

I am not trying to put you off, but it's just important that you understand yourself and that you have a plan.

[Georgia324]

Hi @hylian you are quite right, sorry that I asked the question. You've given me a lot of food for thought, which I will take into my preconception appointment with the perinatal psych. It's not just about the perinatal period; it's the forever that follows. Thank you again; if I'm honest it's not what I wanted to hear - but it's definitely what I needed to hear.

[hylian]

@Georgia324 Not at all - there is nohing to apologise for :)

I wish you all the best whatever you decide... bipolar is not a fun thing to be living with.

[Georgia324]

@hylian the challenge is, it can be extremely fun at times, but not in a way that induces long term happiness!

[Georgia324]

@Sweetladyjane do you mind my asking how you find parenting two children with a bipolar diagnosis vs having one child?

[Sweetladyjane]

@Georgia324

@Sweetladyjane do you mind my asking how you find parenting two children with a bipolar diagnosis vs having one child?

I’m not going to lie - I needed a lot of support at the beginning and formula fed so their dad could do the night feeds. I found it was important to my mental health to prioritise sleep and also getting some alone time so I’d either walk the dogs or go upstairs and have a long bath to clear my head. I also had very supportive in laws who would take the children for an hour or two if I needed them to.

It’s gotten easier as they’ve got older (both teens now) and are at school. I’m a single parent now so I’ve had to prioritise routine and schedule so that I don’t get too stressed / overwhelmed. I also only work 15 hours a week spread over three days so I’m not overdoing it.

I would say that you need to look at how much support you’d get with night feeds and giving you a break alongside what you’d get from the mental health team.

I was really scared when I found out I was pregnant with my second but because I knew what to expect and had lots of honest conversations about what I’d struggle with and what support I might need it was manageable and whilst I did experience symptoms after the birth it wasn’t as bad as first time around because the support was already in place to catch me.

[Georgia324]

Thank you @Sweetladyjane , this is really, really helpful. Sleep, routine, me-time & stress management are all huge elements of my wellness plan and have become even more important (and even more elusive at times) with a child.

After reading your message I wrote down all the things that would be different next time round, if we decided to go ahead and TTC.

We actually had a lot of help from my in-laws but where I didn't have much help was my husband for a couple of reasons that I won't bore you with - but that, I know, would not be the case again.

I would be on an anti manic medication, which I wasn't last time (I was on lamotrigine and an SSRI). I would have a list of things to watch out for in hypomania (rather than revelling in having a wild sex drive post partum...as an example...).

I would formula feed exclusively (for sleep & because I expect to be on lithium). I would ask to see the MH team more frequently.

One final Q (I promise): for how long were you stable on your meds regimen before TTC your second?

Thank you again

[Georgia324]

Do I sound obsessive much?

[Sweetladyjane]

Sorry, I just realised I didn’t reply to your last question. DC was conceived quick quickly after DC1 (we thought it would take awhile but I got pregnant the first month of trying) so there’s only 18 months between them. I was stable on my medication and they made a few tweaks whilst I was pregnant then upped them when I was post partum.

[Georgia324]

Thank you for sharing

[Lochness1975]

Hi OP I have bipolar 2, and have two children 23 and 18. As we know it affects people differently, I was very lucky, both pregnancies and after delivery I never had any bipolar symptoms, no depression, no hypomania. Routine and plenty of sleep worked for me.
have you spoke with your care team
about your plans? X

[Georgia324]

Thanks @Lochness1975. We saw the perinatal psychiatrist last Friday who treated me during my first pregnancy and postpartum. He's given some useful info - we have decided to stay on meds as a result - and we have some additional Q's to email him. He said he will have a follow up call with us. Broadly questions / requests focus on sleep:

• we will save up for a night nurse 3 nights a week (estimate £7k )
• if i have to deliver early for physical health reasons like last time I want an elective c-section not an induction (mine took 4 nights and days of little sleep)
• i need to write a full care plan and symptoms to look out for & actions to mitigate, with my husband
• this includes being on a higher dose of lithium postpartum to stop hypomania / mixed episode.