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Episode 390

Brigid

In today’s episode, Brigid shares her experience with bipolar disorder and the challenges she faced in planning her first pregnancy. Brigid and her partner met with her psychiatrist to create an action plan regarding her medication before conception. Unfortunately her change in medication led to a hospital admission and months later, still determined to have a baby, she conceived while knowing that her medication may affect her baby’s heart. From preconception to postpartum, Brigid was supported and cared for by an exemplary healthcare team who guided her through an early labour scare at 28 weeks, gestational diabetes and preeclampsia. Sleep was a priority for her mental wellbeing in the first six weeks postpartum so a long hospital stay and family support ensured Brigid didn’t relapse in that high-risk period. We need to hear more stories like Brigid’s to reduce the stigma of mental health and medication and I have no doubt this episode will comfort those women currently navigating a mental health diagnosis and pregnancy.

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“I was diagnosed with bipolar when I was 16 after I had my first manic episode which was quite traumatic. I had a few manic episodes following that which led to hospitalisation which was quite confronting for myself and for my family. I was fortunate to get really good support from services in south west victoria and I’ve got a really strong and supporting family and friend network. The diagnosis was really overwhelming; growing up I had anxiety and I was treated for it in primary school.

“I have Bipolar 1 so I can have a manic episode where I present as a person that’s not like me; I’m erratic, I talk really quickly, and I don’t realise I’m unwell so there’s nowhere else for me to be aside from in hospital. I can also go into a deep depression that sometimes lasts for nine months. In saying that, when I’m on the right medication and eating well and exercising and checking in with myself, I go really well and lead a normal life; I work, I’ve got a partner and a baby. It can be challenging at times but there’s been many positives along the way as well.

“Two and a half years into our relationship, my partner and I started talking about having a baby. We saw my psychiatrist before we started trying to conceive because we wanted to protect my mental health. At that stage I’d been stable for five years; I hadn’t had a hospital admission during that time. Unfortunately the plan was that I had to slowly come off one medication and go on another and that process took a good four months. It was a very slow process as I had to come off two mood stabilisers and the lithium was tricky because there was a risk the baby could develop a heart defect or be completely fine; I decided to go off it and unfortunately I did end up in hospital after three weeks which was devastating, to be honest. My partner took me into hospital which was one of the hardest things we’ve ever been through….it was really challenging. I was there for a couple of weeks and having a baby was put on the backburner and that’s when we had to discuss whether it was feasible. After a few months I was back on track and we saw our psychiatrist and they said I could stay on lithium. I’d just have to be monitored really closely and so would our baby, especially his heart.

“Mental health and pregnancy was another hurdle and it was something we were all quite worried about. I was considered high risk because of my bipolar so at 12 weeks I was accepted onto the Continuity of Care programme and that was fantastic for us. They went above and beyond for us and checked in regularly. At my dating scan the baby had a low heart rate and my heart just sank. The doctor rang me that afternoon and said they wanted another ultrasound in a week’s time. We had to wait a week and I just felt so much guilt but luckily the next ultrasound was fine and everything looked good at the 12 weeks scan. At 20 weeks I needed an indepth scan at the Royal Women’s and I just felt sick because I knew if there was an issue it was going to be my fault. But the scan showed a perfect heart; there was absolutely nothing wrong.

“There wasn’t a lot of information on women who have bipolar and have been pregnant. But in sharing my story I’m helping someone else and that’s such a lovely feeling. I still felt very anxious and I had a few trips to ED over the slightest things but I got better as the pregnancy progressed. We’re very lucky with the services we have down here, I was always so welcomed and the maternity and mental health care teams were just phenomenal.

“With my psychiatrist and obstetric team, we planned a caesarean as I needed to be off lithium 12 hours prior to birth because it can become toxic to the baby, so it gave everyone a bit more control. But also, for myself and my partner, the whole process had been quite unsettling and it was nice to know that there weren’t going to be any unknowns. I was told that I wouldn’t feel any withdrawals from being off the lithium for that short amount of time.

“At 28 weeks I hit a kangaroo on my way to work so I went straight to maternity and they were doing CTG monitoring and they advised me to stay overnight in hospital. The next day I was having tightenings and the obstetrician who was on was quite concerned and they were becoming more frequent so the Head Obstetrician came in and discussed that I may need to be flown to Melbourne. I was flown to Melbourne which was petrifying and we were so concerned but after more monitoring and in-depth scans they assured me that everything was okay and I was discharged the next day.

“At 32 weeks I developed preeclampsia so I was in and out of hospital. I felt light-headed, I was sick and vomiting a lot and had no energy at all. I finished work a month early on advice from my team. I also had gestational diabetes so they moved my planned caesarean forward. That afternoon I went home from my appointment and I lay on the bed to have a nap and then got up to go to the bathroom and started losing all this clear fluid. I wasn’t really sure if it was my waters because I was 36+5 weeks but sure enough it kept coming. I was surprisingly calm, which is unlike me but I think I was just relieved that the baby was coming. I had a quick shower before we left home because I was insistent on washing my hair.

“We got to the maternity ward and they confirmed it was my amniotic fluid so the midwives started discussing the plan. I’d taken my lithium that morning but I hadn’t taken my evening dose which was fortunate. I had to wait a while for the caesarean team and I was contracting and they were getting more intense so towards the end the pain relief wasn’t doing much but I knew the spinal block was coming.

“When they finally lifted Harry out, I just burst into tears. It was the most beautiful moment of my life. We were able to stay together in recovery but Harry needed to be monitored very closely so he had to go to special care when I went back onto the ward. We were prepared for a NICU stay as we were warned in early pregnancy that he may have needed to be monitored.

“Breastfeeding wasn’t an option for me because I couldn’t breastfeed while on lithium. In postpartum I was at a high risk for relapse so the medication was important for my mental wellbeing. We also had an extended hospital stay so my sleep could be monitored because I was at risk of relapsing in the first six weeks, so we were really lucky and got amazing support. The midwives would take Harry at night so I could sleep and that really helped. I couldn’t take any medication to ease my milk supply as my team were worried it would interfere with my bipolar medications so I was quite engorged and while I had gotten my head around not being able to breastfeed, it was really challenging and upsetting when my milk came in. I felt confident and ready to go home. We had a plan in place that was discussed during my pregnancy but when it came to putting it into practice, I found it really hard. My partner and my mum did the night feeds so that my sleep could be protected and I was still on medication during those first six weeks to help me sleep and it was making me quite drowsy. I felt so guilty thatI wasn’t getting up to feed my baby but while I was lucky to have a really strong attachment to Harry, but I felt so bad that I couldn’t be his mum at night. I had to rethink things and tell myself that if I fed him at night, I could potentially relapse and what Harry really needs is a mentally well mum. I just felt so guilty.

“I’ve adjusted to motherhood well. It’s certainly had its challenges but I’m so blessed to be Harry’s mum. I’m back on my pre-pregnancy medication – sodium valproate and lithium – and I’m seeing the effects of that. I’m certainly emotional at times which was tricky to define whether it was normal new-mum emotions or related to my bipolar; I found that tricky. My maternal and child health nurses have been great at helping me define what’s normal emotionally in postpartum and I feel really supported and cared for by my psychiatrist and counsellor. They say it takes a village and it couldn’t be more true in our case; the medical support, family support and our beautiful friends have held us. They’ve helped us achieve our dream of having a little baby. “

Topics Discussed

bipolar, Continuity of care, gestational diabetes, One baby, Planned caesarean, Pre-eclampsia

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