It’s a boy/girl/alien/I can’t relate/guilt/aaaaaah

Firstly, I talk a tiny bit about sexual abuse in this post so please don’t read on if you think it might be too much for you. Not much as I am banned from thinking about it by my psychologist! but it very much relates to what I want to write about today.

And sorry it has been a little while since my last post. Somehow water got into my laptop and it wouldn’t work for a while. As with the miracles of technology here it is up and running again!

I have had time to think about what to write about next. As ever, so many words and so many ideas and limited space to write about it. I’ve also been extremely tired these last few days and had an unwelcome return to hg, along with a dip in my thyorid so it’s been a bit of a trying time.

What has been on my mind though throughout this is my baby. You may well think ‘well durrrrr, it’s inside you, how can you not think about it’ but really, it’s surprisingly easy to distance yourself in your head from what is happening to your body. I mean, people do it all the time if they are over/underweight etc. So even though your belly looks like Mt Versuvius, the baby’s kicking you in the bladder in the middle of the night and you get out of breath after walking 5 paces, still it doesn’t feel real.

Something that has been real, however, has been finding out that it’s a girl. As some of you know, I was abused by our (female) housekeeper as a child from the age of 3-6. Basically as soon as she could get me on her own once my mum left my dad. So, no detail here on what happened as it isn’t relevant (and as said, I’m not allowed to think about it). Also it had the knock on effect of making my relationship with my mother even worse.

Mum engages in what DH describes as ‘psychological warfare’ which, for me with bipolar and resulting Borderline Personality Disorder traits from the abuse, meant we did not have a happy time of it with each other growing up. Mum has an ambivalent relationship with women doesn’t like them but is attentive to men to the point of fawning all over them. So I grew up with that.

Before you think she’s an evil bitch, no she isn’t. She is damaged in her own way, but the problem is she can’t see what she is like because no one has ever told her. As soon as this twigged with me it was easier to deal with. I got an education and I got out. After spending most of my 20s trying to please her, it wasn’t until I met DH and started to really understand me as a person and my illness that I could stop the guilt of never being good enough and begin to get angry about what happened, and start to heal myself.

So, this is not about the woes between me and my mum or my abuse. It’s about the impact this had on me finding out we were having a girl. I was at first elated, and then terrified. The fear was awful. And memories of my abuse resurfaced.

Before finding out the sex of our baby at 20 weeks, I was convinced it was a boy. I don’t know why. I just didn’t want to think of it being a girl. Part of me also wanted a mini-me of DH :) but a large part of me didn’t want to think of what it would be like, or what I’d have to face up to, if it was a girl. Which was very funny as I knew DH wanted a girl and before falling pregnant we thought it would be a girl we’d want first. We even had the name ready.

When confronted with the ‘it’s a girl’ news I then went into hibernation in my brain. I was listening to hypnotherapy cds telling you to bond with your baby and all I got was a white, blank wall. I got flashbacks of what happened to me when I was little. I thought of the misery I had growing up and as a teenager. And I was just plain scared.

I hadn’t seen my psychologist for a while so DH made me call her to make an appointment. It was such a relief to talk to someone about it and she immediately asked how I felt having a girl. Being able to share my fears about my daughter going through exactly what I went through was a relief.

Firstly, I now know rationally that I won’t be an abuser myself. The idea makes me want to puke. But there’s that tiny seed in your mind that has read online that those who are abused turned into abusers. Even writing this freaks me out a bit. Fortunately my psychiatrist said that was not the case and just the fact that I found it abhorrent meant that I would be ok. There’s also that fear that other people will think you’re abusing your child. I still  have that a bit but DH has told me that I’m being ridiculous. All this irrational stuff that I think I know is now irrational and will be ok.

The other thing is other people abusing your child. I know that the majority of kids never experience this. I know though that abuse is hidden and happens far more than we realise. DH and I have talked about it and he says, very sensibly, that all we can do is educate her to look after herself and that she trusts us to come to us with anything. He points out that I never had that trust or stability at home so by providing a loving environment we can minimise the risk to her.

As for what happened between me and my mother, well I was terrified too of projecting onto her my own experiences. I think we try so hard not to be our parents anyway, but here I really was trying to go the opposite! I started to post on a few threads on Mumsnet that really helped. It was good to see that other women found having daughters very therapeutic in helping them get over their issues with daughters. It’s silly, I have close female friends and I know I don’t dislike women the way my mother does. What my psychologist and ladies online said was that having self awareness was half the battle in ensuring history doesn’t get repeated.

And I was told to not worry so much :) I felt soooooo guilty that I wasn’t some beaming earth mother. I felt like I had something growing in me that was so far removed from my sense of reality.

Interestingly, the memories of abuse returning coincided with my lithium levels dropping around the start of the year. Finding out I was having a girl was a trigger for memories I had ruthlessly repressed my whole life and boy were they buried deep. I was retreating back into my little world of doom scenarios, paranoia and clawing blackness. This was punctuated by memories that left me feeling like I’d been punched in the gut. I was so paralysed sometimes I couldn’t move. AND the hormones of pregnancy meant I felt emotionally all over the place and wasn’t

Fortunately my psychiatrist bullied me into taking more lithium. As my levels started to rise again, so my control returned over my memories. I developed techniques with my psychologist to distract myself when the thoughts of abuse came back. Every time I would associate an action I’d do with my baby with abuse, I would think of all the positives and doing things with DH rather than the fact that act had led to my situation. Or, I just think to myself ‘I’ll deal with it when it happens’. It’s very dangerous to have psychotherapy when pregnant – it’s not allowed. So during this time I have to distract myself until I can deal with these new memories at an appropriate time.

I’m much more in control now. I’m doing pregnancy yoga more and find myself finally getting more excited about having a baby. I couldn’t relate to it for ages and ages. But now she’s kicking and moving around it’s easier (and scarier haha) to think ‘wow I’m having a girl’. I can’t wait to cuddle her and tell her how much I love her. I can’t wait to tell her how wanted she is. I send those thoughts to her all the time and DH talks to my belly telling her how excited he is to play with his baby girl in three months. I can’t wait to read to her some of my favourite books that were mine as a child, take her to absorb all the museums and galleries and just mooch around in summer looking at all the beautiful architecture and canals and clogs and stuff :)

Still scared. Still worried I’ll turn into my mum. But I don’t think that will happen. I will make mistakes. But what I will let my daughter know is that she is loved, wanted and will always have stability, safety and security with her parents. I never had that and if that’s what I can provide to her then to me that means more than all the playstations, clothes and toys in the world. Material counts for nothing – love and being loved is everything.

Hyperemesis and bipolar. Lucky us!

Please note that I talk a little bit about a psychotic and self harm episode in this post, so don’t read on if it might cause any problems for your condition.

There’s so much I want to write about, so much I want to share, that I almost can’t get the thoughts out coherently to write something that is a) sensible and b) legible. But something that affected this pregnancy so badly has been on my mind.

Staring into the mirror today, I wanted to write about diet, exercise, pregnancy, bipolar, and all the links between it. This was inspired by the row of acne that had appeared seemingly overnight on a person who has never struggled with it ever before. But I want to have more of a think about that post as I firmly believe diet plays a HUGE part in having a negative impact on modern day living.

But not today because that requires thought and some good research to back up my theory.

I am thinking of depression today. I’m not feeling low emotionally; actually pregnancy and impending motherhood, combined with not having to drag myself to a job I hate every day, has meant I’m probably mentally the well-est I’ve ever been these last few weeks. It’s a lovely feeling. But I’m bone-gnawingly tired. It eats away at every single atom of my being. Pregnancy tired is like nothing I have ever experienced before.

Combine this with struggling with hyperemesis which, for the ease of writing I’m going to refer to as HG throughout the rest of this article, it’s been a massive hit of physically sick as a dog, mentally unable to think straight and exhaustion combined with insomnia.

So, what is HG quickly? It stands for Hyperemesis Gravidarum which is an extreme form of nausea and vomiting in pregnancy (NVP). NVP is very common, and around 70-80% of women will experience it in some form. With HG, however, it is relentless nausea and vomiting, with women experiencing sickness 10-12 times a day as normal and unable to keep any liquids or solids down. 1 in 100-150 women will need hospital admission as they are so severely dehydrated or malnourished.  Just to reiterate, that is NOT morning sickness! Morning sickness also subsides by around week 12 of pregnancy, whilst HG persists in varying forms throughout pregnancy and, sometimes, even after birth for a few weeks.

HG affects 1%-3% of women in pregnancy according to the excellent support network in the UK, Pregnancy Sickness Support. Think of all those women all round the world having babies – a quick Google says around 130 million a year – and then think, of that around 4 million are wrapped around a bucket for most of that time, unable to do much apart from suck on an ice cube.

I’m part of a thread on Mumsnet which has been a life saver. The wonderful women of the Hyperemesis thread, run by a quite marvellous mother hen who ensures there is always a support space for mums to be to hear from others and just have a moan. Other posters generously share wisdom on medication and what to do to get through to the somewhat pigheaded medical community what women need to do to get treatment.

It’s hard to explain the toll this has on you. Don’t be sucked into the marketing bullshit of pregnant women serenely eating lettuce and drinking smoothies whilst doing Tai Chi in Hyde Park on a misty morning, playing with their children and running marathons. I know you exist somewhere you lucky things, but it is not really like that when you have HG. You LOSE weight. I actually shrunk in my first trimester which was alarming enough. You cannot eat a thing. Your tastebuds change on a daily basis and I was devastated to not be able to enjoy a Ribena any more; it was like something had died in my mouth. The thought of going near toothpaste or a toothbrush is retch-inducing so you’re at risk of cavities due to no dental hygiene for several months. One poor woman tore a face muscle vomiting, another developed an abcess and several of us pulled stomach muscles with the force of our sickness.

And this goes on for pretty much NINE months. Some women are unmedicated. Doctors refuse to administer even the most basic antiemetics. I swear to god if one more person in my family had recommended ginger to me I was going to cut them out of my life. Women are told by supposed medical professionals to change their diets or buy sickness travelling bands, wtf???

There is a persistent lack of understanding that medicine is ok in pregnancy so long as it is monitored. There are horror stories of women being so sick that they are in hospital being advised to have an abortion because there is nothing safe to give them and their baby. Which is, quite frankly, rubbish.

I was very fortunate. Around eleven weeks I couldn’t cope any more and went to my GP who immediately prescribed me a front line, commonly used drug called Emesafene, essentially an antihistamine with vitamin B6 after checking it didn’t interact with my thyroid medication and lithium. Now, this is in the Netherlands so if you want to know what might work in your country or what to ask your doctor about there are the usual links below. Whilst I was working I took two a day and it just about powered me through the day, along with probably far too much diet Coke and Nutella sandwiches, along with sipping ice cold tap water (I went off bottled water!) which was all I could eat or drink. It didn’t really ease up until I stopped working and was able to properly rest.

What has any of this to do with bipolar or depression you may wonder? Well, consider the impact that has on your body. I’m one of the fortunate ones who a) got a GP who knew what to do and b) got medication that worked. You’re permanently feeling like you’re about to puke or doing the deed itself. Your body is very weak and you’re trying to at least keep down your pregnancy multivitamin so the baby develops ok. You’re off work and potentially with an unsympathetic employer so you are worrying about that. You’re unable to get out of bed or, if you’re lucky, you’re lying on the sofa, unable to see friends or family as you are in effect housebound. And chances are you have a GP who tells you to buy a packet of Ginger Nuts and you’re saving your precious energy stores to battle with them on your next visit to beg to even try some of the basic medication that is available and within the NICE guidelines. And you’re worried about the impact all of this has on your growing baby.

Stress + HG = high chance of prenatal depression. Prenatal or antenatal depression affects as many as 1 in 10 women. A dear friend of mine had it severely for most of her pregnancy. Recently we discussed on our thread how having hg was impacting on our moods. We all felt that we had been so low at several points, plus the stress of having to battle with the establishments both medical and work related, meant that most of us had had some form of depression at some point. This had taken its toll on partners and those inspiring women who were on baby no 2 or even 3 and had young children who were being impacted as well.

Stress + HG + bipolar = high chance of prenatal depression + serious chance of bipolar episode. I should know as I narrowly dodged this bullet.

Because of my bipolar and the fact I’d had a miscarriage, my very nice GP in all good faith referred me to my local hospital. Neither I nor she realised at the time that all my care would be transferred to the main university hospital in the city and be led by the perinatal psychiatric team. I’d gone to see her to get an increase in my thyroid medication which was duly done, and off I trotted to the local hospital expecting to be told I’d be scanned from around 8 weeks when there would be the best chance of seeing the foetal heartbeat. To my bemusement and slight fear/paranoia, I was told they wanted to see me immediately and I would be scanned from six weeks onwards. This totally freaked me out, and I didn’t know then that they had no experience of dealing with patients with psychosis or bipolar or any form of mental illness.

My scan at six weeks showed not much, but that all looked quite normal. My scan at 7 weeks was a different story. I had by this point seen the perinatal psychiatrist and been told I would be switching hospitals, but that there shouldn’t be any harm in going to the last planned scan in the meantime. How wrong we all were. I was told by the dumb bint calling herself a doctor that my lithium was just for my ‘mood’, my blood pressure was too high (I had just come off a flight from London after being away for a work event and had sat in the waiting room for an hour and a half as they were so delayed), and that my bowel was too full for her to see anything on the scan. She then went onto say that she couldn’t tell if it was a ‘good’ pregnancy, there had been no growth and that I should be prepared to miscarry and to come back in a week. Bye bye and out the door in 5 minutes DH and I were pushed.

To receive news like this when you are full of pregnancy hormones is horrendous enough for any woman. If you add to the mix the chances that person can have a major psychotic episode then it’s pretty devastating. I went home numb. I couldn’t sleep. And I started to hallucinate in the middle of the night, punching my middle as I wanted it ‘out of me’, that this ‘dead foetus’ was spreading intense black all throughout my body. I could feel it skittering over my skin like a million black bugs. It was enveloping me, choking me and I needed it gone. I was scratching at my arms, scratching at my stomach and fortunately hadn’t managed to hit myself that hard in the lower abdomen before sanity in the form of DH stopped me.

Thank my stars that DH woke up and sat with me for the rest of the night. Poor man had to deal with the news himself, as well as the fact that his wife was convinced she had been taken over by seeping black death.

We went back the next day as I wanted a pill to ‘get things going’ and have the black death out of my system. I was convinced the baby was not to be. The doctors refused to see me, said there had been slight growth and everything still looked on track to be fine, it was just too soon to see a heartbeat. I stood there in this reception area in floods of tears, unable to understand why people couldn’t make it all go away. So I refused to go back there and had received my appointment to see the specialist gynaecologists and thyroid experts at 13 weeks. I would wait until then. I managed to see my psychologist that day who calmed me down, and also my regular psychiatrist who both were wonderful and talked me around.

I decided that my body would tell me what was right and wrong. If it was not meant to be then I knew from painful heartbreaking previous experience what would happen. And that my body would take care of it. I hoped I hadn’t harmed it, and was creating elaborate schemes in my head to get back at the stupid consultant who had left me in such turmoil. Equally, if the baby was actually growing, then I would wait and see what my consultant had to say at the next appointment.

In the meantime, my HG kicked in. Massively. My GP whom I wept all over when prescribed my medication, couldn’t understand why I was so worried as they had, he felt, been wrong to scan me so early. The fact that I had such awful symptoms that were getting worse rather than better was, he said brightly, a good sign!

Those six weeks were the darkest things had been for me for a very long time. I had no idea if my baby was ok or what was in me. I could barely move without needing to be sick or experiencing such nausea. I couldn’t sleep properly in case my death demon came to visit me in the night so was exhausted. I had to drag myself into work, and then tell them, well before I was ready to do so as I was so sick. I hated everything, and mainly hated myself. And I didn’t want that negativity to be passed onto my baby. I was worried about my lithium impacting the foetus. I worried my thyroid would fail again and the baby wouldn’t be. Such anti energy. It’s not good for us.

Obviously things turned out fine. I cried the whole time waiting for the doctor and cried when DH explained what happened. Actually I cried all day and it didn’t sink in really that all was ok until I reached my 20 week scan and saw a normal, healthy baby. To this day I can’t look at the scan screen without looking at DH first for him to tell me it is ok.

First trimesters are the worst. They don’t have to be. There are so many women who are just in raptures about their baby and sail through pregnancy. But for us with HG it is a long, long road to nine months and pregnancy is terribly tough. We can’t wait to give birth and get our bodies back. For those of us with bipolar as well, we can’t wait to be able to bring our brains back from the brink. I’ve teetered several times and it is only through the strength of my DH and finding fun things to focus on such as my dog that I’m still here.

Please don’t underestimate the impact of pregnancy sickness on your mental health. Make sure you go armed with information so you can get the medication you need to stop the vomiting. Taking care of yourself physically and mentally when pregnant must be your main focus. If that means stopping work like I did, then do so. Nothing is more important than being very, very nice to yourself. In the wise words of the Hypermesis Support ladies, this shall pass.

Links

Pregnancy Sickness Support

http://www.pregnancysicknesssupport.org.uk/

Pregnancy Sickness SOS

https://sites.google.com/site/pregnancysicknesssos/

PANDAS for pre and postnatal depression

http://www.pandasfoundation.org.uk/index.html

The big D and whether to come out or not?

I did do my yoga DVD yesterday which was fab. But again something that has been on my mind a huge amount (namely losing out to a job I KNOW I should have had) prompts me to write about this issue. I’ve pondered this a lot over the last few months since finding out I was pregnant. My bipolar diagnosis is relatively new to me, having only had around a year and a half to figure it out in my brain. Pregnancy and having a family are still in this day and age viewed with suspicion and mistrust by employers, with women so often having to play a game of do I tell, don’t I tell.

I’m an inherently honest person. I am crap at politics at work because if I don’t like someone or if I think something is not working I’ll say so. I’m no good at brown-nosing managers who suck just to get myself ahead. Fortunately it’s not often I have found myself in organisations that have those types of culture but where I have worked in them, I have struggled. If that’s they way you want to do things, then all power to you but it isn’t my way. I have found that people often don’t want to be upfront. Smoke and mirrors give me a headache. It’s not like that everywhere and I think it’s the norm to prove yourself with work rather than who you can flatter, but hey it takes all sorts to make the world go round. I’ve thrived in teams where managers and senior management have been upfront and willing to engage in good debate and take on board different views and opinions.

I’m very glad to date that I haven’t spoken out about my bipolar to previous employers though. I’ve developed a suspicion and mistrust which will take a while to be overcome, hopefully by being able to focus on what I’m good at as opposed to slaving away for peanuts just to make ends met. As for being pregnant, hyperemesis didn’t leave me with the opportunity. I had to say something as I was spending most of my time in the toilet.

To what D am I referring to then? it is, of course, DISCRIMINATION.

Personal stuff

I try very hard not to discriminate. I happily employed a pregnant lady as she was far and away the best at the job. I’d rather have someone brilliant for six months who will achieve so much than someone useless who will cost me money in the long run as they sit in that job for the next 10 years doing nothing. I try my hardest to be understanding about people who are under pressure and need time. Don’t take me for a ride and yes, there are business needs that should be met, but at the end of the day an understanding and supportive employer goes a long way to a happy employee who won’t take the piss. The majority of people are fab, let’s not forget this.

But oh boy, there are some awful attitudes out there.

My friend was asked whilst walking into an interview how many children she had and was she planning on getting pregnant. Another removed her wedding ring after one interviewer pointed at her finger saying she’d be off having babies soon (she’d already had two children!). Yet another dear friend continually had her bump referred to by her manager disparagingly and was excluded from projects throughout her pregnancy despite them supposedly coming under her team.

I am discriminated against because I am pregnant and no one wants to employ a pregnant woman. I could be discriminated against if I disclosed my bipolar disorder. I had never experienced much discrimination in the workplace or in life generally, aside from age perhaps a couple of times. Until I had my latest crash, where I was told I was suffering from depression pending a further psychiatric review. I was having a vile time at work with no support and when I told my boss I was diagnosed with depression and might need to take it easy for a bit, two weeks later I was out the door with a four month payout to make me stay away for good.

More recently, I knew my contract was coming to an end and wasn’t sure I wanted to carry on with the company anyway. I interviewed for, and got offered, another job. Because of my hyperemesis, combined with the fact that at that stage we didn’t know if the pregnancy was viable, I felt honour-bound to say I was 11 weeks pregnant but I wanted to accept the job. The job offer got withdrawn but I was told ‘well at least you know you were first choice but we can’t deal with the team upheaval’.

You’d think as well that women might be more supportive and understanding. But nope, just the examples listed above are a pretty even split between male and female.

Goes to show you can legislate as much as you like but it makes no difference.

It knocked my confidence to bits, particularly trying to be open about not being very well and then being taken to pieces and made out to be awful at what I did. The reality was they just didn’t want to deal with someone being mentally unstable or pregnant. It’s taken me to this point to recover from that and will take me a long time to trust again which is a bit sad. Maybe if we all trusted each other more then we wouldn’t be in such crisis.

Why didn’t I appeal which I could have done (particularly with the withdrawn job offer and just to say Dutch law is even stricter on this than UK law)? Because I don’t want to work somewhere like that in that kind of environment. I don’t want to be with people like that. I didn’t have the energy or the time or the inclination. Because I believe in a dignified silence and leaving on good terms. What good does it do me or my illness or my baby to get angry? My life is worth more than that. I also believe there are other ways of changing attitudes. Wider things I could be doing that are more positive. My health and keeping in balance are more important to me than dealing with these petty people. I also think their lives are all the poorer for it and a big believer in karma. She can be a real bitch sometimes. What goes around comes around.

And I am actually the most content and happiest I have ever been in my life right now.

Numbers

So, what are the statistics? Apparently in 2006 discrimination in the workplace against pregnant women amounted to 6.5% of all cases in the US. There are some stories that make my jaw drop such as http://www.nwlc.org/tags/pregnancy-discrimination-act and http://www.nwlc.org/our-blog/pregnancy-discrimination-far-thing-past from the National Women’s Law Center in the USA. In the UK the charity Maternity Action estimates that as many as 30,000 women are pushed out of work each year with a further 200,000 facing unfair treatment. Just for having a baby. Which surely must be the most natural thing in the world and kind of essential for survival of our species.

Let’s combine that with statistics of people living with a mental health illness. The fantastic campaign, Time to Change, in the UK, states that 1 in 4 people will have some form of mental illness in any given year. It’s not far off the 1 in 3 statistic for cancer. It’s a HUGE amount of people who experience some form of depression, illness or something else.

And 9 out of 10 people with a mental illness experience discrimination. 9 out of 10. Holy shit. I didn’t even realise it was that high.

So yes, the point of this thread – we face discrimination as pregnant ladies and we face discrimination because we all should be in the loony bin and are incapable of working. No matter all it needs is a bit of compassion, understanding and flexibility. I hate to say it but there it is. We’ve got a double whammy going here.

So what do I DO about it then!

And we wonder why people don’t talk about it. Reading those numbers kind of makes me a bit mad. Who knows about my bipolar disorder? My family and close friends. I’ve never ‘come out’ about it. I feel a bit of a fraud and I’m working up to just being able to link this blog on Facebook.

Another part of me wonders why the hell I should. I am me, I’m not a patient. It is no-one else’s business apart from mine and why should it matter? It is an intensely personal issue, actually, as is the matter of pregnancy and starting a family. But I don’t think as a society we are there yet.

When economics comes into the equation, however, this is where things get skewed. I could write all day about how much money and finances and the way our world is structured is responsible for so much social evil today but that’s a whole different blog let alone post! Let’s just leave it at some people only see numbers and the bottom line whilst others see beyond that to the potential. Bit like oil and water when I’ve encountered this at work.

I think all we can do, and I am only at the start of this journey, is to be open and up front. Write about it, educate people about it. Education is key to changing attitudes. I don’t really have the answer but I know I want to do more to change attitudes. I LOVE Stephen Fry, for example, for being so open and making such candid programmes about bipolar disorder. I don’t think people realise how much it costs him to talk about these things sometimes and he is my hero for doing so.

I will revisit this again when I get more inspiration. But there are lots of wonderful people out there doing their best to change attitudes. I will make a list soon to share. Let’s take heat that it isn’t all doom and gloom either. Lots of people are fantastic and lovely and wonderful.

You may well see me soon out and proud. I think I  might judiciously prune some people from Facebook and share this blog.

Links

Maternity Action

http://www.maternityaction.org.uk/wp/2013/12/overdue-a-plan-of-action-to-tackle-pregnancy-discrimination-now/

MIND

http://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/ and I am wondering about finding out some more about the Dutch stats too (just need to get a translator aka DH!).

Time to Change campaign

http://www.time-to-change.org.uk/

‘Self-care can be first step in #mentalhealth care’

demonicdivas:

This. I need to write about this some more as well (I’m getting such a list of things to write about now). If we don’t take charge of ourselves then what choices do we have left?

Originally posted on Mentally Wealthy:

When seeking care for a mental health concern, doctors at Baylor College of Medicine say there are important steps you can take even before your consultation.

According to Dr. Sanjay Mathew…… (read on)

https://www.bcm.edu/news/psychiatry-and-behavior/self-care-can-be-first-step-in-mental-health

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My baby will be damaged blah blah blah

I was going to write about something else today, but it requires me putting on my new yoga dvd and actually doing it. I’m a bit too comfy on the sofa to have gotten around to that so far! I was looking through images for my page to make it a bit more attractive (expect to see many theme changes over the coming weeks as I have a playaround), and I saw so many pictures of bumps and pills it really got me thinking about medication and bipolar. It also is helping me build up to a big post around the psychology of trying to conceive which I hope to write about soon.

But in the meantime, here’s the question of the day – how much harm do bipolar medications do to the conception process and the unborn baby? As ever, links to relevant articles will be at the bottom of this blog.

For many, many years, women with bipolar disorder were told not to have children. It was too dangerous, the risks were through the roof, we would pass this onto our kids, they would be blighted forever with cardiac issues, psychological issues, we wouldn’t be able to look after them…..the list goes on.

Fortunately, we live in more enlightened times where a woman has more control over her decisions and her own body. We aren’t treated like idiots because we have a mental illness. Ergo, we can choose whether we feel able to manage the rigours of family and child rearing and, in that process, whether we decide to stay on medication or not. I can only share things from my own personal experience (and please note that I’m not a doctor so it’s all what I have been advised/experienced/read up about), but thought I would tackle this in a two-phase article; before pregnancy and during pregnancy.

Before I begin, just to put my medication into perspective. I live in a country which gives out paracetamol as a cure all for every illness and to get any extra medication is a big, big deal. The Dutch are big on self-help, medical intervention only where absolutely necessary, and not medicating unless it’s super serious, much to the horror of us expats who move here. I used to long for Boots and Superdrug where I could get something to fix any ailment I had over the counter, My poor DH, for example, had bad tonsillitis for two weeks and was told to go home and it wasn’t until he went spotty with a rash all over  his body that they finally gave out antibiotics. It took me a LONG time to get medication for my thyroid as well which was more frustrating as that I found more debilitating than the bipolar in some regards.

On the flip side, however, I am glad I am not on a huge drug regime. I was very reluctant to take anything and am glad I finally gave in and tried the lithium out. I have responded very well to it and, fortunately, have only had one psychotic episode which we were able to control without drugs since. I will talk about that another time though!

Pre-pregnancy

I could look at this in two ways but actually they all end up as a positive. At the time, I was on 600mg of Camcolit (lithium) a day. I’m definitely a ‘low dose’ kind of girl. When they increased me to 800mg I was sick as a dog and it made all my bipolar symptoms worse. I spent a week shivering at my desk convinced the whole office was out to get me!

I am pretty sure this accelerated my thyroid collapse. Now, all my research and speaking to my doctors told me that lithium wouldn’t cause miscarriages or make me infertile. On the contrary, as my moods were more stable so were my hormones, freeing up my body to focus on producing the right hormones at the right time and bringing me more into balance.

As for my thyroid, I really really need to do a long old post on this. But I firmly believe this is the reason that my miscarriage happened and why I struggled to conceive for so long. How else can I explain when, being put onto 125mg of levothyroxine, I was then testing positive six weeks later? I had made life changes as well, such as going gluten-free (again I will explore this later), and being generally more positive and happier. I had also done a lot of positive thinking exercises which again I will write about later. Given that I live with something that affects my mind, I am a strong believer in what the brain can do!

I should also comment that I didn’t discuss really with my doctors that I wanted to get pregnant. The scant advice I have read for women wanting to start a family with bipolar is to talk to your psychiatrist or GP. My care team certainly knew I was ttc, but I didn’t get any extra advice apart from that they would need to do more blood tests and I would be referred to the perinatal psychiatric services at the main hospital here. I suppose I should have taken their lack of concerned-ness as a positive sign that they weren’t phased at my wishes to have a family and if they thought there would have been any issues then it would have arisen.

What they did say after my miscarriage was that my thyroid would have played a part. So again, there you go. I can’t emphasise enough how important it is to keep an eye on those TSH and T4 levels if you want a successful pregnancy.

So, did taking lithium affect my conception chances? It’s a resounding NO.

Pregnancy

Now, this is where there is a ton of advice. And a lot of it I think VERY scary and intimidating and unnecessarily so. I feel so fortunate to be in such a no-nonsense country. I have stayed on my lithium and confess to gibbering with fear at every scan, terrified that I’m going to see a problem with my baby’s heart. That is the largest risk factor with taking lithium and one that was, until very recently, considered very high risk.

But why continue with medication? Well, mainly to stop another episode. We have to have ourselves in balance to deliver a healthy baby to the world. There’s also a 1:4 risk of postpartum psychosis immediately after the birth. There’s also a 1:4 chance of postnatal depression. So yep, that works out that, of all the ladies with bipolar having babies and giving birth, there’s a whopping 50% chance of a serious episode right after the birth.

Recent research that came out (I think) of the Netherlands (yay) showed that the chances of the baby being affected by lithium were much lower than originally thought. They are, I have been told, 1:2,000 which is less than 1%. My consultant also said he’d never seen a baby with the heart defect in all his years of practice and he must be in his sixties. So I felt pretty secure in taking it. I was actually more worried about my thyroid not working properly so I was very careful about taking that little pill every morning and following the instructions to the letter.

What I found funny was that the NHS do not recommend taking lithium in pregnancy which really surprised me. How can drug regulation and guidance be so completely different from country to country in the EU? But that’s a blog article for another day….

My medication got spread out so I had to take 200mg 3 times a day at regular intervals. It helped as the lithium dosage needed to be spread evenly so as not to cause a spike, which would have more impact on the growing foetus. I had blood tests every four weeks to monitor both thyroid and lithium and regular checks for liver, glucose, antibodies, and I have no idea what! For my first two rounds of blood tests they took 8 vials. For someone who hates needles this was really quite a trauma, particularly when you have a noob nurse digging around in your arm saying there’s no vein when you know that’s your ‘good’ arm!

Anyway…..

Basically, what happens in pregnancy is that as your volume of liquid goes up (so far I have gained 14 kilo, sadface), so the effectiveness of your lithium goes down as it decreases in strength in your bloodstream. We have to maintain a steady supply of lithium above 0.4 for it to be within the clinical treatment range. I’m going to talk about depression and pregnancy and hyperemesis in another post, but suffice to say it is horrible. I couldn’t do anything but focus on keeping a bit of water down. Around Christmas much to my relief my work contract finished and I was able to rest and recover from the hyperemesis. Except I was still very down. I was very frantic, I was very anxious. I was filled with nervous energy and no outlet for it. I hated EVERYTHING. Nothing was good enough. I wasn’t good enough. I had doom scenarios in my head, and would go from A-Z in less than a second, convinced everything was going wrong. I started behaving erratically again. I was convinced every man and his dog were out to get me. DH was beside himself with worry. And I was suicidal. These were such unwelcome emotions that I hadn’t experienced for over a year, I was devastated. And I was powerless to stop them.

Some part of my brain acknowledged that possibly maybe my lithium might be a bit low. It wasn’t until my later round of blood tests showed that it was at a paltry 0.2 in my bloodstream that I realised where it was all coming from. Reluctantly I agreed to an increase of lithium to 800mg a day, taken 4 times a day in 200mg doses. After all, I had read about the devastating effect of lithium on babies, right? Awful stuff. Why would I pollute myself with that?

I saw the head psychiatric honcho at the hospital who made me cry he was so nice. He said that the hormones in my body, namely the stress hormone cortisol, would have such a negative impact on my foetus, far more damaging than taking lithium, He said it was important to keep me in balance so the baby would be able to grow and thrive. They couldn’t do that unless I took my medication.

That was three weeks ago. Lithium count is now 0.35 and I am a different person. DH said it was like night and day again and was so glad to have me back. My liver is doing strange things but apparently that’s just because it is working harder to process the extra lithium.

So, is it worth it, this drug taking whilst pregnant? 

Yes, 100%. I wish I could advise on other types of drugs as I know there are many that aren’t safe. Particularly some of the anti-psychotics. But what I can say is that lithium is working well for me and I’m so glad because to be back in my black space was beyond awful.

This is already a bit long, but I am going to do a separate piece on the risks of lithium compared to other things during pregnancy. You have to do what feels right for you. Be guided by your doctors but also by your own instincts. Do you want to go to those crazy highs and crushing lows during pregnancy? We are at such risk and, if like me, you are already super protective of the growing life inside you, you’ll do anything to make sure your baby is ok.

So go with it. Don’t google stuff. Don’t feel pressured by idiots who get all sniffy at you taking medicine. Or your family. Or anyone who is basically uneducated about bipolar which would be (sadly) the vast majority of the world’s population. Do what is right for you. If you think you can manage without medicine then great, go for it. But don’t feel bad if you keep taking your pills.

Links

Bipolar UK – pregnancy leaflet

http://www.bipolaruk.org.uk/assets/uploads/documents/information_leaflets/bipolar_uk_bipolar_disorder_pregnancy_childbirth.pdf

OTIS – Lithium and pregnancy

http://www.mothertobaby.org/files/lithium.pdf

National Alliance on Mental Illness – Managing pregnancy and bipolar disorder

http://www.nami.org/Template.cfm?Section=bipolar_disorder&template=/ContentManagement/ContentDisplay.cfm&ContentID=17899

National Center for Biotechnology Information - Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies.

http://www.ncbi.nlm.nih.gov/pubmed/22000820

Link

Getting pregnant with Bipolar disorder

I’m playing catch up with my blog a bit! I wanted to start as soon as I fell pregnant but horrendous hyperemesis prevented me from doing that. So the next few posts are all a run up to current day.

I wanted to write a post about ‘is it possible to get pregnant’. More technical stuff will come, but for now I’ll share my personal journey. I struggled with unexplained infertility and for a long time was convinced it was my bipolar. The literature touched on the link between mood disorders and infertility but almost overwhelmingly looked at what happened once conception had taken place. How much does our illness impact on the whole baby making thing?

When we first started trying to conceive, I had no idea I was struggling with a mental illness. I had been on the Pill since I was fifteen, and came off the pill just before my first marriage in 2010 as I thought it was the natural progression of my then relationship (thank the Lord for no pregnancies with my first husband!).

I then met now DH and after a few mishaps with the morning after pill decided to have a copper coil fitted. It was horrible, terrible and never again. It was only in for about four months as I just didn’t get on with it.  And by then, of course, DH and I were so in love we didn’t want to wait starting a family.

I fully acknowledge I had NO CLUE about conception. I thought I was a well educated woman, who knew her body. Clearly I did not as it took many many months of trying before I even started to Google how to optimise timing of sex to catch that elusive egg.

I also had a full blown depressive episode straight off the back of my manic phase. I was convinced I would never become a mother. This was also exacerbated by the fact that I was so depressed I couldn’t make any sense of the numbers I was reading or the statistics. I couldn’t quite get into my head that, yes, there was an increased risk of infertility due to all the hormones charging around but, hang on a minute, it’s not quite the doom scenario that was in my head. I could only replay the doom scenario in my head. 

On top of that, I was in a job I hated and which bored me, and all I could think of was the driving need to make money of any sort to try and pay off the enormous debts I’d run up in my last manic phase. I also was overweight as my weight is like a yo yo with bipolar. In my manic phase I had turned anorexic and stopped eating for four months. And then of course had started to eat and eat in my depressive phase.  I was convinced I was too old, too fat, too ill and too crap to ever ‘deserve’ to get pregnant.

In the meantime, I started to get into the referral system for psychiatric assessment in the Netherlands. It was taking months and months, but I was finally beginning to receive treatment. By the end of 2012 I was sat in front of my psychiatrist looking at blood test results, being told about lithium and the impact on my thyroid and health, how I definitely had bipolar 1 with borderline personality traits, how I would live with this for the rest of my life and be medicated for the rest of my life.  Everything was just a blur. I felt a bit like a machine being told what I could and couldn’t do. And all that was screaming in my mind was that I wasn’t ‘normal’, I would never get pregnant and I would never ever have a chance to be as others could.

DH took me home and I cried and cried. The next day, I started to research bipolar and fertility. According to my doctors, stress and anxiety produce hormones that repress our fertility. One article from 2011 shows that women with Bipolar 1 were 16% less likely to have children. (there are links to articles at the bottom of this post for interest).  Another great article from the European Society of Human Reproduction and Embryology from 2006 that reviewed published research showed that it was a complex relationship between infertility and mood disorders but that one definitely existed.

What frustrated me though was that there was nothing about what you could DO about it. Putting my illness to one side, I am a firm believer in DOING rather than just talking about it. I wanted some answers on what I could do to improve the situation. I wanted to change where I was. If I was never going to be a mother then I damn well wanted to be sure I had tried everything in my power to time it properly.

And then boom! in February we were pregnant. As I said in my last post, this ended in miscarriage and made me so unwell. I won’t write about it here. Perhaps I will write about that one day, my little bean. But not for here.

Fortunately for me, I had a series of blood tests a few days before I miscarried which showed that my thyroid had gone through the roof. My TSH and T4 were all over the place. Now, as you know, taking lithium and other mood stabilisers/anti psychotics can cause hypothyroidism or other issues with your thyroid.

I’m going to write a separate post on the thyroid as I think it’s so important. I comment on Mumsnet quite regularly and every time I see a thyroid post I’m in there writing! We will look at this on another occasion but ladies (and gents) it is so important to keep getting this checked.

Anyway, back to the timeline. By June 2013 DH and I had gone for fertility testing and the results had come back all positive. There was nothing wrong with either of us that meant we couldn’t conceive. This was a big mental block removed for us both as DH was convinced his sperm were failures and I was convinced my ovaries and eggs were useless and my body and brain in general were rubbish (more on psychology later).

Come July 2013, I was so sick I could barely get out of bed. I was exhausted, depressed but with a low depression different to the black of my bipolar. Just like a low level bzzzzz. I was freezing cold in the middle of summer and my weight had ballooned. Nothing fitted me. I couldn’t stay awake at work and I was struggling to drive. I thought I was going mad. My psychiatrist was convinced it wasn’t bipolar and sent me for another round of blood tests.

I got a call the day I tested. Your TSH is at 40. Ten times (I think)  what it’s meant to be. Your T4 is too low. You need to get to your GP straight away.

This time round I was relieved. Here was something tangible that explained what was going on (more so than bipolar I don’t know why!). On the day of our wedding, I was in the doctor’s surgery receiving my prescription for levothyroxine. The change was immediate. I felt better, I had more energy, clothes fitted me. And within six weeks I tested positive again in October 2013. So far, so good.

Is it harder to get pregnant with bipolar disorder? We have an increased risk of infertility compared to women who don’t have this. There´s no getting round it. But, I think it´s only a slight increased risk. If you take the study in Sardinia, for example, where the researchers said statistically women with bipoler were 16% more likely to have infertility issues (I interpret this as 16% less likely to get preggo), then that still leaves us with a 84% chance of getting pregnant. It’s not 50/50 or even 75%. It’s actually pretty good statistically.

At the end of the day, nothing guarantees pregnancy. There are heartbreaking stories all over the web of women with unexplained infertility with no mental health illnesses who have miscarriage after miscarriage or who have never been able to get pregnant, of men who have literally no useful sperm.  Couples with five rounds of IVF trying desperately for their miracle baby. It´s too much of a random if, buts and maybes, the conception journey.

What you have to hang onto is that the vast majority of women do get pregnant. That´s what helped me. It might happen in a month, it might happen in three years, but it happens. Every day, every minute. The problem with the interwebs is that it doesn´t capture all the success stories every day. Don´t feel discouraged. Don´t feel disheartened. Bipolar is not an automatic ´no´ to pregnancy. Out of all the odds there, the 84% (so long as you have no other underlying fertility issues of course) is really pretty good.

I’m going to do some more research on all of the above, and also more on the ‘I have bipolar – how do I get pregnant‘ question. I know in my heart what worked for me, and I hope to share that with you all in time.

So, the upshot is - can you get pregnant with bipolar disorder? Yes, of course you can! Don´t get discouraged. Remain positive. Oh, I know it is hard. But please know that your bipolar disorder should not be an obstacle towards that much wanted family.

Links to the two articles

Fertility reduced in bipolar I disorder patients
By Mark Cowen
08 March 2011
Acta Psychiatr Scand 2011; 123: 283–289

http://www.medwirenews.com/47/91378/Psychiatry/Fertility_reduced_in_bipolar_I_disorder_patients_.html

Oxford Journals, Medicine, Human Reproduction Update, Volume 13, Issue 6, Pp. 607-616.

http://humupd.oxfordjournals.org/content/13/6/607.full

Beginning at the beginning – bipolar and pregnancy

Welcome firstly to the start of my blog. My aim is to write about bipolar, being a woman, pregnancy, fertility, all the assorted stuff that goes with it and ultimately becoming a mum and motherhood itself. When I decided with DH (darling husband, I’ll be using that term a ton) to start trying to conceive,  I was reading up on bipolar and pregnancy and what it meant. You know what, there was really bugger all available which was quite disheartening. My main source were women who were bipolar and already blogging. But it’s like a black hole out there for information so my hope is that you lovely ladies have a resource here to come to and ask questions of to find out more from each other.

A bit about me before I continue; I’m in my mid-30s, British by origin but lived all over the world. My current nesting place is in the Netherlands where my DH comes from. I was diagnosed here, and have received nothing but wonderful, wonderful care from the mental health teams here. It is a major factor in our deciding to stay in this country rather than move back to the UK. The system here hasn’t failed me yet, whilst in the UK I fell through the net on more occasions than I care to remember.

DH and I started trying to conceive around two and a half years ago. I was like many women, assuming all would be fine and I would fall pregnant straight away. How wrong I was. After numerous tests, researching desperately for some answers, I still wasn’t pregnant by the end of 2012. Then, a miracle seemed to occur and by February last year I tested positive. My life as I knew it ended five days after testing positive with a miscarriage. I will talk about that some other time, but suffice to say it was the end of my world. Fast forward through numerous tests and blood screenings and it emerged I had severe hypothyroidism in July 2013. Six weeks later, in October 2013 after being on medication for my thyroid I tested positive again. As I sit and type now I’m 23 weeks pregnant with a little girl and feeling her kick and move inside me is just awe inspiring. My life will change again in June when she arrives with us.

Just from those two paragraphs above will I hope come a wealth of information over the coming months and weeks from my experiences getting to this stage. And just think, there’s so much to share and discuss and the baby is not even here yet!

Thank you so much for reading and I look forward to hearing people’s comments and discussions in the future :)