Women with bipolar disorder and pregnancy: factors influencing their decision-making

Abstract

BackgroundWomen with bipolar disorder are at increased risk of having a severe episode of illness associated with childbirth.AimsTo explore the factors that influence the decision-making of women with bipolar disorder regarding pregnancy and childbirth.MethodQualitative study with a purposive sample of women with bipolar disorder considering pregnancy, or currently or previously pregnant, supplemented by data from an online forum. Data were analysed using thematic analysis.ResultsTwenty-one women with bipolar disorder from an NHS organisation were interviewed, and data were used from 50 women’s comments via the online forum of the UK’s national bipolar charity. The centrality of motherhood, social and economic contextual factors, stigma and fear were major themes. Within these themes, new findings included women considering an elective Caesarian section in an attempt to avoid the deleterious effects of a long labour and loss of sleep, or trying to avoid the risks of pregnancy altogether by means of adoption or surrogacy.ConclusionsThis study highlights the information needs of women with bipolar disorder, both pre-conception and when childbearing, and the need for improved training for all health professionals working with women with bipolar disorder of childbearing age to reduce stigmatising attitudes and increase knowledge of the evidence base on treatment in the perinatal period.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Perinatal mental health: a review of progress and challenges

“…There have been no trials, to our knowl‐edge, that have examined whether preconception mental health interventions improve distal maternal and infant outcomes, but there is a growing literature on what women with mental disorders would like from preconception care. Qualitative studies involving women with psychotic and mood disorders highlight their wish to receive non‐judgmental care, better family planning information from generic services, as well as information on adverse effects of medicines on foetal and infant development, on genetic risk to future children, and on risk of relapse if prophylactic treatment were to be stopped 155‐159 .…”

“…Women have also commented on previous traumatic experiences of being told not to get pregnant at all 155,156 . For most, if not all, women with severe mental illness, the centrality of motherhood in their lives is clear.…”

“…Women also expressed dislike of the terminology of “high risk”, which they found unhelpful and anxiety provoking 155 . Similarly, warnings about preconception health can be potentially damaging, reduce feelings of agency and choice, and at worst push women further into destructive practices.…”

“…Indeed, pregnancy planning could be a central part of recovery. Currently, the right to a family and optimizing medication for a future pregnancy may still be often met with discouragement or prohibition 155,157 .…”

Postpartum psychiatric disorders

“…Understand this stigma and the fear that women have regarding postpartum mood disorders is essential. The voices of women with postpartum mood disorders must be incorporated into the development of services to ensure the needs of women, their infants and families are met241,242 .…”