Self-managing for two The challenge of childbirth for mothers with bipolar has been highlighted by Bipolar UK and national media over the past few months. Helen adds her own story. When I was diagnosed with bipolar disorder in my late teens, the only medication found to make any difference to the intense and destructive mood swings I experienced was lithium. I am enormously grateful that it enables me to remain relatively well. However I have always been aware of lithium's significant side effects, in particular its potential to cause birth defects. This became a bigger issue when my husband and I decided we would like to consider starting a family. Major upheavals Pregnancy and birth inevitably bring major upheavals and we realised that trying to manage these without lithium could be extremely problematic, especially as a previous attempt at withdrawal had resulted in me becoming so unwell that I required hospitalisation. In addition, I found out that my bipolar diagnosis meant I was already at increased risk of illness during pregnancy as well as puerperal psychosis, a severe form of postnatal depression. Coming off lithium, even for the first trimester, would not be an option for me. Our situation seemed so complicated that we tried to bury our parental feelings but even the large, affectionate dog we acquired couldn't fill the baby-shaped hole in our lives. In order to have a baby, I'd have to rely on a medication known to increase the risk of congenital abnormalities. It was a bitter pill to swallow. Lack of information We discussed how we might cope with a baby with a birth defect, or if I became very unwell during or after pregnancy. The lack of up-to-date information about staying on lithium whilst coming off the contraceptive pill was frustrating but we researched as carefully as we could. It took us a long time to conceive. So long that, when I woke up sick in the night, I assumed I had a stomach bug. An ultrasound scan confirmed I was nearly three months pregnant. From the very moment I saw my tiny bean-shaped baby on the screen I knew I didn't care if it was a boy or a girl as long as their heart had not been damaged by the medication. In addition to my expanding belly, I carried a huge emotional load which may be why I approached my pregnancy cautiously and pragmatically, rather than excitedly. I swallowed my lithium with multivitamins and fish oils, avoided substances I knew to be unhelpful to my mood, and tried to follow advice on healthy eating and gentle exercise. It was not an easy pregnancy, but for none of the bipolar-related reasons. I became anaemic and developed gestational diabetes. I was offered many additional medical appointments which I tried to view as stepping stones towards the baby we so longed for. These included checks on my physical and mental health, regular blood tests to allow for titration of my lithium and extra ultrasound scans. Self-management Nevertheless my mood remained stable. Since completing a Bipolar UK course several years previously, I had embraced the concept of self-management. I decided that as well as 'eating for two', I'd also 'self-manage for two'. I became aware of my triggers that may result in a mood change, identifying warning signs and using coping strategies. Some triggers were known: dealing with health professionals cause me to feel anxious. Others were exclusive to pregnancy, such as fearing morning sickness would prevent me keeping the lithium down. In addition to plenty of sleep and rest, making time for active relaxation each day was priority. I found meditation, swimming and antenatal yoga beneficial. I channelled my 'high' feelings into creative activities, setting myself strict time limits to prevent exhaustion. I ensured regular contact with friends and family, but allowed myself to avoid social situations I thought would be too stressful. Determined façade Experiencing such a challenging pregnancy took its toll on my usual good humour and I was impressed by any health professional to see through my determined facade to the vulnerable individual underneath. Dr Ian Jones, a special advisor to Bipolar UK, was an excellent source of information. Other professionals who seemed to understand well included a particularly perceptive psychologist and a reassuring health visitor. Not so helpful was the overbearing clinician who suggested I be admitted to a psychiatric hospital to stabilise my mood. Towards the end of my pregnancy, I became increasingly fatigued, both emotionally and physically. So discovering my baby was breech was a relief as it alleviated complicated birth decisions. It would be a caesarean section attended by a paediatric team able to provide immediate medical care to my baby, should it be required. My lithium levels would be monitored closely and hospital admission could be planned for. Advance directive Although my birth plan was short, I had written a comprehensive advice directive detailing signs I may be becoming unwell and my wishes in the event of postnatal depression or psychosis. My psychologist briefed the maternity ward staff on my bipolar and arranged for me to have a private room where my husband could stay. I decided not to breastfeed. Extreme tiredness can be a major trigger for me and bottle-feeding would mean Matt was able to share responsibility for feeds. The risk of further lithium passing to my baby would also be eliminated. Clean bill of health After such a nerve-wracking pregnancy, it somehow seemed fitting that our baby was born on Halloween. I remained calm by practicing hypnotherapy techniques. She was admitted to the special care unit for monitoring, as a precaution. Three months on, Josie is beautiful, bright-eyed and bouncy. Most importantly, she's been given a clean bill of health and I have remained well. I feel so grateful that we made the difficult decision to bring her into the world, despite everything. Throughout the long slow months of pregnancy, I felt as if I was holding my breath. Now I can finally breathe out, ready to face the next challenge motherhood will bring. Find out more information on bipolar, pregnancy and childbirth.