Poet Sherri Levine always wanted to have children, but she has bipolar disorder, which causes extreme mood swings, and her mother had it, too. Should she risk passing it on?

She takes lithium to manage her symptoms. Because of the risk of birth defects, it is not considered safe to take lithium during pregnancy, but she knows from hard experience that within two weeks of stopping her medication, she will become manic. The added stress of fluctuating hormones and her changing body will not help. 

Her doctor told her to let go of the motherhood dream. Her husband, who didn’t want children anyway, agreed, but Sherri was and still is devastated. “I don’t want to be an aunt; I want to be a mother,” she said, fighting tears. 

Why not adopt? Her husband didn’t want children, and she wasn’t sure she could deal with the stress of the adoption process.  

So the choice was made. People don’t understand, she says. If she agreed not to get pregnant, why is she still grieving?

I think a lot of us here know the answer to that question. When we close the door on parenting, we lose a dream, the life we had expected to have, the children and grandchildren we might have had, a chance to live like our friends and relatives, and the right to claim a rose on Mother’s Day. It’s what Jody Day calls “disenfranchised grief.” You’re losing something you never had, so our friends and co-workers find it hard to understand.

People don’t talk enough about mental illness and childlessness, Sherri says. We need to get the conversation going. Those living with it need the support not only of a team of doctors well-versed on the conditions, medications, and risks, but supportive friends and families who offer love and acceptance.

In doing a little research, I find most of the attention focused on depression during and after pregnancy, not so much about going into a pregnancy with a diagnosed mental illness, such as bipolar, schizophrenia, or depression. It’s a big deal. Many psychotropic medications can cause birth defects in the developing fetus, but not taking them and leaving the illness untreated can be dangerous for both mother and baby. In some cases, it may be possible to find drugs that are safe, but not always. Sherri has looked at other possibilities, but none would manage her illness as well as lithium does. She couldn’t take the chance.

Over the years, childless people I talked to have mentioned concerns about mental illness as a reason they didn’t have children. It’s not always the woman with the problem. Men can pass on genetic-based illnesses to their children. They may also feel that their illness makes them incapable of being good dads. 

A few things are clear:

1. It’s not just bipolar disorder. There are risks taking any kind of medication during pregnancy. Bipolar medications are particularly dangerous, but there are some drugs that seem to be a bit safer. Medications for depression and anxiety also may endanger the baby, and stopping them could endanger both mother and child. 
2. If you take prescription drugs for emotional issues, you need to confer with your mental health professional, OB-gyn, and primary care doctor about the pros and cons of pregnancy. You will need support from your partner, along with a team of people who really understand this stuff. 
3. Ask them: How dangerous is it for me to continue my meds? How dangerous is it to stop? Is there something else I can take that would be safer? Do you think I can handle the stress of pregnancy and childcare? 
4. Ask more than one professional. The answers are rarely black and white.

Have you or someone you know struggled with mental illness that became a factor in their decision about having children?  Were you/they concerned about medication and birth defects, passing the illness to their offspring, or being able to cope with the added stress of being parents? Let’s talk about this. Sherri Levine, who wrote about this topic here a few years ago, has offered her email address for people who want to talk privately with her about this. You can reach her at sherrihope68@gmail.com.

Some resources: 

Bipolar and Pregnant by Kristin K. Finn, 2007. This looks very helpful, although Amazon has only used copies.

Bipolar and Pregnant by Katie McDowell, 2017. It’s more of a memoir of a woman who did get pregnant shortly after her bipolar diagnosis. Looks good.

International Bipolar Foundation

Mayo Clinic symptoms and causes of bipolar disorder