Having a mental illness does not have to stand in the way of having kids. Experts discuss top concerns they hear from parents and offer advice.

By Tonya Russell
October 14, 2020
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"Once an anorexic, always an anorexic," were the words a doctor told Lauren Giles and they fueled the anxiety that plagued her when she decided to start a family. That statement, as well as being 39, made her doubt she could carry a baby, much less have a healthy pregnancy. Despite being fully recovered from anorexia and purging disorder, fears of relapse loomed.

Mental illnesses are not rare, and they are certainly not new. Forty million Americans deal with anxiety disorders, and 17.3 million had at least one major depressive episode in 2017 alone. And while we know much more about mental illnesses now, there is still stigma attached to them. It's common for people like Giles to question whether or not to take the path of parenthood while dealing with a mental health diagnosis.

Experts say mental illness shouldn't stop you from wanting or having kids. They weigh in on common concerns those with a mental illness have about parenting and how to get through them.

Can I be a good parent?

This question is typically wrapped in stigma or first-hand experience. Many adults with mental illness have been raised by parents who were also suffering from one. According to the American Journal of Psychiatry, 20 to 45 percent of anxiety, OCD, and depression diagnoses have familial and heritable components, as well as 50 to 60 percent for alcohol dependence and anorexia nervosa. Some have been raised by parents who may or may not have been diagnosed but exhibited some of the most severe symptoms of their illness. It's easy to worry that your own children may be exposed to similar experiences that may have affected you growing up.

But managing a mental health condition is, of course, possible and can allow you to be the parent you want to be. "You are working to address what is holding you back, and finding healthy ways to cope with it," says Roseann Capanna-Hodge, Ed.D., LPC, BCN, who treats parents with mental health conditions. By seeking professional help, says Dr. Capanna-Hodge, problems can be addressed and treated. "You find a way to manage it, move beyond it, and not let it define you," she adds.

Will my symptoms get worse?

A Norwegian study found that women with symptoms of anorexia were five times more likely than the average woman to be dieting at 32 weeks pregnant. Having a relapse was one of Giles's biggest concerns, especially as her body began to change. "I would joke with my friends about how, in the first trimester, you don't have a cute pregnant bump yet, you're just fat," she says. "But as pregnancy progressed, I found myself actually feeling really good about my body."

Giles didn't have any major pregnancy complications, but she did suffer severe Braxton-Hicks contractions early on. She was forced to give up biking, her sport of choice, and switched to easy running before taking on yoga. It's not uncommon for someone battle an eating disorder to feel triggered after altering their activity, but that was not the case for Giles.

"I'm really happy to say that I didn't relapse at all during my pregnancy," she says. What helped? Therapy and finding a dietitian who specializes in eating disorders. Prior to finding one that was a fit, she stumbled upon people who were more interested in helping with her post-baby "snap back," rather than helping her strive for a healthy pregnancy.

"When I started seeing my registered dietitian, it was totally different," says Giles. "She put together a plan for me that accommodated my mostly-vegetarian diet and focused on whole foods, and she coached me on how to navigate changing my diet without obsessing about weight or calories." Once she was pregnant, Giles informed her OB-GYN of her mental health history, and she was never told how much she weighed. She credits having a knowledgeable team for her staying in her recovery.

Bottom line: Having a toolkit of positive coping mechanisms and working closely with medical professionals on a treatment plan can help reduce symptoms of mental health conditions. That's especially important for someone battling a condition that may have debilitating symptoms, such as bipolar disorder or schizophrenia. "If you are already struggling emotionally before a baby comes, that strain could potentially trigger a behavioral episode,” says Dr. Cappana-Hodge. Bring your therapist into the conversation, as well as a physician, to discuss how a baby may add to the ups and downs and how you can best work through it. 

Will medication harm the baby?

Christy Duan, M.D., a New York City-based psychiatrist explains that this question comes from shame, as most medications are safe to continue while pregnant. Drugs that could harm a fetus are typically not given to women of child-bearing age. "There's a common misconception that women shouldn't be on any medication during pregnancy, or that being on medication makes someone a bad mother. This is not true," says Dr. Duan. "Every situation is unique, and there are many valid reasons to choose medication."

Instead of succumbing to the guilt, she recommends that her clients recognize the need for radical self-care. The reason? "Untreated mental illness can affect your biochemistry, the development of your baby during pregnancy, and your baby's attachment once born." Any decisions regarding medication should be addressed with your prescriber and going off of them without guidance can lead to episodes of psychosis or severe depression.

If your prescriber is a primary care doctor, she often recommends also looping in one who specializes in perinatal or peripartum psychiatry. "These psychiatrists have experience working with women who are thinking about becoming pregnant, and women who are pregnant or postpartum. They can discuss the nuances of research with you when it comes to medications during each trimester and with breastfeeding. That way, you can make the most informed decision for your situation."

How will I take care of myself and a baby?

Parenting is unpredictable and will not be without challenges, but Dr. Cappana-Hodge recommends having a child care plan in place prior to giving birth. A support system can go a long way, as well as boundaries with that support system. Having a loved one who can step in can help with keeping necessary appointments like therapy sessions, or even getting through trying days.

Jessica Friedman, a mom, editor, and writer living in Australia, had a history of depression and trauma, and she took the initiative by attending group therapy and saw a psychiatrist while pregnant. Through those preventative measures, she learned valuable coping skills, like keeping a safe, quiet area of the house pristine, so that she could retreat if necessary. She was hopeful and excited, until news that her baby was breech changed her birth plan. Then after giving birth, her depression took a scary turn. "After six weeks of sleep deprivation, I crashed really hard," she says. "I went to the emergency room with suicidal ideations and was put on an antidepressant that got me back to about half-speed."

What came next was finding out that she had postpartum depression, which was treatment resistant. She endured a few years with daily panic attacks, sensory overload, and joint pain until she found a doctor to effectively treat her. Despite what she experienced and with the help of her husband, she had a healthy, happy baby who is now 8 years old. "I love my child, and I love being a parent."

Self-compassion is key, according to both Dr. Cappana-Hodge and Dr. Duan. Both experts also believe that a diagnosis should not deter anyone from having children. With proper treatment and a plan that works for you in place, taking care of yourself and your baby is possible.

"There are lots of things that we can do to support our own mental health, and more importantly, to protect the mental health of an unborn fetus long before it's even created," says Dr. Cappana-Hodge. "That's really powerful, and people don't know enough about that."

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