Striking a delicate balance

One in 20 people has a mental illness, so it stands to reason that there areparents out there dealing with pregnancy, childbirth and child-rearing whilecoping with mental health problems. Mothers are particularly vulnerable andwomen taking medication must approach this particular journey with careIrish psychiatrists have become extremely supportive of womenwith mental health problems having children, which shows how far we've come

Conceiving and carrying a baby while taking Prozac and lithium was the only way that psychologist Lauren Slater could become a mother. She wanted a family, but needed drugs to balance her mood and prevent emotional suffering so intense that, at times, it prevented her from functioning normally.

Most women, when they become pregnant, shy away even from taking an aspirin, and Slater had all these protective instincts. Yet she knew that if she came off her drugs, the effects would be disastrous. So she did a web search and concluded that taking Prozac and lithium during pregnancy appeared to be safe. She decided to become pregnant, and tells her story in her memoir, Love Works Like This: Travels Through a Pregnant Year (Bloomsbury £9.99).

Doing a web search on the drugs you are taking is the best approach for women who want to become mothers, says Dr John Sheehan, a specialist in perinatal psychiatry at the Rotunda and the Mater hospitals in Dublin. Doctors can advise, but there are no black-and-white answers about the effects of psychiatric drugs on the foetus during pregnancy. Many drugs that have been used for decades appear to be safe, but since clinical trials on pregnant women are unethical, no one can be absolutely certain.

Coming off your drugs during the last four weeks of pregnancy is always a good idea, to prevent the baby suffering withdrawal symptoms at birth. The drugs can then be resumed following the birth. Dr Sheehan's advice: Consult a perinatal psychiatrist to discuss the issues before you become pregnant.

Ideally, women should be off drugs when they conceive and for the first trimester. Sometimes this is possible, and with careful monitoring and support, which can include learning alternative ways of handling their mental health problems.

Other women need to keep taking the tablets because their conditions are biochemical and recur without medication. Irish psychiatrists have become extremely supportive of women with mental health problems having children, which shows how far we've come. "The days of the asylums are long gone," says Dr Sheehan.

One in 20 adults has a mental illness of some kind. Many want to become parents - and they do. Fertility levels amongst women with schizophrenia are now the same as in the general population. Women with mood disorders such as depression and bipolar disorder (or "manic depression") are able to have children like anyone else. These women tend to be very "clued in" mothers, says Dr Sheehan. Their experiences of coping with mental health problems make them even more conscientious and aware of the demands of parenting, as well as being tuned in to the emotional needs of their children.

No one is immune from emotional distress. Pregnancy and new motherhood can place women at greater risk of developing psychiatric symptoms, says Dr Siobhan Barry, another psychiatrist who specialises in helping women cope with mental health problems during and after pregnancy. The normal five-week-old baby needs between six and 24 feeds a day. Fatigue and anxiety are common for new mothers. As Slater puts it; you have to learn to be "selfless".

"Babies want and need intensive attention, yet many Irish women get relatively little support. Women actually get less support when their babies are five to six weeks old than they do in the last trimester of pregnancy. Hormonal changes, combined with a lack of social supports, can lead to depression in many new mothers," says Dr Barry.

OFTEN, women are told that if they are going to take anti-depressants for post-natal depression, then they must give up breastfeeding. This trade-off worsens the depression for some breastfeeding mothers, because it makes them feel even more inadequate. In fact, mothers can continue to breastfeed while taking antidepressants, says Dr Barry.

She blames the media for falsely idealising motherhood as a time that cocoons women in pink or blue bubbles of nurturing and love, oblivious to the hard work and anxiety that new motherhood tends to bring. Having a baby is a demanding choice that changes your life, affects your relationships, costs a fortune and limits your freedom. It's hard enough when you're in the full of your health.

Can a mentally ill woman be a good mother? "I still don't know the answer," writes Slater, "All I do know is that my life has been marked, and marred, by gaps of dysfunctions, times when I am, as they say, in hospital. In bed. Know this. You have a remarkably dedicated father. He will fill in. And I will always be there, even if I'm not there, even if I'm on some ward or in a crazy cloud, I won't forget you, Eve. I will come back to you. Always."

It's a brave approach. Some mothers, says Dr Barry, have had postnatal depression so severe that they have opted for sterilisation. Others are willing to walk over hot coals to have families, even if that means going through the painful process of coping with serious mental health challenges.

On balance, psychiatry has come a long way in supporting women like Slater.

If you have mental health issues and want to have a baby, there are people there to help you.

There is no stigma about this. Yet, often, women are afraid to admit that being pregnant, or having a beautiful new baby, is making them feel anxious or depressed. Women who have suffered infertility and had difficulty becoming pregnant, may get little sympathy from families and friends who keep telling them how lucky they are. Practical problems relating to housing or work can add to the stress.

Conflict in relationships with the baby's father or other family members may cause feelings of despair. Some women become so frightened in the last trimester of pregnancy, that they develop the symptoms of Post Traumatic Stress Syndrome, with sleep disturbance, intrusive memories and nightmares.

Whatever her problems, a lack of social support heightens a woman's risk of experiencing mental health problems during pregnancy and new motherhood.

Talk to your doctor about all this. Nobody is really alone, but to get help you have to ask for it.