psychiatric medicine and breastfeeding

[objet_trouve]

(Did I put this in the right section?)

I met with my psychiatrist the other day and we discussed my desire to get pregnant. Knowing that my mom is a former La Leche League leader (and anti-vaccines, and a host of other not so popular ideas), she immediately started talking about breastfeeding.

I understand that the medicines I'm on could be bad for pregnancy and breastfeeding, which is why we're (me and my doctor) already making plans to go off of them for the pregnancy. I had assumed I'd be going off of them for breastfeeding as well (just seemed logical to me). But she was saying that it would be dangerous to not go back on after pregnancy. I haven't had a bad episode with my disorders for two years (except once when she prescribed something I was allergic to, and it wasn't that bad, i.e. I wasn't hospitalized, I didn't try to hurt myself or anyone else), and I'd gone off a few times for various reasons (mostly pharmacy problems).

But my biggest concern was her wording. I was concerned over statements like "no matter what anyone tells you, breastfeeding doesn't have any benefit that would outweigh the benefits of psychiatric medicine", and "you don't have to look it up, there's no other way for you to do this except bottle feeding". Telling me not to look it up, and telling me not to listen to anything anyone else tells me (which, I have a feeling she meant my mom) just makes my mind go on high alert. I have never valued the word of someone who won't cite sources and encourages me to not think for myself. It's like what Stephen Colbert on the Colbert Report often says "It's true! You can look it up! But don't."

I was also bothered by her very absolute statements like "All women with bipolar disorder get post partum depression really bad", and "you'll wish you had listened to me when something horrible happens". I wasn't even contradicting her when she said that. I was silent through her whole speech.

It also kind of felt like she didn't remember my psych history very well. She said she felt her patients should be stable for several years before trying to conceive. When I asked her what she meant by "stable", she said at least one year without any suicide attempts or hospitalizations. My last hospitalization was 4 years ago when I was 20 (I was hospitalized twice that year, during a break-up where I wound up homeless, and when my favorite grandfather died. I had a lot of circumstantial factors as well, for example, recovering from supposed "ex-gay therapy". I was finally diagnosed with PTSD and bipolar after years of counselors and church leaders telling me all my psychiatric problems were the result of being bisexual). When I told her of this, she looked at my history, and said "well, I can't really tell you not to do anything. It's your choice", which makes me wonder if she just doesn't think any of her patients should ever get pregnant (not unheard of for patients with genetic disorders, like bipolar is considered to be).

So, I agree that these medications (lithium, risperdal, cogentin, mirtazapine) are most likely bad during pregnancy and breastfeeding. But I also still don't see the harm in going off of them for breastfeeding purposes, and keeping bottles and my meds around just in case I really do start going nuts. I suggested this and she said "You will not be sane. You don't have to experiment. You owe it to your baby to not even try that." But she also couldn't tell me why it would be wrong to even try. She told me if I was smart, and if I really cared about the health of my kid, I just won't even consider it.

I try to go by the book, be honest with my doctors and try to take their advice as best I can, but I'm losing faith in my doctor. She went from congratulating me on how well I've been doing to trying to prove I haven't made any progress, and trying to tell me not to research.

Does my idea sound bad to any of you? Going off meds, or going off meds and going on the one my doc recommends for pregnant women, unless I do start feeling crazy again, or unless my husband thinks I'm getting too down, or too manic? I don't see the harm in trying this, especially because I've been off my meds and handling babies in the past (my mom has 8 kids, and I'm the oldest. I even helped with one baby who had one of those feeding buttons, while not on medications).

So do you guys think I'm being unreasonable/unsafe?

Also, is the doctor imposing her own views on breastfeeding on me? I know she disagrees with my mom's views on a lot of things, and it wouldn't surprise me if this was one of them.

I'm sorry this is so long, I'm just feeling very uncomfortable and very upset. This stuff is so far above my knowledge, that I'm starting to wonder if I'm getting in over my head by even trying to have kids. So many things to think about and deal with, and on top of that, I feel like I can't even always trust doctors, the people who are supposed to be experts on this stuff.

[VisionaryMom]

I bf both of my DC without meds. I won't have another biological child because of the PPD/PPP I got after both births. I stopped bf to go back on psych meds both times. So, I completely understand where your pdoc is coming from there. The post-partum period is just so bad (for me, anyway) with hormones and no sleep and your body hurting that adding bipolar issues on top of that is hard. My BP was under control for quite a while before having children, but I ended up hospitalized after DD was born.

I wouldn't say not to try bf. You need to come to a decision you can feel peaceful about that works for you. Still I do agree that between "breastfeeding but insane" and "bottle-feeding but sane," I'd choose the latter. There are physical benefits to bf, yes, but everyone's emotional health matters, too.

[Oubliette8]

you're going to be off the meds anyway for your pregnancy, yes? I really don't see any harm in trying to go a bit longer to breastfeed. Its not an all or nothing thing- if you find that you cant cope without them, there's no reason you cant stop BFing and go back on the meds. Its not like you decide to BF and are then locked into that decision no matter what. In my personal experience, PTSD can sometimes look quite a bit like Bipolar so you my find that you don't even need them anymore at all. Or you might discover that you DO need them. But if you never task the chance, you're never going to know. Frankly, your psych's statements, going only based on what is reported here, alarm me. The all-or-nothing statements, her sense of absolutely knowing what is best and that you shouldn't bother educating yourself, the idea that you'll need meds for life and going with out them is irresponsible, its patronizing and not empowering. Its also not true- yes, SOME people get bad PPD, SOME people need meds for life, and for SOME people psychiatric medication outweighs the risks. But I don't think that because it happens to SOME people you shouldn't try. I don't think you are being reckless. It sounds like you've thought about this, and you know what the risks are, and you are willing to go back on the medication IF you have issues. I think you're making an intelligent decision based on your own situation.

I have one suggestion. Are you in therapy? I know pregnancy can bring up PTSD triggers for many people, and having somebody to help you through that, plus the general stress of pregnancy, and who can act as sort of an outside opinion after birth as to your state of mind might be helpful for you. Not necessary for everyone, but might be something to think about.

[vocalise]

I'm bipolar II, and went off meds to get pregnant with my ds. I was fine throughout the entire pregnancy and for 2.5 years of breastfeeding.

This time around, with dd, who was a surprise, I went off meds as soon as I found out I was pregnant and, again, was fine through pregnancy. But I have been hit pretty hard by depression since her birth, and am now in the process of weaning her while working up to a therapeutic dose of my meds.

I agree with the above poster: give it a shot, and have everything lined up in case it doesn't work out (including a counselor or close family member who can honestly tell you if they see you starting to head south). There are enormous benefits to breastfeeding for ANY length of time, and your p-doc sounds like her dogmatic perspectives on the matter are getting in the way.

[eko_mom]

Originally Posted by BrandiRhoades

Still I do agree that between "breastfeeding but insane" and "bottle-feeding but sane," I'd choose the latter. There are physical benefits to bf, yes, but everyone's emotional health matters, too.

I had a dx of bipolar 2 about 8 yrs ago. I have been med-free for 5 yrs since becoming preg and bf-ing my first and second children. I wouldn't say that I have been sane though, particularly this second time. Its been 9 mo since the birth of my second child and the PPD is unbearable to me and I am becoming unbearable to everyone else. I hear where you are coming from wanting to breastfeed but I agree wholeheartedly with BrandiRhoades. Still, it doesn't hurt to try. I would say that you should make some kind of contract with yourself with identifiable touchstones in advance so you will know when to go back on the meds when the time comes...in case when the time comes things aren't so clear.

[Mom2M]

You could try a different bipolar med that is ok for breastfeeding to see if it works for you. Lamictal is what I'm thinking of but I don't know if there are others.
Good luck,
Deb