By Katherine Ponte, JD, MBA, CPRP
Trying to become a mother while living with mental illness can be incredibly challenging. My mental illness struck me during my prime reproductive years and delayed my plans to start a family. When I began exploring my options, I experienced the painful weight of stigma; Even my psychiatrist discouraged me from having children.
The stigma surrounding mental illness prevents many people from starting families. Some of these perceptions echo times in U.S. history when laws and practices even prevented people with mental illness from becoming parents. For example, in the early 20th century, laws were passed throughout the U.S. allowing for coerced and forced sterilization of people, including those with mental illness to “protect the human species.” As many as 70,000 Americans were forcibly sterilized during this time.
I don’t have children, but I would still like to. As I reflect on my mental health journey and think about my future, I’m struck by the need for more compassion and support for people living with mental illness to become the parents they know they can be. I believe there are ways we can change the current narrative and offer more support to people pursuing parenthood while managing mental health conditions.
Perhaps the most hurtful impact of the stigma surrounding mental illness is the common belief that women with mental illness cannot be good mothers. In a society that values “self-sacrificing mothers” and rewards adherence to gender norms, we often deem that a “good mother” has few needs and challenges of her own; rather, she can commit herself in her entirety to her children.
Mental illness can certainly make some aspects of motherhood more challenging, but it doesn’t disqualify those of us living with a mental health condition from being good parents. In fact, research suggests that many issues faced by mothers with mental illness are generic to all parents. While mothers with mental illness may experience more unique challenges from their symptoms, or from medication and treatment obligations, these risks can be managed with the guidance of a good collaborative care team.
Beyond informing hurtful ideas about parenting ability, stigma and discrimination play a devastating role in legal matters. Custody loss is one of the most extreme examples of stigma and discrimination against parents (particularly mothers) with mental illness. Removal rates of children from parents with mental illness have been found to be as high as 80%. This can have tragic consequences for families, as many children are separated from loving parents.
There are several important planning considerations for anyone with mental illness pursuing parenthood.
When starting a family, it’s critical to assemble a highly skilled, compassionate and collaborative medical team. It should include an obstetrician (dealing with pregnancy, labor and puerperium) who is preferably attuned to issues of mental health. A psychiatrist with expertise in medication management, such as a reproductive psychiatrist, can help develop an effective medication strategy through pregnancy that mitigates potential risks. Because pregnancy can be a high-risk time for relapse of mood disorders and other psychiatric conditions, it’s important to have vigilant continued care. Ideally, a team would also include a therapist, especially with expertise in cognitive behavioral therapy (CBT) and mindfulness. It may also be helpful to identify perinatal (meaning prevalent during pregnancy and as long as one year after delivery) and/or post-partum mental health providers. Post-partum depression affects up to 15% of mothers yearly.
All mothers-to-be must take good care of their health, including practicing stress management to achieve the best outcomes. Self-care, especially good sleep, nutrition and exercise can be very beneficial. At all stages, it is important to have a good support network to help with the stressors of becoming pregnant, being pregnant and raising children. Parent skills training can be very helpful to manage some of these stressors. Acknowledging your illness and struggles and treating it are essential.
Those living with mental health conditions can have troubles conceiving. Stress can interfere with a woman’s ability to get pregnant. Women with a history of depression are twice as likely to experience infertility. Anxiety can have a significant impact on the duration of infertility.
Because I was highly symptomatic and had experienced several relapses during my thirties, I was afraid to try to start a family. I also believed the stigma that women with mental illness should not be mothers. I waited too long to try to start a family, and by the time I did, I was infertile. Had I known that in vitro fertilization (IVF) was a viable option for me earlier, I could have had a cycle to collect eggs while I was still fertile, during one of my periods of remission. I could have then pursued pregnancy using my biological eggs when I felt ready. I think it’s highly unfortunate that I did not know of this option. I strongly feel all psychiatrists should speak to their female patients about family planning and parenthood options, and too few do.
It's important to note that there are other equally rewarding ways to become a mother. These may involve IVF through the use of donor eggs and/or donor sperm without and with a surrogate. Adoption in the U.S. or abroad is another option, but it can be more difficult for potential parents with mental illness due to stigma. It is also important to note that every woman has a right to decide not to become a mother and should not be at all stigmatized for this decision as they so often are.
All women should be entitled to a chance at motherhood, but it is critically important to ensure optimal mental health for their safety and that of the child. For many, children can be a tremendous source of purpose and meaning. It can be a powerfully motivating force to work as hard as one possibly can to reach and stay in recovery. You’re not only doing it for yourself, but you’re also doing it for those who love and need you.
Author's note: I would like to thank Maryanne Davidson for encouraging me to share my story.
Katherine Ponte is happily living in recovery from severe bipolar I disorder. She’s the Founder of ForLikeMinds’ mental illness peer support community, ForLikeGoals, , BipolarThriving: Recovery Coaching and Psych Ward Greeting Cards. Katherine is also a faculty member of the Yale University Program for Recovery and Community Health and has authored ForLikeMinds: Mental Illness Recovery Insights. She is on the NAMI-NYC Board.
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