I've dreamt of having a baby my whole life, but when I was diagnosed with BPD in my early twenties I sometimes feared my dream was ruined. Would I be able to cope? Would pregnancy send me into emotional chaos? Would anyone even want to have children with me? Would I be a 'bad mum'? Would my mental health problems 'damage' my child? As those of you who have read my blog or book know, it took numerous years (with many ups and downs) to learn how to manage my BPD, strengthen my self-confidence and get my life into a calmer and happier state.
Fast forward through five or so years of tumult and uncertainty—to the point where I had a wonderful partner, a fulfilling job, a comfortable home and had been through Dialectical Behaviour Therapy—and I knew I was ready. After the trauma, heartache, heartbreak and excruciating emotional pain, I had reached the stable situation in life that I had dreamed of and was longing for a baby.
As I write this blog, I'm thirty-one weeks pregnant and am so excited to have my baby in my arms. Given my BPD and tendency to become very emotional very quickly, thinking about having a baby has required much thought from me over the last couple of years. I wanted to give myself the best possible chance of staying mentally well in pregnancy and beyond for my baby. I thought I would take a moment now to tell you about the specialist mental health and maternity care I have been able to access in my area before and during pregnancy. Perhaps it might be of interest if you're planning to have a baby and have BPD.
Perinatal Mental Health Services
Perinatal Mental Health Services provide specialist mental health care for people who are pregnant, planning a pregnancy or have a baby up to the age of twelve months. They generally support people who have, have had, or are at an increased chance of developing, 'moderate to severe' mental health problems. The psychiatrist I used to see for several years told me about this service in my area and she said that when I had a time frame for wanting to get pregnant, she would refer me for pre-conception counselling. I was grateful for this referral as I had anxieties about being pregnant with BPD and was looking forward to speaking to someone about it.
Pre-conception Appointment
I hated this appointment. The psychiatrist was as cold as ice. I felt so weird sitting there with my husband, sharing our private thoughts about something so personal as having a baby with someone who seemed to be a robot. I would share something emotionally important to me and then she would ignore it only to parrot a question at me like: 'What dose is your sertraline?', 'how long have you been off antipsychotics?', 'how many hours do you sleep?' Urgh. It was a case study on how not to do person-centred care.
Regardless of what I said about medication though, the psychiatrist clearly thought I should stay on it even though she kept saying 'of course it's your choice'. I explained to her that my medication has always been the least significant strand of my mental health care, far less important than therapy, relationships, lifestyle and reducing stress (I mean, there is no specific recommended pharmacotherapy for BPD in the UK). I told her I had pretty much made up my mind that I wanted to come off my medication before getting pregnant and, furthermore, the research she presented me with during the appointment made me more certain that coming off my medication was absolutely the right decision for me and my future baby. She kept saying 'happy mum, happy baby', which to my mind is a trite, overly-simplistic phrase that winds me up.
Anyway, that appointment ended and I decided not to let it put me off engaging with the service in the future in case I had a more positive experience. As a seasoned mental health 'service user', I have learnt to keep an open mind. For every unhelpful professional there seems to be an absolutely amazing one and sometimes it's luck of the draw.
Coming off my medication
I had a few false starts with coming off my sertraline over about eighteen months. I think there were two occasions when I had to go back on it after trying to come off it due to my mood. I rushed myself and attempted to come off it over Christmas (never a good idea) and not just any Christmas, but the infamous lockdown one when all my plans were cancelled. I knew I had to go back on it when I was crying for two weeks over the Christmas holidays, thinking of self-harm and suicide on the daily just like I used to.
After that, I decided to stay on it a while and then later I worked with my GP on a very slow tapering schedule that spanned several months. My GP was lovely and I requested her every appointment to avoid re-explaining myself every time. The warm person-centred care she gave me was a breath of fresh air and the gentle tapering schedule worked. She also gave me sound advice about not letting others judge me over what I do with my life. It's been over a year and a half now since I came off my sertraline and I haven't had any issues. Brilliant!
Booking appointment
When I was about seven weeks pregnant, I self-referred to my local hospital's maternity services as my GP had advised. My initial 'booking appointment' a was cold experience in which a midwife asked me very personal questions in a very impersonal manner. My responses were robotically recorded in on-screen tick boxes, even if they didn't really fit a box. When she asked about my mental health history, I told her about my BPD. Naturally, there was no box for BPD so she asked me which one to tick and I said 'other' and asked her to write down 'borderline personality disorder'.
The letter that I received a few weeks later with an 'outline of my care' said I had 'bipolar disorder'. It is really annoying given the fact they are very different and require totally different care. I contacted the admin team and asked them to correct it. Of course, at my next appointment it wasn't corrected and at the next appointment the doctor said 'so you have bipolar disorder'.
Specialist Midwife
At my booking appointment the midwife said she didn't know if I would meet the criteria to be cared for by the specialist midwife for people with mental health problems and other circumstances such as domestic violence, FGM and drugs and alcohol difficulties. I was pretty much certain I would meet the criteria when the team assessed me by phone as I have a long history of severe mental health problems involving suicidal ideation and self-harm. Maybe the midwife at the booking appointment thought a person 'like me' couldn't have that 'kind' of history.
Being with the specialist midwife, rather than the general midwife team, means I get all my appointments with the same midwife, rather than seeing a different one each appointment. It means we get to know each other and I don't have to give context every time. As a person with BPD, I often feel like I have to prove myself in front of professionals (thank you stigma) so it's helpful to see the same midwife every appointment. It also helps me feel safe and build trust. My midwife also has a direct phone number which I can call or text, instead of having to go through the general enquiries number.
I'm pleased to be with the specialist midwife as I feel it offers me a bit more protection than being with the general team. Next week, for example, I'm going to make a birth plan with the perinatal mental health team and that will be shared with my specialist midwife. This birth plan is made with my mental health problems in mind and how to protect my mental health during birth. I get extra home visits after my baby comes home too. I also feel that I have more ability to ask for, and receive, support should I need it. I have been able to get an appointment with the 'birth options' midwife and maybe this was easier as there is a prior understanding of my needs.
Birth options clinic
I have an appointment with the birth options midwife next week so watch this space! I'm getting this appointment as I want to do everything I can to ensure I get my needs met during the birth given my history of medical trauma (I wrote about it in my book and at various points on my blog). I want to try to avoid tiny rooms with no windows and staff members standing over me if I'm on the floor in a corner for example, as I feel this would trigger some horrific and distressing memories for me.
Mental Health Team Birth Planning
Urgh, this appointment was awful. I thought it was about making a birth plan that would look after my mental health and reduce the likelihood of trauma and emotional distress. Alas, it was yet another opportunity to bash me over the head about why I’m not taking medication! Via Microsoft Teams, the psychiatrist showed zero understanding of BPD and made zero attempts at doing anything useful for me. Once again, I was there telling her all the things that could be done to protect and promote my mental health during the birth, only for her to tell me that this ‘wasn’t what the appointment was about’. Apparently the appointment was about making a plan to prevent ‘relapse’ after the birth. She advised me to take ‘preventative sertraline (medication) just in case of a relapse’.
Honestly, the thought of taking medication when I was perfectly well ‘just in case’ I were to become unwell, made me feel uneasy. It all just felt a bit ‘wrong’ to be honest- a bit like tempting fate and living in the expectation of feeling awful after the birth. I didn’t want to automatically *expect* a mental breakdown after the birth of my beloved and longed-for beautiful baby. It felt unnecessary to pop the pills the same day I gave birth (as the doctor was suggesting) in expectation of an impending crisis. I didn’t want to do that or be in that doom-ridden frame of mind given how well I had been in pregnancy.
If I had been struggling mentally in pregnancy, then I probably would have taken medication. As I have said many times, I’m not against medication- it has saved many, many lives and has been helpful to me at various points in my life. What I am against though is taking medication when I don’t even feel I need it. I voiced all of this to the doctor and respectfully disagreed with her. Luckily the appointment ended soon after, as I wasn’t finding it supportive in the slightest.
A couple of days after the appointment I received my the ‘care plan’ we had apparently made in the appointment. It didn’t resemble anything I had said that was important to me and it was a tick box thing that made me feel unsupported and unheard. There were even a couple of things on there that I didn’t feel were accurate, such as the wording about initiation of breastfeeding- which we hadn’t even discussed in the appointment. I emailed politely requesting changes which were instigated in the form of a copy and paste from the email I had sent: ‘she requests [insert my words from the email].’ Oh and my husbands name was wrong yet again as it usually is.
This appointment made me feel really down and affected my confidence to be honest. It was really deflating. It felt hollow and deflating— exactly the opposite of how a pregnant woman should be left feeling after interacting with mental health services. [Update 05.12.22 Luckily since the birth I have had some positive mental health care which has been much more person-centred and useful to me.]
How I've been feeling generally
I've been mentally well throughout the whole pregnancy, in spite of horrible pregnancy nausea. There was a blip when I had anxiety about my blood test results. I shared a lot in my first trimester post and will write more in my second trimester post too. My main emotions relating to my pregnancy are excitement and love! My husband and I just cannot wait to meet out baby and hold her in our arms!
It's not easy to find content on pregnancy and BPD, so I hope this post is helpful for you if you have BPD and are hoping to have a baby or are pregnant. I will keep writing as many posts as I can manage about my pregnancy.
- Rosie x