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Both bipolar disorder and pregnancy have unique medical challenges. How do those challenges converge? Is it safe to take medication while pregnant? What about while breastfeeding? Is the postpartum period more or less dangerous for someone with bipolar disorder?

Is it important that your mental health doctors and pregnancy doctors are on the same page and, if so, how does the person who’s pregnant navigate that? Listen in as our hosts discuss all this and more.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. He also hosts Healthline Media’s Inside Mental Health podcast available on your favorite podcast player.

To learn more about Gabe, please visit his website,

Dr. Nicole Washington

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe Howard: Welcome, everybody. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole Washington: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe Howard: Dr. Washington, I’ve never been pregnant.

Dr. Nicole Washington: Wow.

Gabe Howard: I know. I know.

Dr. Nicole Washington: Wow. Shocker.

Gabe Howard: I know, but I don’t have children either. And I know nothing. I don’t have the ability to become pregnant. I’m also not a father, so I’ve never been the primary support person for a pregnant person, you know, like a girlfriend or a significant other, a wife. I know nothing. I want to put that out there. The conversation that we’re about to have, pregnancy with bipolar disorder, Gabe Howard can contribute almost nothing. But I do have a lot of questions.

Dr. Nicole Washington: Okay. I’m ready. I’m ready.

Gabe Howard: If you live with bipolar disorder, what are some stability signs that you need to look for to know that you’re stable enough to have kids? Because having kids is scary,

Dr. Nicole Washington: It is very scary.

Gabe Howard: Right? I just, that’s a hard stop. Forget about bipolar disorder, like.

Dr. Nicole Washington: It is very scary. Yes,

Gabe Howard: Kids. Terrifying

Dr. Nicole Washington: Kids are terrifying.

Gabe Howard: Kids equal terrifying.

Dr. Nicole Washington: It is. I have two of them. And yes, they’re terrifying. I think you make a really great point because the honest to God truth is, I would be much more supportive of a pregnancy in someone who came to me who was stable. Right? Who hadn’t had a mood episode in several months to a year, a person who had not been hospitalized, a person who was very stable on medication that we were not concerned about disrupting a pregnancy. And we would work through that and we would come up with a great plan. I would be less supportive of someone who literally just got out of the hospital in a manic episode who said, We decided we’re going to have a baby.

Gabe Howard: In my family, nobody plans pregnancies. We just all end up pregnant, right? I don’t know how your family is. I just I’m saying that in the last 25 years, I think there has been one planned pregnancy. All the other ones were oops, including me. Like, I am here because my mom went, Oh no, shit. So do you find that people living with bipolar disorder are doing family planning with you? Are they sitting down and saying, All right, Dr. Nicole, I live with bipolar, you are my psychiatrist and I am now thinking about getting pregnant, or is it more the other way? Which is, oh, shit, I’m pregnant?

Dr. Nicole Washington: I do have some people who come to me and want to do family planning. But a lot of my clinical work has been with more unstable populations or people who really are still dealing with a lot of mood episodes. And so in that population, I do see a lot more of the, uh-oh, I’m pregnant. So then what that means for me as a psychiatrist is every person with a uterus that I see who is of childbearing age, then I have to be extremely mindful of what it is I’m prescribing them, and I have to think about it in terms of this person could get pregnant at any moment. So I have to prescribe, very defensive prescribing, in case of pregnancy. And if we do end up having to use a medication that is not something that is typically recommended for pregnancy, then we are having lots of discussions about birth control and things like that. But as we know none of those things are foolproof.

Gabe Howard: I’m thinking about this from like a very practical standpoint. And again, not a woman, never been pregnant, but this didn’t factor in to Gabe’s care. This idea that what happens if Gabe gets pregnant when he’s on these medications?

Dr. Nicole Washington: Yeah.

Gabe Howard: So it seems to me that if you have a uterus and you can get pregnant and you are of childbearing age. Am I understanding that correctly? Like maybe the best medication you choose not to prescribe or you consider not prescribing because somebody might become pregnant? Is that, is that a factor for people who might become pregnant, that they might not be getting the best care just in case?

Dr. Nicole Washington: Not the best care. I mean, we have tons of drugs out there. We have tons of options. There are just a handful that we know if a person gets pregnant on particular medications, it can affect development of that baby. And a lot of times we don’t know we’re pregnant until that phase has passed. Right. So when all the good stuff is developing, sometimes we don’t know that we’re pregnant until weeks later and so then it’s not beneficial to go back and say, Oh, we probably shouldn’t have been on that.

Gabe Howard: So let’s talk about that, though. So let’s say I’m there, I’m stable on medication. I’m getting stable on medication. It’s all going well. Dr. Nicole is just knocking it out of the park. Kudos. Right? And I say I’m pregnant. Now, you know, as a doctor, you’re like, okay, you can’t be on this drug, right? That’s a reasonable thing. We want to protect the fetus. That’s important to parents everywhere. Nobody disagrees with that. But you’re stable. You’re not manic, depressed, suicidal, whatever brought you to Dr. Nicole. And you’re like, okay, so I’m going to take that away, making your baby safer. Doesn’t that put the mom in harm’s way?

Dr. Nicole Washington: So a lot of things go into that, right? How far along is the pregnancy? That makes a huge difference, right? If it’s something that we know could affect developing fetus early on, but you don’t find out you’re pregnant until 16, 20 weeks, then if any damage has been done, it’s already been done. So your stability has to come into play. I’m always thinking about Mom’s stability. By and large, if a person is stable, we are going to roll with it. There really are only a couple of things that we might change because of a pregnancy.

Gabe Howard: I’m trying to wrap my head around this. Just if I was sitting there, because when I sit, when I sit in the Dr. Nicole offices of the world, I’m thinking about myself. I’m super selfish. Like, what can I do to lead my best life? Have the fewest side effects? And as I love to say, get to Hawaii? I’m not thinking about anybody else when it comes to my medication. So I’m trying to think like, how would I adjust that? Now I’ve got to think about myself and I recognize that this is just probably the female experience.

Dr. Nicole Washington: Yeah.

Gabe Howard: Some of this I can’t understand because I’m male and nobody has ever talked to me about becoming pregnant before. But

Dr. Nicole Washington: Yes.

Gabe Howard: Walk me through this for our listeners, because I think some of our listeners are like, look, I have enough to deal with and now you want me to worry about my unborn child? It sounds like a lot. And I don’t know that we’re doing anybody any favors by saying, Yeah, yeah, we’re asking you to worry about your unborn child and yourself at the same time, and you have mutually exclusive goals, except that they’re kind of the same, except they’re diff and you’re like the ringmaster of all of this. And as you pointed out, many people, they’re probably shocked they’re pregnant. They’re in their oops, oh, shit moment.

Dr. Nicole Washington: It is a lot. But I will say, anybody who’s carried a child knows from the moment you find out you’re pregnant, you’re always worried about two people. You’re always thinking about how your decisions affect your unborn child. Unless you’re in an episode that really doesn’t allow you to have that level of clarity. So that can be a pretty dangerous spot to be in and one that I’m typically always concerned about. I’m concerned about everybody. Let me just say that. I don’t want anybody to say Dr. Nicole only cares about pregnant women. That is not true.

Gabe Howard: [Laughter] That’s not, not true. Not true.

Dr. Nicole Washington: I am concerned about everyone. But when it comes to pregnant women and women who have small children at home, I am just a little bit more concerned. I am just a little bit more worried about you when we visit. And so I do tend to take this very, very seriously and really, really drive my point points across when I’m seeing people.

Gabe Howard: And what are these points that you’re driving across?

Dr. Nicole Washington: Before pregnancy even occurs, I’m driving home the point that we need to think about your medication regimen in a way that if you got pregnant tomorrow, we would feel comfortable keeping you on what you’re on, right? If you’re stable, we want to keep riding that train. We do not want to be disruptive. We are going to do that first and foremost. Once you’re pregnant, then we have to talk about meds because a lot of women say, well, I don’t want to take medicine because I’m pregnant. Like I don’t want my baby to be exposed. I get that. I’ve been pregnant. I know what it’s like to think, Oh, I have a headache or a cold, but I don’t want to take anything because I’m pregnant, because I don’t want to negatively affect my baby, because all of your thoughts are with this person who’s growing inside of you. But your untreated bipolar disorder can be just as much of an exposure to that fetus as the medication that you take. So untreated mental illnesses have an effect on your unborn baby, right? Moms who are depressed may have lower birth weight babies, have difficulty bonding once the baby’s here. Like the depressed womb, the manic womb, the things that your body goes through when you’re in these episodes can also be an exposure. So to set your baby up for success, the best thing you can do is to get stable on medication or stay on the medication you were taking for the most part.

Gabe Howard: This is where it’s kind of getting complicated for me because moms are people, right? The mother is a person that needs to be cared for and bipolar disorder is serious.

Dr. Nicole Washington: Yes.

Gabe Howard: The child is important because children are important and need to be cared for so that they have their best chance at a long and healthy life.

Dr. Nicole Washington: Yeah.

Gabe Howard: We hear about people living with bipolar disorder, myself included, who not only did bipolar disorder hurt me and it’s living in my brain, but it hurt my mom, my dad, my wife, my brother and my sister, my friends.

Dr. Nicole Washington: All right. Think about the people who are impulsively going out and partying and drinking or doing drugs during a manic episode or, you know.

Gabe Howard: Well, yeah.

Dr. Nicole Washington: That is also something we have to think about.

Gabe Howard: Because if you can’t control those urges and impulses

Dr. Nicole Washington: Right.

Gabe Howard: And, you know, mania is like, hey, I’m invincible, I can drink a bottle of vodka four months pregnant.

Dr. Nicole Washington: Right.

Gabe Howard: That’s going to harm the baby as well. And so many people are like, hey, but I wasn’t on prescription medications.

Dr. Nicole Washington: [Laughter]

Gabe Howard: Yeah, but you weren’t eating healthy. You weren’t getting the right diet and exercise. You were drinking, smoking, vaping, illegal drugs. You were staying up all night. You lost your job, and now you don’t have insurance or you can’t afford the baby

Dr. Nicole Washington: Yes.

Gabe Howard: Or just I hate to, I hate to ask every question this way, but what do you do, Dr. Nicole? I feel like you’re in charge suddenly. Like, how do you fix this?

Dr. Nicole Washington: We have real conversations. We talk about how yes, we do not do studies on pregnant women because it’s unethical. So you don’t see drug studies on pregnant women. But we have lots of data for decades of women who have bipolar disorder, schizophrenia, depression who have taken medication during pregnancy. We have the information about outcomes. We feel pretty comfortable knowing what medications can cause what, we have that information. So we have those conversations. I talk to them about stability, right? Safe pregnancy, healthy babies. And we just have the conversation. I mean, ultimately, at the end of the day, it is that person’s decision to make. And do people disagree with me? Absolutely they do. And some of those times it works out well. They don’t have a manic episode or a depression. Their pregnancy goes fantastic. And we can talk about getting back on meds afterwards. But I would be fooling you if I didn’t say that a lot of them end terribly. Because the hormone shifts in pregnancy, the stress on your body definitely can induce an episode, especially if you’re not treated. So it can end up very, very badly.

Gabe Howard: So let’s say that I’m pregnant and I come to you. You’re my doctor. And I tell you, Hey, I just got pregnant. It was an oops. And I’ve discontinued all of my psychiatric medications for the time of my pregnancy. But I still want to see you. What do you say?

Dr. Nicole Washington: First of all, I would give you the Dr. Nicole face, as people call it. And it would be like the mom face, like you did what? And we would talk about how let’s not do that ever, like, ever. Anybody listening, don’t ever just make a decision, pregnant or otherwise, to stop your medicine without contacting your person who is prescribing your medication. Okay. Then we talk about what to do. I mean, you stopped all your meds. At this point, I will probably outline to you why I think that’s a very bad idea. And I will go over your med list that you were taking and we’ll talk about the risk and benefits and taking those meds during pregnancy. And then it’s your decision. Then the ball’s in your court. I can’t, follow people home and open their mouth and shove pills down it because the board would probably come after me if I did.

Gabe Howard: Probably. That is frowned upon.

Dr. Nicole Washington: That is frowned upon. So ultimately, it’s that person’s decision. I think my role is to educate the heck out of them so that they have all the tools to make a good decision, not whether they choose to make a decision that I think is a good one or not. That’s irrelevant.

Gabe Howard: Okay. So let’s say that they go against medical advice.

Dr. Nicole Washington: Okay.

Gabe Howard: We’ll just all use professional terms.

Dr. Nicole Washington: Okay.

Gabe Howard: You gave them the spiel; you gave them the info. They listen to this podcast episode and they’re like, you know what? Nope, not doing it. I’m not taking the pills. Will you still see them as a patient?

Dr. Nicole Washington: I probably would. Some people will, though. Some people won’t. Right? A psychiatrist could say, I am not going to treat you because of your non-adherence or your unwillingness to take medication. A person could say that. I probably would because I just feel like this is such a vulnerable time to leave somebody without care. So I think it’s best that even if I can touch base with you monthly and we can see each other and I can make sure you’re doing okay, so that if I start to notice some mania, if I start to notice some depression, then we can have further conversation. I also think it’s important when a person’s pregnant that their support system be involved in these conversations. So whether that’s the father of the baby, whether that’s their parent, whether it’s a good friend, whoever’s going to be that person’s primary support during this pregnancy, I think they need to be involved in some of this discussion because I think it’s really bad if a person that’s pregnant has decided they’re not going to take meds, is at risk of a mood episode and nobody around them knows any of this. They just think that they’re taking their meds as usual and everything’s fine. I think those people need to know.

Gabe Howard: We often hear when it comes to raising children that it takes a village. Does that extend to pregnancy? Does it take a village to be pregnant, Dr. Nicole?

Dr. Nicole Washington: I mean, I think it probably should. But you got to think a lot of times women are alone. They feel alone. They feel alone when they’re pregnant because they’re the one carrying the baby. They’re the one with the swollen ankles. They’re the one with the cravings and body shifts. And it’s hard to say, like, Oh, we’re in this together because we do not have swollen ankles together and we do not have all these other things together. But you do need support. You do need a village. I mean, you need people especially, I think when you have an illness like bipolar disorder, sometimes those people are going to notice if you’re shifting into one episode or the other before you might even notice. So it’s important that those people be involved, but it needs to be people you trust and it needs to be people that if they say, Hey, I think it’s time that you go back and talk to Dr. Nicole about getting back on your meds or, you know, I think it’s time we talk about this. You need people like that. You need a good village.

Gabe Howard: And on top of all of that, the stakes are higher. Right? It’s no longer about just that person managing their bipolar disorder and the medication anymore. It’s about all of those things and a pregnancy.

Dr. Nicole Washington: Yeah.

Gabe Howard: How do you work within the confines of that?

Dr. Nicole Washington: I mean, we have to sit down and look at, okay, when did we start this med? When did this particular thing happen? We do have to take pregnancy into consideration, especially for depression. When a person comes in and I’m screening them for depression. A lot of those depression symptoms overlap with pregnancy, trouble sleeping, appetite changes, motivation, energy. So I have to really focus in on the low mood and the ability to enjoy things and, you know, things of that nature. Same with the medications. I have to look at the timeline and when did it start and all that good stuff. And we come to the best educated thought we can. Am I going to be wrong? Sometimes. Maybe. Maybe I will be.

Gabe Howard: That just sounds so scary. Like it’s so ominous. Will my doctor be wrong while I’m pregnant? Maybe. That is a honest answer, right? That. That is a truth, that is honest, and everybody needs to hear it. But yeah, yeah. I’m like, no, you need to be right. I mean, that kind of made me feel some way. And I’m not pregnant.

Dr. Nicole Washington: But so when I say you make your best-educated guess. This is going to come from experience and literature and data. So it’s not just me going, Oh, I think we’re good. Like this is based on training and your psychiatrist has been trained to deal with these kinds of things, and they go to conferences every year to refresh their memory of certain things and to learn new things as they change. So we are making these guesses, I guess, if you want to call them that, based off of a lot of education.

Gabe Howard: So just to be clear, you don’t have a 20-sided die?

Dr. Nicole Washington: No.

Gabe Howard: That you’re rolling in the back and that’s how you’re making the decision?

Dr. Nicole Washington: This is not the magic eight ball where I say, is it the medicine or the pregnancy? And I shake the eight ball. That’s not it.

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Dr. Nicole Washington: And we’re back discussing bipolar disorder and pregnancy.

Gabe Howard: Dr. Nicole, how do you interface with somebody’s OB/GYN, with somebody’s midwife, with somebody? I don’t even know all the pregnancy doctors

Dr. Nicole Washington: Yeah.

Gabe Howard: But I know that if you’re pregnant.

Dr. Nicole Washington: [Laughter]

Gabe Howard: With bipolar disorder, you have more than just a psychiatrist. How does the psychiatrist interface with the rest of the team?

Dr. Nicole Washington: Yeah. I’ve had lots of conversations with the obstetrician who is going to be delivering the baby and who’s taking care of the mom throughout the pregnancy. Once we get to the postpartum phase, I’ve had discussions with the pediatrician about meds and breastfeeding. It really takes a team of us for a successful pregnancy really for anybody, but especially someone who has bipolar disorder. All those parts need to be able to communicate with each other so that we can make sure we’re doing what’s best right. Because I don’t want the obstetrician to say, well, absolutely, you shouldn’t be taking any of those meds because you’re pregnant. Well, that’s not helpful. It’s also not helpful for the pediatrician to say, no, you absolutely shouldn’t take those meds because you’re breastfeeding. So usually I need to talk to those specialties so that we can have a conversation about this mom’s history. Why I think she needs the meds, what I think could happen if we don’t do meds. But by and large, most of the big organizations, the big psychiatry organizations, the OB/GYN organizations, the Pedes organizations, most of us are on the same page when it comes to stable mom is what we’re looking for. Stable mom gives baby the best chances. And so typically we’re all working for that goal.

Gabe Howard: Do you find that you ever get pushback from other doctors that they just you mentioned I don’t want her on that medication because she’s breastfeeding. And of course, you have a different opinion on that. How do those things get worked out? Because obviously what my community hears is are the times that OB/GYN and psychiatrist are, you know, in some sort of cage match. Usually, you know, my psychiatrist says that this is healthy and my OB/GYN says that it’s not healthy. And now you’re the patient and you’ve got two doctors whom you are relying on and trusting who are not on the same page.

Dr. Nicole Washington: Right. It used to be a much bigger deal. Years ago, like I feel like I would have more of these conversations where I’m trying to convince the obstetrician that this person needs to be on these things maybe a decade ago. We’ve come a long way in our thoughts about pregnant women with mental illness and the medications. I rarely, rarely see that anymore. I think we know more. Again, that education comes in. You know better, you do better. I don’t I don’t see that nearly as much. If I did see it, I would just have to tell them what I think and I would just have to tell my patient, hey, I don’t agree with your obstetrician. This is what I think. This is what they think. And unfortunately, the patient would have to be the one to decide who it is they’re going to listen to.

Gabe Howard: Not to drive this into the ground, but how should the patient decide?

Dr. Nicole Washington: Yeah. I don’t have an answer for that one. I don’t have one for that one. I think it’s going to take some conversation with their support system. Right, their team, because they may not be equipped to make that decision alone because that’s a huge decision to make. I would even recommend a second opinion if you felt strongly that maybe one of those specialties was off. If you say, Well, I don’t know, Dr. Nicole is not making a whole lot of sense right now, I’m going to get a second opinion. Do it. I always recommend second opinions. Anytime patients disagree with me, I’m like, Hey, you should get a second opinion because I’m one person, right? I am not the end all be all of psychiatry. If you don’t agree with what I’m saying and it is going to interfere with care, then I want you to get a second opinion. I want you to go see somebody who doesn’t know anything about your case and get that opinion, but make sure they have all the information in front of them to give you good advice. Don’t go and leave stuff out that you don’t want them to know. But I do recommend second opinions frequently.

Gabe Howard: Pregnancy is difficult. You’ve described before, hey, you know, being a mom is hard. Being pregnant is hard. It’s a scary, scary thing. And I think that sometimes people who live with bipolar disorder, they get pregnant and they’re scared. They’re like, oh, it’s because I have bipolar disorder. But it’s not.

Dr. Nicole Washington: No.

Gabe Howard: It’s because pregnancy is a terrifying thing.

Dr. Nicole Washington: Absolutely. Pregnancy is terrifying and not always a moment where a mom feels like she can advocate for herself because it’s so scary and sometimes she just may not have the emotional capacity or bandwidth to be able to advocate. So that again points back to why it’s important to have a team. And so even then, in that previous scenario, what if the patient said, Dr. Nicole, I agree with you, I am horrible when I have an episode and every time I go off my meds I have an episode. I’m terrified of having an episode during pregnancy. Then I’m going to coach them up a little bit on how to advocate with their OB So I’m going to have them tell their OB Hey, listen, when I go off my meds, I usually have manic episodes. When I am manic, these are the things I do that are reckless. I have not found any way to manage these without medication in several years. I feel like I need to be on some kind of psychiatric medication and the discussion that I have with the OB sometimes is, okay, you don’t want them on A, B or C, what are you comfortable with them being on? And then maybe we can compromise.

Gabe Howard: I myself was too terrified to have children. Maybe it’s because I have bipolar disorder. Maybe it’s because I’m a coward. I honestly don’t know. But I do know this. I know that when you’re worried about something, when you’re scared about something, I think that’s a good thing. Sincerely, I sit backstage a lot. A lot as a speaker. I’m sitting backstage, and these people come over to me and they’re like, I’m terrified. I’m so nervous. I got the butterflies in my stomach. And I always look at them and I say the same thing. Good. And they’re like, What do you mean, good? This is. I’m like, No, it means you’re taking it seriously.

Dr. Nicole Washington: Right.

Gabe Howard: You understand the gravity of the situation. You want to do a good job, you’re leaving no stone unturned.

Dr. Nicole Washington: Yes. Yes. You know, we’ve talked a lot about the pregnancy. A lot of times we focus so much on the bipolar during pregnancy, bipolar during pregnancy. But what about once that little rascal gets here? We also have to talk about the postpartum period. I mean, life is forever changed at that point. And there’s other considerations that go into treatment of someone with bipolar disorder after they have the baby.

Gabe Howard: Are postpartum issues higher in people with bipolar disorder than they are in people who do not have bipolar disorder?

Dr. Nicole Washington: A person with bipolar disorder has a higher likelihood of having a mood episode after pregnancy because of all the hormone shifts and fluctuations, the stress of the body during the delivery, that whole process. Now I got this new baby at home and what am I not doing sleeping regularly because I have this newborn? And we know that sleep is just a foundational need for someone who has bipolar disorder. We all need sleep, but we know that poor sleep is one thing that can have a huge effect on a mood episode. So there’s lots of things that go into play during that time. So we’re concerned about that. We’re concerned about postpartum psychosis in someone who has bipolar disorder. As a matter of fact, if a person comes in who’s never been diagnosed with bipolar disorder and they come into the hospital with postpartum psychosis, we tend to think of them as bipolar disorder until proven otherwise because that correlation is so high. It’s not uncommon for this to be the diagnosis point.

Gabe Howard: Really?

Dr. Nicole Washington: Because think about stress. I mean, there’s no bigger stress than carrying a baby and delivering and all that. So sometimes this is the diagnosis point. This is the initial presentation with postpartum psychosis. This is the point. So we are having to be really, really mindful of that postpartum period. Does mom want to breastfeed? Because then now I have to call the pediatrician and we talk through the whole breastfeeding thing because now we’ve created this situation in the world where if you’re not breastfeeding, people will tell you you’re a terrible mom. These breastfeeding advocates are like, you got to breastfeed or your baby’s not going to be smart and your baby’s not going to do this and your baby’s not going to get into Harvard and your baby, you know, all these things. And so a lot of times moms feel really guilty about not breastfeeding or even considering not breastfeeding because of the fact they take medication and don’t want to further that exposure. We do know that medication does get into breast milk, the levels of it for the most part. There are a lot of meds that are safe in breastfeeding. We think the levels that baby gets exposed to are negligible. So not that high. And we’re comfortable with breastfeeding. It really is super individual on that too, because some mom might say I just would rather not have any further exposure we exposed during pregnancy. Let’s just do formula and call it a day. But some people are really adamant about breastfeeding and the bonding that they feel they get extra with the baby during that time.

Gabe Howard: One of the things that I often hear whenever this discussion comes up is, well, it’s not about you, it’s not about you, it’s not about you, it’s about your child. And I agree with that on the surface. But I’m often surprised at how many people are like, Well, it’s not about me, it’s about my child, and I need to save money by not going to the psychiatrist, taking my medication so that I can give that money to my child. And I always think, oh, wow,

Dr. Nicole Washington: Yeah.

Gabe Howard: Yeah, you’re not you’re not understanding that quote at all. You being the best that you can be is good for your child.

Dr. Nicole Washington: Absolutely.

Gabe Howard: So I want to say, listen, if you live with bipolar disorder and you’re using your child as an excuse not to take care of yourself because, oh, I’m I’m reverting my wellness time into time with my child. Yeah, but if you’re not well, that’s that’s not quality time.

Dr. Nicole Washington: Yeah, absolutely. Absolutely. And you know what? You can have a very successful pregnancy. You can have a very successful postpartum period. You can have a very successful motherhood slash fatherhood, but you just have to take care of your business and you have to treat your illness like the serious thing that it is. And maybe you could afford to be willy nilly before, but you can’t now. So you need a good relationship with whoever is prescribing your medication. You need a good therapist. All those things need to be in place to help you be like the parent you want to be.

Gabe Howard: This absolutely sounds terrifying. So I want to give a big shout out to all of the parents out there who are managing bipolar disorder and raising their families and are killing it. They’re just nailing it. I know so many people who live with bipolar disorder and they have their families, their houses, their jobs, they’re boring just like everybody else, right? They’re just boring suburban parents. And I don’t think that we see enough of them because when they go walking down the street to the park with their family, nobody says there’s a mom with bipolar disorder and her two kids, they just say there’s a mom with two kids. Right. But I want you to know, there’s there’s so many moms there’s so many dads who are living with bipolar disorder and they are absolutely killing it as parents.

Dr. Nicole Washington: Oh, absolutely, right.

Gabe Howard: I sit around in a lot of groups. It’s like I just want to be like everybody else and I’m terrified. I’m pregnant. Congratulations.

Dr. Nicole Washington: Right. You’re just like everybody else.

Gabe Howard: You’re just like everybody else.

Dr. Nicole Washington: I think I’m going to screw up my kid. Welcome to the club.

Gabe Howard: Welcome to the club.

Dr. Nicole Washington: Welcome to the club.

Gabe Howard: Dr. Nicole, it’s always great to hang out with you. And thank you for opening up my eyes to to what it means to be pregnant, what it means to have children, and all of the things that we need to consider. And, of course, it’s important to state we didn’t cover them all. Every single person is different. These are just sort of like the top. But it’s okay to be scared. It’s okay to be confused. I think what it’s not okay to be is alone in your room thinking that you’re the only person who goes through this or that you don’t have a support team or that you don’t have doctors. The Doctor Nicole’s of the world, they are aware of people with bipolar disorder and pregnancy. And there’s so many people who are aware of mental illness and parenthood. And of course, there’s just so many people who are aware of what it’s like to be a parent. And we are all in this together. Even those of us who have no kids, we make great babysitters.

Gabe Howard: My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” which you can get from Amazon because well, everything is on Amazon, but you can get a signed copy with free swag just by heading over to my website,

Dr. Nicole Washington: And my name is Dr. Nicole Washington, and you can find me on all social media platforms @DrNicolePsych to see all the things that I have my hand in at any given moment.

Gabe Howard: Dr. Nicole and I are both public speakers and we travel nationally or internationally and we could be available for your next event. You can find out all of that information on our respective websites and can you do us a favor? Wherever you downloaded this episode, please subscribe or follow. It is absolutely free and finally share us. Tell everybody about us. Sharing this show is how we grow. We will see everybody next Monday on Inside Bipolar.

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