"What if I get ill?" perinatal concerns and preparations in primi- and multiparous women with bipolar disorder.

BACKGROUND: Women with bipolar disorder have a high risk of illness relapse postpartum, including psychosis. The aim of the study was to explore how perinatal women with bipolar disorder relate to the risk. What are their concerns? How do they prepare for the dual demands of mood episodes and motherhood?

METHODS: A qualitative study was conducted. To ensure rich insight into the research questions, 13 primiparous and 13 multiparous women with bipolar disorder (I or II), were individually interviewed in pregnancy or early postpartum. Thematic analysis was applied.

RESULTS: Across parity, concerns for illness relapse included concerns for depression and psychosis. Primiparous women worried about "the unknown" in relation to postpartum reactions. Overall, the most significant concerns were the impact of mood episodes on mothering and on the partner. Concerns regarding the infant were maternal medication, mood episodes affecting the child, and heredity. Resources and preparations included: support from the partner, the family, and health services; adjustment of daily life; and mental strategies. Women were aware of the postpartum risk, but their levels of personal concern varied between low, moderate and high. Women with low level of concern for illness relapse had made the least deliberations and preparations. A subgroup of women with high level of concern also had limited resources and preparations.

CONCLUSIONS: The findings highlight the importance of including a psychological and psychosocial focus in perinatal prevention planning and counselling. Even if women with BD are informed about the increased risk of illness relapse postpartum, they relate to it differently. Their level of personal concern impacts their perinatal deliberations and preparations, which in turn may impact postpartum adjustment. When counselling these women, it is important to assess their personal risk recognition, perinatal concerns and available resources and preparations, and support them accordingly. Extra attention should be given to women with a low level of concern, and women with a high level of concern who have limited resources and preparations. These women represent particularly vulnerable subgroups that are critical to identify and offer comprehensive follow-up.