When mum-of-two and mental health peer worker, Taegan, was first diagnosed with bipolar mood disorder, she didn’t believe motherhood and her mental illness would mix. So in the lead up to starting a family, Taegan spent years preparing, learning, getting second opinions, asking questions, and researching - everything she thought to best navigate motherhood with her diagnosis.

After a manageable pregnancy and postpartum with her first daughter, Taegan expected herself to navigate any challenges that could arise with a second baby in the same way. Unfortunately, nothing could have prepared Taegan for a surprise postpartum depression diagnosis followed by an involuntary admission to a psychiatric hospital - four hours away from her daughters.

I thank @nurture_by_taegan for sharing so openly about the unpredictability of navigating pregnancy and motherhood with a pre-existing mental health diagnosis - from postpartum rage, TMS, medication, mixed opinions from health professionals, societal misconceptions about mental ill health, and relapse prevention, to the power of self-compassion along the way.

“I've got an ongoing mental illness - bipolar disorder - which I was diagnosed with when I was 21. I'm a bit later to have kids, so I was 35-ish when I had my first little bub, and then 37, turning 38, with my second. So yeah, I have this big history of navigating mental illness pre-babies and it was 100% thrown on its head when I had babies.”

“I was actually relatively lucky with my journey. It can take years for people to get a bipolar diagnosis. I, in year twelve, definitely struggled with perfectionism and some depressive-like symptoms coming into play. By the time I moved away the following year for uni, I crumbled and was diagnosed with depression and put on medication and told, ‘this will fix it, it'll be fine’. And I spent the next three years being ‘fine’ every time my medication was upped!”

“Slowly but steadily, my medication [an SSRI antidepressant] level was going up, but I'd bottom out whether that was a month down the track, six weeks down the track, a few months down the track, I would bottom out again and have to bump up the level.”

“It got to a level where I had an induced manic episode because of the medication I was on, which sounds horrible, but it was a blessing in disguise because it actually showed what was happening underneath and got me the start of the help that I needed and the diagnosis that I needed.”

“Early in my diagnosis I was resistant to medication in general, but hugely resistant because the medication that was gold standard for my illness at the time [lithium], I couldn't be pregnant on.”

“So at the time, the thoughts were, ‘you definitely would have to come off medication to even attempt to be pregnant’. It wasn't correct in my thinking, but it equated in my head that I probably shouldn't have children if I had to be on this medication that didn't allow me to be pregnant whilst taking it.”

Taegan managed her diagnosis with a combination of medication, psychiatry, and psychology.

“I think the hardest things in those few early years is I was a high achiever. I'd bounce back and think I didn't need to do any more work because I'd bounced back. So when it all came to a head again, whenever that happened to be, whilst I had developed some skills around it, I felt I hadn't done enough work to negate or navigate what was in front of me… and ‘navigating it’ in the sense that I have ‘control’ over the underlying biology and neurochemistry of my brain sets me up for failure.”

“I feel like society is constantly telling me I should be stronger, I should have a better mindset, I should override my feelings of no motivation and push through for the betterment of my mental health. But unfortunately, part of my condition is, I will relapse. If I go into this thinking that I have utter control, it sets me up to completely bottom out because ‘I have failed’. And that's not the case.”

“So seeing it as something that I have to live with and get better at navigating is a far smarter goal, if we're talking goal-setting, to aim for. Of course, every time I relapse, I'm hugely frustrated! But with a self-compassionate lens from the understanding of my illness, that's short lived, and I can navigate it better.”

Equipped with these skills, Taegan decided to start a family. “I was in the best place I'd been. I was navigating my ongoing illness. I was navigating the best I had. We spent two years looking into specialists that could help us, what it was going to look like, how best to stay well in this space. We had two miscarriages prior to the birth of my first little girl, and we navigated quite well. That was part of our story, part of our journey, and we did quite well.”

“Medication-wise, I was seeing my psychiatrist, and an additional psychiatrist as well. In a turn of events, the gold standard of lithium was allowed in pregnancy for my case, at a lower dose that was safe enough for the risk we wanted to take with our pregnancy, but it needed to be really closely monitored.”

“I made the decision in our pre-work that I wasn't going to breastfeed because there was a risk of my medication, not all medications, but my medication passing through. And also, I know sleep is a huge trigger in my illness and having my partner be able to feed was going to be a huge bonus. So that was a decision we didn't take lightly.”

“I like to say I thought we did as much as we could, but we did as much as we knew of, and it was driven by me. Like, I was the one researching, making phone calls. This wasn't a clear pathway, even though I know other people were having to navigate this, it wasn't a clear pathway.”

“My pregnancy, I was really sick, I had HG and I lost a tonne of weight and I didn't stop vomiting, and that had implications for my medication as well, but we managed.”

“The newborn bubble was quite lovely for us together. We did well. Even looking back at photos recently, like, there was more ups than downs in that first year of life and we thought we were doing pretty well. I think deciding to have another child was based on that experience. Like, we thought we managed… And it wasn't that I wasn't struggling first time round, it was that we were managing with the skills I had. So I could say it was bipolar and episodes were coming up and I was navigating it.”

“Rather than potentially getting back into work and then have to deal with that transition again, we decided that maybe we'd have another babe closer together. I vividly remember my psychiatrist… he's not a perinatal psychiatrist, he's my long term psychiatrist that I've had for ten years now, saying ‘it's a bit like deciding to stay in the war zone longer, Taegan, you're deciding to stay in the trenches rather than come out for reprieve’. And I thought that's a really funny way of thinking about it, but it 100% was.”

Taegan was also supported, short term, by the hospital’s perinatal psychiatrist six weeks either side of her birth. “But I was doing well, so I got discharged.”

“When we got pregnant with my second daughter, Greta, Harriet had just turned one. We had had two early miscarriages prior. Again, we navigated that as part of our journey. It was COVID. We were locked down. I'd made the decision to temporarily move back to the country to be with my parents to support my one-year old.”

“I was really sick again, potentially sicker than I was with Harriet, and I was trying to navigate a toddler as well.”

“I had anxiety from the get go, not only from the previous miscarriages, but this inherent ‘oh, no’ constantly circulating in me.”

“After those early miscarriages, we had decided I was going to return to work and I was going to have this break and reset everything. And then we got pregnant with Greta. So the fact that we had these return to work plans that I had to change was also quite hard for me to process.”

“We got childcare for Harriet so I could have this space to return to work, but we kept it so I could manage the pregnancy and that was hard for me to accept. Like, now she's going to childcare two days a week because I'm not managing. So already, my internal dialogue had changed, my self compassion had fallen away and I was in this survival mode, which probably persisted the whole of the pregnancy.”

Prior to going into spontaneous labour at 37 weeks, Taegan thought she would try for a VBAC. “But my anxiety had hugely peaked. Like, I couldn't get my head in the game at all… I ended up with this emergency section again, which I was okay with, but Greta had a heap of fluid on her lung and had to go to PICU [Pediatric Intensive Care Unit], so she spent four days in PICU. And I wouldn't say my experience is traumatic, but there were so many times that I thought I needed to advocate for myself better or I could have done better for the situation. And I did quite well at seeking out support there and then to process all that, but it added to the chaos of my survival.”

“Again, our newborn time was quite lovely. My husband had another extended period off. Navigating two was always going to be a challenge, but we did somewhat find a groove and there wasn't a pivotal moment that everything changed and went downhill. It was just hard. Like, the way I would normally navigate episodes in my mental health was a real struggle to navigate it the same way. It wasn't as effective, it wasn't working. Intrusive thoughts were a huge component of every day. And I'd done work on intrusive thoughts and how much time and effort I put in them, but they were relentless, like, constant.”

“I think probably looking back at what I was journaling and what I was writing at about four to six months of my second babe, it wasn't a shift, but it was something different. And I was saying, I can't get on top of this. Like, I'm not getting reprieve, I'm not managing. And not that it was brushed aside, but when I mentioned this to my GP and my psychiatrist, who both aren't perinatal trained, it was very much, ‘this is part of your journey. You've now got two kids, you've got increased stresses. This is understandable’. And I kept trying to tell myself that, but inherently knew something was different.”

“I went an extra six months and I actually started working that time because it was this idea in me that I was lacking purpose external to motherhood. I was doing writing in this space and I felt really connected to what I was writing. And this job opportunity came up to be a peer worker in a mother-and-baby unit. And I jumped at it. I jumped at it. I thought, ‘yes, this is it. This is the external bit that I need to get some validation. It'll be okay’. And it was okay. The job was great, but there were still underlying issues that I was feeling.”

Something new to Taegan that surfaced at this time was rage. “So this incurable anger in me, so frustrated. There's this inherent rage and it was consuming. Like I was infuriated! I think I wrote about it once, about slamming my phone in a protest of anger. Slamming my phone on a table, and it smashed. And I can remember looking at it like, how have I got here? How have I not got the skills to process the feelings I have inside without doing something like that? And that was new and so confronting… I'm pretty good at navigating getting my needs met. What is happening now that I can't move past this? Like I'm not being heard. Yeah, there was more to it, like, this is not me, this is bigger than me, there's something else is happening, I need help with this.”

“As a mum, if you're feeling the need to hide how hard this is: you deserve support. You have the right to reach out!”

This is when Taegan was diagnosed with postpartum depression by another psychiatrist. “He said it so matter of fact. He's like, ‘well, it's pretty clear to see that you've got postnatal depression’. And I can remember it just being like a truck hit me, but a relief at the same time. Like, thank God! This picture has been so jumbled in my mind that I'm not doing enough and not managing. But there's something else going on here. Like, I had this underlying postnatal depression - constant - and me saying the constantness of motherhood is not computing with me, but it was the constantness of my depression and me functioning with that as well as I could that was just being missed.

“I've had mixed answers from professionals. There's still this ongoing debate that, well, maybe it's just perinatally you with bipolar. Like, maybe it's not postnatal depression, which is fine if that's how you want to look at it, but for me, it was inherently different to what I was experiencing prior to being a mother.”

Despite her initial relief at this diagnosis, things quickly took a downward turn. “The month after that diagnosis was really traumatic and turmoil, as I processed all of that.”

“All of a sudden my postnatal depression was labelled and allowed in a sense, and I think in freeing myself from that, trying to process all that, I had a really big bipolar episode on top. So it was the mixed episode, which is really challenging to diagnose in itself. And I've had them before, but this one was bigger, like it wasn't a matter of me ‘soldiering on’. No. The wheels were off.”

”My brain was just crying out for a break - the circuit break that we were needing. My brain was firing and it wasn't making sense to me. It wasn't making sense externally, but it was in huge need of respite.”

“It involved a hospitalisation and ten days away from my kids because of COVID… I was in an adult private unit. The mother-and-baby unit in South Australia, I worked at - not ideal to be admitted there, but also, this was my second babe, 13 months old, and it’s for under 12 month olds.”

“And I have worked in adult units. I knew what they were about. I was a recluse. I spent the time in my room doing the hard yards to get myself better. It had to happen. It was a circuit break for me that looked at my health as a whole.”

“It's not that I'm shameful of a hospital stay… doing that work before kids, holding that shame for yourself, the guilt that you felt - but it was only you affected! Adding a partner and children inherently, maybe not correctly, that guilt is personified.”

“It was eight years since my last admission, so I'd done all this work pre-kids naively, hopefully, thinking that that wasn't part of my story anymore, but it had to be.”

“It was hard pressed to keep me there. And of course, there's always means to keep a patient there that needs to be there. And that's where I ended up. I think I did two days post my ITO* being revoked. It was like I can no longer hold in me my need to be here and my need to be a mother.”

“My littlies were actually in the country, so they were four and a half hours away. So immediately we went to see them.”

“I know that I was really fortunate to have enough support around me to facilitate everything I couldn't do because I was still coming out of an episode where I was really unwell. But not everybody has that.”

“And if I'm honest, twelve months down the track, it's taken twelve months of recovery work that isn't stopping now. I've got to a place now that I can go back to a psychologist and work with this. Like survival mode for the last twelve months involved a move back down to the country for more family support, to sort of give me the space and structure and support that I needed.”

“It was decided collaboratively that I probably needed more time before jumping into both of them. And I still had appointments in the city that I had to go to. So my eldest came back to the city and my youngest stayed another week [in the country]. And then after that week, with support, we slowly got our groove back.”

“Some of those decisions, whilst I was part of them, inevitably, family, under the advice of medical professionals, are making what they think the best decision is for you in the circumstances. Even the people closest to you probably don't anticipate the ramifications that that means mentally for you. But we got there… It's so tricky. Maybe I couldn't have managed, but my mum internal barometer was screaming that not only did I need my girls close, but they needed me too.”

Taegan has since been processing the mixed episode and her admission. This involved regular appointments with her psychiatrist as well as the commencement of TMS [transcranial magnetic stimulation].

“It was two weeks after that [admission], that I started TMS for a month. It was a huge commitment. It was once a day. I think the treatment itself was sort of 20 minutes to half an hour, but getting there and having children minded, my appointments were midday every day, so getting out of the house for an hour and a half every day, I think it was four out of five days for a month! It was really challenging.”

“On paper, doing questionnaires pre, during, and after [TMS] I improved. Like, I definitely improved. Yes. Statistically, I improved. I have talked about it a lot with my psychiatrist since and I don't personally know if it had a big enough effect for me to warrant signing up for it again… But, yes, on paper it had an effect and maybe it got me back to a place of functioning enough and everyone's so different. I was definitely hoping for more.”

“My long term psychiatrist - who's been brilliant, he actually introduced me to a recovery sort of process which changed my trajectory - but when I was processing, I thought hospital stays were no longer part of my story. And he looked at me with empathy and he said, ‘Have I ever given you that idea?’ Like, he was taking ownership as part of it! And I'm like, ‘no, that's me’. And he's like, ‘I'm so sorry, Taegan, but this is your illness. And it won't always be part of it, but sometimes it might be’. And that was really validating.”

“Like, sometimes we're our own harshest critics and coming from some of that perfectionist stuff and the control that I wanted over my illness in early days, like, I'm not to blame! My illness - above me, part of me, but separate from me as well - that's part of it. Like, it's unfortunately part of it. So it was validating that, yeah, this isn't necessarily my fault.”

Now twelve months post her admission, Taegan is planning to recommence some of the inner child work she had done prior to having children. “I've just met a new psychologist who I'm going to do a bit more work in this area, but I haven't had the capacity because it was that big! To make space for more than survival - that was out of my capacity for the last twelve months! I couldn't actually add anything else in to the mix. Inherently wanting to do self work needs the space and time to be able to do it.”

Coming out of survival mode, Taegan acknowledges that thinking about a relapse prevention plan is crucial for the future. “Somebody who has an ongoing illness, whether that's long-term anxiety or long-term depression or bipolar or something physical, we all have a need for relapse prevention.”

“Mine's ongoing! So I did all this work before babies and I had a relapse prevention plan on paper... My husband had looked at it even the other day and said, ‘we used to navigate this really good’, like bang, bang, bang, we knew what to do! We don't now because we haven't actually spent time out of survival mode to really look at what it means as a mother to have a relapse prevention plan.”

“Because I've looked at the relapse prevention plan from 2017 pre-babes - none of them work now! None of them work with kids in the house.”

“It's a work in progress and it always will be… I'll have to do this multiple times. Everyone does. It's not a recipe for everyone that you can keep forever.”

“I probably think it's around that stuff that I wish I had have known. Not that it would have changed it necessarily, but yep - ‘Taegan, you've done great work getting yourself up to being able to consider babies and doing that - it's going to be ongoing work!’”

“There's challenge every day with being a mother in general. Navigating our own emotions while helping to assist navigating a little person's emotions is a huge responsibility.”

“And while I said before that I'm an advocate for doing work and having space and doing the dreaded self-care or nurturing work because you deserve it, as a human being. As a mother, even, I rely on ‘doing this work benefits others’ - like, it benefits others! Now, me being the wellest I can benefits my family unit. So, yeah, first and foremost, yes, I need to do it for me and my enjoyment of life. But on the days where that's hard to access, doing it for my girls is another bloody good reason.”

Listen to the full episode:

*ITO

In Taegan’s words, “A psychiatrist or a medical professional can write an involuntary treatment order [ITO] for a certain period of time to keep you within care involuntarily if you're not agreeable to it. And there's so many reasons why people aren't agreeable to this. It's not based on one doctor's point of view. It's always reviewed by an external source. And mine was definitely reviewed by an external source. I made sure of it. But it's to keep people safe. It's to try and get them into some care.”