Wednesday 22 May 2013

Bipolar and pregnant

Thank you to guest blogger Zoe for allowing us to share her thoughts on the recently reported case of a woman who was granted legal access to abortion following a challenge to her ability to consent. This is cross-posted on Zoe's own blog 'The Fementalists'.

Today a woman, identified only as “SB”, won her High Court battle to be allowed to have an abortion. This fact may seem strange to many readers as since the Abortion Act was passed in 1967 legal abortion has been mostly accessible to women in England, Scotland, and Wales . However, the woman at the centre of this case has bipolar disorder and it was argued by doctors and her family that she lacked mental capacity to consent to the procedure. Lawyers representing the health authority told the judge “she is believed to lack the capacity to make a decision regarding the termination of her pregnancy due to her mental disorder.'' Fortunately, the judge disagreed with this assessment, stating that it would be "a total affront" to her autonomy to decide that she was unable to have an abortion.

I have been following this case closely as I also have bipolar disorder and as a young woman with a male partner I worry a lot about the possibility of an unplanned pregnancy, to say nothing of worrying about what my future holds in terms of planned pregnancy. It was stated in the Court that the woman in this case had stopped taking her medication and thus relapsed, culminating with her being detained under the Mental Health Act. However, many medications for bipolar are not suitable to take when pregnant as they can cause birth defects such as neural tube defects, heart defects, and developmental delay or neurobehavioural problems. Thus many people have to stop taking their medication if they wish to continue with their pregnancies. This is believed to be what happened in the “SB” case. While this may seem like a relatively minor thing, the consequences of this can be devastating. Rates of relapse into bipolar mania and psychosis are estimated at 50% to 75% respectively and WebMD states that Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions than pregnant women who do not have bipolar disorder.” So clearly the risk of being detained under the Mental Health Act also greatly increases during pregnancy because of the additional problems caused by stopping medication.

For me, this represents the nightmare scenario. Finding myself pregnant with a wanted foetus only to stop my medication, relapse and be detained under the Mental Health Act, and to then decide that for my own health I would like a termination and be denied it because it is argued that I lacked capacity. It is truly a terrifying prospect to find yourself unable to control your own body because you have a mental illness. Much more needs to be done to provide perinatal care for women with severe and enduring mental illness to ensure that a situation like this never arises again. Fortunately in this case the judge has made the right decision and SB is expected to have an abortion in the following days. Arguably, this situation should never have arisen in the first place.


  1. I would love one of the national bodies to push reproductive healthcare for people with mental health needs higher up the agenda. It's a complex field and I see informal forms of manipulation and coercion used far too often. Student mental health nurses get no/next to no training in this area,and far too often advice and decisions are made based on opinion rather than evidence (of which there is little because it's under-researched). Thanks for your interesting blog.

  2. Kudos to the judge on this occasion. It would have been an affront indeed.