title: Women with bipolar disorder and pregnancy: factors influencing their decision-making.
abstract: BACKGROUND
  Women with bipolar disorder are at increased risk of having a severe episode of illness associated with childbirth.
  
  
  OBJECTIVE
  To explore the factors that influence the decision-making of women with bipolar disorder regarding pregnancy and childbirth.
  
  
  METHODS
  Qualitative study with a purposive sample of women with bipolar disorder considering pregnancy, or currently or previously pregnant, supplemented by data from an online forum. Data were analysed using thematic analysis.
  
  
  RESULTS
  Twenty-one women with bipolar disorder from an NHS organisation were interviewed, and data were used from 50 women's comments via the online forum of the UK's national bipolar charity. The centrality of motherhood, social and economic contextual factors, stigma and fear were major themes. Within these themes, new findings included women considering an elective Caesarian section in an attempt to avoid the deleterious effects of a long labour and loss of sleep, or trying to avoid the risks of pregnancy altogether by means of adoption or surrogacy.
  
  
  CONCLUSIONS
  This study highlights the information needs of women with bipolar disorder, both pre-conception and when childbearing, and the need for improved training for all health professionals working with women with bipolar disorder of childbearing age to reduce stigmatising attitudes and increase knowledge of the evidence base on treatment in the perinatal period.
  
  
  BACKGROUND
  None.
  © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
authors.affiliation: , BSc, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Dolman
authors.affiliation: , MRCPsych, MRC Centre for Neuropsychiatric Genetics and Genomics, University of Cardiff, UK.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Jones
authors.affiliation: , MRCPsych, Section of Women's Mental Health, King's College London, UK.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Howard