I understand there is research that shows a link between 'birth trauma' and bipolar disorder.  Our daughter, who has been diagnosed with bipolar, was delivered using forceps.  There is a history of bipolar disorder in my husband's family.  To reduce the chances of a child she gives birth to also having bipolar, what is your view on her electing to have a caesarean?  (Hypothetical question only)  Thank you.

Dear Sandy -- 
Hypothetical, but certainly a logical question to ask.  First I'd want to find out how much reduction in "birth trauma", which for now we can deliberately leave as a rather open and somewhat vague concept, is achieved for a woman of your daughter's age when/if she becomes pregnant.  I'd want to ask an OB-Gyn how much risk reduction one gets for a young healthy woman; I'll bet that's a pretty low number. 

Meanwhile, I hope that event will be very carefully planned. The risks of taking a medication known to cause fetal abnormalities (not bipolar disorder) may be bigger, statistically, than those posed by birth trauma.  For that, we'd need to know how often birth trauma is the "trigger" for later bipolar disorder, in a genetically susceptible individual.  To my knowledge, we have absolutely no idea about the size of that number.  In fact, I don't often hear about birth trauma as a "risk factor" in the development of bipolar disorder (by comparison, that is often cited as a risk in the development of schizophrenia). As an example of how far from considering the question you pose, here's an article which would have been the perfect place to mention this issue, if anything was known:  Kimberly Yonkers and her colleagues wrote a summary last year, Management of bipolar disorder during pregnancy and the postpartum period.  They do not bring up the question you raised.  

I haven't reviewed the literature on the subject of "birth trauma" and risk of bipolar disorder.  If you have a particular reference there you'd like a comment on, I'd be interested in seeing that.  I'd want to make sure we weren't confusing the data on schizophrenia and bipolar disorder.  But you may be aware of something I haven't heard about yet. 

Dr. Phelps
 

May, 2005