Chapter 9 236 wellbeing. Fourth, more than half of the participants feels impaired as a parent due to mental health problems. Part II Psychiatric vulnerability and birth outcomes Chapter 4 reports findings from a retrospective cohort study on the occurrence of UPs in women with current or past psychiatric diagnoses, and the impact of UPs on maternal and neonatal outcomes. Results show that UPs are more common in women with current or past psychiatric diagnoses (39.0% vs. 29.6%, OR 1.56, CI 1.23– 2.00, p<0.001), specifically those with depressive, personality and substance-related disorders. The presence of UPs does not create clinically relevant changes in maternal or neonatal outcomes such as mode of delivery, preterm birth and low Apgar score. In Chapter 5, the results of a retrsopective cohort of women with bipolar disorders are presented. Neonatal (re)admission rates and other obstetric outcomes are comparable for neonates exposed versus not exposed to lithium. However, women with bipolar disorders, regardless of lithium exposure, have relatively high rates of obstetric complications such as caesarean sections (29.1%), gestational diabetes (12.8%) and hypertensive disorders of pregnancy (8.5%) compared to women without bipolar disorders in comparable samples. The findings from this chapter underscore the vulnerability of some women with bipolar disorders for pregnancy complications. Part III Psychiatric vulnerability and lived experiences with family planning Chapter 6 illustrates the intricacies of family planning decisions among women with psychiatric vulnerability in a qualitative study with focus groups. Together, four major themes illustrate how family planning decisions are shaped by (prior) psychiatric vulnerability, holding space for the complexity and ambiguity of the interaction between psychiatric vulnerability and family planning decisions. The ‘Shadows of the past’ theme is marked by childhood trauma, adverse events, and inadequate parenting. The ‘Shadow of the present’ theme addresses awareness of psychiatric disorders and emotions toward psychiatric stability. The ‘Shadow of the future’ theme describes how social influences, stigma, and concerns about transmitting psychiatric disorders shape future imaginaries towards desire for children and decision-making regarding having children. Last, the retrospective design of the focus groups provides room for reflection on previous decision-making. Women’s narratives are interspersed with emotions such as regret, grief, and relief. The ‘Reflections’ theme illustrates how women’s current emotional lives are impacted by their former decision-making.
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