Table 2 Themes and subthemes with illustrative quotes
Centrality of motherhoodContextual factorsStigmaFear
Desire to have children
  • I’ve always loved babies, I have … really strong maternal urges all the time’ I felt very … angry. I thought: how can you not appreciate what a huge thing this is for us – to possibly think of never having children?’

Cultural and religious factors
  • ‘In Asia they don’t believe in mental illnesses’ ‘My family keep harassing me to have a kid’

Anticipated stigma
  • ‘My worst fear is people thinking I’m less capable because I’ve got bipolar … [what if people] think she won’t be able to look after her kids?’

Fear of becoming ill
  • ‘I was really, really scared [when I stopped Valproate]’ ‘I’m very fearful … at the possibility [of] postpartum psychosis … I can barely even think about that’

Physical and psychological readiness
  • ‘you’ve got to get fit’

Stigma against mothers with mental illness
  • ‘… I try not to tell everybody … they don’t get it really’

Fear of damaging the baby
  • ‘problems like birth defects … that scares me’

Biological clock
  • ‘it’s ticking like mad’ ‘there’s only so far you can defer this decision’

Stigma from health professionals
  • ‘we were made to feel that we were being irresponsible in thinking about it’

Fear of Social Services involvement
  • ‘I don’t want my child to be taken away’

Economic factors
  • ‘you worry … about the quality of life that you can give them’

Stigma against women unable to breastfeed
  • ‘I got a lot of “Why aren’t you breastfeeding? Why?” … I never heard them talk to anyone else like that’

Fear of being a bad parent
  • ‘I was concerned about … the pressures of being a mum’

Family history
  • ‘[Idon’t want a] child to go through such difficult times’

Fear of passing bipolar disorder to child
  • ‘it’s the last thing in the world that I would wish upon her’

Degree of social support
  • ‘I’m phenomenally lucky that I have my husband’

Threat to relationship
  • ‘it might be … too much pressure on him’

Local service provision
  • ‘it was very helpful, talking to [a perinatal psychiatrist] … you just couldn’t get that information from anyone else’