Antenatal depression and antenatal anxiety: Jen’s story

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antidepressants pregnancyI struggled with undiagnosed antenatal depression and antenatal anxiety.  I felt like such a fraud.  My husband and I had planned for this baby.  I should have been overjoyed and glowing.  Instead I walked around in a fog of self-hatred, irritability, and unrelenting worry.  My internal monologue consisted of, “I should be happy, dammit!” Why couldn’t I enjoy this pregnancy?  It was my final pregnancy, and we were giving our nearly three-year old daughter a sibling.  Where was my pregnancy glow?  Why did I feel like all I did was complain, vent and whine?

Why couldn’t  I relax?  I felt so much pressure to get my oldest potty trained before the new baby arrived.  I felt like all loose ends needed to be tied up.  I had to finish my toddler’s baby book before the new baby arrived.  I had to make sure I was exercising daily.  I had to maintain a tight control on my blood sugar.  I had gestational diabetes with my first pregnancy, so I spent my final pregnancy watching my food intake.  Every time I heard a comment about “eating for two”, I wanted to rage.  I did not have that luxury of eating whatever I wanted.  The meal plan made me miserable.  If my numbers weren’t within the expected range, I immediately panicked.  I was terrified that my daughter would struggle with complications from my gestational diabetes.  Not even the ultrasound showing a healthy twenty week baby girl diminished those fears.  I felt like I had no right to complain or worry.  I knew what to expect.  I needed to just suck it up and deal with it.

Like postpartum depression, antenatal depression looks different for each mama.  My lovely friend Susan describes her antenatal depression like this.  “I just remember feeling a crushing weight and numbness. I wanted to not be pregnant anymore and had thoughts of throwing myself down the stairs. That’s what sent me to a perinatal psychiatrist. All my joy left like I was in a vacuum – and I was suddenly convinced a new baby was the end of everything as I knew it.”

My experience of antenatal depression differed from Susan’s.  My depression manifested itself in extreme irritability, bordering on rage.  I had no patience for anything – traffic, my husband, my daughter, my parents and my sister, my friends, and my co-workers. One of the triggers for my rage was my daughter’s refusal to take naps on the weekends.  I could barely control my reaction.  I would yell and scream at my husband.  I would need to leave the house to give myself an adult timeout.  I still cringe when I remember an epic tantrum that occurred during my seventh month of pregnancy.  I was at a concert at an outdoor venue.  I cut in front of everyone waiting in line for the bathroom and for water, simply because I was pregnant.  I was rude to everyone that day. I took out my rage on anyone in my path.  This irritability and rage manifested itself in full-blown postpartum depression and postpartum anxiety after my youngest was born.  I wish I had recognized these signs sooner.  I could have treated this during my pregnancy when my initial struggle began.

Antenatal depression and antenatal anxiety are not as widely known as the other perinatal mood disorders.  We do moms a disservice when we fail to screen for depression and anxiety during pregnancy.  We need to focus on both the needs of the mother and the needs of the baby.  Mothers are vulnerable during both pregnancy and the postpartum period.  Ask the pregnant mom how she is doing and really listen.  I read this amazing piece that Andrew Solomon wrote regarding depression in pregnancy.  Thank you Andrew for speaking up for both the mothers and the babies.  If you are feeling fragile, do not read Andrew’s piece.

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Pregnancy Anxiety and Family History of Miscarriage

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Pregnant BellyFirst-time mothers can find many things to be anxious about when they become pregnant. What will pregnancy be like? Will my baby be healthy? Did I start taking my prenatal vitamins early enough? Am I really ready for this? But some women may have an additional fear that seems more relevant than it might to other pregnant women: Will I be able to stay pregnant, knowing that my mom had a history of miscarriage?

This anxiety was something that I had to deal with when I discovered I was pregnant with my son shortly after beginning infertility testing. After a year of trying to conceive, I had been getting rather depressed about failing each month, and the beginning of that year of trying may or may not have started with a miscarriage I was too afraid to see my doctor about. I know now that that was a bad decision, not telling my OB/GYN about the three weeks of heavy bleeding that had forced me to reschedule my initial annual exam where I’d intended to ask for a prenatal vitamin prescription, but I didn’t bring it up because I didn’t want to know for sure. My mom had suffered three miscarriages when I was a kid – the reason why there ended up being eight years between the births of my two younger brothers – and I was trying to shield myself from the emotional aftermath of knowing for sure whether it was a miscarriage or just an exceptionally heavy period. My periods were awful and unpredictable when I went off the Pill. I still have plausible deniability.

So there I was with a positive pregnancy test around Christmastime 2004, overjoyed that I was finally pregnant, but haunted by the shadow of a possible miscarriage. Some of these things are genetic. Some are due to environmental factors. Some don’t seem to have any reason whatsoever. Were those genes passed on to me?

These fears led to a tearful call to my OB/GYN just after New Year’s. I was spotting. They tried to reassure me over the phone as they set up the appointment for me to come in. Spotting can happen in a normal pregnancy. It doesn’t mean anything is wrong. But predisposed as I was to anxiety, this was no consolation. I saw the CNM I liked at my OB/GYN’s office for a pelvic exam and a urine test. The blood was brown, though, old blood, and my pregnancy test was positive. My cervix was inflamed, though, so they sent me to the local women’s hospital for an internal ultrasound because they didn’t have any ultrasound techs in the office. I was only five weeks along, so all they could see what the egg sac and yolk sac, which was good enough for them to reassure me my pregnancy was fine. Only if I started seeing red blood along with cramping should I worry and give them a call.

I didn’t have to make another call like that, but my anxiety didn’t go away.

My inflamed cervix ended up needing to be treated, and I was prescribed MetroGel for it. MetroGel is considered Category B for pregnancy risk, but I was still in my first trimester, and I was terrified that something bad would happen if I introduced this foreign substance so close to where my baby was developing at such a crucial period. I ended up waiting until the first day of my second trimester to actually use the MetroGel. That decision in itself was risky, as an untreated infection can also potentially harm a developing fetus, but it was what I considered the safest route at the time.

Thankfully, my anxiety levels decreased appreciably once I reached 24 weeks. That was the magic number in my head where I felt I could stop worrying about a miscarriage, because about 50% of babies born prematurely at that fetal age survive. And with each passing day, I knew my son’s chances of surviving and being born relatively healthy were just getting better and better.

Unfortunately, my anxiety came back with a vengeance after my son was born, alongside my undiagnosed postpartum depression. If I’d known then what I know now, 10 years later, I would have talked to my doctor. I would have tried to get help. I know I would have avoided taken any medication during my first trimester, but I might have considered some of the lowest-risk medications during my second and third trimesters according to the best available information at the time. I certainly wouldn’t have waited until my son was three before finally seeking treatment from a psychiatrist.

I know I couldn’t have stopped worrying about losing my son, but I could have had someone to talk to about it if I’d looked into therapy. But that’s why I think Postpartum Progress is so important – so people like me can encourage other women to get the support we never had.

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Rethinking Antidepressants and Birth Defects

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20150507_112831Ruta Nonacs, MD, PhD, of the Massachusetts General Hospital Center for Women’s Mental Health, posted a very important blog post yesterday regarding a large new study published in the British Medical Journal regarding SSRI’s (the type of antidepressant medication very commonly prescribed) and venlafaxine (marketed as Effexor in the US). The study focused on children in five Nordic countries and their exposure to any SSRI and venlafaxine. They were looking at whether babies born to moms who take these antidepressants during pregnancy are more likely to have babies with birth defects.

The results?

According to Dr. Nonacs, “To summarize, this large Nordic study found no substantial increase in the overall prevalence of birth defects among infants exposed to SSRIs or venlafaxine in utero.” And we’d point out that this study looked at more than 2 million births in Denmark, Finland, Iceland, Norway, and Sweden. TWO. MILLION.

This study, in addition to having a large size with an even larger control group, also “… restricted the study population to women with at least two children and were able to conduct sibling controlled analyses by looking at sibling pairs who were discordant for exposure to SSRIs or venlafaxine.” (source: MGH blog)

A quick Google search for any news of this study being reported by mainstream media provided no results. Surprising, given that the study was published in mid-April. We looked everywhere, considering this would be huge news to the hundreds of thousands of women who are pregnant and unsure how to treat their mental health issues. It seems the media would prefer we continue to believe antidepressants and other medications for mental health are harmful.

Granted, we should all do our due diligence when taking meds that may affect the precious little ones in our lives. But we also need to take care of ourselves and not allow fear-mongering to prevent us from doing so when research aplenty has proven that we can do so without greatly increasing risk to the most precious little folks in our worlds.

But it seems, for now, we can breathe a little easier when we do need to take our meds to keep ourselves moving forward through life. And this, this is a good thing.

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A Third Pregnancy, A Chance To Heal

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by guest contributor Lindsey O.tea

My first pregnancy I was blissfully unaware of what pregnancy and childbirth was like, and honestly I wish that I could get a bit of that naiveté back. Every bit of those 9+ months was new and exciting and fun. I loved learning about everything my body was doing and how my son was growing. My birth was a little scary at the end but with the techniques I learned in my Bradley classes, I was able to achieve my goal of an unmedicated birth.

The second baby was conceived quite by chance shortly before my first son was a year old. The anxiety kicked in and I was feeling more isolated from my husband because of the demands of his job and his inability to well, care. My entire pregnancy I hoped and prayed that the baby would be breech so I had an excuse to not go through an unmedicated vaginal birth again. My husband assured me that I would be disappointed in myself and the experience if I “wussed out” and agreed reluctantly to help me re-study our Bradley book. Every time we sat down to go over it I would have a rush of fear and start to cry or get angry and decide I was done for the evening. I just didn’t want to think about what the process was going to do to me again.

At some point in the last ten weeks of that pregnancy I decided to be “tough” and “suck it up,” telling myself that having unmedicated births were the greatest gifts I could give my children on their birth days. Also I had decided this was our last baby so I just had to do it this one last time. Labor was quicker, I was strong and determined and confident. I kept my wits the whole time (well transition was the usual craziness, but I held out) and had another unmedicated birth. This time, a nine pound, one ounce screamer. And then the room fell silent. I was holding my baby and didn’t notice much but wasn’t allowed to sit up, and then all I really remember was a lot of fundal massage and cramping and code words. Honestly, I felt like crap and couldn’t walk and was incredibly dizzy. Later that day a nurse informed me that I had hemorrhaged and they were about to give me a transfusion but I stabilized. The OB who delivered said something about me being past the point of blood loss that “we worry about losing the mother.” They then told me that the severe cramping was because I had been given Pitocin through my hep lok. They kept me an extra night for in hospital care for GBS+ reasons which I disagreed about and then guilted me into a heel stick for my baby because he was “big” and they wanted to check for diabetes. Where was my husband for ALL of this? You tell me. I was ALONE. However, I knew that at least I would never ever have to go through this again.

Fast forward exactly 3 years later and we are stunned by the conception of another baby who will be here in less than 13 weeks. I was in a funk for two weeks and it took me three months to get back to reality and my responsibilities with my business and mothering. Here I am, now, in some ways getting my mojo back and in others an absolute mess. I try to do what I can when I can in different aspects of my life to maintain order but there is a lurking emotional monster somewhere near me at all times. I have broken down now in two midwife appointments and cry whenever I think about having to do that again. I have been diagnosed with PTSD and clearly I have anxiety/depression which I have never experienced in my lifetime. I fear that I may die next time, that I may bleed out, tear horribly as I did with the first two, or just have something dangerous or scary happen. It takes up a good deal of space in my daily life. So what do I do about this?

I have answers from everyone and suggestions and loving advice but all I can think about is this: I am not telling anyone what I really want. What I really want is control. I want to have a birth I am happy about not because I “did it for the baby” or did it to make my husband proud, or did it because I felt I had to after being given a sense of control from a child birth program. I want to feel I had my best outcome in a birth because I got what I needed to have closure (I will be getting some form of permanent birth control after this baby, as will my husband). I NEVER in a million years thought I would say this, but I am seriously considering a c-section. Do I care if anyone judges me in this? Honestly, I did until the anxiety took over my life. I don’t want to let that evil in any more than I have. I see this as a chance to heal and I don’t think I would have been forced to deal with all of the bottled up stress from my first two births if this third baby hadn’t come along. I want to heal from this and I want to feel like I can close this chapter in my life and let it all go. I also want to make my body a safe place for this child while she is still there and right now I know it is not. I can’t go on hoping to have the decision made for me and suffer like this all the way to the end and then come up with some last minute decision about how I will birth. I’m still working this out in my head and will have a discussion with my midwife at the next appointment so I definitely don’t have concrete plans for anything yet, but I feel better knowing that I am finally taking full ownership of this and not allowing myself to feel pressured in any direction.

If I could say anything to anyone who utters one word to a pregnant or postpartum mom, I would urge them to take consideration for the mother and her well-being and not spend so much energy on the baby. Let her shower, rest, do the chores for her, hold the baby for her while she eats dinner, and let her cry to you if she hurts. But most of all tell her it’s okay and it’s normal to feel whatever she does or doesn’t feel. Let her be in charge and own the entire experience and not feel like she has to put on a brave face for you. I wish I had been more vulnerable after those first two pregnancies so that I could be more open for this one.

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