Just Because I Have Depression Doesn’t Mean I Shouldn’t Be Pregnant


Many people have suggested that I shouldn’t try to address
how bad I’ve felt during my pregnancy — or say that I
shouldn’t have gotten pregnant at all.

Posted on July 10, 2017, 14:40 GMT

Gracia Lam for BuzzFeed News

When I went to drop off a prescription for Lexapro at
Walgreens, the woman behind the counter asked me how far
along I was. Twenty-eight weeks, I told her, just starting
the third trimester. “You’re going to be so uncomfortable for
the next few months, but it’s going to be great,” she said.
“I loved my pregnancies. I wish I could feel that way all the
time.”

The irony of being assured that I was going to have a great
experience with the rest of my pregnancy while I was
procuring an antidepressant wasn’t lost on me. I smiled and
nodded and made a mental note to myself that I was, in fact,
happy for her that her pregnancies went so swimmingly, even
though mine had not, and even though the prospect of “feeling
that way all the time” struck me as horror-inducing.

I had been diagnosed with antenatal depression, the medical
term for depression while pregnant, just a few days before,
and it was severe enough that my obstetrician had sent me to
the emergency room in hopes that I’d be able to see a
psychiatrist on the spot. I’d arrived at her office for my
28-week appointment after three hours of hyperventilating and
tears. What in any other case would have felt like a moderate
inconvenience with my work schedule had in my mind escalated
to a decision that would determine how competent I really
was. That creeping horror had become one of the defining
feelings of my pregnancy — forget any kind of “glow.”

Over the prior six weeks, breakdowns like this one had become
more frequent, and were accompanied by a general malaise. I
stopped wanting to eat, I stopped gaining weight, I stopped
talking to my friends and family, it took everything I had to
make doctor appointments and keep them, and every step I took
was like moving through molasses. I was even having symptoms
of postpartum psychosis — graphic, sudden, vivid visions of
harm being done to me or the baby by strangers or by
accident, in addition to suicidal thoughts — just, you know,
three months early.

Creeping horror had become one of the defining feelings of my
pregnancy — forget any kind of “glow.”

This isn’t a source of shame for me. I’ve been receiving
mental health care since I was twelve, mainly for high-level
anxiety and, as an adult for post-traumatic stress disorder.
The fact that I struggled during pregnancy wasn’t a shock: I
had a hunch that I might have a hard time based on the fact
that hormonal birth control always threw me for an emotional
loop.

But it’s not easy for everyone who becomes depressed while
they’re pregnant to talk about it. While searching for
stories that looked and felt like mine, I soon found out why.
I had heard similar sentiments in various comment sections,
but Andrew Solomon’s 2015 article on the challenges of antenatal depression
for the New York Times became a breeding ground for highly
polarized reactions. Commenters with something negative to
say fell into two categories: people with a sort of
“eugenics-lite” argument who said women who have depression
shouldn’t procreate, or commenters who denied that depression
while pregnant was a problem that actually existed.

“My advice to women such as Mary in this story is not to
reproduce,” said one commenter, mentioning that a cousin had
made that decision and “feels sad, but I agree with her.”
Another wrote: “Some of the women described appeared to be
seriously mentally ill. That does not appear to be a good
qualification for motherhood!” Another suggested that if you
have a condition that could be worsened by pregnancy and
medications for which carry an unknown risk to the fetus,
“You would… maybe adopt a child?”

Such judgments aren’t just the province of anonymous internet
commenters. In Origins, journalist Annie Murphy Paul
describes her experience of observing a depressed, pregnant
participant in a research study:

I have every reason to feel empathetic, but to my chagrin I
find that I feel repelled. Her drawn face is jarring above
the lush curve of her belly, and the deadness of her affect
seems painfully at odds with the life moving inside her.
For the first time, I begin to understand why the notion of
depression during pregnancy arouses such discomfort.

My first impulse is to call the commenters’ and Paul’s
reactions plain old sexism, but they seems less a judgment on
women per se and more an example of our culture’s
extraordinary anxiety over the risks around pregnancy in
general. It’s another form of the phenomenon I’ve encountered
during my own pregnancy, of people telling me what I should
or shouldn’t do — eat deli meat, drink alcohol or coffee,
have sex, pursue a vegetarian diet, take Zofran. But in this
case it’s either that, because I had risk factors for mental
health issues and developed antenatal depression, I shouldn’t
have gotten pregnant at all, or that I shouldn’t worry about,
put a name to, or even try to address how very, very, very
bad I feel.

Sociologist Barbara Katz Rothman describes pregnancy
as the “pregnant canary” in the “coal mine of
medicalisation,” meaning that it was one of the first aspects
of health to not just be professionalized, but framed in the
context of a risk so great that it merited constant medical
surveillance. And, strikingly, one of the factors that led to
the medicalization of pregnancy after centuries of
cooperative care from midwives and doulas was the eugenics
movement.

It’s not easy for everyone who becomes depressed while
they’re pregnant to talk about it. 

Sociologists Helga Hallgrimsdottir and Bryan Benner
explain in their 2014 article “Knowledge is Power,” that the
rise of obstetrics and first-wave feminism’s embrace of
science to help women “achieve their womanly potential” in
the US and Canada was tied to nativist movements. These
groups were concerned with creating ideal citizens, in this
case through ideal health, which in families was the
responsibility of women. So, by the early 20th century,
pregnancy became an issue of morality: “The pregnant woman’s
conduct was exclusively governed by invoking distinctly moral
directives aimed against avoiding possible – and avoidable –
dangers,” write Hallgrimsdottir and Benner. This included
manuals by authors of varying expertise, such as Roger
Norman’s 1914 The Wife’s Handbook, which
told women that they could be “fit candidates for matrimony”
while being unfit, medically, for motherhood. Women were
warned to exercise caution when selecting mates in order to
avoid risks to the future of the human race. By the
1960s, avoidance of danger and risk had become the dominant
narrative of medical care in and after pregnancy.

Such overly cautious language has since extended to risks to
the fetus, despite the fact that it can be difficult to
determine what puts a fetus at risk. “No one can weigh
unknown risks and benefits,” as bioethicists Rebecca Kukla and Katherine Wayne note,
because pregnant women cannot be included as research study
participants on the basis of potential risk to fetuses, which
puts us all in a double-bind. As a result, doctors, family
members, and strangers feel free to instruct pregnant folks
to abstain from practically everything. And apparently that
abstention can include getting pregnant to begin with if you
have depression or are taking medication to treat said
depression if you’re pregnant.

When I was not yet pregnant, but honest with loved ones about
how I assumed pregnancy probably wouldn’t suit me, they told
me that I’d change my mind once I was pregnant. During my
first trimester, when I was laid out with hyperemesis
gravidarum, an especially severe type of morning sickness,
friends who were uncomfortable with my distress constantly
told me, “It’ll all be worth it in the end!” or “You’ll feel
so much better in your second trimester!”

By the 1960s, avoidance of danger and risk had become the
dominant narrative of medical care in and after pregnancy.

When I was in the ER, the two social workers on shift told me
that my depression was “just hormones” and that everyone goes
through it, a popular but incorrect understanding of the
biological processes at work. To clarify: It is
hormones, but fluctuations in hormone levels are known to
affect mood by interacting with neurotransmitters. By the end
of pregnancy, levels of the reproductive hormone progesterone
are 10-12 times higher than it is at the height of your
menstrual cycle, which, according to a 2001 study in the Journal of
Clinical Endocrinology & Metabolism,
may affect some
pregnant people’s mood more severely than others’.

If you’re either depressed already or, as in my case, you’re
sensitive to hormonal changes, that can mean certain
destruction of your emotional well-being. Saying that
anything is “just hormones” is a tremendous underestimation
of how complex the endocrine system is and just how much of
your body it affects.

Even the pharmacy tech at Walgreens performed a similar
version of denial, inasmuch as she wanted to reassure and
guarantee me that pregnancy was going to be great. Everyone’s
strongest impulse has been to convince me, and perhaps
themselves, that I will have an overall positive experience
with pregnancy, even in the face of ongoing evidence to the
contrary. Rothman notes that “weighing the risks” of our
experiences and actions in pregnancy also means weighing the
risk of other people’s responses. Perhaps the people who deny
that my depression is happening and tell me it will be
a positive experience are trying to protect me from other
people’s judgments, or the way they assume I will judge
myself, or maybe even the way they would be inclined to judge
me if they actually acknowledged that my account of my
experience was truthful and accurate.

But this, too, is related to medicalization. Authority on the
pregnant person’s experience has been removed from the
pregnant person and placed externally, first in the hands of
doctors, but also in the hands of the medically untrained
onlookers. This is where denial becomes dangerous, because
hearing over and over that I should endure this feeling,
it’ll get better, it’s just hormones, it’s normal, I’ll be
fine — it means that I postponed treatment until the pain was
too intense to tolerate.

Baffling over why a depressed person would choose to get
pregnant doesn’t take into account the desire to live a full
life for one’s self. 

For me, that was relatively early. And thankfully so: The
best indicator for postpartum depression is antenatal
depression. It’s one thing to be pregnant and untreated, but
entirely another to be a child’s primary caregiver and
untreated. Some medications that are prescribed for
depression can take up to six weeks to kick in. I got a head
start by getting treatment three months before my son
arrived. By the time he’s here, I’ll be able to take care of
both of us.

I’m a good self-advocate when it comes to my medical care,
and I was able to get effective treatment in a timely manner.
But that isn’t the case for everyone. Kukla notes that
“social marginalization can create the appearance of
incompetence.” And an article from the British Journal of
Psychiatry discusses experiences of psychiatric
professionals not trusting their patients, and stigma surrounding mental illness is
well-documented. Self-advocacy in an
environment like this is difficult. I have to imagine that if
you’re depressed and unpracticed with self-advocacy, you feel
the resulting judgment and self-doubt all the more heavily,
all of which has to have a chilling effect on a pregnant
patient’s willingness to speak up and get the help they need.

I ultimately do agree that pregnancy is risky, but I think
it’s risky in the same way leaving my apartment, driving a
car, eating food, or engaging in interpersonal relationships
are risky. One of the big takeaways I have from getting
treatment for anxiety and trauma is that if I can’t tolerate
a normal-sized risk, I’ll be too scared to do anything, and
that in turn carries its own risk. It’s hard for me to
believe that the physiological process by which the
continuance of our species is ensured is so dangerous that I
just shouldn’t be pregnant at all. And, I’ll point out, a
2002 study published in the British Medical Journal
showed that cultures that view pregnancy and childbirth as
normal physiological processes (rather than abnormal dangers
meriting high surveillance and risk avoidance) tend to have more medically ideal birth
outcomes.

If I had the chance to go back and tell myself what pregnancy
has been like, it also wouldn’t have deterred me, because I
wanted to go through this experience and see for myself what
it was like. Baffling over why a depressed person would
choose to get pregnant when it carries a risk of creating or
worsening their depression doesn’t take into account the
desire to live a full life for one’s self.

Finally, it bears pointing out that the intolerance of risk
in pregnancy, this paranoia over outcomes for children,
implies that birth defects, chronic conditions, hereditary
conditions, and mental illness necessarily represent failure
and obstruction to the child’s future. I was born with a
hole-in-heart birth defect and, clearly, a propensity for
mental illness. This hasn’t made my life less worthwhile or
satisfying or full. A less than perfect life is still worth
living. I wouldn’t deny it to myself, and I wouldn’t deny it
to my son. ●

Rebecca Vipond-Brink is a journalist based in
Chicago.

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