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The one awful secret about pregnancy that no one tells you

pregnant woman

I knew I was supposed to be happy. Instead, I felt like I was being torn apart.

Last week, the New York Times Magazine published a piece by Andrew Solomon called “The Secret Sadness of Pregnancy.” It went up on their website on Thursday, but it took me until Sunday—the day it appeared in print—before I could read it. The subtitle alone was enough to gut me: “Pregnant women often fear taking the antidepressants they rely on. But not treating their mental illness can be just as dangerous.”

I found an empty table at a coffee shop and pulled the article up on my laptop, sunglasses at the ready in case I started crying. It’s been almost exactly five years since those two little lines appeared in the window on the pregnancy test, but even the smallest reminder of what my pregnancy was like can leave me shaking and weeping. Even though I now have a beautiful, healthy son, I still can’t rid myself of the sour taste of fear that coloured those days.

Like Mary, the woman described at the beginning of Solomon’s piece, I was convinced throughout my pregnancy that there was something wrong with my son. I can even pinpoint exactly when these thoughts started: Three weeks after conception, in a mall bathroom in Calgary, Alberta, when I got up from the toilet and saw that the bowl was full of blood. I hadn’t even taken a pregnancy test yet—we were on vacation, and I wanted to wait until we got home—but at that moment I knew two things with great certainty: I was pregnant, and there was something wrong with the baby.

Bleeding during the early weeks of pregnancy is fairly common, and mine soon stopped. Our twelve-week scan showed a perfect fetus, all huge head and stubby little limbs. My relief bordered on euphoria and I couldn’t stop laughing as the technician ran the probe over my belly. In response, the fetus bounced and wiggled its arms wildly. 

I was sure that it would be smooth sailing from then on, and I began to look forward to the usual complaints of pregnant women: the food cravings, the mood swings, the huge, unwieldy belly. But as author David Adam so brilliantly put it in his description of intrusive thoughts, that first snowflake of fear soon turned into a blizzard.

It didn’t matter how many ultrasounds I had, how many blood my doctor ran, how many beautiful kicks I could count in an hour. In spite of all the reassurance I received about my son’s health and growth, I remained convinced that he was in danger and it was my fault. No amount of evidence to the contrary could shake this belief. I stayed up late researching possible complications, and my husband would often wake up in the middle of the night to find me sobbing over my laptop. I had panic attacks at least once a week. 

Eventually, things were so bad that my boss put me on a modified work schedule, hoping that I could use the time off to relax. But I couldn’t relax. Instead, I wound up starting my maternity leave at 32 weeks, in part because my mental health was making it impossible to do my job properly.

As I grew bigger, my diet shrank. Nixed from the list were raw fish, deli meats, soft cheeses, caffeine, pork, fish that might contain high levels of mercury, and everything made with alcohol. If a strange cat approached me on the street, I would flinch, terrified of toxoplasmosis.  It was a pain to cut all of this stuff out of my life, but I kept telling myself I was doing risk management.

I tried to tell my obstetrician what was going on, but he just smiled kindly and said that all pregnant women are anxious. I tried to believe him, but I sincerely doubted most other pregnant women would find themselves howling into a pillow for three hours, certain their child would have fetal alcohol syndrome because they’d accidentally eaten soup made with red wine vinegar.

I sincerely doubted most other pregnant women would find themselves howling into a pillow for three hours, certain their child would have fetal alcohol syndrome because they’d accidentally eaten soup made with red wine vinegar.

I fantasized about going into early labour, thinking that if they could just get the baby out of me he would be safe. I trusted the NICU machines, with all their shiny, efficient parts, far more than I trusted the shady, suspect recesses of my body. I was convinced that the longer my son stayed in me, the greater the danger was that whatever secret life-giving process was happening inside me would go awry and kill him.

The worst part was that I knew I was being unreasonable. I knew that the vinegar presented no risk to the baby, and I knew that he would be healthier if I could carry my pregnancy to full term. But I just couldn’t stop asking myself “what if.” And if I understood that my feelings were completely detached from reality, how bad would my concerns sound to a doctor? I became afraid to tell anyone how I felt, because I was sure that as soon as the baby was born, they would lock me up and take him away.

Meanwhile, everyone kept gushing to me about how this must be the happiest time in my life. I felt like a monster.

It took me months to figure out that I likely had antenatal depression, the medical term used to describe the feelings of despondency a mother experiences before giving birth. Antenatal depression is incredibly common, with one researcher suggesting that ten percent of women will experience it at some point in their lives. But the condition is rarely discussed, in part because so few women come forward to talk openly about their own experiences with it.

My son’s birth eventually led to postpartum depression, which at least had the benefit of being more widely known and better understood than antenatal depression. But it was still eight weeks before I got any help. My family doctor put me on Zoloft and referred me to the postpartum depression program at a local hospital. There, I started seeing a psychiatrist and going to group therapy once a week.

But even once the worst of the clouds had cleared, some of my anxiety still lingered. I would time my baby son as he played to make sure that his attention span was within normal range. I kept a list of the words that he knew on my phone, just to make sure that his speech development was on track. I didn’t let him look at television or phone screens because I’d read somewhere that it was bad for eye development. To everyone else, I must have looked like one of those hyper-competitive super mommies. But really it was the same old depression, cloaked in the guise of a “better-safe-than-sorry” mentality.

If postpartum depression is rarely discussed, then antenatal depression is totally off the radar. I didn’t even have a proper name for it until I read Solomon’s article, just a certainty that something about pregnancy had caused my neurons to misfire so badly that nearly every night found me gagging with fear. And yet one study shows that the percentage of women affected by antenatal depression is exactly the same as that of women affected by postpartum mood disorder. So why don’t we hear more about it?  

The truth is that discussions about antenatal depression are happening—they’re just mainly happening on online message boards. Parenting communities and mommy blogs exemplify the best and worst parts of the Internet. Swift judgments and pile-ons abound, with debates about breast milk versus formula or working moms versus stay at home moms expanding ever outward into the ether. But on the other hand, these arenas also offer up some of the most honest discussions about parenting available. There’s no book in the world that will offer you frank discussions like the ones on subreddits like r/babybumps and r/depression about prenatal mood disorders.  

On one of these threads, a young mother writes that her doctor prescribed her Paxil 20 weeks into her pregnancy, after she’d complained of symptoms of depression. 

“Since my first trimester I’ve spent days in bed, sobbing uncontrollably, having panic attacks, and keeping away from friends and family more than I should,” the author of the post wrote. “I’ve had suicidal moments which really isn’t something you can talk about with most people especially when you’re pregnant. I just don’t know how I can do this.” The mother is torn between taking an SSRI, which comes with a small risk of birth defects, and continuing to feel extreme depression.

Unlike the comments on Solomon’s article—most of which seem to be written by eugenics enthusiasts who believe that all mentally ill people should adopt, rather than risk passing on their conditions—the replies on these forums from Reddit users are actually helpful. They’re sympathetic and brimming with thoughtful advice from people who have been in a similar situation. 

“You are brave for addressing this with your doctor,” one user writes after advising the original poster to take the antidepressant. “Don’t get frustrated if the clouds don’t lift right away…. It’s a tricky process to find the thing that works. But it will happen.” Places like Reddit offer venues for people to trade tips and stories about taboo conditions like antenatal depression, and the semi-anonymity of the Internet makes people feel safer about disclosing what they’re going through.

Many doctors are hesitant to prescribe medication—including antidepressants—during pregnancy, because they do still present some risk to the baby. Instead, women are expected to struggle through somehow, miserable and un-medicated, for the safe of the baby’s safety.

But as Solomon points out, foregoing medication can carry its own risks to both mother and child. Studies show that there can be adverse outcomes for children of mothers who experienced mood disorders during pregnancy, and not receiving treatment can endanger the mother’s life as well.. On the other hand, antidepressants do cross the placental barrier and can impact the fetus’ development. In the case of antenatal depression, there are no easy answers.

The problem is that there won’t be any answers until we start publicly talking about this. Message boards are great, but they can’t write prescriptions or offer psychotherapy. So long as antenatal depression remains a secret shame – one often brushed off or downplayed by doctors – things will continue exactly as they are. And the way things are right now is dangerous – not just for unborn babies, but for their mothers too.

Photo via harinaivoteza/Flickr (CC BY SA 2.0)

Anne Thériault

Anne Thériault

Anne Thériault is a Toronto-based writer and cat enthusiast who blogs about feminism, mental health, and parenting. You can follow her on Twitter at @anne_theriault.