I just can't stop crying. I know I am supposed to be happy, and this pregnancy, this baby, it's what I have always wanted. But I can't feel anything. The days never seem to end and everything feels overwhelming already -- how can I handle taking care of a baby when I can't even seem to take care of myself anymore? Everyone is worried about me, and I feel so guilty. I am already failing and I haven't even really started motherhood yet.
Women walk into my office expressing variations on this theme nearly every day of the week. Rather than experiencing the joy, excitement and anticipation often synonymous with pregnancy, they instead are marred by persistent, functionally debilitating symptoms of depression and/or anxiety -- symptoms that we designate as antenatal, since they occur within pregnancy. Over the course of this three part article, I will use the phrase "antenatal depression and/or anxiety" because there is often a lot of overlap between these two mood states during pregnancy.
While mood symptoms during pregnancy are less talked about than their postpartum counterparts, experiencing them is far from rare and in fact, up to 15% of women suffer from antenatal depression and/or anxiety.
Jane is one such woman. Married for four years, she is 20 weeks pregnant with her first child. During the months while she and her husband were attempting to conceive, Jane felt a constant pit in her stomach from anxiety. She hoped it would abate once she conceived, but it remained woefully present. She told herself that once she hit 12 weeks her anxiety would dissipate.
As she progressed into her second trimester, Jane remained tired, irritable and anxious, and despite her OBGYN's assurances that running was safe, no longer had any drive to engage in this former favorite activity. Furthermore, her social impulse had vanished along with her joy in exploring new restaurants -- in fact, she rarely felt like eating, was not gaining enough weight, and her OBGYN fretted about the baby's size.
Jane's husband was keenly aware that his wife was spiraling downwards. Formerly risk averse, Jane now had to be reminded to take her prenatal vitamins and needed to be warned that a glass of wine wasn't a good idea in her current state. Frank disinterest in everyday life erupted into anger or tears at the slightest provocation -- a far cry from her previously calm demeanor. Touching her hand at the "wrong time" could launch her into a tirade -- deeper intimacy seemed impossible to her husband, who felt lost and didn't know how to help Jane, who was steadily fading away.
Jane had been hoping for a daughter before she got pregnant, yet she had little reaction to the news that her wish had come true. Whereas she used to think up baby names for fun, now she called the baby "it," and waved her husband off when he tried to talk about names with her.
She secretly felt profoundly disconnected from her baby. One day on the bus, a man offered her a seat and it took her a moment to remember why he did so. Her life felt like a black and white movie in slow motion that she wanted desperately to walk out of because she was glued to her seat.
Jane could be one of any number of women who have walked through the door of my office looking for help. Astonishingly, only 1/3 of women seek and receive treatment for antenatal mood symptoms, meaning the majority of women suffer needlessly, potentially to their and their baby's detriment. Therefore, asking for help is a huge positive first step towards health.
Given how awful Jane and women like her feel, why not race to a doctor for treatment? Many women express a sense of failure in experiencing depression and anxiety during pregnancy, as if they are somehow letting their baby-to-be down. They express guilt for needing treatment and fear the potential negative impact this treatment may have on their baby. However, as I explain to each woman in my office, treating antenatal depression and/or anxiety is paramount for mom and for her future baby's health. Pregnancy is a symbiotic rather than antagonistic relationship -- mom must be well for baby to be well.
Mind and body are equally affected by antenatal depression and anxiety which can put the pregnancy, fetus, and future baby at risk. Please check back soon for Part 2, which will dive deeper into why treatment is so important and the risks for mom if she remains untreated throughout her pregnancy. The series concludes with a discussion of treatment options, including but not limited to psychotherapy, medication options, acupuncture, exercise and lifestyle choices.
The first step toward wellness is asking for help.
Postpartum Support International (PSI) has excellent resources available to support pregnant and new moms suffering emotionally.
Postpartum Progress has an extensive, valuable online support community.