Pregnancy isn’t Magic: Prenatal Depression

Dear Amalah,

I’m 37 and a half weeks pregnant, and I’m not ok.

On my best days I can fake it, but on my worst days I feel like I want to disappear, that nothing is right, and that anything and everything is wrong. My fiancee says he feels like he’s losing me…that the person he used to know is fading away and being replaced with someone bitter and depressed and mean. My solution is to get up a few hours earlier so I can cry in private and get it out before he sees me.

This baby was a surprise (accident? mistake?). Two weeks after getting engaged in a wonderful, year-long romance I discovered I was pregnant. My fiancee and I had been planning to hold off on the whole having kids thing for a few years while we better established ourselves as a couple, and when we had jobs and he had crossed the threshold into his late 20s (we’re both grad students–he’s 26 and I’m 29) but despite the consistent use of an extremely reliable birth control method, the universe had other plans. His first reaction was to assume I would terminate the pregnancy and we would wait until we both felt ready. I made the Planned Parenthood appointment and was counting down the days until my D&C, because what I want more than anything is a family, and a functional family doesn’t exist when one party is only there out of obligation.

I think that is when I started to break. I spent my first few weeks of pregnancy grieving for this baby. I didn’t want my fiancee to touch me, hold me, or talk to me, and I spent my time not engaged in the essential activities of daily living curled up in bed.

Eventually we started to talk and I told him what I was feeling and together we decided yeah, the timing wasn’t perfect, but what is a perfect time to have a kid, anyway. Since that day, he has been behind me 100%. Though it’s tempered by a healthy dose of fear and uncertainty, he’s thrilled to be a dad, he reads the baby books, and can’t wait for our son to be born.

Except now I don’t know if I can do it. It all feels wrong. Everything is wrong. I’m so scared. First, about labor: my baby is in a bad position, and I’m terrified he won’t turn, and I’ll have to have the medicalized/interventionist birth that I’ve done everything in my power to avoid. And I know that if that happens, I will blame myself. And there is our relationship: I take all my fear and anxiety out on him, even though I don’t mean to. I am afraid that I am wrecking anything we ever had, and there won’t be a chance to repair it once a baby is in the mix.

The intimacy that we previously had is gone. Mostly because I have exactly two comfortable sleeping positions that both necessitate the use of body pillows, I don’t remember the last time we cuddled together or even just enjoyed each other’s company. I am shrill and demanding and mean to him, even though I honestly don’t mean to be.

I see a therapist, but it only seems to calm me down for about two hours every week. I just don’t know how I am going to get through this when I don’t have a vision of peace and calm and love waiting for me on the other side. What if it only gets harder? What if this is what drives us apart anymore, and I lose my partner because I’m too fucked up to be in this relationship?

I feel like the parts of me that aren’t sustaining a child are dying. I am afraid that I will never get the old me back, and that my relationship with myself, my partner, and my child will suffer irreparable damage. I live with these fears constantly, with almost no reprieve.

I don’t really even know what I’m asking for right now. Hope, I guess? Some redirection and reassurance?

Thanks,
L

Oh you poor, sweet, wonderful thing. I am so sorry you are not okay. I wish I could make it all okay.

Has your therapist, by any chance, mentioned the possibility of prenatal depression? Because that is a Thing and while I am not a doctor nor am I authorized to play one on the Internet, it sounds very much like a Thing you might have (and are clearly not being very effectively treated for by this therapist). Here’s an article about it, and here’s another one. Slate ran a three-part series on it.  The excellent Postpartum Progress blog has an entire category dedicated to it. Studies suggest prenatal depression is every bit as common as postpartum depression, and every bit as real and serious, and yet most of us are completely unaware that it can happen or of what warning signs to look out for. And I include myself in that “most” group, until my THIRD PREGNANCY, when my OB brought it up after I volunteered the information that my father was dying of cancer and wouldn’t most likely live to meet the baby. Thanks for the heads’ up all those other times, doc! Particularly since prenatal depression can happen without any external stress factors, but is more the result of misfiring, messed-up hormones. (Though since just about every pregnancy IS accompanied by external stress factors, it’s super easy to lay blame on things OTHER than the misfiring, messed-up hormones, and super hard to distinguish “normal” hormonal shifts from the not-normal ones.)

Let me warn you, however, before you click on those links: They might scare you. (Oh God, you already clicked on them, didn’t you? I’m sorry.) Prenatal depression is a serious, SERIOUS condition and can have adverse effects on both you and your baby — especially if you feel so depressed/sad/worthless that you stop taking care of yourself (eating right, taking vitamins, going to doctor visits, turning to alcohol, etc.). There appear to be a lot of links between untreated prenatal depression and other complications during labor and delivery, which again, I haaaaate being all scary but I’m going to need you super motivated to kick some mental health ass by the end of this column. (Then we’ll all hug, ‘kay?)

Of course, like all depression, everyone experiences it differently. For some people, it’s less “depression” and more “I am two breaths away from a panic attack at all times.” Some just have persistent, intrusive generalized anxiety. Some people cry all the time; some find themselves incapable of crying or feeling any emotions at all. Some people lose their appetite while others overeat.

Add to this overstuffed, mixed bag of symptoms the simple fact that “normal” pregnancy hormones can cause some of these things, and you’ve got a serious condition that is really, really easy to miss. Oh, I’m not eating much because of morning sickness. I’m eating too much because of cravings. I’m crying all the time because I’m just generally weepy. I’m not sleeping because I’m uncomfortable. I’m detaching from my partner because I feel fat and gross. I feel scared all the time because labor IS scary and my worries about money and timing and the effect this pregnancy is having on my relationship are ALL TOTALLY VALID THINGS TO WORRY ABOUT.

But. You are experiencing All Of These Things turned up to 11. Past 11. To an uncomfortable, painful, overwhelming level and you are describing great suffering here. And I can see you trying to contort your suffering into something that makes sense: unplanned pregnancy, last minute change of heart, shifts in your relationship, and above all blaming “yourself” for not embracing the joy! and excitement! and squee! that the world expects you — exalted glorious carrier of life — to feel. (Which: Eff you, world. Go get me a cheesesteak.)

This isn’t your fault. This isn’t you failing at pregnancy. There’s nothing different you could have done to prevent this from happening. And above all, this isn’t how it’s going to be forever.

Call your OB or midwife IMMEDIATELY. I freaking mean it. TELL THEM. Call your therapist. And if your therapist gives you a blank look at the words “prenatal depression,” find another one. (I might vote for that ANYWAY, because I’m not really feeling the love for a therapist who sees you weekly and yet still let you get to this point.) Get a referral for someone who specializes in pre/postnatal depression and call them. Print out those scary links and shove them in people’s faces — your partner, doctor, therapist — and say THIS. THIS IS ME. THIS IS NOT OKAY. HELP ME.

Prenatal depression is not like other pregnancy complications, like gestational diabetes or pre-eclampsia. It doesn’t always immediately and miraculously vanish after birth. Sometimes, yes! But sometimes, no. According to BabyCenter, about half of women who experience depression and anxiety during pregnancy go on to develop postpartum depression. (AckmorescarylinksI’msorry.) So please — please please please — don’t think that because you’re so close to the end of your pregnancy that it’s not “worth it” to raise the alarm and cause a fuss. Get a treatment plan and support network in place now. There are antidepressants you can take while breastfeeding, there are (better) therapists, there are holistic options, there is whatever you feel comfortable with. And get comfortable with the idea of leaning into your partner and letting him help without freaking out that you’re imposing on him or driving him away. Open up to family members like your mom or a sibling or someone you trust and let them know that you could really use their help and support in the months ahead — cleaning, delivering food, babysitting, whatever.

But above all, believe me: This isn’t how it’s going to be forever. There is light and hope and wonderful years of clear-headed motherhood ahead of you. Please just reach out for it, today, right now.

[Editor: in addition to Amalah’s links, here is the direct link to contact information for Postpartum Support International which also provides assistance for prenatal mood and anxiety.  Their depression helpline phone number is 1-800-944-4773. They offer free and anonymous info sessions.]