Q&A: depression during pregnancy

Jodi writes:

"This will be short and sweet. This is my first pregnancy and I am almost three months along. I am very excited and feel lucky because I got pregnant the first time I ever went without protection (thank god I was a responsible teen). I am 33 and as my ob/gyn said "On the senior citizen side of birthing"  (hell of a bedside manner I know ). Anyway here is my thing I have been feeling DOWNRIGHT DEPRESSED for a few weeks. I am usually outgoing and love to have fun but I just feel sad and kind of remorseful that I have not done more of the things I set out to do. Did you ever experience this? It is making me feel very guilty."

33? Is old?

Bwahahahahahahahahahahahahahahahahahahahaha. Hahahahaha. Ha.

Excuse me while I wipe the tears from my eyes.

I think your OB must have had extremely limited experience if s/he thinks 33 is "on the senior side" of first-time pregnancy. Even the technical definition of  "older" first-time mother doesn't start until 35. I had my first baby at 29 and I've always been The Kid with other moms of children my son's age. (Now that the kids are around 4, all the other moms at my son's school seem to be in the 38-45 age range.)  I know a ton of women who didn't have a first baby until age 38 or 39 (note that I'm not saying that it's advisable to wait until that age specifically, or that you'll have an easy time conceiving then, just that I know plenty of people who had first babies then).

All this is to say that 33 sounds positively early to have a first baby to me. Your OB's comment is uninformed and a wee bit insulting.

But about the depression. Did I ever experience this?

YES.

I spent the first trimester of my first pregnancy in a serious, almost debilitating depression. I had just started building a little teeny career in something I liked better than my old "career." All of a sudden I was pregnant (with a baby we'd been trying to conceive, but somehow didn't think would come so soon) and felt like I had nothing to show for my life, which would now, of course, be over, because you can't do anything with a baby.

I dragged through the days, too exhausted from the pregnancy and too heartsick from the depression to do more than two things each day (and sometimes one of them was take a shower). I started having panic attacks. When I went in to a prenatal visit the midwife could tell I was not doing well and she basically twisted my arm to see the therapist that worked with women at the birth center.

What the therapist told me was this: There are extremely powerful hormones surging through your body when you're pregnant. Different women react to them in different ways. Many women become depressed under the influence of these hormones. The only thing to be done about it is go through the motions of living day by day as best you can. Getting up in the morning is a victory.

What I know is that the depression may change or lessen or disappear by the end of the pregnancy, or it may not. I felt a little better in the second trimester (until the World Trade Center was attacked a few miles from my apartment), and then the depression came back slightly in the third trimester. Since I have had depression in my "normal" (non-pregnant and non-lactating) life, I knew I was at a higher risk for post-partum depression, but I never developed it (I made a hard-core plan to prevent it and it worked).

There's a website called Pregnancy and Depression that has collected all the available research studies about depression in pregnancy (it also has some info about treating depression while breastfeeding and during mothering, and some info about bipolar disorder). Most of the studies are evaluating the risks to babies of exposure to antidepressants while in utero, but I thought this study was interesting and kind of sad. The conclusion is "Rates of depression, especially during the second and third trimesters of pregnancy, are substantial. Clinical and economic studies to estimate maternal and fetal consequences are needed."

I can tell you what I think the maternal and fetal consequences of prenatal depression are. I think those of us who are depressed during pregnancy doubt ourselves. I think we feel guilty that we're not glowing, happy little earth mothers, basking in the miracle of human repoduction and our own fecundity. I think we feel cheated out of enjoying something our culture tells us is the pinnacle of human experience, and terrified that we won't enjoy being mothers. I think we're afraid that there's something inherently wrong with us that means we won't be good, or even adequate, mothers to our children. I think we think that if we're so depressed during pregnancy we don't deserve to have children. I think that's why no one talks about prenatal depression.

But it's real. It exists. It's caused by hormones and the enormous changes we're going through in our views of ourselves and in our relationships. It doesn't have anything to do with how much we'll love or enjoy our children, and it certainly doesn't mean we won't be damn good mothers. It does not have to mean that we'll get PPD. It just means that we're not the happy preggos in the magazines. But that's OK. We'll keep on getting up every morning, and we'll waddle through our days until delivery, and then when the baby is crying at 3 in the morning we can think "At least I'm not still pregnant."

So, Jodi, don't feel guilty. You're going through a ton of changes and you have enough hormones to kill an elephant racing through your system. If you end up coccooning yourself your friends will understand. And life's not over when you become a parent. You can't do much of anything for the first year or two, but then you'll get your groove back, only with renewed efficiency and a BTDT kind of fearlessness (that undoubtedly comes from knowing rightly that once a small person has puked into your mouth there's really nothing left to be afraid of).

If you're not already supplementing with flax seed oil, consider starting now--it can't hurt. But try to cut yourself a break, and know that better things are coming for you soon.