As Maternal Mental Health Week comes to a close, I feel compelled to share a piece of my journey that I’ve kept mostly private—my greatest fear during my pregnancy after loss— in order to help raise awareness. This is #RealMotherhood, and there is #NoShame.
I’ve suffered from mental illness my entire adult life—primarily anxiety and treatment-resistant depression. Thankfully, after years of struggle and medication adjustments, a new medication came on the market, and it changed my life. I don’t say that lightly. Ten years ago, I would have never guessed I would be well enough to get married and have children, even though that was my greatest desire.
Then I met my husband.
It became clear early in my relationship with my husband that he also really wanted children. And, as we navigated our relationship, we began talking about what our journey to parenthood would look like.
My psychiatrist had always advised me against getting pregnant. At one point he said, “Why would you want to risk how far you’ve come in the nine months of pregnancy? Is it worth it?”
But, when he saw how happy I was and how I was maintaining stability, he recommended I consult with a perinatal psychiatrist.
Preparing for a Potential Pregnancy
Lloyd and I met with the perinatal psychiatrist a few months after we were married. We knew I would have to make some medication changes. We would also have to assess the risks of of some other medications and make decisions.
Overall, the consultation was encouraging. While there was no specific pregnancy data on my main antidepressant—the one that changed my life—early, unpublished research looked reassuring. We decided to keep me on that medication. One of my other medications needed to be replaced with a safer option. One medication had to be discontinued completely, and there wasn’t anything safe that could replace it. Two more medications had minor risks to the baby, but the perinatal psychiatrist advised that the risks of going off of those medications were equal or greater than staying on them. Healthy mom, healthy baby.
It took several months to wean off of the medication that had to be changed. Then it took a few more months to start the new medication and reach a therapeutic level. Nine months after we were married, we “pulled the goalie,” and actively started trying to conceive.
In our twelfth month of trying to conceive, we were ecstatic to find out we were pregnant. It was a few weeks before Christmas, and we couldn’t wait to surprise our families over the holidays.
My treatment plan included frequent monitoring by my regular psychiatrist, weekly appointments with my therapist, and appointments with my perinatal psychiatrist once a trimester and as-needed postpartum. My risk for perinatal and postpartum mental illness was high, much higher than the general population, so we called in all the troops. My team also talked to my husband about what signs to look out for.
Then at ten weeks, the floor collapsed beneath us. The doctors had “concerns” about our baby’s lagging growth. Ten weeks later we learned he had no heartbeat during a fetal echocardiogram. We were devastated. But, what should have broken me mentally didn’t.
My therapist checked in with me daily for six weeks. I met with my psychiatrist frequently. But, through it all, I remained present, didn’t numb the pain, and worked through my grief. Self-care was the highest priority, and I focused on those needs.
Three months after our son’s death we were given the all-clear from the maternal fetal medicine specialist as well as my psychiatric team to start to try to conceive. The process was excruciating emotionally. After nine months of trying to conceive, we were referred to a reproductive endocrinologist. Our daughter was conceived a few months later through intrauterine insemination (IUI).
Once again, I was closely monitored by my medical team, and they worked together and consulted each other throughout the pregnancy to make sure I stayed healthy physically and mentally. Heightened anxiety during pregnancy after loss is well-documented. My team met with me whenever I needed them. I could visit the OB clinic whenever I needed to hear the heartbeat or have reassurance. I received more frequent ultrasounds as well.
At about three months pregnant I started having terrifying nightmares. But, they weren’t about my baby dying. No, in these nightmares, immediately after the birth of my full-term, healthy baby I had a psychotic break. Instead of going home with my baby, I was admitted to the psychiatric unit, which is located in the same building as labor and delivery, a few floors down. I was unable to bond with my baby or even see her. I was unable to breastfeed as I had hoped and planned.
My greatest fear wasn’t that my baby would die. My greatest fear was that I would break.
With that fear came increased fears that my medications would cause problems for my baby. I increasingly worried that my son died because of my medications, even though my specialists had all assured us that was not the case. I felt tremendous guilt on top of the anxiety.
My therapist and I worked through these fears but they never went away. In fact, I think they still linger some, even now over two years later.
Our daughter was born at 36 weeks after I developed pre-eclampsia.
She weighed 4 pounds, 11 ounces and was 16.5 inches long—tiny but fierce. She was able to stay with us and didn’t require any time in the NICU or special care nursery.
My team continued to stay close and make sure I was managing the fourth trimester without suffering any postpartum mental illness. When my daughter was about six months old, I had a check-in with my psychiatrist. He always wanted me to bring my daughter with me. He liked to check on her as much as he wanted to check in with me. I think he wanted to make sure she was developing appropriately too. He would never say it this way, but he wanted to make sure my meds didn’t break her. And I appreciated the extra reassurance from him.
At that appointment, he checked us both then said, “Ok. Make an appointment to see me in six months. You’re both doing fine.”
Never in the ten plus years I’d been seeing him had I gone six months between appointments.
I got to my car, buckled my daughter in her car seat, sat in the driver’s seat, and cried.
I didn’t break her.
And, maybe even more importantly, I didn’t break me.