I was nine months pregnant and I couldn’t stop crying. Pregnancy is an emotional time for any woman, but I carried additional concerns. I had been managing depression for 13 years and had been taking medications throughout my pregnancy. I knew the risk I was taking. But all of a sudden, I couldn’t shake the guilty feeling that I had no right to have a child, in part because I had depression. How selfish could I be? I could not stop crying at what I had done, even though I was on the verge of giving birth.
I had talked with my obstetrician and psychiatrist extensively before even considering becoming pregnant. It is not just depression that I manage; when I finished college I had a breakdown so severe that I experienced episodes of psychosis and became delusional. I’ve had to take anti-psychotic medication ever since. But even back then, I was thinking I would not and could not take these powerful medicines when and if I became pregnant.
I met with a gynecologist when I was in my mid-20s and told him I took Paxil and Zyprexa. What would I do if I wanted to get pregnant? He was an older doctor, from a different generation. “Well, you’d have to stop taking them, “ he said. If only it were that simple.
Four years later, I again raised the issue with a psychiatrist. “I want to try not taking these medicines for a while,” I told him.
I was nowhere near having a baby then, but I was convinced I had to try to live without the medicines, to have a test run, before I got pregnant. “You don’t need to test this out now,” the psychiatrist told me. But I insisted and I went off the medications.
Slowly and almost imperceptibly, the symptoms came back. I had been diagnosed with schizo-affective disorder when I was 22, on top of major depression. It’s not quite the same as schizophrenia, but has some similar features. Off the medicines, again I developed a slight, but growing, intolerance to sensory stimulation. I felt invincible, grandiose. I attributed it to the fact that I was happy. I had finished graduate school and had met my future husband. It wasn’t until I landed in the emergency room that I realized I’d had a relapse. The experiment had to stop. I needed to go back on the medicines.
In 2010, my husband and I decided to try to have a baby. This time I was with a psychiatrist who was more up to speed. He said that remaining on the medicines while pregnant was a question of weighing the benefits against the risks. Given my prior experiment, the risk for my stability without the medicines was clearly greater than any benefit for my child’s health if I stopped taking them. If I weren’t healthy, I might not make good decisions for my own, or my baby’s, health. He switched me from Paxil to Sertraline, a medicine believed to have fewer risks.
A pregnant friend of mine had told me of episodes of uncontrollable crying during her first trimester, and she had no mental health issues. Even knowing that, I was terrified when it happened to me. What scares me most about my mental health condition is the fear of not being in control. Yes, I was taking my medications during this pregnancy, but would the hormonal overhaul of my body be too much for me to handle? I briefly considered not continuing with the pregnancy. But my psychiatrist increased my Sertraline and I felt like I could carry on. The rest of the pregnancy continued without incident, until the ninth month, when so many doubts started to creep in.
Who has the right to have children I wondered? Only perfect people? What about people with other chronic conditions, such as diabetes, or with a family history of heart disease? Should they not be allowed to have children because they may pass on inheritable diseases? What about mean people? Should they be barred because they may pass on unfavorable personality characteristics? These are questions I grappled with in my last week of pregnancy, when it was far too late to turn back.
Once I gave birth and my son was given a clean bill of health, the worries subsided. I did not breastfeed. Not a drop. Again, the benefits had to outweigh the risks. This time I got that message from my son’s pediatrician. There was no need to subject my son to my substances that could be passed through breast milk when formula was good enough.
I had asked my obstetrician if I should try a milk bank, convinced by the prevailing message that breast milk is the end-all and be-all. “No, no, that’s not safe,” said the doctor. “You don’t know how those banks screen milk. There is nothing wrong with formula. Your baby is getting plenty of antibodies from you during the pregnancy to develop his immune system.”
So formula it was. So far my son has been very healthy, but I endured more than a few raised eyebrows about my decision to not breastfeed, as if it should be automatic. I have not felt the need to explain myself.
In the end, my depression might actually help me be a more attuned mother. My obstetrician told me that having depression would make me better able to watch out for symptoms of the condition in my son. When I first exhibited signs of depression, they were not recognized. My goal is to make sure my son grows up emotionally strong. I think I can fortify him to cope with any issues he may have. On top of that, I want to make sure he knows I am always there for him to talk things through. In this way I hope his emotions don’t get bottled until they implode, the way mine did.
I don’t think a life with depression is not worth living. Having it and recovering from it and managing it has allowed me to be more compassionate. And 18 years of regular psychotherapy have made me very strong emotionally. Strong enough, I hope, to face any parenting challenge with the best of my abilities.
Melisma Cox is a higher education administrator living in Northern Virginia. She is working on a memoir illuminating mental illness in an effort to shed the stigma.
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