What Is Prenatal Depression? One Mama-To-Be Shares Her Story
Written by Jo Piazza
Photography by Photographed by Maria Del Rio
It was the third day of my picture-perfect Hawaiian babymoon and I couldn’t stop crying. It was the ugly kind of crying, the kind that comes with snot and sobs, the kind that completely confounds your husband, who would later swear you’d been perfectly happy only an hour earlier.
I was happy only an hour earlier.
“What are you upset about?” Nick asked me.
“Nothing. I think I’m depressed,” I said, staring at the ocean, willing my heart to stop pounding so hard against my rib cage. God I hated that word.
“What do you have to be depressed about?” He was both worried and confused.
That was the problem.
I don’t have anything to be depressed about. But I still feel like shit. Beginning my pregnancy a little over six months ago, I was well-informed about postpartum depression. It’s something we’re all starting to talk about more and more. The model and celebrity and famous Instagram mom Chrissy Teigen even wrote a beautiful essay about her own battle and shame surrounding postpartum for Glamour. I have plenty of friends who experienced postpartum in varying degrees and as someone who has dealt with bouts of anxiety in the past and who carefully weaned off Zoloft prior to getting pregnant, I knew very well that I could be a candidate for certain symptoms myself after I gave birth.
But no one told me it could happen while I was still pregnant.
“Do you want to harm yourself or others?”
“Not today,” I replied for the fourth time during my appointment with my OBGYN.
She gave me a look. I was not supposed to joke.
“I’m not suicidal. I’m not violent. I’m a little depressed and anxious and I just want to fix it before I have my baby,” I replied in what I thought was a very reasonable tone. I wanted to be open and honest with my doctor about what was happening in my apparently messed-up brain, but she wasn’t making it easy. Constantly questioning whether I was suicidal brought on a tidal wave of shame for even broaching the subject. I wasn’t that bad. I just wanted, needed, a little bit of help.
The doctor handed me a laminated piece of paper where I was supposed to rate my various symptoms on a scale of one to five. Trouble sleeping? Five. Mood Swings? Five. Feelings of anxiety and panic? Four. Feelings of hopelessness and dread? Four.
The symptoms of prenatal anxiety can include, but definitely aren’t limited to the following.
1. Panic attacks, a racing heart, palpitations, shortness of breath, shaking.
2. Persistent worry.
3. Abrupt mood swings.
4. Feeling constantly sad, low, or crying for no obvious reason.
5. Being nervous, ‘on edge’, or panicky.
6. Feeling constantly tired and lacking energy.
7. Having little or no interest in all the normal things that bring joy.
8. Sleeping too much or not sleeping very well at all.
9. Losing interest in sex or intimacy.
10. Withdrawing from friends and family.
11. Being easily annoyed or irritated.
12. Finding it difficult to focus, concentrate, or remember.
“Do you want me to wipe this clean for the next person? Would tears work?” I cracked a flimsy smile. That look again. My doctor recommended I speak to a behavioral counselor upstairs. The counselor, all 23 years and six months of a PhD of her, gave me a pitying pat on the shoulder. “Do you want to harm yourself or others?” she began. I simply said no this time. “I usually work with drug and alcohol addicts. You don’t abuse drugs do you?” I looked down at my belly. “No.”
I again tried to explain how I was feeling as best as I could. Starting around week 22 of my pregnancy I began waking up most mornings in a panic, my heart pounding, throat tight, dreading the day ahead. I should preface this by saying I embarrassingly have no reason whatsoever to dread the day ahead. I love my job as a writer. I have a book coming out in a month that people seem to really like and I’m knee deep in creating a new novel that I love. I have an incredibly supportive group of friends and I’m married to the best guy in the entire world.
I’m not nervous about having this baby. He was very much wanted and planned and so far, knock on wood, I’ve had a very healthy pregnancy. I think I have the normal amount of concerns. I want him to be happy and healthy and I struggle with how to raise him as a strong feminist man in a country run by men who don’t respect women as much as they should. But those thoughts don’t trigger my physical symptoms. My physical symptoms come on without warning, like I’ve been knocked down and flipped over by an ocean wave I didn’t know was behind me.
My anxiety usually goes away within twenty minutes and there are whole days where I’m better than fine, perfectly happy and normal. And then there are days when I’ll cry for no reason at all, where it takes everything I have to get out of bed, where my entire life seems completely overwhelming. And then, as quickly as it came on, it will all disappear again and I will go back to feeling good. This is part of what scares me, the juxtaposition of the two, the uncertainty about when the bad times might appear.
I don’t sleep well any more. It can take hours just to fall asleep. I’ll pace up and down the long hallway of our apartment, my chest pounding, my throat tight, stomach roiling like I want to throw up but don’t really have to.
I tried to convey all of this to the perky behavioral counselor as she cocked her head in a way I knew she wanted to express concern and compassion.
“You’re sure you don’t want to harm yourself or others?” The repetition of the question was making me want to harm others.
“How about medication? Would you like us to prescribe you something. There are plenty of things you can take during your pregnancy.”
Depression and anxiety medicine don’t agree with me. Zoloft made me sweat something awful at night and stripped me of any sex drive. It made my brain a little fuzzier around the edges, kind of like smoking weak pot back in college, another thing I never really enjoyed. The wrong anxiety and depression medication led to my own mother’s nervous breakdown just months before my wedding. The drugs are a choice and I’m happy that a lot of pregnant women have them as an option. They weren’t an option for me.
“I guess talk therapy then. You’ll need to have an evaluation call with psychiatry.” I agreed. This was what I wanted.
She gave me the wrong number for psychiatry. It was their fax line. I finally got someone on the line who informed me I would need to call back. It was lunch hour.
If I were really on the brink of madness this could be what put me over the edge. Of course, maybe I am on the brink of madness because it’s nearly putting me over the edge. At the very least it made me no longer have the energy to try to make a doctor’s appointment. Eventually I was able to get ahold of a human who gave me a referral for an evaluation for a therapist. This entire process has taken longer than a month and I have yet to have my first appointment.
Everyone expects you to be wildly happy when you’re pregnant. People love to throw around words like glowing and beaming. “Are you so excited?” I’m asked several times a day. And I can truthfully say that yes, I am so excited. But what I can’t say without an overwhelming feeling of shame is that I often feel really low.
It’s hard to answer honestly when someone asks “How are you feeling?” They want to hear AMAZING. Nine times out of ten they don’t want the truth. And that’s incredibly lonely. I want to be a glowy, happy pregnant person and I’m just as confused as anyone about why I feel this way. That confusion only leads to more guilt, since there isn’t any tangible reason I should be feeling this way.
What I wanted my doctor to tell me is whether this was normal. Because apparently prenatal depression is much more common than anyone lets on.
“Of course it is normal,” San Francisco-based therapist Sarah McLaughlin explained in a way that offered me a lot of reassurance. “Even with feelings of excitement come doubts, anxiety, a change in schedule, recalculating expenses, etc. So, adjusting to the major life change of bringing a child into the world and wrapping one’s head around it can be daunting. Doing that while growing a freaking human inside of you and trying to deal with the societal pressure to be ‘glowing and radiant and ecstatic’ is challenging, to say the least.”
McLaughlin assured me that research suggests that anywhere from 9-20% of women may experience prenatal depression or anxiety with symptoms that fall outside the normal variations in mood we would expect. “The statistics are similar to the rates of postpartum depression. Prenatal depression is a risk factor for postpartum depression, and yet we don’t hear much about it,” she said.
Since opening up about my own depression and anxiety in the past few weeks I’ve heard stories from friends and friends of friends all of whom experienced the same exact thing I’m going through in some shape or form. One woman told me she cried every morning in the shower for 15 minutes throughout her entire second trimester. Another friend asked her doctor if she could induce early to get back on her meds since she had such a difficult time functioning through her third trimester.
The best thing to do, according to McLaughlin, is to not suffer alone in silence, to share your concerns with your doctor and other supportive figures in your life if your doctor is a pain in the ass like mine was. It also helps to slow your life the hell down as best you can.
“Take it easy. Yes, it feels like there’s a lot to get done before the baby comes, but take care of your physical health first. Get plenty of sleep. Exercise,” McLaughlin says. “Pregnancy is an excellent time to seek out therapy, why not have that additional weekly support while you go through basically the biggest change in your life? Developing a community with other moms and pregnant women is important, too, to normalize and validate the experience. There are many support groups for this. Surround yourself with real, non-judgmental, non-mom-shaming women.”
It helps to talk about it. It helps to write about it. It helps to hear that I’m not the only person going through this. Pregnant women shouldn’t feel shame about admitting they’re less than perfect all the time. It in no way reflects how good a mother you’ll be, a fear that begins for a lot of us at conception. No one has the perfect pregnancy, no matter how nice a filter we put on our Instagrams. It’s time we got more comfortable talking about the things that are hard and maybe a little imperfect.
Jo Piazza is the bestselling author of the new memoir How to be Married: What I Learned From Real Women on Five Continents About Surviving My First (Really Hard) Year of Marriage.
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