How Should We Treat Depression in Pregnancy?

Adam Urato, MD
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This month another study came out showing that children who were exposed to antidepressants in utero have higher rates of anxious/depressed behaviors in childhood.  This follows a separate research study (in the prestigious British Medical Journal) that came out last fall, linking antidepressant use during pregnancy to an increased risk of psychiatric disorders in the exposed children. And just this week the fifth MRI study was published showing that antidepressant exposure in utero affects fetal brain development.

There is much controversy surrounding this topic and a great deal of misinformation. Two issues, in particular, seem to be getting “missed” in much of the public discourse.

1. Worry about antidepressants does not mean “no treatment” for pregnant women

The first misconception is the notion that depression during pregnancy should not be treated because treatment may entail risks to the fetus. Let me make it clear from the outset: depression is a horrible and potentially deadly condition and it should be treated in pregnancy.

For some, treatment can involve medication use. However, it can also be treated with psychotherapy, exercise, family/group support, and other non-drug approaches.

Depression is truly awful for the suffering it causes the pregnant woman. Such suffering can have effects not just for the woman, but also the family, the community, and the baby. In the worst-case scenario depression can lead to suicide. Rates of suicide have increased significantly in the past decade — and depression is implicated in the vast majority of these cases.

Even for those who do not consider suicide, the suffering caused by the depression itself is horrible. The problem with depression and pregnancy is not that the mom needs to have a stronger will, “suck it up,” and forgo treatment, but rather that depression is a serious condition that is becoming more common among pregnant women.

This is a maternal health and a public health problem that needs to be recognized. The research on the risks to the fetus from the use of antidepressants suggests that we need to have alternative approaches for preventing this condition from developing in pregnant women and treating it if it does occur.

As noted above, treatment of depression can involve, among other things, psychotherapy, exercise, and antidepressants. In some of the discourse on this topic, pregnant women who choose to take antidepressants are portrayed as making a selfish or whimsical lifestyle decision. This isn’t fair or accurate. The decision to take a drug during pregnancy is a challenging and often agonizing one. Any argument that women who suffer from this condition should not have children or receive compassionate care is unfair and unhelpful.

In sum, the take-home point should be clear — depression is a serious condition and depression in pregnant women needs to be treated. The question is how best to do that.

2.  Research has shown that antidepressant use poses a real risk to the fetus

The second area of misunderstanding is the notion that antidepressants might somehow not have any effects on the developing baby or the pregnancy. Antidepressants are synthetic chemical compounds, manufactured in chemical factories, that pass into the fetal bloodstream and enter the amniotic fluid and developing fetal organs throughout the pregnancy. As a result, an antidepressant of course can have consequences for a baby’s development.

The question isn’t whether these chemicals affect the developing baby but rather how they affect the baby. Given the discussion above (under point #1), it would be nice if we had antidepressant drugs for pregnant women that didn’t cross the placenta or cause any fetal effects. But that notion is illogical. After years of study in animals and humans the scientific evidence clearly shows that antidepressants do enter into the developing baby throughout the pregnancy and are associated with pregnancy complications and fetal effects.

This just makes sense. It’s implausible (absurd actually) to believe that drugs that enter the adult brain and cause significant changes in that organ won’t also cause effects when they enter the developing fetal brain.

Antidepressant exposure in pregnancy has been linked to autism, ADHD, speech and language problems, childhood epilepsy, adolescent depression, and other difficulties (e.g. delayed motor development). Newborn brain MRI studies show that SSRI-exposed babies have changes in their brain structure, white matter microstructure, brain connectivity, and cerebral metabolism.

And it’s not just the baby’s brain that can be affected. The drugs enter into all of the baby’s developing organs and are likely to have widespread effects. Studies consistently show these drugs to be associated with, for example, increased rates of preterm birth, birth defects, newborn behavioral syndrome, and postpartum hemorrhage in the moms. Furthermore, we have no idea what the long-term effects might be for the children and adults who were exposed in utero.

The public is often confused by scientific studies that do not show the antidepressants to be associated with some complication (e.g. autism) or another (e.g. preterm birth). The press often reports the results as showing that the drugs are “safe in pregnancy.” What the public doesn’t realize is that scientific studies will often not declare an association between, for example, antidepressants and autism or preterm birth, unless there is a statistically significant finding (e.g. a p value < 0.05).

This is often a difficult bar to achieve in human research studies. Many of these studies do, in fact, find an association, but without a statistically significant p value. Reporters or the authors then conclude that there is no risk with antidepressant use. Then, a few months later, a different study might be published reporting statistically significant harms associated with the drug’s use, the drug is declared unsafe, and the public is totally confused.

What’s happening is that harmful effects of drugs on developing babies can take years to demonstrate consistently with statistical significance. For example, SSRI antidepressants have been used in pregnancy since the late 1980s, but it is only now, decades later, that MRI studies are being done and they are all showing effects in the brains of the babies who were exposed (here and here and here and here and here). So, make no mistake about it, synthetic chemical compounds going into the brains and bodies of developing babies do affect development — they must. And when it comes to chemical exposures in pregnancy, the “arc of history” consistently bends toward showing increasing harm over time.

Reconciling points one and two

At first glance, the two abovementioned points — 1. that depression during pregnancy should be treated and 2. that chemical exposure poses risks to fetal development — seem to create a real conundrum. Yet there is a straightforward solution: prioritize non-drug approaches to treating depression in pregnant women.

Non-drug approaches to depression — such as CBT, mindfulness, exercise, light therapy — have been shown to work as well as antidepressants in numerous studies. Furthermore, initial use of an antidepressant may lead to long-term use, and, in general, long-term outcomes with antidepressants are poor. Longer-term studies regularly show better outcomes for the unmedicated patients.

This approach validates the importance of treating these women while attempting to minimize fetal exposure to synthetic chemical compounds during development. Furthermore, given that most patients find it difficult to stop taking these medications, the argument can be extended to say that we should prioritize non-drug approaches to treating depression in women of childbearing age.

What to do then with the pregnant woman who is appropriately counseled regarding the risks, benefits and alternatives to antidepressants and still wishes to take them during pregnancy? That answer is simple: Support her and give her the best care possible during her pregnancy.

Unfortunately, the public discourse on this topic suggests that there are only two approaches: 1) respect depression, care about depressed pregnant women and tell them the drugs are safe and won’t affect the developing baby, or 2) protect developing babies, tell pregnant women not to be treated, and make them feel guilty if they take antidepressants.

Fortunately, there is a better approach. That approach (and what depressed pregnant women and the public need on this issue) is compassionate care and accurate information that recognizes the potentially severe consequences of depression while making it clear that chemicals going into a baby throughout its development will likely have consequences for that development. Non-drug approaches can be prioritized in order to safely and effectively treat depression without ongoing fetal chemical exposure.

There is no “one size fits all” approach to this issue and patients need information on the risks and benefits for all therapies for depression, including medication, psychotherapy, exercise and other options. This approach can actually work in practice. Health care providers can show compassion and care for pregnant women suffering from depression, counsel them regarding the risks and benefits of various treatment options, discuss alternatives, and support them with whatever they choose to do — depression during pregnancy need not go untreated. With rates of depression increasing and rates of antidepressant exposure growing, it’s imperative that the above misconceptions are corrected and that pregnant women and the public get the proper information and care.

44 COMMENTS

  1. One has to wonder how long it will take the medical community to wake up to the reality that all the DSM disorders are “invalid” disease entities.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    And that the psychiatric drugs create the symptoms of the DSM disorders.

    https://www.alternet.org/story/146659/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    For goodness sake, the antidepressants have a black box warning on them now, even stating they cause suicides and violence.

    Although, drugging pregnant women en mass certainly does seem to be a very profitable business model for today’s iatrogenic illness creating, pedophilia and easily recognized iatrogenesis covering up, “mental health professionals.” But it is the opposite of “first and foremost do no harm,” for both mothers and children.

    I do agree, the doctors should stop lying to women, and claiming the SSRIs are “safe meds.” They are not. And I do agree that non-drug options are much better options, than force drugging pregnant women with neurotoxic drugs. That’s abuse of power, and disgusting, in reality. And it’s good the doctors are now comprehending that exercise is good for people, rather than trying everything possible to get a person to stop exercising.

    But I believe the best solution would actually be to make it illegal to psychiatrically drug any woman of child bearing age or younger in the future. And given the reality that the psychiatric drugs actually create the symptoms of the DSM disorders, it should actually be illegal to force or coerce these drug classes on any human of any age.

    • Hi Someone Else,

      It’s taking the public a very long time to realise that they’ve been duped.

      All longterm Mental Health problems are caused by psychiatric drugs and solutions to all the original problems have always been available.

      The solutions were there before the drugs arrived. It’s just a question of figuring out which choice of action is the most suitable.

      I was talking to a lady two days ago and she told me that since she joined a worthwhile “peer group” anxiety and depression ceased to exist as a problem for her.

      • Yes, I agree, Fiachra. “The solutions were there before the drugs arrived.” People helping people in a “non-hierarchical culture,” which used to be what the US was about, rather than people harming people for profit, is the solution.

        As an American, who grew up in a culture where we were taught “all people are created as equal.” I just didn’t understand our “mental health professionals,” in particular, but also much of our mainstream medical community, were miseducated to believe we should be living in a satanic, hierarchical culture. Especially since America was founded on the wisdom that caste systems, and hierarchical systems don’t work, and are the opposite of the beliefs America was founded upon.

        The problem seems to be the psychiatric industry had delusions of grandeur long ago, that they could control all of society, with their fraud based theories, and their iatrogenic illness creating drugs.

        https://topdocumentaryfilms.com/psychiatry-industry-death/

        The psychiatrists apparently had an easy job bribing the American religious leaders, including the leaders of the religious hospitals, and the mainstream doctors into buying into their very profitable, but satanic system. By promising to cover up the child abuse of the religious leaders and their satanic wealthy, as well as the easily recognized iatrogenesis of the mainstream medical community. My understanding is that it was also easy to bribe the teaching profession.

        Psychiatry is all about power and control over other human beings, rather than proper management of a society, based upon the rule of law. As has previously historically occurred, psychiatry is only given undeserved complete control, when the globalist banksters’ banking system is about to implode within a country, due to it’s Ponzi scheme nature.

        A little about the history of the fraud of the war mongering and profiteering, psychiatric empowering, globalist banksters currently in charge of America.

        https://www.youtube.com/watch?v=5hfEBupAeo4
        https://www.youtube.com/watch?v=U71-KsDArFM
        https://www.youtube.com/watch?v=we4i4AdGa-A

        These psychiatric crimes happened in Bolshevik led Russia and in Nazi Germany already, and I think lots of other countries, according to history. And the US monetary system was taken over by the wrong banksters long ago, in 1913 specifically. And the US monetary system is about to implode because the wrong banksters are in charge.

        The American banking families who knew giving out bad loans is a bad idea, because you’ll lose your bank, were defamed and drugged long ago. Our children were raped. So the psychiatrists could aid and abet the satanic, globalist, fiscally irresponsible banksters, who needed bailouts in 2008. A little about these globalist bankster’s “luciferian” hobbies:

        https://www.youtube.com/watch?v=m6qDFA8n9xw

        And, of course, covering up child abuse has been, and still is, the number one function of today’s psychiatric and psychological industries today, according to their own medical literature.

        https://en.wikipedia.org/wiki/The_Freudian_Coverup
        https://www.madinamerica.com/2016/04/heal-for-life/

  2. He didn’t mention super nutrition, which uses diet and proper supplements to treat depression in pregnancy. More physicians should be aware that, towards the end of pregnancies, expectant mothers can become zinc deficient due to their rising serum copper levels just before birth. Proper treatment for depression from this late process involves the use of supplemental zinc and large doses of B6 to help with the zinc’s absorption.

  3. “…the suffering caused by the depression itself is horrible.” I object to the idea that “depression CAUSES suffering.” Depression IS suffering, and calling it “depression” is only a way of categorizing this suffering. It is highly misleading to make it seem like “depression” is some outside force that takes over your brain and MAKES you suffer. There is no evidence, nor even any kind of mechanism, to support this kind of far-fetched conceptualization, though of course lack of evidence has never been a barrier to psychiatric hubris in the past.

    Moreover, there are lots of REAL REASONS that women get depressed during pregnancy. These include biological reasons, like loss of sleep, rapidly changing nutritional needs, and hormonal shifts that alter normal expectations and routines; psychological reasons, such as the fear of parenthood, childhood issues being brought up by the idea of being pregnant, changes in body image, conflicts between the desire to continue working and the desire to stay home with the baby; and social issues, including changing relationships with and expectations of others, loss of connection with single or non-parenting friends, challenging behavior from older siblings, and most often ignored but very important, the common initiation or escalation of abuse by a partner that so frequently occurs during this vulnerable time in a person’s life. That is a very abbreviated list that could easily be expanded on at great length. Being pregnant is stressful and brings up a lot of crap. Being depressed during this time is hardly surprising and often 100% normal given the context. None of this is discussed in the article.

    In my view, “depression” is not a “disorder” to be “treated.” It is a (usually) temporary condition that arises when a person is in a situation s/he is not happy about but can’t immediately get away from. It is not something that needs “treatment,” it needs understanding, patience, and empowerment to seek one’s own solutions. Until we stop framing “depression” as something that “happens to” people rather than something they are experiencing and over which they have some degree of control (however difficult that control may be to exercise), we will continue to have dilemmas like whether or not we want to pass on brain-damaging chemicals to our vulnerable fetuses in huge numbers.

    • as to your first paragraph:
      Yes! That is just like telling someone that their head hurts BECAUSE they have a Headache!

      as to your second paragraph:
      Thank you! Thank you! Thank you! And an addition to the list: even if the partner is not abusive, pregnancy did not allow for sex after about 6 months’- I was too big to breathe! And lying down flat (no matter the position) was impossible from the heartburn that caused. Between that and postpartum recovery (I suffered a 4th degree tear with my first child), it was about 6 months of no sex. Not having that release available also took its toll- on the marriage, and on me as a person.
      And then there’s Birth Trauma- the things women are subjected to while in labor/birthing is horrific. And having that possibility looming ahead sure makes subsequent pregnancies fun! I was not willing to be traumatized again, and had my second child at home with a wonderful midwife, but not all women can do that.

      • Steve and LavenderSage

        Thank you for those necessary comments. While this blog has many strengths it also has some glaring weaknesses, some of which which you have correctly critiqued.

        The author of this blog tended to demonize depression by abstracting it from the real life experiences in the world that bring it on. He also made no distinction between the more milder experiences of depression and the severe forms of the experience. ALL experiences of depression by women are often routinely “treated” with mind altering (and cellular altering) drugs after a 5 minute discussion with a doctor and/or psychiatrist.

        AND I will repeat a criticism I have made of this author”s previous blogs when he continues to alternate between using the word “baby” and “fetus” to describe a developing fetus.

        This misuse of language is very contentious and politically volatile in a world that is increasingly restricting the rights of women to control their bodies and reproductive rights. Right Wing forces in society, of course, want the word “baby” to be used to describe a developing fetus so as to claim a “murder” has been committed when a women makes a righteous choice to end a pregnancy due to its enormous impact on the trajectory of their life.

        Richard

        • The removal of context from experiences labeled as “mental illness” is the central tenet that allows the DSM and psychiatry to dominate the definition and discussion of care of the human psyche. It must be identified and challenged whenever and wherever it appears!

        • Richard, if you were the “fetus” created when your mother made the “righteous” choice to have a relationship with someone, would you also categorize her choice as “righteous” when you were terminated?
          Of course having a baby has an enormous impact on a woman’s life. But didn’t she know how babies are made?
          Is a fetus (which is known to be capable of feeling pain) really just a mess to be cleared up?
          Today, we have “fetuses” being born at 20 weeks and surviving. Your camp is having in increasingly tougher time categorizing such lives as “just a clump of cells.”
          By the way, I’m not right wing.

          • By the way, it’s particularly ironic having someone on MIA arguing against the fact that fetuses are alive. Anyone dealing with trauma using newer healing modalities knows that many traumas we experience are from the pre-birth period.

          • So what are you saying – that if it’s rape/failed birth control, then it’s okay to kill?
            Are you looking for a mitigating factor because even you subconsciously recognize that a fetus is a life?

          • I’m pointing out the erroneous assumptions you’ve made, Gabi: that pregnancy is always a result of a sex act that was the woman’s choice, and that if she’s smart enough to understand how babies are made and smart enough to use birth control, there would be no unwanted pregnancy to contend with!
            I think it’s mercy to terminate an unwanted pregnancy, since you asked. As a child who was abandoned by both my parents, I firmly believe it would have been better for me not to have been born. As a mother, I felt “the quickening” and that’s when the pregnancy became the baby. Both babies. What I miscarried (twice actually) at 11 weeks’ gestation was indeed just a bloody glob. And when I got pregnant a few years later and knew I could not handle another pregnancy (not to mention baby!) at that point in my life, I had an abortion. It was right at the end of the first trimester, by the time I had enough money saved up, and would surely have been viable. I do not regret that decision; it was what I needed to do for me and my 2 kids. So I’m very clear on what’s a life.

          • gabi taylor

            You say you are not Right Wing but you are promoting one of their most important political positions – the subjugation of women.

            You certainly can’t call yourself a feminist since you advocate for women NOT having any control over their bodies or reproductive rights, which is absolutely fundamental to feminism or support for the equality of women.

            Richard

          • God forbid I am not a feminist. I think what feminism has “achieved” for women has been a disaster. Women are definitely equal to men, and definitely different from them.

            Reproductive rights is such a ridiculous term. Unless you define it, it doesn’t mean a thing. Do you support abortion right up to the last second before natural birth? Or do you have some magical arbitrary line between clump of cells and baby?
            Yes, I have no doubt that many people are so convinced that what they did was right. So? Many murderers of adults also feel the same.
            LavenderSage, I’m so sorry that you with you were never born. But don’t make the same assumption for everyone else who wasn’t aborted but might have been. I would hazard a guess that most of them are happy to be alive.

            Richard, you’re fighting against reality – you don’t like, for whatever reason, the fact that physical acts have consequences that we are supposed to take responsibility for. You want to pretend that a woman can “have it all.” Nobody can have it all. There are consequences to every choice we make. Even women who were raped and had abortions often express anguish in later life about their decisions. Plenty have their babies and don’t regret it. Others have abortions and become infertile. An abortion is not like blowing your nose and poof, it’s gone. Open your mind a little to the other side of the story. I regularly donate to an organization that provides financial help to expectant mothers who would otherwise have abortions, and do you have any idea how many really want to have their babies but are scared they won’t be able to provide for them?
            Again – please look at the whole picture and put the propaganda to one side at least temporarily.

          • I think it’s very easy to take for granted the many, many improvements that have happened in society as a result of the feminist movement. It is quite disingenuous to trash feminism while enjoying the benefits you deny have accrued to you. It reminds me of people getting down on unions, but try to take away their 40-hour week or their vacation or sick time and see how upset they get. Feminism, like any movement, has its downsides and its extremist members and is not perfect, but to claim that feminism has not brought a very large and dramatic change in the US and world culture is just plain unappreciative denial.

          • Well, I guess I’m just as much entitled to my subjective opinion as anyone else here. For sure there have been some side-benefits to the feminist movement, but I would argue that the basic premise of the movement – that we’re all just the same with accidentally different bodies – has done a huge amount of damage, apart from the fact that it’s a lie.
            But as oldhead pointed out already, this is a total waste of time because certain people are not even arguing facts and ideas – they’re just spouting propaganda.

          • Who said that was the basic premise of the feminist movement? The basic premise is that women are human beings deserving the same rights as men. Our society has always (and to a large degree continues) allowed men to get away with things that women are punished for, allowed men to make decisions and rules and control the lives of women and children, allowed men in power to behave abusively toward other women, children, and other men lower in the hierarchy than them. Consider domestic abuse: in 1970, there were NO shelters, NO domestic abuse laws, NO protection at all for an abused spouse – if you complained to the police, they’d ask you what you’d done wrong to deserve it. We have come an INCREDIBLY long way (though we still have a long way to go) in reducing the #1 cause of injury or death to younger and middle-aged women. That is not a “side effect” of feminism, that was one of the primary areas of intentional focus of feminism, and it’s pretty disrespectful of the women who in some cases risked their own lives to bring about these changes to suggest that it was all about saying that men and women have the same bodies and the same needs.

            On the other side, feminism helped make it possible for men like me to become nurturing dads and to be there for their kids with full social support. When I stayed home with my son back in 1986, a visit to the park with my infant son (and I was the ONLY man there on almost every occasion) led to suspicious glares that seemed to indicate I was probably a child molester. Nowadays, there are men walking through the park in droves every weekend and plenty on weekdays as well. This has nothing to do with men and women having the same needs and the same bodies. This is major cultural change that would never have happened without feminism.

            I can certainly entertain the idea that feminism may have had side effects (to use your term) that may not have all been positive. But your concept of what feminism is reflects a complete misunderstanding of the subject. It’s not about bodies. It’s about POWER and the abuse of power by men over those they deem below them in the power structure. To consider that a side issue is factually inaccurate and again very disrespectful to those who fought to give you the increased power you now enjoy in society. And I was there, I lived through those times, and I know what it is I’m talking about. You don’t want to go back to 1970, trust me on that point. And one major reason our society is better for you is because of those early feminists who risked their lives and reputations to make it so. Maybe you should read up on it and see if I’m making this up.

          • Not that I presume to speak with extensive authority about women’s issues but, if people here (primarily men) are attempting to define feminism, I would include the materialist/class analysis that, just as in economic terms control of the means of production is the key to class power, with women’s oppression it is control of the means of reproduction, i.e. women’s bodies.

          • It’s great that your experience of feminism has been one of increasing respect for women. But my experience has been of increasing demands placed on women, increased expectations. A woman without a career is considered and taught to feel “less” whereas a man who doesn’t feel the inclination to play in the park with his kids doesn’t confront the same inferiority feelings. What this can play out as, is women after birth feeling that their identity has been lost because now they are back to being “just women.”

            What feminism has failed to do, in my opinion, is to teach respect for women as women, not just as human beings. I believe the reason this happened is because it wasn’t the agenda at all. The agenda was to enable women to succeed in a man’s world, which may have worked in a way, but with a tremendous cost paid by the conflict inherent in being a modern woman.
            Since this article is about PPD, I think that this point is particularly relevant. In traditional – and yes, very hierarchical – societies, women after birth are pampered and given often a month off to recuperate and devote themselves to their new babies. In the western “equal” world, women are expected to manage it all – be a great mother, and go back to their careers. The fact is that most women cannot succeed at both. Mothers and children suffer.

          • Gabi,

            regarding pre-birth trauma and trauma in general, in my opinion there is no way to inhibit traumatic experiences because human beings like everything in nature are not ‘perfect’ and never will be. For every troublesome issue we sort of ‘solve’, new challenges arise. That’s an intrinsic part of life’s comlexity.

            Thus there never can be a ‘perfect’ solutions that benefits all. Like the debate about abortion, well, there is no simple answer. The most sensible thing to do in my opinion is to try to ‘understand’ people and their respective decision as well as establish certain ‘guidelines’ that reflect current state of the art knowledge and laws for the more serious issues. Naturally, as human insight changes (hopefully increases), guidelines and laws will change. We simply do not know enough about consciousness at the time being and because you came up with pre-birth trauma, well, we certainly do not know enough about spirituality or the ‘soul’, whatever that may be.

            A ‘perfect’ environment where every human being is happy and thriving is an utopia that gives me the creeps. There would be absoutely none opportunities to grow. There would be no minor in music compositions, nothing that touches us deeply and moves us to tears. The powerful and gripping feeling of people overcoming a painful experience, the forgiveness and moments of shared emotion after a long time of conflict, everything that moves us to the bones and inspires to strive for a better tomorrow would seize to exist. Nobody’s view would ever broaden because in an already perfect world there is n need for further grow, at least not that kind of growth that comes up with totally new ideas and solutions. As Einstein said, “no problem can be solved from the same level of consciousness that created it”. First, problems are needed, second, to truly solve it you need to jump into the unknown and be open for a broader understanding.

            I became pregnant at a stage in my life where I was just not ready to become a mother. It was before my troublesome mental illness time and it was about financial issues because I was still a student and I was seperated from my boyfriend who had ill-treated me. I didn’t want our child to have to grow up with me being a single parent, maybe unhappy because I would secretly think I had to pull back from my studying and active life and wouldn’t be able to make a career, and with a ‘bad-ass’ father who had been violent and still couldn’t take responsibility because he had not matured enough yet. See, I was not in a really severe situation, I could have handled being a single parent, but I didn’t want to. If you feel to judge me and call me egoistic, that’s fine. To a certain degree that is true, because I wanted my freedom. But I didn’t abort because I was still very self-assured and felt like tempting fate and somehow decided to let fate decide. If the fetus would abort naturally, fine, if not I would have to deal with it. The challenge was, to find a way that I could live with and fully stand by without having to sacrifize myself, as woman often are expected to do (the nurturing motherly being who unselfishly steps back for her family, especially for her children but also for her husband etc., devoting her life to support others and still radiate joy and happiness and be content in that ever-serving position). Well, my belly grew and thus I had to finally face it. I confronted my boyfriend and I can tell you, that was the beginning of a very, very tough journey, but it was a beautiful one. He reacted very sweet and we finally felt like Bonny and Clyde, because we both decided to give our little one up for adoption. And we went through the later part of the pregnancy together with much love, and some fights also because his deep psychological wounds were still present but in mostly pushed in the background because of our deep wish to give that baby a loving entry into this world. It’s an open adoption and I can tell you thats a very difficult thing to handle. It has beauty and pain combined and one needs a lot of maturity to handle such a situation with grace.

            I got pregnant a second time after that and if you ask yourself if I haven’t figured out by now how babies are made 🙂 I can tell you that I prefer natural contraception because I am really not into drugs much and that pregnancy was a true miracle because my boyfriends little super-swimmers somehow survived my period and 14 days afterwards in my body. Still there were no signs of mental illness present but it was a year after adoption and in the middle of the intensive domestic violence time where I had decided that love would conquere anything and I heroically tried to make it through the tunnel together with my boyfriend. At that timeit was an incredible relief to be able to have an abortion. And I do nit have any regrets to that. I am sure, if there was a ‘soul’, although it didn’t feel like that, it happily sits somewhere on a cloud and waves at me right niw with understanding and even thumps up for me being tough and brave enough to reach my own decisions and follow them through – regardless of their outcome, because any decision can be the wrong one, as I said before, this is not a perfect world and was never meant to be. There are consequences, as you rightly pointed out, but that abortion did feel right for me.

            Concerning pregnancy and mental illness, I am quite sure the bodily changes influenced my vulnerability to psychosis. I could feel my body becoming softer and myself being more open and absorbing and, well, just the awakening of that female qualities that made it harder to cope with the continous attacks that I was receiving (and provoking, because I thought I could do confrontation therapy with my boyfriend). And half a year later I succumbed to psychosis.

            Regarding feminism, see, I am a woman working in a traditional male field, geoinformatics, and I am very happy about the things that feminists have acchieved. Of course there are differences between man and women, but, well, lets face it, you are very intelligent as one can see from your posts. May I ask why you are so angry about that topic? Is there something specific that bothers you? Do you think feminine qualities like the mentioned willingness to sacrifize theirselves for the greater good of their family are valued too little these days or even smiled upon?

            For me its not the intrinsic qualities of male or feminine energy that I would dispute, but I very much want to decide myself which qualities I want to express at every moment in time. I do not want to be put in boxes, wether because I have this or that gender or wheter I am from this or that class or race or wether or not I have a certain psychological ‘vulnerability’ (= sensitivity which can be also seen as a strength, depending on viewpoint and situation). I pretty much value my freedom and prefer not to be constrained more than necessary by certain features of my being. Like in nature there is just so much leeway in almost anything we encounter.

            Therefore, that trauma thing I sort of understand because indeed abortion or adoption or keeping a baby under difficult circumstances comes with a great potential of generating or intensifying ‘trauma’. Although as I see it, thats part of life and we will never be able to prevent all traumatic experiences. Its more about how we handle it when it has happened, thats important in my opinion. The feminism part I do not fully grasp what poibt you are trying to make?

          • Gabi, just read your latest comment and it answered my question. And I do agree, although I would phrase it a bit differently, in that the feminine qualities are still belittled and seen as inferior. To strengthen them we don’t have to go back to traditional roles I hope.

          • Gabi, I think you hit on a VERY important point here – feminism focused on giving women more power WITHIN THE CURRENT SYSTEM THAT EXISTS. When women became more able to work in high-paying jobs, they also discovered that even those in high-paying jobs experience oppression on a very serious level – long hours, not being able to take time for family needs (I had to ARGUE to get THREE DAYS off when my first son was born in 1983!), being bullied by abusive bosses, and being at the beck and call of the corporate capitalist juggernaut that determines how everything runs. The absurdity of our “parental leave” policies in the USA is a huge contributing factor to “Postpartum depression.” As is the fact that decreasing average wages have created a situation where instead of being ABLE to get a job, women (and men) are now forced to work full time when their babies are young in order to survive economically. But I don’t blame all this on feminism – it is a result of our sick and sickening social/economic system which demands that close to everyone, male or female, has to sell his/her soul to the Company in order to survive. Feminism, in my view, never actually intended initially to deal with these power structure issues, and they remain substantially unchanged (actually worse) than they were in the 1970s.

            All that being said, I don’t want to take away the effective work in balancing power and creating more safety for women and children that has resulted from the feminist movement. There are hard stats backing me up on this. Like I said, there is still a hell of a lot more work to do, and perhaps the current challenge among activists of all stripes is to start banding together to deal with the larger social power dynamics that really drive racism, sexism, classism, etc. Because even having totally equal access to opportunity in a society built on oppression will not end the core assumptions that power over someone else is the most valuable commodity available.

          • Rape results in 00.01% of all pregnancies. I see why there might be an exception for victims of rape. But how that justifies killing any of the other 99.99% of babies is beyond me.

            “Marijuana can have medicinal benefits for women with advanced breast cancer. Ergo we should legalize recreational drug use and all become pot heads.”

            A lot more men are militant abortionists than women. This makes sense since it’s cheaper to pay for an abortion than make child support payments. Just ask ex-congressman Tim Murphy.

          • So Rachel, I am a woman too, what would you call me then in that I have ‘murdered’ a baby or fetus without having been raped in that particular situation?

          • Fiachra

            You might want to read up on the history of the use of the terminology surrounding the battle over defending the right of women to have an abortion. Their insistence on the use of word “baby” (to describe a fetus) is very important to all those trying to deny women control of their reproductive rights.

            In fact, I would equate its political significance to those who are very invested in calling psychiatric drugs, “medications.”

            Richard

      • Right. “Headaches can cause pain in your head!” It is hard to understand why people can’t see this tautological idiocy for what it is.

        And I appreciate your expansion of my list! As I said, the list can go on and on. One I did not mention is the differential attention before and after birth – suddenly while pregnant, everyone is all excited and wants to touch your belly and wants to share their baby stories, but after the birth, everyone drops off a casserole and then doesn’t talk to you again for 6 months or sometimes ever.

        My wife did a brief sociological study of postpartum depression around the world. She found that there are cultures where there is essentially NO postpartum depression AT ALL. Interestingly, those cultures were the ones where the mother had the least to do besides caring for the baby and the most continuous support from other members of the community for the longest period of time. I’m sure the same would be true for pregnancy – lots of attention and genuine support would ameliorate a lot of stress and bad feelings for everyone in the family.

        I also appreciate your mentioning our bizarre childbirth practices and their contribution to prenatal/postnatal feelings of depression. Obstetrical care is almost as irrational and destructive as psychiatry, with treatment decisions made through myth and tradition and attempts to intervene with actual science met with scorn and ostracism. Consider that a third of US babies are born by C-section, and no one finds this alarming. The unnecessary anxiety and disempowerment of moms by birth practices in the USA is criminal.

        • Notice that until recent years most obstetrical care was done by men. I wonder if that accounts for much of the bizarre stuff that used to happen to women when birthing children. And notice that in this country it was men who led the battle to keep midwives from working with pregnant women. And I also notice that there are huge numbers of men in the Pro-life movement, men who demand that they should be able to tell women what to do with their own bodies and lives.

          • Regarding my birth experience I have to say although my boyfriend and I very much tried to get a natural water-aided birth it didn’t work out and I was very happy when the male doctor took over sort of very seriously and firmly suggested to me that its enough suffering and time for needles and asssistence. The midwives at that point felt quite annoying with their approach of “you have to let the baby come out, cutvthe inner bonds, feel the vibe of your body”…

            I am also quite happy that we now have the means for alternatives to breast-feeding and abortion that I think are also a result of abondoning this motherly viewpoint of everything must be ‘natural’ and everything ‘artificial’ is somehow bad. I think a patriarchal viewpoint aways comes with the accompanying patriarchal-wife’s perspective, thus blaming it all on men is not the thing we want.

            As an emancipated woman I need an accompanying emancipated man, where I no longer am reduced to the traditional female ways but he also steps out of traditionally male roles but without loosing his masculinity. And what I sort of felt when reading your comment is that uncertainty many males feel when talking about sort of ‘female issues’. Men are enabled to share their view on certain female topics and I am sure that if males would be the ones to become pregnant, abortion wouldn’t be such a difficult topic and you would get the means freely with some clear laws on what is accepted and what is not (e. g. until what time and what circumstances an abortion is sensible). Patriarchy is something very different to masculinity.

  4. “Becoming Mum” is a superb Acceptance and Commitment Therapy (ACT) self-help book extremely useful in overcoming perinatal and postnatal depression – drawing upon strategies within ACT, mindfulness-based Cognitive Behavioural Therapy and Behavioural Activation – all of which have an evidence-base in the treatment and prevention of depression. Becoming Mum would be a useful companion to any woman seeking to prevent or overcome both perinatal and postnatal depression. Highly recommended, and relevant sites: https://becomingmum.com.au/ and the authors site here http://www.koawhittingham.com – check out both! Btw research shows ACT and similar modern psychotherapy self-help books to work better with the help of a skills coach a.k.a. therapist.

  5. Another excellent brand new ACT self-help resource, postnatal orientation but still relevant “Postpartum Depression and Anxiety – The Definitive Survival and Recovery Approach” – “is a unique, user-friendly self-help approach to support and guide mild, moderate and severe sufferers to a place called recovery and beyond.” From New Zealand, and a great newspaper article about it here – http://www.stuff.co.nz/life-style/parenting/101541339/christchurch-postnatal-depression-survivor-and-psychologist-team-up-to-write-book – hope both of these may be helpful to some.

  6. Drugging fetuses endangers fetuses in two ways: 1. increased risk of birth defects, and 2. the baby, just like the mother, if she ever ceases her drug use, will experience withdrawal at birth. The mother of an unborn baby has two lives to care for, and drug use/abusage is not good prenatal care. Call it medication if you choose to do so, the mother who takes a psychiatric drug is “medicating”, to use the same word, her “healthy” child, and “medicating” “healthy” children is a good way to produce “sick” children. “Talk therapy” has to be an improvement over “drug therapy” when that “drug therapy” involves drugging “sick” an ordinarily “healthy” baby. A little postpartum depression *cough, cough*, horrible term, is preferable to a deformed, dead, or disfigured, and drug addled, infant.

    • A few years ago I went to a talk given by a pre-eminent psychiatrist who was supposedly an expert in the United States in the treatment of pregnant “mentally ill” women. He stood at the front of this large group gathered to hear what he had to say and stated that it was perfectly all right to use the psychiatric drugs on pregnant women because the drugs had absolutely no detrimental effects on the fetus! And the arrogant quack then stated that even if there were effects you couldn’t let a “mentally ill” woman run around untreated, even if she was pregnant. I got up in the middle of his talk and left the room.