Pregnancy brain

Apparently, in lieu of psychotropic medication, I’ve got pregnancy in my brain.

“Who knows — the pregnancy hormones may help lift your mood naturally,” said more than one well-meaning but grossly inaccurate psychiatrist, therapist, obstetrician, or friend.

“Thank you for humoring me as I go off these magic mood stabilizers,” I mumble to myself each time I take on the endeavor.

I appreciate the good intentions, but wishful thinking isn’t what, come this summer, will have gotten me through roughly four years of being off mostly well-working, quality-of-life-saving medications. It will be four years of intentionally suspending highly beneficial treatment that took a decade to find, for the sake of having children. That includes three pregnancies, time for pre-pregnancy preparation and then postpartum, and a half-year attempt. And God bless my children and my husband, and I love them with all my heart, and it’s a personal choice to make, and the things we do for our kids, and thank God for family, friends, support systems, and therapy — but what am I, insane?

No, actually. The answer to that, after making a very calculated decision after three varying experiences going off meds previously, is no, I am very much not insane. I even passed a recent perinatal depression screening to prove it. But I would be lying through my teeth if I said the decision in itself wasn’t extremely weighted, or that the reality of the situation isn’t, at times, ridiculously challenging. But we make choices in life and we go through with them and sometimes we just hope for the best while planning for the worst.

And that’s the key: planning. That, and screening, both of which amount to a woman, along with her partner, making herself aware of mood-related episodes that might occur during and after pregnancy and devising an educated game plan in case such a situation arises. Better yet, I’d say don’t even wait until the “in case” stage. By then, once a person already is in such a state, navigating the terrain gets even more difficult. Be more prepared than that. Draw yourself a map. Ahead of time. Just in case.

A woman need not have a mood disorder to experience perinatal or postpartum depression. In fact, according to recent statistics, 1 in 7 women experience depression or anxiety during pregnancy and postpartum (with some estimates reaching as high as 1 in 4 for both perinatal and postpartum periods). Signs may include exhaustion, appetite or sleep disturbances, mood swings, and feeling anxious or overwhelmed.

The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for depression at least once during the perinatal period, and new guidelines from the U.S. Preventive Services Task Force recommend that all people 18 and older, including pregnant and postpartum women, be screened for depression. One questionnaire that might be used is the Edinburgh Postnatal Depression Scale in postpartum and pregnant women. Screenings can be helpful, according to the American College of Obstetricians, because fewer than 20 percent of women in whom perinatal depression is diagnosed self-report their symptoms. If a condition isn’t being reported, it simply can’t be addressed or treated adequately.

There is no reason why, in this day and age, a woman should have to go through perinatal or postpartum depression alone. Therapy, relaxation techniques, and, in some cases, yes, medication, both during pregnancy and postpartum, all may be beneficial in helping combat depression. Conversing with others with similar experiences is invaluable. Enlisting the help of family, friends, or a baby nurse can make a world of difference in a woman’s mental state, especially when it allows her to get some much-needed sleep.

Speaking of, a word on night feedings (a little rant, if I may). After the emotional and physical trials many women go through with fertility and miscarriages; and the unspoken pressure from our family-focused and children-centric communities (as manifest with the ultimate dictate of “Pru urevu” — be fruitful and multiply); and the two cents from everyone and their mother about how best to raise your children; and the guilt from pregnancy books that have entire chapters on breastfeeding concluding with a single abbreviated paragraph saying that, well, if you can’t or choose not to nurse, you and your baby probably won’t really go to hell; and the guilt and understandable worry of having to choose to either go on some sort of medication during pregnancy or breastfeeding versus “toughing it out”; and the preconceptions of how wonderful and blissful it is to have a newborn; and the constant pressure on women in society at large to do it all and have it all; and the pressure to stay on top of everything while on a few hours of sleep night after night, which can clearly be detrimental to a person’s mental health — my suggestion is this:

Give yourself a break and the luxury of six hours of sleep in a row and let someone else do a night feeding, whether it be with pumped milk or formula. You are not doing you, your baby, or other family members any favors by sacrificing your sanity.

All this is not to put a shadow over the miracle of pregnancy and childbirth. Someone’s experience may be completely positive, or mostly so, and that’s a wonderful thing. But it’s not always the case that it feels like a wonderful thing, and it’s completely unhelpful for a woman to feel guilty about not feeling 100 percent blessed, this on top of possible symptoms of perinatal or postpartum depression.

And while, surely, there may be reason for someone like me, with a pre-existing mood disorder, to be more cautious when going through pregnancy, it’s important for every woman entering this arena to be aware of the signs and symptoms of pregnancy-related depression. Because even at its most conservative estimate, 1 in 7 sure is a lot of people.