Prenatal Depression: The Pregnancy Condition No One Talks About

Photographed by Maria Del Rio
I'd assumed it would take at least a few attempts to get pregnant, so I should have been happy when I conceived almost immediately. And I was. For four days.

I hadn’t yet taken a pregnancy test, but I track my ovulation and cycle very carefully, and when my period didn’t arrive, I just knew. Every time I went to pee and still didn't have my period, I'd text "Still pregnant!" to my boyfriend. I floated around, imagining how I was carrying the little cells, feeling how special my body was in taking care of them while they grew into the baby we wanted.

And then, the fourth day after my missed period, I was suddenly crying myself to sleep. “Being Pregnant” and “Having A Baby” loomed ahead like a black hole. I didn't know it yet, but I was suffering from prenatal depression, which I'd never even heard of. I continued in ignorance about this clinical condition, which I now know affects between 14 and 23% of pregnant women, for another 10 weeks.

Prenatal depression is the stealthiest of emotional pickpockets, robbing every milestone of its happiness. When it came time to officially take a pregnancy test a week later, I was overwhelmed with dread just looking at the box. I peed on the stick, left it in the bathroom without looking at it, and went back to bed to stare at the wall. There were three possible scenarios: carrying the pregnancy to term, having an abortion, or magically time-traveling to a point when I wasn't pregnant. I was rooting for the third, and looking at the test was going to make that impossible.

I texted a photograph of the positive test indicator to my mom, with no message, and spent the rest of the afternoon hoping my boyfriend would talk me into a better state. We made a list of all the things pregnancy was preventing me from doing. It was admittedly a pretty short list. Unable to find an excuse for how I was feeling, I had to carry on Being Pregnant and Having a Baby.
Photographed by Gunnar Larson.
I delivered the news to family and friends with the same level of enthusiasm as I might have shown if I’d been sharing wallpaper samples, but everyone was thrilled for me. Even though I knew it was customary to wait until the end of the first trimester, I told the news to colleagues, taxi drivers, shop assistants, anyone — hoping to suck up happy reactions by osmosis. I met the congratulations with a calm reminder that lots of pregnancies didn't make it to the critical 12-week point. By some sleight of mind, I also managed to pretend to myself that it wasn't happening at all.

I hated myself for my fickleness. It was as if pregnancy had turned the floodlights on character flaws I never even knew I had. How could I be so un-self-aware, irresponsible, and selfish, dragging my partner and an unborn baby into a fleeting whim?
My behavior became even more at odds with my constant sharing of the news. I couldn't be bothered to eat, I stayed in bed, I was tearful and withdrawn. I hauled myself to social events only if I absolutely couldn't cancel, and I generally disappeared from view. I made excuses not to see my doctor and start the process of check-ups, silently hoping for a miscarriage in the meantime. After two years of tearful goodbyes whenever I visited my gorgeous nieces, hoping motherhood was in the cards for me, now I suddenly kept bringing up the fact we still had time to terminate. By then, my boyfriend had also told family and was devastated at the prospect of not having the baby. But I was too removed to care. I wasn't just tearful over sentimental TV ads or picking fights about unloading the dishwasher; it was a constant loop in my head of I don't want this. I DON'T WANT this. I DON'T.

And then, on my boyfriend's birthday, I'd retreated to bed because pretending to be cheerful was only possible in shifts, and I needed a cry break. A random internet search led me to a Dr. Google diagnosis: prenatal, antenatal, or prepartum depression. A multitude of different terms dedicated to describing a condition I had never heard anyone talk about. I lay in bed reading, tears rolling down my face at the stories of women who had faced the same predicament. For the first time, I felt relief. Diagnosing myself with prenatal depression was as close to feeling happy as I could get.
Far from feeling stigmatized, I now had an explanation that absolved me for the feelings I was so ashamed of. I could ignore the voice in my head and take the abortion idea out of the equation entirely. "I'm not in my right mind," I told myself, "so I don't have to listen to me." Freed from following my emotions, I relied on the rational knowledge of my sudden change from happy to sad, bolstered by memories of wanting a baby. I felt able to be open about how I was feeling and resigned to wait it out while going through the motions of trudging to midwife appointments and eating healthy food when instructed.
Photographed by Gunnar Larson.
Anti-choice campaigners might leap on my story or the notion of prenatal depression as an argument against abortion, pointing out that women who experience this can’t trust their emotions — that if they terminate their pregnancies when they’re suffering from a temporary bout of depression, they will regret it later. But not every woman who is depressed wants an abortion, nor does every woman who wants an abortion feel depressed. An unwanted pregnancy is one thing — and I support a woman’s right to choose how to handle that, if it happens. A very much wanted pregnancy that leads to a sudden and extreme change in emotional state and behavior demands examination — and for that, we need awareness. I found very little information online. The majority of what I did find was on parenting sites, which a depressed pregnant woman may be inclined to avoid.

We hear a lot about postnatal depression, and medical professionals are trained to spot it, but even when I asked my doctor whether I might be suffering from prenatal depression, it was basically met with a shrug. (That said, I was living in England at the time, where standards of care may be slightly different — Europe is known to have a significant “treatment gap” when it comes to mental health.) I chose not to press the point with him or seek another opinion, still hoping the condition would resolve itself.

There’s no single explanation as to why this happens, or to whom, and the causes may range from hormonal changes to stress to other prenatal health issues, with varying severity and duration. In a perfect world, all pregnant women would be routinely screened for depression and anxiety. In fact, a 2015 opinion from the American Congress of Obstetricians and Gynecologists states that clinicians should screen all pregnant patients for depression and anxiety symptoms at least once, partly because the fallout from this problem can be dead-serious: maternal suicide is a bigger cause of maternal mortality than hemorrhage or hypertensive disorders, ACOG notes. While taking antidepressants may not be 100% safe for pregnant women (they should weigh the risks and benefits with their doctors, especially if they took the drugs before becoming pregnant), psychotherapy can be helpful — but only if the problem is detected, of course.

My depression lasted 13 weeks — until one day, for no obvious reason, I just felt better. Unfortunately, this was not before depression had stolen another milestone: I went for my 12-week scan, trying to ignore the hormonally induced hope for either a phantom pregnancy or one that couldn't proceed. Luckily, the screen showed what it was supposed to: a black-and-white moving thing with a recognizable skull. If anybody noticed I wasn't feeling what I was supposed to, they didn’t say.

Once I began to feel like myself again, the rest of my pregnancy went well, and I made up for my “missed” scans with a 3D scan at 29 weeks. I watched the baby open his mouth and blink, and seem to smile and wave in utero, and I felt overwhelmed by joy. All the happy emotions I had been unable to summon during that first trimester had finally arrived. Sitting here now, next to a perfect, sleeping angel of a baby boy, writing about how I once hoped for a mother-to-be's worst nightmare, I feel sickened by the ingratitude. But it wasn't me; it was an illness. The same hormones that were helping my body create a life were trying to kill it in my mind.


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