An open letter to an unborn child

Dear unborn child,

You are loved.

I hope you never need to read this, but if you do, know that you are precious.

Even if when you are born I am in shambles – eyes bloodshot, smelling of poop (from your diapers), tears rolling down my cheeks.

This has nothing to do with you and everything to do with my own fears of incompetence, as a mother, as a person.

If you do read this note, know that it’s because I turned out to be one of the 10 per cent of the women worldwide who are depressed while pregnant, or one of the 13 per cent who suffer post childbirth.

The numbers are from the World Health Organisation – but I feel a tepid dip in the pool of woe that affects us.

I have battled the blues for some time. For now, I am on medication and safe. But once pregnant shall I stay medicated or give it up so as to give you a better chance at development?

For you to understand what I went through, this letter is composed, with the facts – and figures – of what happens when a woman who is taking pills for her moods gets pregnant. And what may happen thereafter.

In short, I am sorry if my mood swings scared you, or have haunted you. If my beady eyes and tear-stained cheeks are how you will remember me. But know that it is not about you. Not now, not in the years to come. You are loved. You are precious.



What is depression?

Depression is a disorder that can addle the mind and the body. YOU DO NOT HAVE CONTROL OF IT – at least not yet. It affects how you feel, the way you think and how you act. It makes you sad and hopeless. Things that you once looked forward to no longer hold any charm. Your mental, physical and emotional well-being is compromised.

When you are depressed and pregnant, it’s a tougher ball game, obviously. There is not only the feeling of hollowness but also fear – of hurting the baby.

“In general, the golden rule during pregnancy is to take as [little] medications as possible to reduce the risk of harming the unborn baby,” explains Dr Daniela Graf, from the German Neuroscience Center.

However, sometimes the black moods are so pitch dark, there’s no choice. Feeling so useless may result in substance abuse, lack of nutrition – it impacts how and what you eat – and lack of sleep. These factors along with the changes in hormones can prove dangerous.

Dr Graf says: “The mother to be should always consult her psychiatrist or gynecologist before changing, starting or stopping a medication during pregnancy and before she is planning to become pregnant. In some cases medications need to be continued during pregnancy. The doctors can give detailed information [about which].”

Pills and problems

Dear child, did you know that taking the medication may up the chances of abortion? Or pre-term birth?  The most common antidepressant type prescribed worldwide is Selective Serotonine Reuptake Inhibitors (SSRI). Dr Graf explains,”Their use in pregnancy has been associated with a variety of risks with varying degrees of proof of causation.

SSRI use in pregnancy is associated with an increased risk of spontaneous abortion and is associated with preterm birth and low birth weight.”

“A systematic review of the risk of major birth defects in antidepressant-exposed pregnancies found a small increase (3 per cent to 24 per cent) in the risk of major malformations and a risk of cardiovascular birth defects that did not differ from non-exposed pregnancies.”

In fact, I came across an American College of Obstetrics and Gynecology and the American Psychiatric Association post that recommends psychotherapy and close monitoring rather than medication for the blues during pregnancy.

“Another study found no increase in cardiovascular birth defects and a 27 per cent increased risk of major malformations in SSRI exposed pregnancies, said Dr Graf.

But you know what’s scarier? What beats the guilt and the stigma and provokes people to action?

“Other studies have found an increased risk of cardiovascular birth defects among depressed mothers not undergoing SSRI treatment, suggesting the possibility of ascertainment bias – worried mothers may pursue more aggressive testing of their infants,” says Dr Graf.

The only thing is…

“A neonate (infant less than 28 days old) may experience a withdrawal syndrome from abrupt discontinuation of the antidepressant at birth. Antidepressants have been shown to be present in varying amounts in breast milk, but their effects on infants are currently unknown,” says Dr Graf.

What happens when you suddenly go off your meds?

As with anything that you use regularly, there is a vacuum when it’s stopped. Dr Graf explains, as of 2001, at least 21 different antidepressants, covering all the major classes, were known to cause discontinuation syndromes.

“Common symptoms include flu-like symptoms (nausea, vomiting, diarrhea, headaches, sweating); sleep disturbances (insomnia, nightmares, constant sleepiness); sensory/movement disturbances (imbalance, tremors, vertigo, dizziness, electric-shock-like experiences); mood disturbances (dysphoria, anxiety, agitation); and cognitive disturbances (confusion and hyperarousal),” explains Dr Graf.

While these symptoms fade between one and four weeks, sometimes they can linger. “A discontinuation syndrome can be avoided by taper[ing] the medication slowly over two-three weeks,” explains Dr Graf.

Fortunately, the American College of Obstetrics and Gynecology and the American Psychiatric Association says that SSRIs can be used during the first trimester without significantly increasing the risk of fetal heart defects or other major congenital malformations. Weaned off the pills and safe then?

Can you eat your way out of sadness?

No, not really. Not all the chocolate treats in the world can help with depression. But there are a couple of things that are known to alleviate the mood. These include foods that are rich in Omega 3 acid – cue the fish- and vitamin B; found in meat, eggs, seafood, green leafy vegetables, legumes and whole grains. The ingestion of Vitamin D – which affects the serotonin levels in a body – can also make a difference.

But what can someone do to feel better?

Let’s talk about it: In a non-judgemental space, with people who care and want to help. Consider their points – take the help they offer.

Exercise: Pregnancy does not mean turning couch potato. Exercising increases serotonin levels and decreases cortisol (stress) levels. Keep a pair of comfortable shoes on hand, always.

Acupuncture: A study published in the journal Obstetrics & Gynecology points to acupuncture being a feasible option when dealing with depression in pregnant women.

Rest: Changes in appetite, mental well-being, etc. may disrupt a person’s sleeping patterns, but regulating them will give you huge respite.

Medication: Speak to a doctor, the benefits may outweigh the risks in this case.

Baby blues and worse…

WHO’s meta-analysis showed that about 20 per cent of mothers in developing countries experience clinical depression after childbirth. In more ‘developed’ areas that number drops to about 13 per cent. Still, as Dr Mrabet Jihene, clinical psychologist at Life Psychological Counselling Centre, explains, “Being a mom is not a matter of instinct- this is a myth. Being a mum is a matter of learning. We are not born mothers, we became mothers.”

It’s normal to feel guilty, upset, annoyed, stressed – all these feelings are normal and we have to pass through some mistakes to finally find our way to the bond with the children.

There are three types of post-partum depression

Baby blues
What is it?

Frequent thing that happens due to estrogen decrease.
Felt for: 2 weeks
Symptoms: Mood-swings, anxiety, sadness and irritability. Sometimes the mother is crying. Concentration, appetite and sleeping problem.
Treatment: Manageable with support and help with the baby.

Post-partum depression
What is it?
If the period of baby blues continues, it may well be that the new mum is facing postpartum depression.
Felt for: upto a year.
Symptoms: Depressed, extreme mood swings, excessive crying and intense irritability and anger, severe anxiety and inability to bond with the baby, insomnia or sleeping too much. She may have thoughts of harming herself or her baby – but these are just thoughts.

Post-partum psychosis
What is it?
The most dangerous of depressions, which can cause a new mother to behave in an irrational way. She may at this point be a danger to herself or her baby.
Symptoms: Will show up in the first three months after the birth. Confusion, disorientation, depression, hallucinations, delusions, and here the attempt to harm herself and her baby.

What can the support system do?

  1. Understand she has a problem. “Many people think maybe she is overacting, or maybe she is overreacting or something like that. We have to understand that she really has a problem and do not underestimate the problem,” says Dr Jihene.
  2. Reduce the stresses. If she finds herself in a stressful situation, help her calm down.
  3. “Give her rest periods from baby care, because she will feel like she’s always obliged to take care of the child and she is obliged to do it the best way and the right way,” she adds. It is important to help her feel that she can take a break.
  4. Also help with house work – “to give her time to look after herself and her baby”.
  5. Nap times matter. “Whenever you can, have extra sleeping time as a new mum,” says Dr Jihene.
  6. Creating bonds. “We can encourage her and show her that she can take care of her child like no other is. For example emphasize on the baby’s smile or sparkle in his/her eyes when she talks to him,” she adds.
  7. No judgement, just conversations. “Invite her to speak about her difficulties without any judgement, because mum will always feel guilty about being perfect,” she says.

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