I had a relatively peaceful pregnancy, until a startling bout of prepartum anxiety took me over around the 36-week mark. Up until then, I’d tell anyone who asked that the worst part of my pregnancy was the voracious, dramatic hunger. (To this day, my toddler still eats like the apprentice ranch hand/bodybuilder he had me imitating.) Then one day, all of my worries and all of my work to find a birth provider I trusted totally overwhelmed me. A combination of insensitive midwives, byzantine labor hospital policies, and my own hormones drove me into a handful of panic episodes. Suddenly, I found myself bouncing around town re-interviewing doctors, and calling my therapist in her off hours.
It is impossible to separate the fumbled, insensitive, or even harmful care women are receiving from their worries, sadness, and difficulties.
We can’t predict and don’t fully understand the onset of pre- and postnatal distress. But that doesn’t mean there is no reason for it. As many as one in five women will experience perinatal mood disorders—distress that can include anxiety, depression, panic attacks, and PTSD during and after pregnancy. The prenatal variety is the lesser-known cousin of the already undertreated postpartum depression and anxiety (PPD/PPA) and often goes hand-in-hand with them. It is, in fact, among the risk factors for postpartum distress. It is impossible to separate the fumbled, insensitive, or even harmful care women are receiving from their worries, sadness, and difficulties. This is so clear to me now, because I know exactly what caused my prenatal distress to go from a manageable buzz of anxiety to a disaster.
In retrospect, I can see that I’d been somewhat anxious all along. First-trimester cramps reminded me of a previous miscarriage and had me submitting doctor’s notes to cancel a family trip across the country. I’d already met half the obstetricians and midwives in New York City in search of the perfect provider and preferably access to labor in water as part of my birthing plan. I spent a couple of days crying because my belly button looked weird, and I thought it might never go back. But that all seemed to come with the territory.
But then came the straw that broke the camel’s back: The week before my prolonged panic attack at 36 weeks, I started having some blurry vision and swelling. I talked to my doula, did a quick Google, and called one of my practice’s midwives to check in. I was expecting a little concern and for it to ultimately be nothing. I thought I might be asked to come in. I knew blurry vision was a preeclampsia symptom but could also be a fluke of pregnancy. I knew, from lifelong experience, the instructions of my favorite doctors, and just pure logic, that being a vigilant patient was helpful.
But when I called in, the midwife—one I hadn’t met yet—was terse. She seemed annoyed I’d even mentioned the word preeclampsia. She advised I go in for an optometry appointment, to check if my glasses prescription had changed. “You won’t have time after the baby is born, anyway.”
I was confused and halting on the phone. Sure, maybe my mild astigmatism had suddenly ballooned. That’s how eyes work, right? Who knows, in pregnancy anything can happen. But as soon as we hung up, I felt dismissed and then enraged.
I took some pregnancy photos. I had trouble breathing. I filled in a coloring book on anxiety. I had endless ruminating conversations about how to calm down and where to have the baby.
I went home, told my husband and my doula and got some nods of affirmation. The midwife should’ve at least asked me to check my blood pressure. She should have at least vetted and addressed the medical concern I was coming in with. I went down to the pharmacy and bought a blood pressure monitor to do it myself. And then I cracked.
How could I fully dilate with a midwife who makes me this livid in a 10-minute phone call? Why did I commit to this practice? Wasn’t there somewhere I could go and feel taken care of?
I found myself spiraling. My husband was leaving for a four-day trip, and I decided to switch doctors, then switch back. (The new-then-canceled doctors were out of network, so I was briefly resigned to spending $9,000 out of pocket just to get a birth experience that didn’t scare me.) I spent the days my husband was away sleeping at my mom’s house, periodically bursting into tears. I told everyone at a party how terrified I was of labor. Then, at my baby shower, I told everyone about how unhinged I felt, and probably in great detail described my hesitations with every doctor I had met and considered. I took some pregnancy photos. I had trouble breathing. I filled in a coloring book on anxiety. I had endless ruminating conversations about how to calm down and where to have the baby. My therapist and doula spent a week checking in on me via text and having calming phone calls with me at odd hours.
The things I didn’t want to have happen did, and I felt OK about them because my doula and husband helped me feel protected and got me the space to try as hard as I could to have my hopes met.
For the first time in my pregnancy, I filled out the Edinburgh Postnatal Depression Scale form, a common screening tool for PPD, and found myself describing a very miserable person. After a vaginal exam with the very kind, very attentive, very expensive new doctors left me in tears, I decided to go back to the practice where I was already settled in and tell my trusted OB that I had felt upset and dismissed by his colleague.
In the end, I delivered with my original practice. My delivery was both fraught and fine. Several of the things I was trying so hard to avoid (hello, cesarean) happened, and in the end I was still OK. But my experience with my birth team validated the feelings I’d had on the phone call with that midwife. I spent most of my hospital labor with my midwife and OB both leaving the room, and only a nurse relaying alarming concerns: “They’re worried about the baby’s heart rate.” Thankfully my doula was by my side and was so experienced she could read the hospital monitors, responding with helpful suggestions. “The heart rate seems to go up whenever you put her on her back, so could we not put her on her back anymore?”
I came, I saw, I had a baby. I was wary, informed, and prepared. I did too much homework, and it was exactly the right amount. The things I didn’t want to have happen did, and I felt OK about them because my doula and husband helped me feel protected and got me the space to try as hard as I could to have my hopes met.
But I was also right in my intuition about the people who weren’t listening to me. And having that intuition, and not being listened to, while marching toward the most dangerous situation I’d ever been in, drove me crazy.
Looking back, I can see my prolonged panic attack for what it was (and what I didn’t really know existed): prenatal anxiety.
Twenty-four hours after I came home from the hospital with my baby, I was admitted to the ER for severe swelling in my legs. Once again, the first person on the phone hadn’t been too concerned, but my doctor and my doula both were. And after all the blood work, ultrasounds, and a very educational, surreal breast-milk pumping session, I was sent back to my OB’s office. Within a week everything returned to normal. (Except the swelling. It would be six weeks before I could wear real shoes again.) But that ER blood work showed I had elevated liver protein levels, an early indicator of likely preeclampsia. Depending on which doctor you now asked, I had been right to worry, and call in, about that too.
Looking back, I can see my prolonged panic attack for what it was (and what I didn’t really know existed): prenatal anxiety. It came and went without a formal diagnosis, which makes it a little hard to own. But the notion that it was just anxiety, not my astute problem-solving, obscures part of what I went through. The anxiety I harbored was fanned into a bigger flame by external forces, actual incidents. I had the luxury of a very present partner and family. I had an extremely talented, life-saving doula. I had a beloved therapist who knew me well. And I still collapsed into a nonfunctioning person—and suffered from some degree of PPA after the baby was born as well.
The notion that anxiety and depression are just “mood disorders” brought on by a new mother’s biochemistry and instability is, in my mind, an oversimplification of the problem. Sure, it can happen to anyone, for a number of reasons or none in particular, and it’s not your fault. But on a systemic level, I think it is a hand-washing. The ways and places in which we deprioritize women, people of color, and especially and most dangerously black women—from hospital rooms to workplaces without maternity and paternity leave, media, and beyond—are something you feel even more strongly when marching toward the difficult, magical, creative stage of new parenthood. I, for one, have never been as sensitive and attuned to the unspoken and to possible futures as I was when pregnant and mothering a newborn. When the people and places that should be helping us instead dismiss us, override us, or even gaslight us a little bit, it’s only natural to be distressed.
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