The first call I made after seeing the unmistakable two lines bleed across the panel of the pregnancy test—on the day that I was officially furloughed from my job as a flight attendant during the coronavirus pandemic—was to my OB, panicked.
I’d learned after my last pregnancy that all of the best-laid postpartum plans in the world aren’t going to help me if I wasn’t proactive about my mental health before delivery.
I didn’t think I could be pregnant because of my history with polycystic ovary syndrome (PCOS), miscarriage, and infertility. But she had me come in, and a quick viability check confirmed it—there was definitely a tiny bean, right there. This was, in every way, Not The Plan. A mere two weeks earlier, my husband and I had agreed that we were probably one and done, but if we were to ever consider trying to conceive again, it wouldn’t be until we were on the other side of the pandemic.
I was already pregnant when we’d had that conversation.
My second call—before anyone else but my husband knew—was to the team at the Motherhood Center in New York City, a mental health clinic for perinatal women. That was where I’d received treatment after the birth of my son almost two years ago, in the throes of a severe PMAD (perinatal mood and anxiety disorder, commonly referred to as postpartum depression and/or anxiety). I’d learned after my last pregnancy that all of the best-laid postpartum plans in the world aren’t going to help me if I wasn’t proactive about my mental health before delivery, and adding an entire global pandemic to the mix was probably a recipe for crisis.
In my first pregnancy, I knew I was at high risk for developing a PMAD: We had recently moved across the country to New York with no family or strong support network; I have a strong personal and family history of mental health issues and a family history of women with PMADs; my husband works in a demanding field; and I’m a flight attendant without consistent work and sleep schedules and an out-of-whack circadian rhythm to begin with.
We also had fertility struggles because of my PCOS. And after I experienced an early miscarriage, it felt like the joy of being pregnant was robbed from me. I couldn’t take it for granted that everything was going to be OK and that I’d come home from the hospital at the end of a healthy pregnancy with a newborn in my arms. I checked for bleeding every hour, and every twinge and cramp as my uterus expanded and my body shifted to make space for my son felt like a death sentence. I walked into every appointment expecting to hear bad news. At one point, our son was diagnosed with a ventriculomegaly (an enlarged chamber in his brain) and I had to traipse from our apartment in midtown Manhattan to a fetal MRI clinic an hour away. I wasn’t even really upset, just resigned, like “Oh here it is, I’ve been waiting for this to happen.” When the diagnosis ended up being incorrect, I was almost upset. Just let the other shoe drop already—I was tired of the suspense. I bought almost nothing for the baby until a few weeks before my due date, when it seemed like it might not be jinxing it to buy diapers and a crib. When I did deliver, my score on the Edinburgh Postnatal Depression Scale was so high, the hospital sent a social worker in to speak with us before they’d release me home.
Even after taking care of what external contributing factors it was possible to control, I still found myself sitting on our kitchen floor shaking.
I laughed when the social worker asked if I was surprised by my results. Surprised? No. I’d expected this the entire time. I had a strong family history of postpartum (and every other kind of) depression. I’d been on antidepressants since I was 25 and am no stranger to therapy. My husband and I communicate about our mental health regularly, and we knew that I was at risk. So we had made plans for how and when I’d seek treatment, when I’d up my meds back to my regular dosage after delivery (my former OB had tapered me off of them), and how I would get sleep in the critical newborn period.
And it wasn’t enough.
Even after taking care of what external contributing factors it was possible to control, I still found myself sitting on our kitchen floor shaking because I was convinced my son was going to crawl into the sink and fall into the garbage disposal. For one thing, my son could barely roll. For another, like most apartments in Manhattan, our kitchen didn’t even have a garbage disposal. I remembered the social worker at the hospital sending me home with information on the Motherhood Center, and we’d filed it away with our discharge paperwork. My husband encouraged me to make the call, I started treatment there, and it saved my life.
But I knew, with everything in my being, that I wanted a different experience the second time around. The research on recurrence of PMADs in subsequent pregnancies is mixed—some studies have shown elevated risks of recurrence, while others have shown no additional risk. Having experienced a PMAD once doesn’t mean you’ll experience one again—just like I’d experienced with miscarriage and infertility.
I had to be more proactive this time, though. I’d white-knuckled my way through a lot of depression and anxiety in my first pregnancy because my previous OB, while technically an excellent obstetrical care provider, was not equipped to handle pregnancies with mental health risk factors. Her supportive and breezy “You’re going to be fine, you can do this, stop worrying” was helpful when I’d panic in her office during appointments, but “You don’t need to go on meds, you’re a good mom” when I was weeping in her office on an icy New Year’s Eve three weeks after delivering could have killed both me and my son. That wasn’t going to work this time.
I learned from infertility and miscarriage that you can do everything “right” and the worst can still happen.
So I switched to an OB who had been excellent with several of my friends’ PMADs. She is willing to collaborate with and follow the direction of my psychiatrist, she checks in on where I’m feeling mentally at every appointment, and I feel confident that she cares about my mental well-being as much as my physical well-being in this pregnancy. I started working with a reproductive psychiatrist to keep my med levels optimized. I’m trying to take each day as it comes—a lesson I think we’re all learning this year. I have no idea what the next six weeks will look like, much less where I’ll be an entire pregnancy from now, so worrying about what might happen is a true exercise in futility.
I learned from infertility and miscarriage that you can do everything “right” and the worst can still happen. I learned in pregnancy after loss that depriving myself of joy doesn’t make a difference in the outcome and there isn’t a tidy checklist that will guarantee me a ticket out of postpartum depression. I’m learning in pregnancy after surviving a PMAD that every day is new, every pregnancy is different, and I can let my actions be informed by my past experiences without living in fear of them.
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