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Pregnancy & Suicide: Is An Attempt Attempted Murder?

antenatal depression

Antenatal depression is as common as postpartum depression. Most women with it go untreated.

After being confronted with the news that her boyfriend was married, had another family and was leaving her, Bei Bei Shuai tried to kill herself. She was shocked and despondent, and ingested rat poison in an attempted suicide.

Her attempt failed. The 35-year-old Chinese immigrant from Indianapolis is alive and well. So why do you need to know about her? Because Shuai was eight months pregnant with her boyfriend’s baby at the time of her suicide attempt, and the baby later died. She has been held in jail on charges of attempted murder until Tuesday, when she was freed on bail.

Suicide and suicide attempts during pregnancy are more common than people realize. In fact, one study published in the journal Obstetrics & Gynecology reports that suicide is the fifth leading cause of death among pregnant women. One key reason for all the suffering that leads to these attempts is the fact that many women who’ve been treated successfully with medication for their depression, anxiety, or bipolar disorder are must go off of it after becoming pregnant. Either they quit because they believe they must, friends and family insist they quit, or their obstetricians make them quit.

Quitting, though, is a serious problem. Research shows that 50 to 75% of pregnant women with a history of depression who discontinue treatment upon becoming pregnant will relapse during their pregnancy. The prevailing wisdom is, of course, that mom should accept the possibility of relapse. Her baby’s health is more important than hers, right? She can stand to suffer for a few months in order to ostensibly protect her forthcoming child. But if she relapses and her depression returns, the truth is that her baby’s health is still in jeopardy, perhaps even greater jeopardy.

Most people are unaware of the effects depression and anxiety can have on a fetus. The results of untreated depression during pregnancy, also called antenatal depression, can include increased use of smoking, alcohol, and drugs, decreased prenatal care, low birth weights, and low apgar scores. Depressed pregnant women have twice the risk of pre-term delivery, are two-and-a-half times more likely to have pre-eclampsia, and are twice as likely to have C-sections. Their babies are twice as likely to end up in the NICU compared to their non-depressed counterparts. Antenatal depression even increases a child’s odds of developmental delay by 50%, and increases the risk of future emotional health problems. According to the 2009 Depression in Parents report from the National Academies, depressive symptoms in a pregnant mother play “… the central role in association with negative outcomes for infants.”

Yet women are still forgoing treatment in droves, primarily because they and their OBs believe their babies will be harmed by the medication. Take the case of my fellow Babble blogger and lovely friend, Casey Mullins of Moosh in Indy. As described by her husband Cody, Casey suffered depression during her pregnancy, but like most she went untreated:

When she was pregnant with Addie, the depression took hold of her and would not let her go.  The doctors wanted to keep her off medication to avoid any potential side effects that might affect the baby. The result of that bad decision? Casey ended up in the psychiatric ward after trying to commit suicide while she was pregnant. Fortunately, Casey had not done any damage to herself or the baby, but the experience served as a dramatic eye opener for both of us.

The side effect mothers and doctors fear most is a birth defect, despite the fact that multiple studies have shown the absolute risk of birth defects from taking antidepressants is extremely low.

In an essay published this month in the Journal of the American Medical Association, Dr. Helen Kim, a reproductive psychiatry expert, questions why we continue to allow women to believe it’s better to forgo their mental health while pregnant.

“Would a physician tell a pregnant woman with epilepsy, ‘Stop your meds and ride out the seizures until you deliver’? Are the medications of pregnant women with mental illness somehow more ‘optional’? Despite the known risks of maternal mental illness and the accumulating reproductive safety data on antidepressants and other psychiatric medications, pregnant women with recurrent mood disorders … are often told by health care professionals to avoid medication … But what can I live with: a lawsuit from an angry family for prescribing a medicine that theoretically may have affected their child, or abandoning someone … with an illness that I know will harm her and her pregnancy?”

While not everyone needs medication for the treatment of antenatal or postpartum depression or anxiety, those of us with moderate to severe cases sometimes do. Having gone through severe postpartum depression and OCD with the birth of my first child, I chose to stay on my antidepressant medication during my pregnancy with my second. I knew there were risks. Risks to my baby girl for taking any sort of medication while pregnant, and risks to us both if I had become depressed and anxious during my pregnancy. When she was born, I’m happy to say she was just fine, and I didn’t experience PPD at all the second time around. I would have preferred not to have to take any risks at all. I love my darling girl. But I had to think of my family and my firstborn as well, and how he would have been affected had I suffered PPD again. How she would have been affected had I had depression while pregnant. How both of them would have been affected had I killed myself.

I don’t know if Bei Bei Shuai had suffered from depression in the past, and if so whether she’d ever been treated. It may have been shame and stigma, or lack of awareness of the resources available to her, that made her believe there was no other solution to her problems than suicide. According to the Associated Press, after her attempt, “… doctors detected little wrong with the fetus’ health for the first few days.” Not long after, however, Shuai’s baby was born prematurely and died three days later from bleeding in the brain. Now the state of Indiana wants her to pay for the loss of her little girl by spending the rest of her life in jail.

Shuai was released from prison on bail today, and now is awaiting her trial. I know a lot of women who, but for the grace of God, could be in her position. Good women. Wonderful, talented, intelligent women. Great mothers. I wonder why we tell them that they must accept struggling with their mental illness while pregnant, but then, should something go terribly wrong, we say they should have done better and whisk them off to jail. Do as we say, ladies, but if it doesn’t work out for you? You’re on your own.

Aside from being a parenting writer here at Strollerderby, Katherine writes the most widely-read blog in the world on postpartum depression and all other mental illnesses related to pregnancy and childbirth. If you’re a pregnant or new mom looking for help and hope from thousands of moms who’ve been there, be sure to stop by. You also can follow her on Twitter at @postpartumprogr.

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