Why Haven’t We Been Talking About Prenatal Depression?

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When I was expecting my first child last year, I went to increasingly frequent appointments with my doctor. Aside from the waiting room variable, I was usually in and out of the office in about a half-hour — which was just enough time for my OB to check for the baby’s heartbeat, feel his position, and ask if I had any questions.

There were never any physical red flags, fortunately. But if the doctor had asked, there may have been a few emotional ones I was keeping well-hidden inside.

Depression doesn’t have a simple definition. Before I first experienced it in college, I thought that “being depressed” meant you were so low, you couldn’t get out of bed for weeks at a time. And although that can certainly be true, that wasn’t my experience. For me, depression looked something like this during those college years: I lost interest in the activities I used to love, I felt emotionally numb, and was generally indifferent to just about everything — all of which led me to overlook the symptoms, until my depression cascaded into a life-threatening eating disorder.

In the years that followed, I was vigilant about addressing any symptoms that reemerged and felt pretty stable with my day-to-day life. I had beat this thing, I thought.

But then, my husband and I began trying for a baby.

I was fearful of postpartum depression before the two pink lines appeared on a pregnancy test. What I didn’t expect was that it would creep up on me before my baby even arrived.
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Knowing just how difficult depression is without a child in the mix, I was already worried about postpartum depression before I even saw the hint of those two pink lines on the pregnancy test. But what I never could have expected, was that it would creep up on me long before my baby even arrived.

Suddenly, there I was, in the middle of my second trimester, feeling like I did during those old college days. I had filled my own head with the expectation that this was supposed to be the happiest time of my life, because I had a baby on the way — and yet I wasn’t. Why wasn’t I?

Those thoughts only multiplied, adding even more stress to the situation.

Looking back, it probably shouldn’t have been all that surprising. I had so much going on physically and emotionally during pregnancy, it was as if I laid out a welcome mat for depression. The silver lining of my previous experience with depression, was that I knew how to recognize it and was able to get help before my son’s birth. But during the time I quietly suffered with it, I was among the estimated 1 in 7 women who experience prenatal depression, according to the American Congress of Obstetricians and Gynecologists. 

Despite my initial fears, my depression hasn’t invited itself back into my home during the four months since my son was born. But my story could have easily gone the other way — and still could.

If I hadn’t felt better before my son’s birth, or even if I start to experience a delayed postpartum depression in the coming months, I would join the estimated 20% of women who experience postpartum depression in the first year. A figure that somehow escaped the public for quite some time. That is, until recently.

Why wouldn’t we take a few minutes to screen women who could be dealing with depression? Women who may be suffering in silence; women who may not even realize they have it; women who otherwise fallen through the cracks.
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Recognizing the need to change the conversation around pregnancy-related depression — or at the very least, start one — the United States Preventive Services Task Force announced a new recommendation in January: Women should be screened for depression before and after pregnancy. The Task Force’s declaration came just a few months after I’d given birth myself; just a few months after I learned, for the first time ever, that prenatal depression was even a thing, and that I had it.

The recommendation itself seems like such a small thing, especially when you consider the screening they recommend is a simple, 10-question test known as the Edinburgh Postnatal Depression Scale. And yet, it has the potential to be huge, for so many women. After all, why wouldn’t we take a few minutes to screen women who could be dealing with depression? Women who may be suffering in silence, too; women who may not even realize they have it; women who otherwise fallen through the cracks.

Of course, there is way more work to be done; this is only the beginning. Beyond hushed conversations with medical providers, we need to strip the public stigma against depression — especially among pregnant and postpartum women — as well as increase the awareness that it can strike at any time, and boost our knowledge of the warning signs. And while we’re at it, let’s stop pretending pregnancy is magical from the moment those two lines appear, straight up until delivery day. From my experience, it is more like one big, crazy, emotional roller coaster — complete with plenty of dips and bumps. Instead of making mothers-to-be feel like we’re supposed to walk on sunshine for nine months straight, we should offer more safe spaces to talk about what’s really going on.

When you are the one in the midst of it, ask your medical provider for help. Open up to your partner. Talk to your friends. Know that feeling overwhelmed, apathetic, or deeply depressed during pregnancy is understandable. But feeling overwhelmed, apathetic, or deeply depressed during pregnancy isn’t something that should be written off.

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