With increasing frequency, postpartum women who have taken antidepressants during pregnancy have shared – usually in tears – that while in the hospital for their labor and delivery hospitalization, a health care provider at the hospital said something judgmental about their being on an antidepressant. For example, one woman said that a nurse told her, “I can’t believe you took that during pregnancy.” Or, “Don’t you know how risky that is?!” Or “How could you do that to your baby?” This is often in the context of women using other medications in parallel for non-psychiatric indications, of which less may be known about the reproductive safety profile, but not addressed by the health care provider.
This situation is disturbing for several reasons. First, many women opt to stop or avoid antidepressants even when they might offer clinical benefit during pregnancy, and many women need medication to stay well. One recommendation does not fit all. In general, women do not use psychotropic medications during pregnancy without good reason. They educate themselves, struggle with treatment options, and in many cases stop medication, relapse, and then restart it when they become ill. Many seek consultation and several opinions about medication use in pregnancy.
A judgmental comment from a healthcare provider seeing only a brief snapshot of the patient’s experience is unhelpful. Also, giving birth to a child is an exhausting physical and emotional experience. A woman is vulnerable and deserves support, not shaming.
There are several explanations for this type of encounter. The topic of antidepressant medication use in pregnancy is complicated, and many professionals feel uncomfortable with the available literature. For those only partly informed, reports of risks may be easier to remember than studies which do not demonstrate risk. Also, sometimes information about risks is disseminated more broadly than reassuring information.
Often the risk of the untreated disorder is left out of the risk/benefit equation of the evaluation of a medication (or underappreciated). In addition, there are remaining prejudices against psychotropic medications, psychiatric disorders, and patients who have them.
Some advice for women who have made the choice to start or remain on psychotropic medications during pregnancy:
1) Remember you made thoughtful treatment choices tailored to your personal situation and family.
2) Try and ignore comments from even well meaning individuals who do not have an appreciation for what you have been through.
3) Surround yourself with supportive friends and family, and check in for visits regularly with heath care providers who know you well.
4) Select an obstetrician who is supportive of your decision and is willing to address your questions and concerns.
5) If it makes you anxious, do not over-search on the internet, and avoid sites that seem particularly inflammatory, unscientific, or unbalanced about psychiatric disorders. The internet provides access to knowledge but also to information overload, and some of it is not accurate.
The above holds true regardless of what treatment you selected, continued, or discontinued during pregnancy. Pregnant women make the best choices they can in their own personal situations.
Marlene Freeman, MD