When Health Care Providers Say the Wrong Thing

When Health Care Providers Say the Wrong Thing

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

7 Comments

  1. Ivy April 15, 2010 at 6:39 am

    I recall when I had my last child which was in 1985. Not only was the nursing staff judgmental toward me because of my membership in a disability class (psychiatric illness- depression and anxiety) but they were judgmental because I brought a child into the world. It was so bad, that my room was not cleaned the whole time that I was hospitalized, the nursing staff pretty much ignored me and attended to the other woman in the room with me, would leave me out in the hallway for more than an hour after I had to be brought for tests, and even when I went for my first out patient visit at the OB/GYN doctor and I had my baby with me, his nurse, refused to hold the baby momentarily so that I could get up on the examining table and I had to manage climbing up on the table with my baby in my arms. He himself just stood by and watched. You never forget when someone abuses you and/or your child.

  2. Katy April 15, 2010 at 8:44 am

    This is a very timely post for me! I am headed to the doctor today to deal with the results of having gone off my anti-depressant medication pre-pregnancy and having concluded that a healthy, functioning mother is more important than being off medication entirely. Thanks for a post that is so relevant to my situation, right when I needed it.

  3. Lori Bobo April 15, 2010 at 10:44 am

    Dr. Freeman,
    This article was very helpful. Some of my collegues in the mental health field still make these judgements about their pregnant clients. I am going to make copies of it and pass it around.

  4. Nicole Rawcliffe April 25, 2010 at 10:37 pm

    Brilliant article! This is exactly what I needed to hear, my husband and I are going to consult with a medication research department through a local hospital to find out the best/safest med to be on during pregnancy. This will be our 3rd (4th counting miscarriage) pregnancy. We are just in the gathering info. stage right now, but I love the encouraging words of this article. We are only sharing our decision with supportive friends and family!
    Mothers dealing with depression and having to make hard decisions should NEVER be made to feel bad, it is because of our concern for our children that make us wonderful mothers!

  5. Karen April 28, 2010 at 11:12 am

    Thank you for addressing this issue. When I found out that I was pregnant with my first child, I stopped my antidepressants cold turkey. After a month or so, I fell in to the deepest and most horrible depression of my life. I started counseling, and even became part of a research project at MGH Center for Women’s Health, just so that I could have even more face time with mental health professionals.

    Even though I wanted with all of my heart to not have to take any type of medication during my pregnancy, I decided that the benefits outweighed the risks (or doubts). The medication helped drastically, and in turn allowed me to be a loving and strong mother for my newborn daughter! I didn’t even suffer from postpartum depression! I’m sure that is because I had been taking my antidepressants for several months before delivery and continued to this very day.

    I would also like to add that I continued my medication right through my second pregnancy, and did not experience depression at all.

  6. Kirstin Johnson July 28, 2010 at 10:48 pm

    Thanks. Excellent recommendation from NAMI.

  7. Rebecca Helms October 5, 2010 at 10:41 pm

    After my second daughter was born earlier this year, a nurse tried to stop me from taking an anti-anxiety medication. Initially she succeeded. This med had been reviewed and approved by my docs and pediatrician for both pregnancies. This conflict served as a trigger to me as a bipolar patient and I struggled with a severe mood swing in the hospital because it was withheld.

    When my first daughter was born, the same thing happened, at a different hospital. The nurses questioned my decision to take my meds and nurse. Of course, I had been through several sessions with the best specialists in our area to review these meds for use during pregnancy and during nursing. In that case, the nurses then left me alone, and did not assist me in general or with the routine postpartum care. I had a level 4 tear which became infected and it took several months to recover. All of this was extremely traumatic.

    Meanwhile, my baby was isolated in a separate nursery after she was born due to some of her health issues. I didn’t need any of these complicating factors to worsen an already difficult situation.

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