About a year ago, my husband and I decided we wanted to have a baby. That makes it sound like we both came up with this idea; in reality, I explained that I desperately needed to have a baby now. He had positive feelings about parenthood, but they were not urgent. His first concern was for my mental health. Did I have to stop taking my psychiatric medication while pregnant? If so, would I be able to function without it? My biggest concern was that if I did keep taking the medication, what kinds of risks would it pose to the baby?
I have spent the last year working with a team of therapists, psychiatrists, other doctors and, above all, my husband, in order to find the best possible treatment for me while minimizing any potential risk to our (future) baby. More on that later, because it's really complicated. First, this is a really important lesson I learned this year:
Get your partner involved. My husband is absolutely invited into a session with any one of my team of health/mental health care providers whenever he has a question or concern. If it is going to save me having to repeat everything I just heard, I ask him to come in with me. He's been to a lot of "first sessions" and sat in a lot of waiting rooms. But I feel supported. He's informed. When I'm not sure what to do, it's a lot easier to ask him what he thinks if he knows what's going on. I want to know what he thinks, every step of the way. He is "100% comfortable" with my decisions so far--and they are my decisions, even though he has tons of input, as it is my body and mind and health we are talking about, here--but I really wanted to know how he felt about my treatment plan before there was a fetus.
Now, on to that treatment plan and how I arrived at mine.
Give yourself time. If you have decided that you need to have a baby by age 35 and you are now 34, revise your expectations. Going in to this, I thought it would just be a matter of weaning myself off my meds. After months and months of gradually reducing ("tapering") my daily dose of the anti-anxiety medication clonazepam, I finally made it down to the last little bit. And I couldn't do it. I could not function (read: sleep, keep a job, avoid daily anxiety attacks). Daily anxiety attacks, it turns out, cause my body to produce a whole lot of "natural" chemicals that can be extremely harmful to a fetus.
I was absolutely heartbroken that I would not have a medication-free pregnancy. I am still heartbroken that I will not be breastfeeding my baby because my doctors and I do not believe that my combination of meds is safe for a baby, not even by a liberal definition of "safe." Which brings me to:
Anyone who tells you that they know which prescription medications are safe for pregnancy and which drugs are unsafe is lying. Let me repeat: they are lying. And I can prove it. We have no clean, clear scientific data. In order for a drug to be deemed safe for people, it must go through something called a randomized controlled clinical trial. This kind of trial is unethical to perform with pregnant women. I recently wrote an article about the details of what I've learned about psychiatric medication and pregnancy for a website for mothers (and future mothers), and it includes a list of resources you can use to find out more information on this topic. For now, I want to emphasize the importance of finding a care provider who will discuss the risks and benefits of taking medication during pregnancy with honesty and respect. Fear drives far too many medical professionals to simply rule out medication without regard for the mother's health.
Your doctors need to make time to talk to you. You need a team of care providers who are dedicated to keeping you healthy, not just the health of your fetus/baby. It may be time-consuming and even exhausting, but take the time to interview and carefully choose providers who will support your decisions, no matter what. I see a psychiatrist, an obstetrician, a therapist, an acupuncturist, a nutritionist and a general practitioner. It makes for a lot of appointments, but they're pretty spread out. (I do see my therapist twice a week.) I also can't remember the last time I bought new clothing, because all of my discretionary spending goes to co-pays, medications, and vitamins and supplements.
But here's what I look for: I need to be sure that each member of my team will talk to me about my options whether I want to stay on your meds, go off my meds, change meds, or change your mind in the middle of my pregnancy. We need more health care providers who treat the entire family, in general, but this is especially important while you are pregnant or planning to become pregnant.
What's best for you is often also healthiest for your child. It's tempting to think that it's all about what's best for Baby. If you stop taking your meds because you want a "natural" pregnancy, this can put you under extreme stress which, in turn, adversely effects fetal development. The changes may not as obvious as a birth defect like cleft-lip and palate, something for which my medication may cause an increased risk, but they are more obvious than you might think. Prematurity and damage to the central nervous system are just two symptoms named in a study about maternal stress and fetal development conducted at the University of California, Irvine. Another study points to emotional and behavioral problems in early childhood.
A happy mother makes for a healthier, happier child, in utero, in infancy, in childhood, in adulthood. It won't help anyone if I sacrifice my own health and happiness, and my anxiety and depression could end up harming my entire family.