On having a baby after a PMAD

by Kaela Koepke

I’d like to dedicate this second pregnancy to Prozac. I’m 3.5 months pregnant with number two and already the difference in my mood between pregnancies is night and day; the contrast is astounding. At eight weeks into my first pregnancy three years ago, I was sobbing at my midwife appointment, petrified of a miscarriage, despite having no personal or family history of miscarriages or health issues that might make me more at risk for a miscarriage. Unfortunately, my midwife looked at me like I was crazy; neither of us caught on to the fact that I was having severe Perinatal Anxiety and Depression that continued throughout the pregnancy. I was in tears every day with intrusive thoughts and worry that something bad would happen to the baby. This time around, I basically slept through the whole first trimester, but it was calm and peaceful in my mind–thank you, Prozac.

I debated for a long time if I would go off medication in preparation for another pregnancy. A perinatal psychiatrist at Swedish Hospital’s Lytle Center for Pregnancy and Newborns in Seattle gave me ample research about SSRIs and pregnancy and advised me to stay on the medication. While the risks are very low, there is some risk, but there is also very real risk with untreated mood and anxiety disorders, which I was all too familiar with, and that risk felt greater for me. A healthy baby is of course important, and my health also matters, my 2.5-year-old son’s wellbeing matters, and I’d like to maintain a marriage. Babies don’t develop in a vacuum: if I’m not well, the baby, my son, and my family won’t be well, and I refuse to suffer like that again.

This time around, I am well equipped with multiple professional and personal supports, knowledge and training from volunteering for Perinatal Support Washington, coping skills and experience I didn’t have the first time, and my dear friend Prozac.

I struggled for a long time with the decision, finally chose to go off the medication, and made a plan with my prescriber to wean off, but when the day came, I just couldn’t do it. Every fiber in my being was screaming, NO do not do this; my gut had never felt so strong. So I stayed on it and I am so incredibly happy I did. It was the right decision for me. I cannot believe the difference in my mind and emotions and am so grateful I get to have a pregnancy free from this illness. It’s helping me understand and grieve more fully what wasn’t normal hardship the first time.

This essay originally appeared in the Perinatal Support Washington newsletter. Perinatal Support Washington has excellent resources for parents, including support groups and a warm line.

I surprised myself when I wanted another baby. The illness lasted almost my whole pregnancy, then 14 months postpartum, for a total of almost two years, before I finally decided to go on medication. As I climbed out of the darkness, I slowly but surely saw glimmers of my old self, and a new even better self came back. My friend said I was more me again than before I was pregnant. The illness robbed me of that sacred transition into motherhood.

The memory of the darkness is sometimes piercingly painful, so I’ve been in therapy for the last year, unpacking the trauma of that time, healing layer by layer, coming to terms with what was and what wasn’t, unraveling old family issues that contributed to the suffering of that time, and dealing with fears of it possibility happening again. I read Karen Kleiman’s books, What Am I Thinking: Having a Baby after Postpartum Depression and Tokens of Affection: Reclaiming Your Marriage After Postpartum Depression. My husband and I are starting couples counseling to fortify our marriage before the next baby comes.

The other day when I talked about preparing mentally for the challenges of having a newborn again, my friend said to me, “Wow, are you going to war or having a baby?” Both, was my answer. This time around, I am well equipped with multiple professional and personal supports, knowledge and training from volunteering for Perinatal Support Washington, coping skills and experience I didn’t have the first time, and my dear friend Prozac. But I know that even all that doesn’t guarantee I’ll dodge another bullet. So I am nervous, but trying to stay present in the moment and trust that I will handle whatever comes when it comes more quickly and more effectively than the first time around. Because I am a warrior mom.


About the Author

Kaela is a stay-at-home mom of one bright shining 2.5-year-old and lives near Seattle, WA. Her pre-mom career was being a Master’s level mental health therapist and chemical dependency counselor. Kaela participated in a PEPS Newborn Group and had perfect attendance. She unashamedly says, “Yes, counselors get PMADs, too. It is an illness that does not discriminate.”

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