This is a semi-regular feature with Dr. Elizabeth LaRusso, a perinatal and reproductive health psychiatrist. Do you have a question, too? Send it to [email protected].
Q: Here is my question. My husband and I always wanted multiple children. Our first and only child was born early, at 30 weeks. We do not know why my membranes ruptured or why he faced some of the complications he did/does.
I’m now quite scared to have a second. I think I would be terrified the whole pregnancy. While doctors insist we’d watch closely if we’d like to try again and I have a “green light”, I almost feel it is selfish to put another life at risk, but more than that, I feel a ton of pressure that things go right this time. How can I better manage the guilt and anxiety?
A: For many women, having an uncomplicated, healthy pregnancy can generate feelings of worry, guilt, and inadequacy. These feelings are often much more pronounced when there is a complication like the one you describe. Society places many expectations on women related to pregnancy and motherhood, but often these expectations pale in comparison to those women place on themselves about having a “perfect” pregnancy or “doing everything right.” There are so many recommendations and opinions, many of them conflicting, most of them changing, some of them confusing, all of them limiting. Women are left to feel that the smallest decision, like eating an un-microwaved turkey sandwich or having a cup of coffee before going to work, can translate into catastrophe for their pregnancy and their child. Women are also left to feel overly responsible for the outcome of their pregnancy, when the overwhelming majority of adverse consequences are related to factors well beyond a woman’s control.
The truth is that for many women, pregnancy is the first time they experience a sense of loss of control, both over their bodies and over their emotions. I have always thought of it as preparation for parenthood: There is nothing like having a child to challenge one’s sense of control and competence, so experiencing some of those difficult feelings during pregnancy seems somehow designed as a trial-run. When a pregnancy complication occurs, especially in an otherwise healthy woman who was trying to “do everything right,” this sense of control and competence may be particularly shattered, and this can be extremely painful and destabilizing to her identity and sense of self. Next there is the grief, which can be overwhelming and complicated. A mother may experience grief related not only to what her child is going through, but also about what she herself has lost, like the chance to have experienced a healthy pregnancy, or the ability to rely on her body, or the belief that she is capable of having a healthy baby.
Although experiencing grief and worry about future pregnancies is understandable and common, for women who have a vulnerability to depression or anxiety disorders, this experience may serve as a trigger for the development of more serious symptoms. Below I have outlined an approach that you can consider to make sure that you get the information, support, and treatment you need to be in the best position to make a decision about future pregnancies. Having mood or anxiety symptoms is both very common and highly treatable, and this does not need to be a barrier to future pregnancies for women who would like to have more children.
Talk to the physician you most trust: Scheduling an appointment with your primary care doctor or your OB/GYN to discuss your symptoms and your worries about future pregnancies is a good place to start. Making sure you both have all the information you need about the potential medical risks as well as having someone who can start to evaluate your anxiety and mood symptoms will be very important in helping to sort out what else might be helpful.
Consider engaging in therapy: Psychotherapy can be enormously helpful for a range of conditions and situations. Although it can be a very useful treatment for anxiety and depression, it can also be helpful for people experiencing grief and loss or those facing difficult life decisions. Ultimately, therapy is about forming a trusting relationship with an objective and supportive professional who can help you to process and understand complicated emotions, to increase adaptive coping skills, and to learn behavioral and relaxation techniques to minimize anxiety. I believe that good therapy is something that all of us can benefit from at various points in our lives when we hit a stumbling block. The same can be said for relationships and couple’s therapy, as even the most loving and committed partners experience grief differently and may approach major decisions, such as having another child, from very different perspectives. Couple’s therapy can help improve communication, increase understanding, and strengthen commitment between partners, and is especially helpful when a couple encounters a situation that seems beyond their ability to solve independently.
Medication may be an option: For women who have moderate to severe anxiety or mood disorders, or women who don’t respond adequately to therapy, the use of antidepressant medication to target mood and anxiety during pregnancy can be enormously helpful. Despite much of the misleading information available in the mainstream media, antidepressants are among the most well-studied category of medication in pregnancy and can be utilized with minimal fetal risk in patients who have not responded appropriately to non-medication options.
Focus on self-care: See my previous blog post regarding self-care in pregnancy
Talk to your partner: Making sure that your partner is adequately aware of your feelings and your worries is very important in helping to share the burden and to get the support you need, regardless of what decision you ultimately make about future pregnancies.
Solicit other sources of council: Sharing your worries with other people you trust and respect (friends, family members, ministers, etc.) can help to minimize the isolation that can sometimes come with the feeling of excessive responsibility. It can also help to get more tangible sources of support. Finally, considering a support group for people who are in a similar situation can be another helpful intervention. Postpartum Support International, www.postpartum.net , keeps up-to-date lists of local support groups and resources.
Be flexible in your time-frame and be willing to re-evaluate your plan: Obtaining a sense of emotional equilibrium, whether that entails getting treatment for a mood or anxiety disorder or just re-adjusting expectations and taking better care of yourself, is very important in minimizing worry and optimizing health. For many women struggling with reproductive health issues, this means that they may need to step back and take more time to address their own needs prior to considering future pregnancies.