Moser waited until the night before her due date to set up the
emotions had persisted throughout her pregnancy, despite the
32-year-oldís efforts to be positive. Thus, the eve of her
2014 due date found Moser and her husband piecing together the
did not have a glowing pregnancy. After two wrenching
miscarriages, the Chicago teacher felt fraught with anxiety
and fear that she tried to suppress. Strangers commenting on
her growing belly left her feeling wilted or incensed. Driving
to a doctorís appointment seemed impossible.
felt like I was walking a plank every time," she said.
one of many women who suffer depression and anxiety while
pregnant. The American College of Obstetricians and
Gynecologists estimates one in seven women experience
depression during pregnancy or within 12 months of delivery.
very, very common," said Dr. Marcela Almeida, director of
the Womenís Mental Health service at the University of
Illinois at Chicago, which treats hundreds of women from
despite growing awareness of postpartum depression or
"the baby blues," anxiety and depression during
pregnancy remain underreported, with no standard screening
procedures in place, experts say.
"itís the most psychologically vulnerable time in a
womanís whole life," said Kellie Wicklund, a
Philadelphia psychotherapist specializing in reproductive
stress, infertility, previous experiences with depression or
anxiety ó all act as triggers, experts said, with isolation
often exacerbating them. Facebook CEO Mark Zuckerberg shared
recently that he and his wife, Priscilla, are expecting a baby
girl after three miscarriages. Their pregnancy journey was
"a lonely experience," he said, adding that he hopes
sharing their struggle will foster openness.
smiling belly shots floating across social media, many say
they feel pressure not to be negative about their pregnancy.
many women report a range of mental health issues while
pregnant ó from suicidal thoughts to poisonous, persistent
unhappiness ó fewer than 20 percent of women diagnosed
during postpartum had self-reported symptoms, according to the
American College of Obstetricians and Gynecologists.
supposed to be enthralled with being pregnant and excited and
have all positive feelings about it, and a lot of women are
just ridden with anxiety," said clinical psychologist Dr.
Gina Hassan, who offers therapy for pregnant women at her
California practice. "Itís very hard to speak openly
about that with others."
week, the U.S. Preventive Services Task Force recommended that
pregnant women be screened for depression.
Centers for Disease Control and Preventionís most recent
relevant statistics, from the 2005-2009 National Survey on
Drug Use and Health, show about 8 percent of pregnant women
ages 18 to 44 had reported depression during the past year.
studies paint an even more troubling portrait. Dr. De-Kun Li,
a senior research scientist studying prenatal depression at
the Kaiser Permanente Division of Research, estimates that as
many as 20 percent may experience depression symptoms during
pregnancy. The reality is likely even higher, he cautioned.
interviews, women recounted a range of struggles.
29-year-old woman battled toxic thoughts and depression, as
strangers constantly asked her about her post-pregnancy plans.
"Each comment would make me spiral further," she
29-year-old mom of a toddler son is delaying having a second
child after her first pregnancy emotionally shattered her and
her husband. Ravaged with twice-daily sickness and what she
now realizes was depression, neither of them was sure how to
woman, 31, said that, during her last pregnancy, she
researched how long it would take to bleed to death without
hurting the baby. For months, scared her older two children
would be taken away, she told no one ó not even her husband,
who is a nurse.
Moser, it was hard to articulate her loss of happiness.
lose that joy that a lot of women and families experience
during a first pregnancy, and strangers donít realize
that," she said. "They just see you being pregnant
and feel like itís acceptable to rub your belly and talk to
you about the baby."
awaiting a child as magical and merry, Hassan said, and that
cultural expectation contributes to feelings of guilt and
shame when hopelessness creeps in instead.
unexpected positive pregnancy test can spur stressors, like
planning for a new phase of life, perhaps marriage or moving
ó those alone being enormous life changes. And even a
pregnancy both orchestrated and welcomed can deal a blow.
are caught off guard," Hassan said. "They planned
the pregnancy and anticipated it, and itís not what they
tailored her practice toward infertility and pregnancy after
seeing her sister and close friends in distress and
recognizing a dearth of support.
come in afraid and with a lot of shame," she said.
"And they feel very isolated."
to the isolation can be friends raving about their
pregnancies. Meanwhile, oneís own baby shower might require
a plastered smile.
Hassan said, women are giving birth later in life, when itís
intended to slip nicely into a cultivated path.
weíve carefully crafted our career and our relationship and
our lives, and then we get pregnant, and itís the first huge
experience of not being able to be in control," she said.
"PERFECT STORM": Experts say the list of issues
compounding stress in pregnancy is long.
ailments take a mental toll. Fears of delivery cloud moods.
Working during pregnancy restricts time for rest, all while
women are forging a new identity as mothers. Worries about the
babyís health can spiral. Infertility or previous losses add
layers of anxiety. Studies also show exposure to racism or
poverty can wreak mental distress.
called everything women go through during those nine months a
a surprise when people donít have a mood impact or an
anxiety impact," she said. "Thatís more
As a birth doula, Eleanor Turner looks out for small signals:
disinterest in a baby shower, perhaps, or a dismissive
attitude about the babyís progress.
client casually says, "I donít really know that Iím
bonding," as an example, said Turner, who owns Lemonade
Babies in Wisconsin, which offers services before and after
pregnancy. Or, "I havenít really felt the baby move, so
I donít really even know thereís anything in there."
said signs of depression, which experts caution can be
mistaken for typical pregnancy changes, include less energy,
changes in sleep or appetite, and feelings of guilt,
helplessness and hopelessness.
negative emotions during pregnancy can domino, spiraling into
fears of motherhood.
does bring up sort of self-doubt, ĎMaybe I wasnít meant to
be a mother, maybe I shouldnít be a mother, maybe this is a
sign,í" Hassan said. "As opposed to, ĎThis is
how my body is responding and something Iím going through,
and itís not necessarily permanent.í"
HELP: The first step toward help, Almeida said, is openness
about feeling down.
screening is needed, Almeida said. The Womenís Mental Health
service encourages a collaborative approach, involving nurses,
social workers and psychiatrists.
every doctor brings up mental health in a prenatal exam. There
is no standard question or protocol to screen for depression
that should be part of the routine prenatal care,"
Almeida said. "In clinical practice, it really varies a
In a May
report, the American College of Obstetricians and
Gynecologists advised that women be gauged for depression at
least once. It suggested a standard screening tool and
readiness to refer to a therapist.
impact of untreated perinatal depression can have a
devastating effect on families," President Mark S.
DeFrancesco said in a statement.
birth, doctors typically use the Edinburgh Postnatal
Depression Scale to gauge mothersí mental health. About a
five-minute questionnaire, it asks about the past week with
statements like "I have felt scared or panicky" or
"I have been so unhappy that I have been crying."
similar tool would be helpful during pregnancy, many experts
American Psychological Association has blasted the lack of
screening. In a 2014 article, it called pregnancy-related
depression the most common serious condition affecting
pregnant women. The authors suggested adding two
depression-screening questions to check-in forms.
urged women to feel comfortable confiding in their physician.
Be honest, she said: "That way we would be able to help
is very personalized, Almeida added. Therapy and medication
both come up in conversations with patients.
women should take medication during pregnancy is a
controversial conversation. Almeida said every person is
unique ó medication might be considered useful for some;
others might benefit from seeing a counselor. Some doctors
might be comfortable treating them through regular check-ins,
who now has a bubbly 9-month-old daughter, said that slowing
down, allowing space for emotions and joining a support group
lot of people feel guilty for having those feelings, which of
course compounds the feeling, because they feel like they
should just be just overjoyed," she said. "Having
people who really understood and were not at all judgmental of
what I was going through, internally, it helped
friends and family can play a huge supportive role, doctors
and therapists said. One thing to avoid? Focusing only on the
baby, or saying things like, "Once the babyís here, youíll
for some women, that doesnít happen," Turner said.
who experts say often are first to spot symptoms, should
proactively ask women how theyíre feeling and provide
patience and a team-oriented philosophy.
can really help the mother feel like sheís not alone,"
women are not alone. Talking to someone, whether a partner or
medical care provider, is an important first step, experts
more itís kept inside, the darker it becomes," Hassan
emotional level, Turner strives to help clients understand
they are not alone or at fault. Emotions ó positive or
negative ó can all form part of the experience, she said.
OK to own those feelings," she said. "Theyíre not
doing anything wrong."
federal Health Resources and Services Administration provides
this Maternal and Child Health resource for depression during
and after pregnancy: