A local mom recently posted an article on taking antidepressants while pregnant. I imagine most people in our area will read that article and conclude, well of course it should be the mom's decision! I can't help but wonder, if the topic of conversation changed from antidepressants to home birth, would readers be as adamant about supporting mom's ability to make decisions that SHE believes will optimize her and ultimately her baby's health? Is the decision to birth at home much different from a mom's decision to take an antidepressant during pregnancy? In both cases she is doing what she feels is best for her body and her baby and, ideally, she is balancing psychological and physical benefits.
The author, Jennifer Kogan, points out that "A recent study in the scientific journal Human Reproduction claims that there are risks — and no clear benefits — associated with taking certain antidepressants during pregnancy" and then goes on to discuss the problems associated with this claim. Interestingly enough, as with home birth, the lack of good evidence is connected to the lack of randomized controlled studies.1 As with the home birth debate, there is a tendency to focus on physical risks while ignoring psychological ones and for the media to use fear-based headlines.2
Let's take a quick look at psychological related morbitidy in childbirth. I am currently reading Optimal Care in Childbirth by Henci Goer and Amy Romano (c 2012) so I am going to refer to this book (fabulous book by the way!). In their chapter, "If Mama Ain't Happy, Ain't Nobody Happy," Goer and Romano point out that in fact:
childbirth-related psychological morbidity may be a more significant public health problem than childbirth-related physical morbidity. While women and babies heal completely from most forms of physical morbidity, psychological morbidity can have a prolonged effect on the individual woman, her infant and other children, her partner and her community. It can even lead to mortality: suicide is one of the leading causes of maternal death (emphasis mine)" (Optimal Care in Childbirth by Henci Goer and Amy Romano, p 531).
In our culture we tend to focus on childbirth-related physical morbidity when we look at risk. Goer and Romano, however, reminded me that a large percent of moms in the Listening to Mothers II Postpartum Survey reported that their emotional wellbeing interfered with their ability to care for their babies and 5% of mothers had considered suicide. Wow. The research shows that "lack or loss of control is an independent risk factor for both dissatisfaction and, more importantly, symptoms of childbirth-related posttraumatic stress, a condition present in up to 9% of women having hospital births in the U.S." (Opitmal Care p 503). In other words the homebirth mom (and the mom on anti-depressants) understands deeply what she needs to be a successful parent, and makes her choice of birth place (or the choice to take antidepresants) based on this knowledge. In fact Goer and Romano point out that women choose home birth do so, among other reasons, because they "recognize that having control... over the birth environment and the ultimate say in decisions about care contribute to long-term emotional health and preparedness for parenthood (emphasis mine)" (Optimal Care p. 503).
I remember being frustrated after reading a commentary on home birth written by Monica Sakala, another local mom. Commenting on parents who decided to birth a breech baby at home, Monica writes, "Why aren’t they being held accountable by the courts?" If a mom took antidepressants during her pregnancy and her baby died from persistant pulmary hypertension (rare but associated with antidepressant use and fatal in approximately 10% of cases), would Monica wish to hold those parents accountable as well?
When it comes to birth, absolutely we need to improve our maternal health system so that physiological birth (and vaginal breech birth) is an option in US hospitals (that is a whole other topic of conversation). But we also have to understand that some women will do the research and soul searching, and come to the conclusion that the needs of their journey to motherhood are best met at home, even in cases where there might be a slightly elevated risk (this risk is not eliminated by hospital birth). We have to have faith that as a rule, a mom ultimately understands what is best for her and her baby. For some, this will mean taking anti-depressants while pregnant. For others, this will mean a vaginal birth after cesarean (or a breech) birth at home.
1 Reading Beyond the Headlines: A Closer Look at the Study on Taking Antidepressants During Pregnancy, posted 11/05/12 on the Lamaze Blog, http://givingbirthwithconfidence.org/2012/11/reading-beyond-the-headlines-a-closer-look-at-the-study-on-antidepressants-during-pregnancy/.
2 Ibid See reference to Study on Antidepressants and media hype