Women are often forced to choose: motherhood or mental health. Here, one mother refuses to make that choice for her second pregnancy. 

Woman considering psych medications during pregnancy illustration
Credit: Caitlin-Marie Miner Ong

My day starts like many others: with the sound of little voices and little feet. With the feel of soft, wet kisses and tight, warm hugs. And with the subtle sight of the sun.

I sit up and pull off the covers. I make my way from my bedroom to the kitchen, where I flip on the Keurig and fill an oversized cup with coffee.

But then, things shift. My "routine" shifts, and instead of pouring milk into my cereal, I pour a handful of pills onto the counter. Uppers, mood stabilizers, and anti-anxiety meds.

Why? Because I am one of 43 million Americans with an illness—a mental illness—and, as such, I take medication to keep me safe, to keep me sane, and to keep me happy.

My meds make me a better person and a better mom.

My meds help balance me out and level me out, and so I take them: without hesitation, without delay, and without regard. But lately, I have been questioning myself and my meds, because I want to conceive another child. My husband and I want a second baby boy or girl. And psychiatric meds? They usually aren't part of the equation.

Most doctors require you to quit psychiatric meds cold turkey before trying to conceive.

Of course, I understand. Most antidepressant medication hasn't been widely tested in pregnant women, and, without research, little is known about the effects of said drugs on the fetus. But this puts many mothers in a precarious position. We are forced to choose motherhood or mental health, and it sucks. It simply isn't fair, which is why I am not choosing. I am going to keep taking my prescriptions.

If I get pregnant, I am going to stay on my meds.

If you think this decision seems reckless and selfish, know that it is not. I have thought about it. I have read about it. I have spoken to my doctors about it—both my psychiatrist and my Ob-Gyn. And I've worried about it.

A lot.

I have worried I am putting myself at risk. I have worried I am putting my unborn—and unconceived—baby at risk. I've spent many days (and nights) thinking of the numerous side effects my mental health medication may have on my child. How will I feel if my baby is born with a heart defect or kidney damage?

But I've also worried about myself if I go off my medication. As someone with panic and bipolar disorder, I worry I will be anxious or manic. Will I be sad, morose, or depressed? What if I become suicidal, as I was during my first pregnancy, and have been in the past? I have to consider how this, too, will affect my family and my unborn child.

And that is a risk I cannot take: as a woman, as a wife, and as a mother.

That said, deciding to take (or not take) antidepressants during pregnancy is a very personal decision. One you must make smarty, soundly, and with the help of your doctor, as some medications are considered safer options than others. (Zoloft, for example, is a well-researched prescription which has shown little to no impact on the fetus.) However, no matter how "safe" a medication may be, it still comes with risks. According to the National Center for Biotechnology Information (NCBI), babies exposed to antidepressants in utero face a slightly higher risk of preterm birth, low birth weight, developmental delays, breathing difficulties, pulmonary hypertension, and postnatal adaptation syndrome; however, the risks are low.

Very, very low.

So, how do I make a good decision? A wise decision? A thoughtful and safe decision? Well, according to Katherine Economy, M.D., an Ob-Gyn with a focus on maternal-fetal medicine from Brigham and Women's Hospital in Boston, you must weigh the benefits versus the risks:

“It’s not one size fits all here,” Dr. Economy told The Atlantic.“It’s always a very personalized discussion. Each woman is different, their exposure to SSRIs are different. For some women [antidepressants] are life-changing, and they can't do their activities and everyday living without them."

And that's how I am.

That's how I have been for a very long time—and many women feel the same. In fact, according to the American College of Obstetricians and Gynecologists (ACOG) 14%-23% of pregnant women experience depression during pregnancy. But peer support doesn't make my decision to stay on my medications any easier. Science, statistics, and facts don't make my decision any easier, and while I am thankful I have to have the unwavering support of my medical team, I'd be lying if I said I wasn't scared.

Being medicated during a future pregnancy terrifies me.

The risks continue to terrify me.

But, in spite of it all, I know the best thing for me, as a person and a parent, is to be healthy. It is to be safe, and it is to be of sound body and mind. And that means staying on my psychiatric medication.

For good or ill, I am staying on my meds.