Life

Joho, Francesco Carta, Anna Petrova, EyeEm, CSA Images, Thomas Northcut, samxmeg, Renphoto/Getty Images

It Feels Like Every Mom I Know Is Medicated

Is there something uniquely challenging about the modern experience of motherhood that requires so many of us to be on SSRIs, or has it always been this hard?

I am eight months away from it now and feeling so much better, but I still don't want to describe what I felt when I brought my second baby, Nellie, home from the hospital. I lived a year in the first three days after she was born. I could see myself walking around and was somewhat comforted by the fact that I seemed to look normal to everyone around me, despite my sense of internal free fall. In reality, I was choked with fear, performing “normal” with all my might, and feeling like a bloodless, leaden ghost of myself.

In retrospect, that I called 911 45 minutes after getting home from the hospital probably should have tipped everyone off that something wasn't going well for me. The firefighters who came storming into our backyard were friendly enough. They checked my vitals and asked if I had a history of anxiety. They recommended I follow up with my doctor and I think we all felt a little embarrassed.

When my OB prescribed me Zoloft 24 hours later, she told me it would “take three to four weeks to kick in” like that was a thing that's fine and normal and I just needed to live with. I had been stumbling around my house with surgical glue holding my insides inside, a reptilian creature demanding milk from my body at all hours, a 3.5-year-old demanding pretend play and snacks and TV — I had already begun to wonder how I might determine or communicate what was happening in my brain without terrifying anyone around me. Three more weeks sounded like 80 years. A ridiculous number, laughable.

For nearly every mom, a “little helper.”

“What's the point?” I thought, and started texting my mom friends. When they wrote back, their responses floored me: Nearly all of them, it seemed, told me that they, too, were taking Zoloft or another antidepressant like it. For nearly every mom, a “little helper.” I was floored that so many of them were medicated in some way, and floored that these women — many of whom were very close friends, though the pandemic meant we hadn't seen each other in a while — had never mentioned that they had been through what I had until I flat-out asked.

As weeks went by, things got a little easier for me. I wished daily for a therapist, but the Zoloft was helping. What I couldn't stop thinking about was how many mothers I knew were medicated. The openness with which they welcomed me to the club was both soothing and heartbreaking. I felt so sad to imagine each of them — each of us — traveling alone through an experience I was trying to claw my way out of. Why were so many new mothers on SSRIs, and what did it mean? And was that even the right question?

I was relieved to be out of the worst of it, but I couldn’t get the nagging question out of my head: Is there something uniquely challenging about the modern perinatal experience — defined as pregnancy and the first year postpartum — that requires so many of us to be medicated in order to meet its demands? Or has it always been this hard?

CSA Images/Getty Images

When I put these nagging questions to clinicians working in the field of perinatal mood disorders — Paige Bellenbaum, LMSW, founding director of NYC's Motherhood Center, and Ann Marie Miner, Psy.D., a clinical psychologist in Portland, Oregon — their answers were yes and yes.

The perinatal period has undoubtedly always been hard for women. But, sharing her own experience at the Motherhood Center, Bellenbaum put it plainly: “We are in the midst of a maternal mental health crisis, because of everything mothers have been through the past two years. We have seen an enormous spike in maternal depression and anxiety. Our call volume has tripled since March of 2020. And still, a lot of women white-knuckle it. They think that they can just ride the wave, and they think that if they can just get through, it'll get better. There's so much shame and guilt around it. A lot of women wait until it almost feels intolerable.”

“You can look at your baby and think that he or she is the cutest thing you've ever seen and think that you've made the biggest mistake of your life. You can think and feel those two things at the same time and that's normal.”

Pre-pandemic, an estimated 1 in 3 women suffered from perinatal mood and anxiety disorders (PMADs). Since March 2020, that number has grown to as many as 72% of mothers. The numbers are tricky, though, because many, many women do not seek help. It is estimated, according to a report from the Motherhood Center, that “over half a million of all new and expecting U.S. mothers do not receive adequate treatment for perinatal mood and anxiety disorders.”

As long as women have been having babies, they have surely felt many of the feelings known today by various names — PPD, PPA, perinatal mood and anxiety disorders — because of the biological and physiological changes that she undergoes during this time, most of which are just beginning to be explored scientifically.

Bellenbaum also urged me to remember that while yes, a lot of us are medicated, it’s a myth that these medications are overprescribed. Rather, it’s more likely that they are underprescribed, since so many women who experience PMADs likely go undiagnosed and untreated.

As for whether mothering is harder now than ever before, the consensus was a resounding probably, yes. Bellenbaum places our modern perinatal experience against an anthropological, historical context, pointing out that until recently, “the proverbial ‘village’ was a part of everyday life. People had babies in the context of extended family. We are designed to have that kind of familial, cultural support around us as we raise children. We have gone from having many people around to having no one around us.” Modernity has stripped us of the support systems that have historically supported us through this time of incredible physical and psychological upheaval.

Women are built to be guided into motherhood by what Miner calls broadly and perfectly “​a community of people who have gone before her.” But how many of us actually have that?

As I began broaching the subject with more and more women, it was almost uncanny the way that every voice — every medicated mom, every perinatal clinician I spoke to — said the same thing, down to the same phrases. Mom after brilliant, exhausted, self-aware mom called their prescription, often obtained after sounding their own alarm bells, by the way, a "Band-Aid." And both perinatal therapists I spoke to described the many, many women struggling through PMADs without meds as “white-knuckling it.” All of which is to say, the ubiquity of nearly every aspect of my own postpartum experience was downright infuriating.

If we sit for a minute and think, or better yet, speak honestly with a fellow mother — someone who has been where we are — it becomes obvious why we need these drugs. We live deep in the “why” of it every day. Pregnancy and new motherhood are a time of incredible transition, defined by a heady combination of biological and psychological changes. Women are built to be guided into motherhood (each time) by what Miner calls broadly and perfectly “​a community of people who have gone before her.” But how many of us actually have that?

Slap pandemic isolation on top of it and we’re doing it in a near vacuum.

CSA Images/Getty Images

A few months ago, when Nellie was about 6 months old, I finally found an in-network psychologist with a perinatal specialty, and it’s been life-altering. We work through the bumps together, she gives context to my experience, and I now feel much more capable of managing the daily demands of life as a working mother of two kids. I’m so grateful, but it’s also painful to imagine how much better my postpartum experience could have been if I’d had this support from the beginning.

I brim with compassion for the person I was at the start of Nellie’s life. I see myself — sobbing in the wee hours, rocking as I nursed her back to sleep, hoping that the love in my body was enough to make up for what I thought was missing in my heart — and I want to simply tell her everything I’ve learned about how very normal that darkness she feels is. To be kind to herself. To know that the fog will lift. And to stay on the Zoloft that in reality I stopped taking after 10 weeks, against my OB’s recommendation, for reasons that are still hazy to me but I suspect had something to do with internalized stigma and desire for perfection. (It probably also had to do with the fact that I still hadn't found an in-network therapist and my OB's office had hold times upward of 45 minutes every time I tried to call.)

“There are moments that are blissful, and there are moments that are miserable and that is motherhood.”

But the more I’ve spoken to friends and experts in the field, the more I see the many stumbles — systemic and otherwise — in my own experience. I'm a highly educated white woman with good health insurance living in a big city. I have a history of anxiety that sits quite obviously on my medical chart in the form of an active Ativan prescription. I had every advantage. Why did I feel so in the dark as a new mother or as a person traveling for her second time through the perinatal period? Why did I only raise my own red flag after having a second child, when I am now certain that I struggled with PMADs with my first? Why didn't anyone talk to me about the fact that my history of anxiety made me vastly more likely to experience perinatal mood disorders?

Preemptive care in the form of meds, therapy, and an understanding of what I felt — overwhelmed, anxious, regretful, guilt-ridden — would have given me a feeling of being cared for, heard, safe, validated. Sitting there holding my newborn, I felt my insides caving in under the weight of the heaviest guilt and regret I'd ever felt. It was the bleakest feeling I'd ever known in my 37 years, and I bore it alone.

What if I could have talked to Bellenbaum — or someone as brilliant and as familiar with PMADs as she is — before I experienced them? She explains simply: “As expecting mothers, we go into this journey thinking things are supposed to be a certain way. If they're not that way or we don't feel certain feelings, we feel like failures. But, of course, it’s not that at all. You can look at your baby and think that he or she is the cutest thing you've ever seen and think that you've made the biggest mistake of your life. You can think and feel those two things at the same time and that's normal. There are moments that are blissful, and there are moments that are miserable and that is motherhood.”

The demands of modern parenthood — which is so much lonelier than it is supposed to be — place a burden on us that we were never meant to bear. That's why most of us cannot.

Getting pregnant, being pregnant, birthing a child, and ushering them into life is a process of total transformation — mental and physiological. Head, heart, soul. As we travel through the perinatal period, a woman births two selves — the baby and herself, rewritten. I want to say to you and to myself — to the person who held her second baby like a stranger, with her heart buried in blackness, mind in a state of perpetual arrest — new and expecting mothers are meant to have support. We're not supposed to do this alone; we are simply not built to. To borrow Miner’s words, “You're not fucking up. It feels this hard because it is this hard.”

The demands of modern parenthood — which is so much lonelier than it is supposed to be — place a burden on us that we were never meant to bear. That's why most of us cannot.

So, take the meds if you need them — they are a modern support for a problem exacerbated, if not caused, by modernity. Take the meds so you feel good enough to help the mothers who come after you. Take the meds so you feel strong enough to fight against the many things that have conspired to pin us into these less-than-ideal circumstances that we, as women trying to mother in 2022, find ourselves in. Answer the various mental health screenings you are offered honestly, and if you are not offered them, ask for one. Speak honestly about your feelings. Know that you are not the only one to find the darkest parts of yourself waiting for you in pregnancy or the early days of motherhood. You will find compassion in other mothers, and hopefully you’ll find some for yourself, too.

If you’re reading this, and you’re in the darkness, you're not alone. You're not a failure. You are worthy of support, you deserve to feel better.