PPD Made One Mom Fearful of Giving Birth Again, so She Decided on Surrogacy

Surrogacy helped one mom avoid the severe PPD she experienced after birthing her first child. It worked for her, but it might not for everyone.

Fact checked by Sarah Scott

Jessica Miller knew something was wrong about 12 hours after giving birth to her first child in 2019.

“I had a panic attack while I was still in the hospital,” says Miller, who lives in Seattle. “I’d had panic attacks before having my daughter so I knew what they were.”

Miller, a nurse practitioner with a solid knowledge of perinatal mood and anxiety disorders (PMADs), was still completely blindsided by what she was feeling. Her symptoms really set in when her baby was 3 months old, and then became progressively worse.

“I was crying all the time,” says Miller. “I had trouble eating. I had trouble sleeping. I was very paranoid about everything. I didn’t want to take my baby anywhere. I didn’t want to do anything. I was so scared to be alone with her.”

The new mom was suffering from postpartum depression (PPD) and postpartum anxiety (PPA). She became suicidal and was hospitalized. With medical help, Miller recovered, but the experience scared her from wanting to give birth again.

That’s why she opted to have her second child via surrogacy. But Miller was nervous about being judged for why she was choosing to use a gestational carrier because of the stigma around mental health. On top of that, there is also a stigma surrounding surrogacy. Recently, Pope Francis even called for a total ban on the practice, deeming it “deplorable.”

But Miller’s experience is just one example of how surrogacy can help people achieve their dreams of a family. And it’s highlighting it as an option for those who have experienced how debilitating PMADs can be—and can afford the expensive process.

The Reality of PMADs

PMADs include PPD, PPA, panic disorder, obsessive-compulsive disorder (OCD), and postpartum post-traumatic stress disorder (PTSD). In rare cases, giving birth can cause postpartum psychosis, which is a mental health emergency.

Between 20-25% of people experience PMADs, which can occur during pregnancy or up to a year postpartum. Research shows changes in hormone levels can trigger symptoms. PMADs can also be sparked by numerous risk factors, including a history of depression or anxiety, and endocrine disorders, according to Postpartum Support International (PSI).

But health conditions and hormonal factors are not the only causes of PMADs.

“What I find most in my practice is the unexpected life changes, changes that mess with your identity or your relationship with your partner, can give you PPD,” says Erin Hickman, LMFT, PMH-C, who specializes in perinatal mood disorders.

PSI shares other risk factors such as lack of support from family and friends, pregnancy or infant loss, financial stress, breastfeeding issues, traumatic birth, and history of abuse.

Hickman points out that birthing parents aren’t the only ones who can suffer from these conditions.

“Adoptive parents get PMADs. Grandparents who take over care of their grandchildren can get PMADs,” says Hickman, also sharing, “I have a dad client who has postpartum OCD.”

Treatment for PMADs

PMADs are treatable but diagnosing them is critical. After suffering from symptoms for 3 months, Miller went to a doctor and said, “I have postpartum anxiety and depression. I need to get into an intensive outpatient program (IOP).” Her physician wrote her a referral.

Miller went to her first IOP in Seattle for about a month before the pandemic hit. She continued with Zoom group therapy sessions, and moved to Ogden, Utah, when her daughter was 5 months old. She was hospitalized a month later, and then entered an IOP in Utah.

Physicians who had specialized training in perinatal mood disorders treated Miller at both IOPs. That came at a cost but her insurance covered it.

Treatment for PMADs typically includes counseling and medication. Support from others, exercise, adequate sleep, a healthy diet, bright light therapy, yoga, and relaxation techniques can also help.

But what was most effective for Miller was the group therapy. The IOP included other people who had started two or three months before her and were getting close to graduating. Their symptoms had decreased. Knowing she wasn’t alone and that others were getting better, gave Miller a glimmer of hope.

“Doing an intensive outpatient group therapy program with other women in the exact same place that I was in was the number one thing that helped me,” she says.

Choosing Surrogacy

Since having a PMAD with one pregnancy increases your risk in a subsequent pregnancy, Miller and her husband were proactive.

“When I was in the pits of it, I thought, ‘If I have another baby, I’m 100% sure it will kill me,’” she says. “So, my husband had a vasectomy when our baby was 8 months old.”

When her daughter was 2 years old, Miller thought about her main therapist in the IOP suggesting she not give up on having another child.

Her therapist pointed her to other options including adoption or using a gestational carrier if she did not want to carry another child herself. She remembers sitting in that group therapy session and thinking, That would allow me to have a sibling for my kid, if I so choose when it feels right, without having to literally risk my life.

After Miller and her husband decided on surrogacy, they began the process of finding the right gestational carrier for their family. For a surrogacy match, each party seeks out an agency to work with. A case worker then sends both the surrogate and the parent(s) profiles of who is considering them.

As Tiffany*, a surrogate and single mom of three kids, was reading Miller’s profile she was struck by how vulnerable, open, and descriptive she was. “I hadn't thought of the mental health side,” she says. “I had only thought of all of these physical reasons why someone might need a surrogate.”

They connected via Zoom shortly after. “It felt immediately right,” says Tiffany. “We just clicked right away.”

Surrogacy can be a lengthy and expensive process–it can cost up to $170,000 (sometimes more) for agency fees, legal and medical costs, as well as the surrogate’s compensation and expenses. It can also come with a mix of emotions. In Miller’s case, she felt guilty knowing that other people can’t physically carry a child and that’s why they choose surrogacy.

“I felt like I didn’t deserve it,” says Miller. “Like I should have sucked it up and been brave enough to try again.”

As the surrogacy process progressed, however, that feeling went away. Once her second child was born, Miller understood that her decision for surrogacy was the right one for her.

“It was like night and day,” she says in comparison to her first child’s birth. “And she was even a colicky baby; she cried a lot the first several months, but it never felt bad or hard or sad or depressing or anxious.”

Hickman commends Miller for prioritizing her mental health and deciding on using a surrogate. While this isn't a surefire way to prevent a PMAD, it may lessen risk factors.

“It takes the pressure off of her body and her hormones, which can be a huge contributor to PMADs,” explains Hickman. “She also avoids the possibility of her own body experiencing a traumatic birth, and it takes pressure off her to breastfeed, which, again, can be a contributor.”

She also emphasizes that PMADs are treatable but support is essential. If you are feeling any symptoms of a PMAD, such as extreme worry, sadness, unwanted thoughts, panic attacks, or just not like yourself, then seek help from your health care provider.

And if an experience with a past PMAD has you worried about conceiving again, also speak with your health care provider on what the right steps are for you.

*Last name withheld for privacy.

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