The Pregnancy Risk That’s Incredibly Difficult to Discuss

For eight months, I tirelessly tracked my periods, stockpiled ovulation strips and pregnancy tests, and even borrowed a busty fertility statue curvy enough to make a Kardashian jealous. After putting our toddler to bed, wearing a stained nightshirt and messy topknot, I’d tap my fatigued husband on the shoulder with a raised eyebrow, tilting my head toward the bedroom—the epitome of romance. I brought home the sample cup and informed him what he might have to do with it, or rather, in it. I’d begun entertaining the pros and cons of IUI vs. IVF; had tests to confirm I was still ovulating; and agreed that, at my next appointment, they should push dye through my fallopian tubes to check for blockage. It’s a miracle anyone gets pregnant by accident.

“I just don’t know how we’ll afford another one,” my husband moaned. Child care is expensive and time is scarce for two full-time working parents who moonlight as a writer and a musician.

A part of me agreed that two children were too many. I imagined myself underslept and overstimulated, racing between soccer and ballet. I could picture the manic orchestration of two packed lunches instead of one; all those emotional negotiations, doubled. (Cheese string or cheese cube? Banana peeled or unpeeled? But you just asked for … )  I was also not particularly excited by the idea of repeating the postpartum period ever again, complete with its bloody nipples and night sweats, rageful fits, and submarine-size mesh underwear. But I had no idea about the emotional deluge that awaited me.

My first pregnancy, at 37, was a product of decision fatigue. I didn’t ache for a baby, but my curiosity poked at me. We conceived without much effort, and I was immediately at peace with the decision. I came to understand that I’m the kind of person who’d never be satisfied not knowing the dark, expansive truth about motherhood. Writers are addicts, too; motherhood was abundant with new material.

This time, I was about to turn 40. As I considered the question, my OB-GYN spoke to me as if getting pregnant “at my age” would be a holy miracle worthy of its own biblical passage. Two of my closest friends had been in yearslong battles with second-child infertility. I saw the money they’d spent and the disappointment they’d weathered. But, I have a brother and I’ve always found it deeply comforting to have one other person who will always speak the language of my childhood. So I persisted, like some baby-obsessed sadist.

“I know, I know,” I said to my husband. “But finances change. Biology doesn’t.”

Then, on a Tuesday morning in May, while waiting patiently on the seat of my toilet, I finally saw the two pink lines. I burst into tears. They were not happy tears.

A sick, sticky feeling of regret rose up to the base of my throat. Dread arrived in the pit of my stomach. I was having the kind of stark realization that comes after you push a red button and immediately understand the deep, eternal consequence of your actions. Instantly I began to mourn my nightly eight hours of sleep, my early-morning writing time, the work I’d done to repair a fragile relationship to my changing body, and the dissolution of my little family of three.

When you have a second child, people say things like, “You know what to do now! You’ve been here before!” And yet, this is exactly where my fear stemmed from. The first time, I only had my own optimism to rely on. This time I knew exactly what to expect, and I knew it wasn’t always pretty.

First came the depression-crying, the kind of tears that run like a faucet, unprovoked and without warning. Nothing prompted them, and I couldn’t attach their overflow to any particular emotion. The crying just … happened. In the car, at my desk, while cooking dinner. I felt sadness as if it were a vague, misty concept that came knocking, uninvited in its hazmat suit, to fumigate my entire body.

Next came the anxiety, a certainty that something would be wrong: with me, the baby, my pregnancy. I feared that because I was less excited about this pregnancy—more distracted, lethargic—that I would somehow damage the baby by osmosis. I got a therapist. She tried to assure me this was not possible and that I was experiencing something called “cognitive dissonance.” I had already created an alternate reality for myself with no basis in fact. Colored by my past experiences and deepest fears, I fabricated a false truth that did not exist. Too bad hormones don’t care about logic—or psychology.

Soon I began to obsess over the postpartum period, certain I would suffer from debilitating postpartum depression. If it’s this bad now, I thought. Aside from some white-hot postpartum rage, I’d managed to evade this common disorder—the subject, lately, of so many articles, books, and movies—after my daughter’s birth, but I remember seeing it from afar. It loomed just out of my periphery; if I’d taken just one wrong turn, I could have been enveloped into its blackness.

This fear only made the tears come harder. I imagined long, mind-numbing days at home, sobbing while the baby shrieked its tinny, incessant wails. I tried not to entertain what sort of intrusive thoughts I might have. I feared I would resent my new baby for taking me further from my writing, my body, my relationships, my daughter. That the baby would sense this anger and grow up to be the subject of one of the true-crime documentaries my husband and I often watched.

More than anything, however, I was caught off guard. I was officially middle-aged, a mother for three years now, and I didn’t consider that I could be this sad during my pregnancy. Especially a pregnancy I planned—and thought I wanted. I was drowning in the emotional quicksand of my own making.

Begrudgingly I’d deliver the news to friends, knowing they’d respond with squeals of joy and congratulations. I didn’t know how to explain that I did not feel like celebrating. I simply told them the truth, that I was sad, that it wasn’t like this last time, that I’m working on it, because people need resolutions. Then one day, a friend sent me a life raft.

“I got on Zoloft as soon as I hit the second trimester. First time in a decade,” she replied in a text.

You can do that? A small, invisible weight was lifted from my shoulders.

Another friend said something similar. She didn’t take one photo of herself pregnant, she told me. She cried often and struggled to be the mom she wanted to be for her 2-year-old. This friend also happens to be a clinical psychologist. I was relieved to hear her personal anecdotes, but I also wanted to know her professional point of view: Why aren’t more people talking about this? Are they? And I’m just left out of the conversation? I asked her to speak with me, not as my friend, but as Dr. Rebecca Lesser Allen.

“Statistically, antenatal depression is almost as common as postpartum depression,” Allen told me. “There’s increased awareness about postpartum depression. You get screened for it by your OB and your pediatrician, and they talk to you about it at the hospital, but no one really addresses antenatal depressive disorders, and I have no idea why that is.”

According to the Cleveland Clinic Journal of Medicine, 1 in 7–10 women will develop a depressive disorder during pregnancy. For reference, 1 in 5–8 women will experience depression postpartum. That’s more than a half million women each year who will confront a depressive disorder at some point during or after gestation.

We can (finally) talk about depression and anxiety after the baby’s born, but not while we’re pregnant? Since it’s not commonly discussed outside of mom circles, does the stigma around it run deeper? Logically, I knew that I had no reason to be ashamed of my emotional downward spiral. Intellectually, I understood that hormones are a racket and it’s OK to feel something other than elation about a pregnancy. The reality of motherhood can be joyful but also brutal. But why is this nuance so hard for us as a culture?

“We have this expectation that people are supposed to feel a consistent, simple way about something as enormous as creating and giving birth to and raising a baby, and that’s not fair,” Allen said. “It’s a huge thing.” Even for those who’ve gone to extensive lengths to get pregnant, it’s not so black and white. “Going through IVF and fertility issues is challenging, complicated, and traumatic, and so there becomes this huge expectation, but the reality is that being a mom is hard,” Allen said.

Allen points to Brooke Shields’ memoir, Down Came the Rain, published in 2005, which contained the story of Shields’ postpartum depression, and the subsequent press in which she promoted it. In the early aughts, such confessions were still new, and Shields received a great deal of criticism for openly sharing stories of her thoughts of infanticide, and for taking medication. Today that kind of vulnerability might receive much more support—but even in 2024, it depends on what side of the aisle you sit.

“Back [in the early 2000s], people believed that postpartum depression definitively meant that you didn’t want to be a mother. Now we know that’s just not accurate,” Allen continued. “I think because there hasn’t been the same normalization of depression during pregnancy, we assume it must mean that you don’t want the baby, simply because we don’t have enough practice talking about it.”

Still. I’m a woman who was born in the Deep South in the early 1980s. The patriarchal, puritanical voices I’d grown up around still speak to me, wanting me to believe that these fears were all my fault. I wanted this, right? So why am I so sad? I explained my fear to Allen: If I admit I feel anything less than elation, I’m afraid I won’t only feel guilty, I’ll somehow be punished.

“It reflects your internalization that this is not allowed,” she said. “And when we feel depressed or anxious during our pregnancy, it creates so much shame because we think, ‘I’m so lucky, people struggle to get pregnant, I’m selfish.’ It’s a bad way to feel.”

What’s even more bleak is that I can’t help but assume that this dead zone in conversation simply reflects our nation’s priorities. Does the silence confirm our lack of concern for women’s mental health? (I feel like I know the answer.)

Part of me wonders if we put less emphasis on maternal health during pregnancy because there is no baby yet. Do we care more about the mother’s mental health after the baby’s born because, in society’s mind, If she’s incapacitated, who else will take care of the baby?! If you look at current public policy, it appears that all religious conservatives want is for the baby to be born, full stop, regardless of the financial, emotional, or physical toll this takes on a mother.

Allen is now out of the haze of newborn-toddler life. As for me, my son was born on Jan. 29. From behind a blue sheet and beneath the lucent glow of an operating light, I heard his first cries, a piercing shriek through air and liquid. For the first time in nine months, I felt pure and simple relief. You could even call it unbridled joy. I thought of Allen, who told me that as soon as her daughter was born, the fear and anxiety she’d carried along her pregnancy melted away. As I cradled my second child to my chest, I cried because he was finally here. I cried because, in that moment, I did not resent him. I cried because I know it doesn’t always happen like that for people with prenatal depression.

I still worry about the chaos of my new life with a newborn and a toddler. I wonder how I will maintain my writing practice, as well as excel in my full-time job, with two children. Ultimately, I find ease in knowing I’m not the only person who’s ever asked such questions. In her memoir, You Could Make This Place Beautiful, poet Maggie Smith writes, “I wonder: How will my children feel if they think that being seen as a mother wasn’t enough for me? What will they think of me, knowing I wanted a full life—a life with them and a life in words, too?”

What will my son think when he finds out that I felt pangs of sadness at his positive pregnancy test? That I struggled with the decision to bring him into our family? That I was overwhelmed by all that I wanted in life? I hope he’ll see an imperfect woman who isn’t afraid to tell the truth. Someone who wants to ask difficult questions. A woman who believes in the beautiful mess of an honest life, nuance and all.