Deciding to have children is a tough decision at the best of times.
Deciding to start a family when you have a long-term illness and take regular medication is another thing altogether.
I recently read an article in The Guardian that discusses the July 2014 guidelines that were issued to GPs by the National Institute of Clinical Excellence (NICE). These guidelines give doctors advice on how they should treat female patients who suffer from depression. In particular, it recommends that GPs talk to these women about their plans to have children and how these life choices could affect their mental health.
Encouraging women with mental health issues to talk to their GP is the right thing to do. Any woman who suffers from a long-term condition and is on regular medication should have a discussion with their GP before trying for a baby.
Yet, these new guidelines bother me.
There are GPs out there who will provide their patients with good and measured advice and will help them weigh up the risks. But there are also GPs who don't know much about how depression should be treated during pregnancy.
Research about how depression is affected by pregnancy (or vice versa) and the risk of taking anti-depressants when pregnant is scant. This is mainly due to the ethicality of testing medication on pregnant women. This leads me to worry that some GPs will give inaccurate and misleading information to female patients who suffer from mental health issues and want to have children.
Having long-term depression and taking medication does not preclude women from having children. I am living proof of this. That is why I want to share my story.
Living with long-term depression: Deciding to become a parent
When my depression was at it's worst I believed that I was destined to be childless.
I couldn't get out of bed. The thought of taking the 30 second walk to the shower was crippling. I wasn't able to look after myself. The idea that I could be a mother was terrifying and highly unlikely.
Years later, I was better. I would never be fully recovered. Depression was and always will be a part of my life. But I had what could constitute a normal life.
I had a full-time job at a charity. I was living in London with my boyfriend and I was happy. I was looking to the future with hope.
Yet, during that time I had managed to convince myself that I didn't want children.
My mind was cluttered with negative thoughts that all led to one conclusion. My depression meant that I should not become a parent ... ever.
- How would I manage being pregnant and not on any medication?
- Surely my history of recurring depression would mean I was at higher risk of developing pre-natal and post-natal depression?
- How would I cope if anything happened to the baby?
- What if it was genetic and my child were to get depression because of me? How could I live with the guilt? How could I subject my child to a future that contained such misery?
I resigned myself to a life without children. I had taken a mature decision and taken control of my depression. I felt pleased with myself.
That was until I saw my psychiatrist.
I was lucky. I had a brilliant psychiatrist. He understood me and I spoke to him about most things. But he also challenged me.
In one session, I was discussing my blossoming relationship with Mr H. This led to the subject of children.
I proudly told him the decision I had made and my reasons behind it.
He replied with one word:
He tore apart every argument I made.
He reminded me that I had often told him how much I would love to have children. And he stated that in his professional opinion, having the stability and focus of a family could be the making of me.
I left that appointment in tears. I had been challenged. And I had been presented with a bright new future. A future where Mr H and I could have a family.
After that, our decision to start trying for children was never going to be romantic or spurr of the moment. I was never going to turn to Mr H and say:
Darling, I want to start trying for a baby. I want to start trying tonight.
Cue Barry White on the iPod and the lights dimming.
Instead, our decision to have children involved many medical professionals and was orchestrated over a number of years. This was mainly due to the very strong anti-depressants that I was taking.
I couldn't even contemplate having children whilst I was on this medication. It wouldn't be safe for the baby and it wouldn't be safe for me.
The process would involve being weaned off the anti-depressant I was on. Once this was done a new anti-depressant that would be safe for pregnancy could be introduced.
Again, I was lucky. A failed attempt at managing my depression without anti-depressants led to my psychiatrist putting me on sertraline. An anti-depressant that is believed to be the safest in pregnancy and would allow me to breastfeed.
Once I had been on the new anti-depressant for a few months and was happy, Mr H and I started trying for a baby. I got pregnant very quickly but at 10 weeks was told that I had suffered a missed miscarriage that would need to be medically managed.
Having a miscarriage was awful and left me feeling empty inside. Mr H and I dealt with the sadness together. Then a few months later, I was pregnant again with our rainbow baby; Little Miss H.
I was monitored closely throughout the pregnancy.
I saw my doctor regularly, discussed my depression with my midwife and was referred to a consultant at the local hospital. They also kept a close eye on the baby's heart to make sure that there were no adverse reactions from the anti-depressants.
I also had appointments with a midwife who specialised in mental health. We discussed how I could change my attitude towards being a mum so that I would not set myself up to fail. I began to accept that it was impossible to be the world's most perfect mother. My child needed my love and that was good enough.
In May 2013 I gave birth to our darling daughter.
My psychiatrist was right. Becoming a mother has been the making of me.
It is hard. Bloody hard at times.
There have been tears and I may have even felt like giving up.
But I haven't given up!
I have got up every morning and looked after my daughter.
I am a mum now and Little Miss H comes first. My family come first. They are my life. And they make me better.
PS. I am not a doctor. This is just my personal experience of deciding to start a family whilst suffering from long-term depression. If you have a mental health issue and wish to have children or think you may be pregnant then please go and talk to your doctor. And if you are not happy with that discussion then please ask to speak to a consultant or midwife who specialises in mental health and pregnancy.
PPS. You can also contact the charity MIND for confidential advice on 0300 123 3393. This helpline is open Monday to Friday (except Bank Holiday) from 09.00 - 18.00.
This post originally appeared on my blog: Mrs H's favourite things.