Understanding Your Moods When You're Expecting: Emotions, Mental Health, and Happiness -- Before, During, and After Pregnancy

A nationally recognized expert on women's reproductive mental health offers the first book to reveal the full range of emotional experience for pregnant women

Lucy Puryear is a practicing psychiatrist and a pioneering expert in women's emotional health before, during, and after pregnancy. Through engaging personal stories reflecting her own practice, she illuminates the little-discussed feelings that are virtually universal for pregnant women. She shows just how normal it is to fear loss of control, to mourn what you assume is an irretrievable career, or to worry that you'll be the world's worst mother. She explains exactly what is happening to your hormonal system -- and why knowledge is power when it comes to the overwhelming hormonal floods that accompany pregnancy and the postpartum period.

Understanding Your Moods When You're Expecting includes reassuring expert advice on:

how to make a birthing plan for emotional well-being

how and why to get essential rest

real-life bonding with your baby

reducing the risk of postpartum depression

eating disorders and OCD

how to make decisions about necessary medications during pregnancy

This book is as essential to a woman's emotional health during pregnancy as What to Expect When You're Expecting is to her physical health.

Introduction

-Growing up as a young girl in Baltimore in the sixties and seventies, I watched in fascination as women fought for equal rights. But I didn’t fully understand why they had to fight for them. As the firstborn child of a man who wanted a son, I was treated like one. My father claims I knew the names of all the positions on a football team by the time I was two. I was allowed to do anything the boys did. My father taught me how to throw an almost perfect spiral and how to shoot a rifle and hunt dove in the Rio Grande Valley. I read the books he’d read as a boy and couldn’t imagine that girls could be treated differently than boys.
From watching television, I knew about Gloria Steinem, Billie Jean King, and the campaign for the Equal Rights Amendment. I wasn’t old enough to have a bra to burn, but I would have burned it if I had been. I was determined not to let the fact that I had been born female stop me, and my parents confirmed that I could do anything I wanted to do. A desire was born in me to accomplish something that made a difference.
As a college student, I became involved in women’s health issues and thought about becoming a midwife or an obstetrician. But as I watched the doctors working in the clinic where I volunteered, I became disillusioned with the way some of them dealt with their female patients. These doctors often treated the women’s physical symptoms but ignored or trivialized their emotional complaints. When at age twenty-five I complained to my own gynecologist about having premenstrual mood swings, he literally patted me on the head and with a patronizing smile said, “Lots of women have that, honey. Don’t worry about it.” I was embarrassed and furious at the same time. I felt like an overly emotional little girl and angry that my complaint hadn’t been taken seriously. At that moment, I decided that I would go to medical school and become a different kind of doctor. I would be a physician who listened and treated women with respect. I imagined myself as an obstetrician who sat by women’s sides as they delivered their babies, listened to their stories, and educated them about their bodies.
I began medical school and was soon confronted with the limitations of the health care system. I realized how difficult it would be to practice obstetrics in the way I’d fantasized. There doesn’t seem to be enough time in the day for doctors to see as many patients as necessary to make a living and also to have a personal life outside of work. The legal climate forces physicians to practice defensive medicine, performing procedures that may not be necessary. New technology often causes doctors to treat lab results or monitors instead of patients.
The few female obstetric residents I knew were subtly conditioned to act like their male counterparts — tough and efficient — to be respected. There was no handholding or staying with a woman while she labored. It was often the nurses who delivered the baby. The doctor’s arrival was carefully timed to appear when the baby was almost born and there was not much left to do but cut an episiotomy and sew it up. It was not that the doctors were lazy or didn’t want to be there; it was just that they had too many women to care for, had too much paperwork, and were too sleep deprived.
In medical school, as I contemplated what the next step for me would be, I was torn. Delivering babies was fun. It is amazing to help a woman give birth through her struggles and her pain. I could watch the television show MaternityWard for hours on end and never tire of seeing the mixture of relief and awe on the mother’s face when her infant was finally delivered.
Being privileged to help guide babies into the world is an incredible feeling. But I had a young daughter and wanted more children. An ob-gyn residency is very difficult, and I knew life wouldn’t get much better once I was finished. Many obstetricians stop delivering babies after several years due to malpractice insurance costs and the great demands the work makes on one’s life. My concerns about whether I could be the kind of doctor that I wanted to be only grew.
Gradually, I realized that psychiatry was a field that could allow me to practice medicine in such a way that I could be fully attentive to the whole woman. As a resident in psychiatry, I couldn’t wait to get up in the morning and go to the hospital. I looked forward to reading everything I could about psychiatric illness and its treatment. The patients were fascinating. Each day would bring a new story, a new tale of human strength in the face of suffering. I learned that all of us have pain in our lives and all of us have families that are less than perfect. As a general physician, I could treat pneumonia or diabetes and save someone’s life. Yet as a pppppsychiatrist, I could help people out of chaos in a way that allowed them and their families to live in the world with joy and hope.
During my psychiatry residency, I was asked to help teach ob-gyn residents about diagnosing and treating psychiatric illness. I began to work in the high-risk obstetrics clinic at Houston’s Ben Taub General Hospital. There I saw pregnant women who had histories of psychiatric illness or had developed psychiatric symptoms during their pregnancies. It was my job to decide whether medication was necessary and if so which medication would be safest to use.
After several months as attending psychiatric resident in the high- risk clinic, the ob-gyn residents began to seek me out to ask questions about their patients. They became more interested in evaluating and treating their patients for emotional symptoms. Women from outlying community clinics began to be referred to Ben Taub for the specialized treatment we were offering. I was increasingly asked to give lectures to other health care providers about psychiatric illness during pregnancy. My future now seemed clear to me.
I realized that there was a huge hole in the mental health care available to pregnant women. Many women wouldn’t ask for help out of fear and shame. Many were told they couldn’t get treatment while they were pregnant. They were told that because they had depression, anxiety, or bipolar disorder, they shouldn’t have children. They also were told that they were at risk of losing custody of their children if they remained mentally ill. And when a woman with a psychiatric diagnosis became pregnant, I was not infrequently asked to decide whether the state should take the infant away after delivery.
This presented a terrible challenge. I was being asked to decide whether a mother was going to be too sick to care for her baby and to evaluate whether the baby would be better off in what I knew was a woefully inadequate foster care system. Unless I could prove otherwise, it was assumed that a woman who had a psychiatric illness could not be a good mother. The women themselves faced a dilemma: they were being told on the one hand that psychiatric medication was not an option during pregnancy, but on the other hand that if they remained psychiatrically ill, they might not be able to care for their children and could even lose their right to parent.
This experience intensified my desire to advocate for women with psychiatric illness. People with mental illness make many of us uncomfortable and frightened. Historically, it was easier to lock mentally ill people up and ignore them. But all of us at some point in our lives will either have an emotional illness or know someone who does. One out of four women will develop a depressive illness at some time in her life. That could be y

LUCY J. PURYEAR, M.D., is a practicing psychiatrist specializing in women’s reproductive mental health. She has been director of the Baylor Psychiatry Clinic at the Baylor College of Medicine, and was expert witness for the defense in the trial of Andrea Yates. She lives in Houston, Texas.

P uryear, a psychiatrist specializing in women's reproductive mental health and director of the Baylor Psychiatry Clinic at Baylor College of Medicine, notes that pregnancy and motherhood are hard work both physically and psychologically. Yet, the author points out, most obstetricians and gynecologists have no training in psychological disorders, and women are often left to attend to their emotional issues without support. Puryear offers an informative resource that takes women from before conception to postpartum, drawing on her own practice and personal wisdom as the mother of four as well as current research. With pregnancy comes a surge in hormones that can make women feel both physically ill and cognitively foggy, and when the first movements of the fetus are sensed, the impending reality can be overwhelming. The third trimester and postpartum period can also bring problems: worries about being a good mother, ambivalence about the baby, concerns about sex or anxiety about returning to work. Puryear reveals that medication and psychotherapy are both options for mothers in distress, pointing out that there are many medical choices moms can make that won't harm the baby. All women, she argues, need more information and support concerning emotional issues during pregnancy: this is a worthy place to start. (June)

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