A tough pill to swallow: Pregnancy, misogyny, and my mental health

When I got pregnant, I was prepared for stretch marks but not the mark pregnancy would leave on my mental health. Before conceiving, I was diagnosed with both depression and anxiety (I’ve always been an overachiever!). And while friends had confided that pregnancy was a particularly trying time, I naively thought it couldn’t get much worse for me. 

By the time of my pregnancy, I had a not-inconsiderable history of depression. In fact, I’d once received a near-perfect score on The Hamilton Test (that sounds like a good thing, but it isn’t, because it’s supposed to gauge how bad your depressive symptoms are). Well, it turns out I was wrong: I am beyond grateful to have conceived my daughter, but it turns out everything – from heartburn to anxiety and depression – can get worse while you’re gestating. And that’s not just because pregnancy is hard – it’s because society makes it harder. And in my experience, this is never truer than it is for gestating parents who need mental health care. 

My pregnancy (like many others) had its challenges. I experienced hyperemesis gravidarum, throwing up eight times a day for months. I also endured multiple threatened miscarriages, gushing blood into my maternity underwear, then rushing to the hospital to make sure my fetus was still alive. At my 19-week scan, I would learn two things 1) My fetus was female and 2) I had, in a freak and rare casualty of pregnancy, lost a kidney. Being knocked up was a mindf-ck, and when you’re already prone to anxiety, all those triggers take their toll. 

I’ve survived sexual assault. I’ve lived through disordered eating and chronic stress; however, nothing I had previously endured held a candle to pregnancy. I’ve never felt less in control of my body! As my belly grew, every twinge or bout of indigestion became proof I needed an emergency C-section. I reverted to childhood fears, half-convinced there were monsters – or at least intruders – under my bed. Eventually, I began to question whether I wanted to continue living. Surely, some disaster was about to kill me and my baby anyway? 

Suicidal ideation is not uncommon during pregnancy, with The Duchess of Sussex herself having openly discussed her thoughts of ending her life when she was pregnant with her first child, Archie. When I told my obstetrician that I had thoughts of ending my life, I’m fortunate to say he believed me. But that didn’t mean things were smooth sailing thereafter. It only takes one jerk on your healthcare team to upset a solid treatment plan. 

In my third trimester, my obstetrician referred me to a perinatal psychiatrist (a doctor who specializes in mental health during and after pregnancy). The day of my first appointment with her, I panicked. What if she wasn’t as understanding as my obstetrician? What if she thought I had no right to be so depressed and anxious? Surely, she spent all day treating patients who had suffered more than I had. After all, I had a home and a husband – I’d even gotten pregnant on the first try. What right did I have to feel so distraught? 

But when we finally spoke, my shrink didn’t minimize my struggles; she validated them. She also explained it was safe to take certain anti-anxiety medications at 37 weeks pregnant, as long as

you had the approval of a physician (which thanks to her, I now did). I walked out of her office with a scrip for Ativan and a glimmer of hope. 

But receiving a prescription for Ativan didn’t provide the relief it should have. When I presented my pharmacist – a man who’d given me everything from Plan B to anti-depressants in the past – he balked. 

“Sarah, I can’t fill this prescription,” he said somberly. I was confused. Had my highly competent specialist filled the scrip incorrectly? Was my pharmacist out of Ativan? No. 

“I’m just not sure Ativan is safe to take right now!” He explained (or rather, mansplained). A man who hadn’t gone to medical school – much less studied perinatal psychiatry – was denying me the medicine I needed out of “an abundance of caution.” The risk of me killing myself wasn’t compelling enough to him. Instead, he wanted me to wait until he’d had a chance to speak with my doctor. I went home empty-handed that day…. 

My pharmacist’s reaction to my Ativan prescription was evidence of many things. Firstly, it demonstrated his ignorance regarding the safety of mental health medications during pregnancy. In the words of veteran perinatal psychiatrist Dr. Gail Robinson: “There is a myth pregnant women should not take any medication.” Part of this myth, as she details, is that people – the public and the patients themselves, not fully understanding how psychotropic medication functions. Dr. Robinson adds,“When I explain how it works and the negative side of not taking this medication, they are most often likely to choose to take it.” When the consequence of not taking a certain drug could be suicidal ideation or self-harm, the best choice for mother – and child – is to take the pill. 

However, I couldn’t shake the feeling that my pharmacist’s decision largely came down to old-fashioned misogyny; he felt more anxious about the thought of a medication hurting my fetus than me hurting myself. Fortunately for my family, I didn’t kill myself because of his mistake, but that doesn’t mean I didn’t suffer. 

Years later, when my beloved daughter was three, she had a stomach virus that sent us sprinting to the doctor. To my surprise, when I arrived at my new GP’s brand-new office, I noticed my old pharmacist had opened a storefront on the premises. 

When I first saw him, I froze. So many times in my life, I’d failed to say the right thing when confronting someone who’d wronged me. But this time, I wanted my daughter, snuggled in her stroller, to see me stand up for myself – even if she didn’t fully understand why I was doing it. 

“Hi Sarah,” the pharmacist said, as if we were old friends. 

“You didn’t give me medication when I was pregnant,” I blurted. 

“Excuse me?”

I took a breath and steeled myself. “I needed Ativan. The perinatal psychiatrist thought I needed Ativan. I was having suicidal ideation and panic attacks. It was your job to give me the medication; not to question it.” 

The pharmacist stammered. I can’t remember exactly what he said, but there was an apology of sorts – only he himself knows if he meant it. But at least I spoke up. In that moment, I vowed to be loud about my suffering for the rest of my life. 

So much of the way our society treats pregnant women is dehumanizing. From strangers scolding you for eating sushi to America’s repeal of Roe V. Wade. But all that nonsense comes down to this: society appears to value fetuses more than the women who carry them. But, in the words of Alberta-based OB/GYN Fiona Mattattall, “It is also often forgotten that without a healthy pregnant person, there will not be a healthy fetus.” 

I’m done swallowing the bitter pill of misogyny when what I needed was Ativan. I hope that the pharmacist learned a lesson…