Passing the final test

I was in the spectacular Manchester Unity building in the city today searching out an old-fashioned goldsmith when I received a phone call from my obstetrician who had the results of my final round of pathology tests. She delivered good news - testing for a variety of blood clotting disorders that may have contributed to my preterm labour came back clear. Now I know with certainty that there is no underlying medical problem to explain why this happened. I know that have no physical abnormalities (like a weakened cervix) that can be diagnosed or treated. My baby had no known 'defects' or chromosomal abnormalities that might have caused my body to reject him. Whilst there was some evidence of a higher than normal number of white blood cells in my placenta, there was no identifiable infection or bacterial agent found to take the blame. It's looking more like those infection-fighting cells migrated to the placenta as a result of labour starting, not the other way around, leaving me with much less certainty than I thought I had a few weeks ago when I clung to evidence of an infection as a potential cause I could live with.

Instead, I've had to face the extremely painful possibility that Max's premature birth was a result of a medication I take for depression and generalised anxiety disorder. This fear has been in the back of my mind for a long time now, and though there is no way of knowing for sure if it had an impact, the possibility remains a real one. The medication I take is in Pregnancy Category C, which means that animal studies have shown adverse effects, but that there are no adequate or well-controlled studies in humans. Nine months before I got pregnant I consulted a specialist psychiatrist to get advice about what it would mean for me to have a baby given my long history of depression and the fact that I have relapsed every time I've tried to go off medication in the past. After detailed consultation, and in conjunction with my GP, she advised that it was best for me to remain on medication throughout a pregnancy despite the potential risks. I felt that this was the right decision. Whilst the medication has side effects, untreated perinatal depression is also not a risk-free state, either for mother or baby.

Ironically, both SSRI's (the type of medication I take) and untreated depression during pregnancy have been associated with an increased risk of preterm birth. In the literature scientists do have about my medication, this chance is still very slight, though. There are thousands of women who take this medication and suffer no adverse affects. My psychiatrist has 25 years experience treating women like me during their childbearing years and this has not happened to any of her other patients. If the medication was a factor, I was the unlucky winner of a very unfortunate lottery, in other words. She has reported my outcome to the manufacturers of the drug and my experience will go towards compiling the kind of statistics that I had to weigh up during that first prenatal appointment.

I saw Melanie every single week during my pregnancy. I did not have an easy time of it. Despite remaining on medication, I became extremely depressed. Hyperemesis (the severe kind of morning sickness I was plagued with) is known for contributing to depression in pregnant women, even those who don't have a history of it. It seemed that I was also particularly sensitive to the progesterone saturation pregnancy causes, which has a big impact on the part of the brain that controls mood. There were quite a few months there when I did not know how I would get through another day. I was almost hospitalised at one point, and the strain that this put on my life, my work, and my relationship was a very real one. The week Max was born was really only the first or second of the entire pregnancy that I had begun to feel like myself again. I had hope that the worst was over and that I might finally get to a point I could enjoy.

During this time, depression meant that I could not be alone for any length of time. I spent days aimlessly driving around looking for things that 'snap' me out of it. So many times I sat in my car on the side of the road simply sobbing because I did not know where to go or what to do to escape myself. My house became a horrible symbol of all I felt inside. We moved in here just after I found out I was pregnant, and all it was associated with for me was sickness and misery. I didn't feel at home in my house, and I didn't feel like I belonged anywhere else. No wonder my car felt like the only space I could tolerate. Being depressed meant that I could not go to work; that I could not do anything useful or practical. I could not pick up a book. I could not stand to watch TV. I can't count the number of hours I sat just staring at the wall. Being depressed meant me thinking that I had made a terrible mistake in getting pregnant. I was sure that I was not capable of loving my baby. I imagined looking at him when he was born as if he was nothing to me. I was numb in every possible way.

Writing this, I remember how much I was suffering during those months. Now that I'm not pregnant anymore, and I so desperately wish that I still were, I find myself unable to reflect very truthfully on what it was like. I romanticise what it was like, and in doing so I punish myself. From where I stand now it feels like it could not have been all that bad. Maybe I was making it up. Maybe I was just feeling sorry for myself and wanted attention. Surely if I really loved and wanted my baby I would have just gotten over it.

It's cruel of me to taunt myself with what I know to be impossible recriminations. In my lucid moments I know, more than anyone, that depression is a very real, very frightening, very serious illness that cannot be wished away or recovered from with sheer force of intention and will. But still I say to myself, with so much self-hate, that I should have been the exception. That I should have tried harder. That I know better, and could have done better, and shouldn't have let myself get in that dreadful state in the first place. If I was a diabetic instead of a depressive would I feel that I 'made up' or imagined my pancreatic failings? Probably not. Why it's then so hard to believe in the very real failings of my brain I don't know. If someone could show me on an x-ray exactly where my neurons were misfiring and where my brain's chemical markers were going awry perhaps I'd give myself a break. Until then, I'm plagued by a misconception that instead feels like a truth - that depression is a choice, and that in choosing it I was also responsible for my baby's death.

I don't know how to live with this uncertainty, with this guilt. I trust, implicitly, the advice of my psychiatrist and all those she consulted about my case. I trust her research and her skills and her experience, but no matter how much she tried to assuage my feelings I cannot seem to find that same sense of reassurance in myself and my own actions.

This is something that is not going to go away. If we try again to have a baby I'm going to be faced with this exact same situation and the exact same set of 'choices' that aren't really choices but instead a never-ending mathematical weighing up of risk against risk. It's enough to make you go mad if you weren't already.

Today I just feel so sorry. I feel sorry that no one can give me any better answers or more certainty. I feel sorry for everyone around me who helplessly watches me fade away into a place that distorts my thoughts and feelings and leaves them with only a shadow of the person they know and love. I feel sorry that something in me is broken and so sorry that I do not have the power to fix it. I am sorry to my little boy for any part I may have played in his demise and I absolutely beg for his forgiveness. I love him and I long for him. I long for him so very much.