The Maternal Mental Health Struggles We Aren't Discussing

This past Mother’s Day was my first as the mom of a daughter. I have
two older boys and have celebrated many previous Mother’s Days, never really
giving much thought to the specifics of the day, or how it is typically observed
(well, at least not beyond the common sentiment that uninterrupted sleep is
always greater than the inevitably ill-fated breakfast in bed). But this year’s Mother’s Day brought on a much deeper reflection than I have ever engaged in about the holiday.

My altered view of the day was partly because I now had a daughter who someday may be a mom herself, opening me up to a flood of thoughts and emotions that simply were never applicable to my boys. To a larger degree, though, my outlook on Mother’s Day was modified due to the overwhelming mental health struggles I faced throughout my recent pregnancy. The unsettling conclusion I reached was that in a month when Mental Health Awareness is a dedicated topic of discussion, we are missing a prodigious opportunity to truly honor mothers. Because in the unilluminated corners of the Mental Health world hide discussions that we are not having about some of the most testing mental health struggles mothers face.

The discovery of my third pregnancy in August, 2020 was nothing like my two prior. There was no missed menstrual cycle followed by the excited anxiousness of taking a pregnancy test. Instead, my body did something it had not done previously —  it made me defiantly ill. Before I ever missed a period I was nauseous, fatigued, and generally unwell. A short time later my nausea turned into vomiting, a couple and then multiple times a day. My sudden illness raised concerns about the flu, or something more serious. I would discover, however, after finally missing my cycle and calling my obstetrician that it was something more insidious than any of the other speculated conditions. I had hyperemesis gravidarum (HG).

After my diagnosis I quelled my anxiety by settling into the mythical thoughts many people harbor about HG.  It’s just bad morning sickness, I told myself. I simply needed to get through the first few weeks, at worse the first trimester.  I sent my husband out to stock up on ginger ale and crackers. But, as I went from four weeks to five and then six … my illness only intensified. By the time I was eight weeks I was vomiting up to 20 times a day. Sometimes more. Nothing was safe to consume, not even water. Whatever I put into my body immediately came back out. I couldn’t hold down my prenatals, my anxiety medication, or even the medications prescribed by my OB for the hyperemesis.

I was entirely physically incapacitated by my sickness. I couldn’t care for my sons (who were both still homeschooling due to COVID-19). I couldn’t work. I couldn’t take care of household chores or my personal hygiene. Tasks like showering, even brushing my teeth, felt like running a marathon with no training. But, even more damaging than the physical toll was that I was entirely mentally incapacitated.

I stopped communicating with friends and family and withdrew from any type of social interaction. It is not hyperbole to say that I thought I was dying.  And, if I wasn’t then I very much wanted to. I am no stranger to depression, but the thoughts and feelings accompanying HG were beyond anything I had ever experienced. I would cry myself to sleep next to the toilet praying that I wouldn’t wake up. I imagined the ways I could relieve myself from the world in the least painful way to my children. As though that is possible. Then in what became my darkest moment, I contemplated saving myself — by terminating the life of my sweet unborn baby. And I scheduled the appointment.

Before writing this, only my husband and mother knew that I planned an abortion.

The shame I felt once I cancelled the appointment was too debilitating,
until my reflection on Mother’s Day, to even consider sharing that information
with anyone outside of those individuals. Next to admitting that I planned to terminate the life of my daughter, the only harder thing to confess is that it was not morality or my religious faith that caused me to reconsider my plan.  It was only a respite from my own suffering that gave me the determination to go on. That is how deleterious HG is.

I know that I am one of the lucky ones. Not everyone gets a reprieve from the illness after an emergency visit that alters their plan. Some women keep the appointment. And I fully understand why. I was hours away from being one of them.

There is a profound deficit in HG awareness. As impossible as it sounds, many women struggle to find a doctor who will diagnose and properly treat their condition. And, for those that do, the doctor’s focus is almost always exclusively on the physical ailments, with no discussion or treatment of the emotional toll the illness takes on the woman. Even with termination being at the far end of the outcomes from HG, depression, failure to attach, anxiety and other mental health conditions are prevalent with the disease. But only those suffering or who know someone who has had HG are the ones talking about it.

What’s worse is that these prenatal struggles are not unique to hyperemesis.  Although we’ve made strides in postpartum mental health awareness, pregnancy related mental health disorders often continue to hide in private support groups, darkened bedrooms, and on shower floors. From intrahepatic cholestasis of pregnancy (which I was also diagnosed with) to Pica, women often face extreme emotional challenges, associated with physical conditions arising during a pregnancy, that few people know or talk about.

I realize that sharing my truth may come with judgment. I also know that someday my daughter will be old enough to read this and understand the implications of what I’ve written. But I am no longer ashamed or afraid to share my story. Our story. Because it is only through the illumination of truth that we can help others stay out of the darkness.  And we owe it to mothers — past, present, and future — to keep them from suffering in the shadows.