What to expect when you’re expecting (and happen to live with mental health issues)
by Amba Gauri
I never quite understood what my friends thought about my mental health issues until I got pregnant. While they knew that I was an activist around disability and mental health with ‘lived experience’, most of them pussyfooted around it, maintaining poker faces when I would mention issues that I faced from time to time. When I told some of them, face to face, about my pregnancy, I noticed a split second where genuine concern crept onto their faces before they would reflect my smile with their own. There would be routine questions about morning sickness and maternity clothes, but also the, ‘So, how are you doing?’ It was kind of annoying.
So, how was I doing? Pretty well, actually. I’ve had mental health issues for a little longer than I’ve had a law degree, with pretty much every professional I’ve gone to giving me a new diagnosis. For those nine months, however, I had no mood swings, no panic attacks, no crippling anxiety, no paranoia, no suicidal ideation and no depression. I was even flying without fear! It was incredible. I wasn’t into the idea of eating my own placenta, but I did seriously want to convert my pregnancy hormones into happy pills.
Luckily, most of the medical establishment was there to burst my bubble.
The first doctor we went to after I tested positive was on the famed ‘cool gynaec’ excel sheet. She asked my partner and me several questions, starting with ‘How long have you been married?’ and ‘Is this your first pregnancy?’ Now kids, remember: if you’ve had an abortion, no matter how early on in the pregnancy, it counts as a previous pregnancy. And will follow you everywhere you go.
She then moved on to questions regarding our health history, and I was like, oh, well, I have mental health issues.
Her eyes widened. ‘Are you on any medication?’
‘Well, I was, till a few months ago.’
She frowned. ‘Better not to tell anyone about the pregnancy till you do the ten week scan.’
This wasn’t an ‘evil eye’ thing. At ten weeks, you do the first screening for ‘abnormalities.’ ‘These medicines have all kinds of side effects,’ she said, giving me a look. ‘Else you’ll have to explain to everyone what happened to your pregnancy.’
Two things distracted me from any concern I had for the well-being of the foetus in my uterus: one, as a disability rights activist, I found her matter of fact approach to terminating of ‘abnormal’ foetuses disturbing. Secondly, I basically paid her 2,500 bucks to pee on yet another stick and have her poke around my belly.
I figured another four weeks would be enough time to find an appropriate obstetrician for the long haul. At eight weeks, I had a scheduled trip to Geneva. The night before my flight, I was about to sit down to dinner when I felt something spit out of my vagina. In the bathroom, I saw a bright splodge of blood on my panties.
‘We have to go to the hospital,’ I told my partner.
We got to this nearby multispecialty hospital and I was led to the emergency room, where another three people asked us how long we had been married. Eventually, a gynaecologist came in and after checking my history, she asked me: ‘Did you have sex?’
I was confused: ‘I mean, yes, that’s kind of what led to…’
She flared her nostrils. ‘I mean now.’
‘Like right now?’
She looked at my history sheet. ‘So you had an MTP (medically terminated pregnancy) earlier?’
‘Yes,’ I said.
‘Why? You didn’t want the baby?’
‘And now this baby is planned?’
I thought about the bottles of wine and packs of cigarettes and the copious amounts of raw papaya salad I had eaten over the ten days before I realized I had missed my period, in Bangkok.
‘Let’s go with that.’
She asked me to pull my pants down, and I obliged, and lo and behold, there was no more blood. ‘Well, that’s it then,’ I said, shrugging my shoulders.
‘No, you need a foetal heartbeat scan.’ She turned to my partner. ‘Get her registered.’
‘I’m already registered here,’ I said, and my partner began to fish around my wallet among the dozens of hospital registration cards I had accumulated over the years.
‘You are? Who is your gynaecologist?’
‘I don’t see a gynaecologist here. I’m here because this seemed to be an emergency.’
‘Who is your doctor here? Let me call him.’
I then had to explain to her that I had registered here four years ago to see their rather famous psychiatrist, exactly twice. It didn’t go well.
Her eyes widened. ‘Are you on psychotic medication?’ she asked.
‘What, no! I mean, there’s nothing wrong with being on…’
She pushed her face into mine. ‘Are you sure you are pregnant?’
I realised from her expression that she honestly believed that I was in some kind of delusional state of phantom pregnancy. By then, my partner had fished out the folic acid prescription from the previous doctor. She looked at it, and seemed slightly convinced.
I was ready to scream, but realised that I would play into a mental health stereotype if I did. Instead, I spent the next half an hour begging a radiology technician to perform a transvaginal ultrasound on me, which he refused, bashfully, as only a woman technician could do so.
‘Just put it in, it’s fine, my husband is standing right here and he’s totally on board. We won’t tell anyone.’
Life doesn’t imitate pornography. Who knew? Finally, with the audio and my bladder turned up to maximum, we heard our first heartbeat.
It was only when I was preparing to see my to-be-for-keeps ob-gyn that I looked at the papers we had collected from the hospital that night. On the patient history sheet, just below the note on my diclofenac allergy, was in large, all caps:
‘*WAS ON ANTI PSYCHOTIC MEDICATION TILL 2012’
I was angry, upset and confused. This was our first record of our baby’s being a thing, and it came with this complete falsehood. Was there an appeals process? I consulted my best friend, who had just had a baby herself.
‘Dude, when you are lying there with your legs open your file gets passed around the randomest of people. And you might not even be in a state to explain the whole randomness that led up to this. Trust me, get rid of the paper.’
I tore it up.
With our eventual ob-gyn, I was honest about everything, right from the moment she began to her asking us the all-important question: ‘So…how long have you been…’ I also told her about the smoking, drinking, and copious amounts of som tam. And then I told her about the antidepressants and the anti-anxiety and all the psychiatric medications I’ve ever been on. She wanted me to continue seeing my psychiatrist because she wasn’t sure how hormones would impact my mental health, try yoga, and talk to her about any concerns I had.
She was more concerned about our seven cats and toxoplasmosis.
I went to see my psychiatrist, who had just about gotten back from her own maternity leave. I sat down in the chair and said, ‘So, I’m pregnant.’
Her face broke out into the widest possible smile. ‘Oh my God Amba,’ she said, ‘This is amazing news!’ I was still recovering from her enthusiasm when she said, without missing a beat, ‘You’re going to be a fantastic mother.’
I had been under dialectical and cognitive behavior therapy with her for more than a year. This woman had read my journaling. I couldn’t ask for a vote of confidence from anyone else, honestly. She promised to help me out with my mental health concerns and also pregnancy and motherhood life hacks she had developed over the last year.
Eventually, my various privileges and accumulated social capital ensured a rather inclusive and positive experience. My ob-gyn and I learned to work around my mental health concerns and her litter box worries. In the end, I was a week overdue and she decided I had to be induced, since the baby just wasn’t budging. ‘How many squats are you doing?’ she asked.
I burst into tears. ‘I’m doing everything I can but the baby isn’t responding at all, what am I supposed to do?’
At the time I didn’t realise that this sentence pretty much sums up parenting during year one. The doctor ordered everyone else out of the room and asked me to talk to her, honestly. ‘What’s bothering you?’
‘What if things go wrong after induction? Can’t we just do a planned C-section?’
‘Everything is going to be okay,’ she said. ‘Tell me what you need.’
I told her that I needed to be given an explanation of everything that was going to happen during the procedure, and have all my bizarre questions answered. I handled a lot of medical negligence cases when I used to practice law and therefore had a very well informed imagination of what could go wrong.
My admit card still mentioned my anxiety and depression, but now, I was okay with that. It was a welcome distraction from the labour pains whenever a new duty doctor would come in, smiling and encouraging, and then their face would be in utter confusion when they looked at my medical history.
‘Are you okay?’ one of them asked, after visibly mouthing ‘anxiety.’
I was five hours into induced labour with only a nitrous oxide canister at my disposal for pain relief. I had dilated barely four cm. I was exhausted and frustrated, but apparently, I had a doctor to calm down here.
‘I’m fine,’ I smiled, beatifically.
She looked relieved.
The ‘not your first pregnancy’ issue was cryptically recorded as ‘G2A1’ on my admit card, and dutifully confirmed to me in excruciating detail in Tamil by every health worker who came to my bedside.
My mom, my completely unprepared labour coach, would ask: ‘What did she say?’
‘Who cares?’ I said, ‘Gimme another hit from the cylinder.’
Having expelled a 3.5 kg baby and more importantly, most of the rest of it (I remember shouting to no one in particular: ‘Is the placenta out? IS IT OUT?’ which was about the craziest I went the entire time), I lay down alone in the labour ward, free to trip on the various painkillers that were injected into me during the course of the very long day. I had a break from performing absolute sanity before my next role as a mother, which wouldn’t go as well as the pregnancy, but that’s a story for another time.
Amba Gauri is a disability and mental health rights activist based in Chennai.
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