"High Risk" for emotional reasons????

[travelmumma]

Hey Mummas,

Breif run down- A traunmatic event took place in my life recently which has resulted in clinicaly diagnosed depression.. I have been put on medication that is safe to use during pregnancy (not pregnant yet- trying tho!!) which is great. However the doc said that because I am now on these anti-depressants that could catergorize me as "high risk" only for emotional reasons.

Has anyone heard of this before?

My heart is absolutely set on a home birth!

I understand that a physical high risk woman may be forced to move her birth to a hospital/birth centre in case something physically goes wrong- Placenta previa/high rish of blood loss etc.... But if my physical and emotional health are fine (Physically in good shape and by the time I am to gve birth I should be emotionally great too) would it still be wise for me to have bubba at home?

I really want this.. Thought some advice from the friendly Mummas would be good!

Thanks :)

[travelmumma]

I should also add that emotionally I would feel far more comfortable being at home rather than in the local hospital where I have known wommen who had episiotomies performed without permission!

[jenrose]

For just depression, and treated at that? Best to ask about risk out policies are the homebirth midwives in your area. 

Yes, some practitioners will risk people out for emotional reasons, but it's not usually depression alone. 

Also, most OBs won't touch me with a 10 foot pole, but I've not had much trouble finding midwives who are happy to work with me, and once I have a midwife happy to work with me, the perinatologist in town is happy to consult with them as needed. Most of my risk factors have little or nothing to do with pregnancy, those that have to do with pregnancy don't make the birth itself more dangerous.

Personally, I think homebirth actually has a lower risk of depression, and might be preferable for that reason alone, but then again, most of my risk factors would get exacerbated by a hospital environment anyway. 

[Kokolove]

He may have been referring to risks associated with anti-depressant use during pregnancy.  There is a small (but real) risk of respiratory distress in babies born to women on SSRI's.  It is pretty easily dealt with at the hospital (especially if they have a NICU), but would be too risky to have happen at home. 

When I was pregnant and had depression I read a book called Pregnant on Prozac.  It very dispassionately spells out all of the risks/benefits of antidepressant use during pregnancy.  It was a good source of information. 

[elus0814]

I would talk to a midwife. My experience has been that OBs slap a high risk label on way too many pregnant women, maybe they get more money from insurance for providing 'high risk' prenatal care? Why would they want someone with depression to have a sub par birth experience that might make the depression worse? I've been 'high risk' for several pregnancies but yet had a great homebirth. A good midwife will be upfront about what is and is not in her scope of practice, just start calling around.

[cameragirl]

There is also some risk of blood pressure issues with some SSRI's during the third trimester. It is theoretical really, but it could happen. You can switch medications to prevent that being a risk. I don't believe that depression by itself would be a high risk situation, unless the mother were so seriously depressed that she might harm herself or the baby. I dealt with depression while pregnant with DD, and was considered low risk. If there is a concern about medication, you can consult with a perinatologist about the medication. I'm pretty sure that they wouldn't bat an eye at it. I have to take Ativan or Valium, as well as pain medication as needed for muscle rigidity, and I am still considered low risk after consulting a perinatologist.

[travelmumma]

Thanks for that Mummas.

The meds that I am on run no risk of problems for baby or me, and have been proved as the safest anti depressants for pregnant woman- so I don't think it is high risk in that area.

As for the depression itself, I am in no way self harming or but harming at all....

I think that the best thing to do would be to just call the midwives and explain??

And keep my fingers crossed?!

[jennybear]

Originally Posted by travelmumma 

Thanks for that Mummas.

The meds that I am on run no risk of problems for baby or me, and have been proved as the safest anti depressants for pregnant woman- so I don't think it is high risk in that area.

As for the depression itself, I am in no way self harming or but harming at all....

I think that the best thing to do would be to just call the midwives and explain??

And keep my fingers crossed?!

All anti-depressants will provide some degree of risk for you and baby. That doesn't mean that being on them is not absolutely the best thing for you to do, but all medications will carry some risk. For example, Zoloft (often the "go to" choice for pregnant and nursing moms) is now part of a class action lawsuit because some experienced birth defects. I still decided (in consult with my pediatrician, OB and psychiatrist) to be on Zoloft while nursing because the benefits far outweighed the risks and that very well may be the case for you.

Still, though, if it's an SSRI (like zoloft, prozac, etc.) it very well could be about potential lung issues/other complications after birth. I'd have a candid talk with your midwife and see what she thinks. 

[IdentityCrisisMama]

There are more than a few categories of risk that some OBs consider high that a homebirth MW wouldn't.  Maternal age, fetal position, maternal weight all come to mind.  It doesn't seem like something to worry about to me.  Besides, it's not a doctor who will decide if you are high risk - it'll be your MW.  Many MWs will do a pre-pregnancy visit and they may be even more willing considering your circumstances.  Perhaps it would put your mind at ease to meet one now?  

[tis_unnatural]

Sorry, I know it's been a couple months since you posted this, but I was kind of shocked by some of the responses you got! I've been on prozac for many years and had a completely uneventful, safe, free standing birth center birth with a midwife. I talked to both my psychiatrist and my midwife about the possible risks associated with being on prozac while pregnant and having an out-of-hospital birth and they both agreed that the risks were very minimal and I didn't have anything to worry about. And they were right. I'm still on prozac and am planning a homebirth with my current pregnancy, and again my midwife isn't the least bit concerned as it doesn't classify me as a "high risk pregnancy". I honestly had never even heard of that being a possibility until now!

Good luck!