Anxiety meds and homebirth

[hermanasista]

I'm 31 weeks and have dealt with anxiety for most of my life (GAD and panic disorder). Over the past ten or so years I have been on a rollercoaster of various meds. My most recent, and effective, regimen was a combination of Lexapro and Wellbutrin.

When DH and I started TTC last summer, I made a decision to wean myself off both meds, and did so successfully. I have gotten through most of my pregnancy med free. All of my ultrasounds have shown that the baby has developed properly, and everything looks healthy.

I am due at the end of May, and over the past month my anxiety has gotten steadily worse, prompting me to reinvestigate my options. I started seeing a psychiatrist a couple of weeks ago, and she decided that going back on the Lexapro was the best way to go.

I'm taking a very low dose (2.5mg) right now, but because I am planning a homebirth, I am feeling really torn about my decision to go back on meds. I judge myself horribly as it is (taking meds has always felt like a "cop out" to me), and would never want to do anything to jeopardize the health and well-being of my baby. I'm also pretty determined to have a homebirth. My psychiatrist is nervous about that, and I haven't spoken with my MW yet, but was wondering if anybody else has experience in this area. I sometimes engage in absolute thinking, which is never very useful...but I have begun to feel like I don't have options. Can anyone shed some light for me?

Thanks in advance for your words of wisdom!!!

[MsBlack]

I recently helped a mom who has been on Paxil for Panic Disorder for about 4yrs. She is also on a fairly low dose, btw, tho not as low as your dose. In any event, mainly we just kept a close eye on her mood and well being throughout her pregnancy. With that, in her case we discovered that she had a tendency to be hypoglycemic, and this tended to worsen panic and other symptoms. So she got very disciplined about frequency of eating and waaaay reducing sugar intake including fruit--this helped her enormously, she really had a hard time believing that there could be a connection but she was down to 5mg by her 8th month, felt good reliably and only had increase of angst on days when away from home and unable to eat as often as she should. I wonder if there might also be a connection there for you? I actually got this idea from another mw...apparently hypoglycemia can bring on anxiety/panic and a host of other physical symptoms (nausea, b/p issues, fatigue,...).

Anyway, this mom did great throughout, no variation through her perfectly normal labor (even tho she went nearly 2wks postdate for the 1st time). After the birth, I stayed in closer touch with her than I do with most moms for the first month (tho I tend to stay in pretty close touch with all of em for at least a week, then decreasing contact over next couple weeks). Anyway--while I think she appreciated the extra check ins, really by that time she had already learned what pushed her buttons (even apart from diet) and had gotten pretty dependable on her own behalf at keeping things chill in her space, and getting fam. help as needed. At 6wk visit, she was doing great--I did encourage her to feel free to call me if needed further, but all I've heard is from her SIL who told me recently that she's doing great, her best pp time so far (4th child).

Anyway--this mom had gone through another pregnancy with her disorder, but things did not go so well. Nothing really shattering, she did have a homebirth (diff. mw) but had a very hard time pp with anxiety/panic--at that time she was not aware of the hypoglycemia connection, for one thing. So I"m saying that for one thing, you would not be the first mom with this issue to have a homebirth! From my mw connections I have heard of many. Also, it is well worth it to explore dietary and other lifestyle issues (esp. exercise, something else that helped the mom I speak of) to help modulate your chemistry and stabilize your mood.

The thing is, you are well informed already. Nothing is likely to be able to sneak up on you. That is a really big plus IMO! So--I think you have every reason to believe that you'll do fine.

[Belleweather]

I had lots of pregnancy anxiety and was looking into meds during my pregnancy to handle panic attacks. Honestly, I think homebirth really helped me cope with the anxiety issues around birthing. I didn't have to go anywhere, and I was in a place that felt safe and comfortable where I knew that if I needed/wanted anything it was there. I'd recommend ignoring your psychiatrist unless he can tell you specific reasons that he has concerns based on your psych history rather than just what he remembers from his 6 week OB rotation in Med School. Talk to your midwife, and maybe focus on keeping the birth very low-key without a lot of extra personel involved, which I know can create a lot of extra stress.

[hermanasista]

So, so helpful!

Thank you both so much for your responses. Lots of great information for me to think about. I feel much better about the whole picture now. I think the thing that concerns me the most is the incidence of persistent pulmonary hypertension in babies who were exposed to SSRIs in utero. When I look online to find information, I find a myriad of medical opinions. Here are just a few:

Center for Women's Mental Health Blog
MedPage Today

Anyway, it's just good to know that I'm not alone in dealing with these difficult issues! I will continue to communicate with my MW, psychiatrist and therapist about all of this. Thanks again!!!

[MsBlack]

Yes, there are increased risks with the SSRIs. The family I mentioned and I worked through a lot of info and questions about this--her former mw was not aware of Paxil's link w/heart defects and stillbirth along with possibility of transient neonate issues such as the pulmonary hypertension you mention (withdrawal issues of various sorts). But I was aware of all this, and so we discussed it at various junctures, made plans that we intended to implement at any signs of these issues actually manifesting. Npne of those plans were needed, in the end--but it contributed to the parents sense of safety and well being to have info, and to make those backup plans. Of course, every homebirth needs a back up plan of some sort--theirs just included elements that would not be needed by moms/babies who were not on Paxil.

Just remember that a risk factor is only that, a risk not automatically a reality. For instance, if the risk of pulmonary hypertension is 10% (just to put a number on it, I don't know), this means that 10 in 100 babies will experience that, and that 90 out of that 100 will NOT. It does NOT mean that 100 women ALL have a 10% risk that might suddenly blow up to 100% certainty. Does this make sense? And of course, EVERY birth, no matter where or with who, carries risks of some sort--including risks inherent in every single medical treatment/drug/procedure known to the medical world for moms and babies in your position.

Birth is as safe as life gets; that is, there are no guarantees. We have to simply choose what feels safest for ourselves--and as Michel Odent increasingly points out, for a mom to feel SAFE is probably THE MOST IMPORTANT element contributing to a healthy pregnancy and birth. Maybe your baby will have breathing issues--it seems sane to me, and something that will serve your feelings of safety--to plan around that. I know that part of my plan w/mom mentioned above was to carefully monitor baby for heart defects throughout the first 4days (some defects do not manifest for a few days following birth). All this meant was that at birth, and every day for 4 days, I listened more carefully to baby's heart than usual, as well as having parents informed about what signs to watch for when I was not present. Really, except for visiting more often in those 4 days, it wasn't so different from any other family because I teach all fams about watching for adverse signs in baby over those first several days--and of course listen to baby hearts/lungs. In this case, the monitoring was simply stepped up a bit from usual...not different, just a bit more.

ANyway--I agree that I would not listen much to your psychiatrist on this issue. However, if s/he pushes the point, you might see if the psychiatrist will listen to you! That is, provide reading material on safety of homebirth for moms/babies like you.

all the best. I think you'll do great.

[DoomaYula]

One more perspective

I take medication for anxiety and depression. I did not take my anti-anxiety meds while pregnant, and I kept to the lowest dose I could with the antidepressant. I also saw my psych regularly.

I felt fine for most of my pregnancy, except for the last month or two, when my anxiety and depression really felt very strong. I send you big hugs, because I felt terrible during that time.

However, soon after giving birth, I felt so much better, emotionally, than I had in months. So perhaps after you give birth, you'll feel better also.