Moody Bitches: The Truth about the Drugs You’re Taking, the Sleep You’re Missing, the Sex You’re Not Having and What’s Really Making You Crazy.... Julie Holland

if my body were using chemical warfare to trick me into reproducing. For many of us, this sensation that our ovaries are hijacking our brains is overwhelming. Estrogen and testosterone levels conspire midcycle to make us act like cats in heat, and it becomes harder with every passing month to resist the tug to breed.

      In major metropolitan cities, the age for starting a family is higher than elsewhere. I have plenty of patients in their late thirties and even early forties who are still hoping to start a family. Many of us are getting our careers in order before we choose motherhood, something that was nearly always reversed just a few generations ago. The quality of eggs produced by the ovaries drops off substantially when you get to the early forties. Because of waiting longer to get started, many of my patients go from being on oral contraceptives for a dozen years or more to taking fertility drugs to help them get pregnant, barely stopping in between these two poles.

      Fertility drugs can be hard on moods. Clomifene, a medicine used to encourage the ovary to pop out a few extra eggs, can trigger massive PMS-type symptoms, as can many other hormones and follicle stimulators being used today to help women conceive. Hot flashes, emotional lability, irritability, and depression are all possible. Rare cases of psychosis or mania have also been reported.

      Nesting, the particular cleaning frenzy that occurs during late pregnancy, is a very real phenomenon. What’s less clear is whether there is some biological process that happens even before pregnancy to help us get our house in order. My sister got herself into fantastic shape before she got pregnant. She quit smoking cigarettes (no easy feat), stopped drinking, and lost weight, getting her body primed as a vessel for a fetus. I’ve seen it happen in my patients repeatedly. They want to go off their meds prior to conceiving and they do. Gynecologists will sometimes recommend that their patients stop their SSRIs, as serotonin increases prolactin levels, which can impair fertility. I also recommend that my patients lay off their nightly melatonin tablets, which also increase prolactin and lower follicle-stimulating hormone, both of which interfere with fertility.

      The decision to stay on meds or go off everything during pregnancy is difficult and complicated. Psychiatrists know that the high levels of stress and cortisol that accompany extreme anxiety and the poor self-care seen during depression are bad for a developing fetus, but what is less clear is how staying on psychiatric meds affects the baby. The risks are low but present. Depending on in which trimester SSRIs are taken, exposure is associated with preterm labor or miscarriage for the mother and cardiac defects, pulmonary hypertension, seizures, and withdrawal syndromes for the infant. There is some concern about a link between SSRI exposure and autistic spectrum disorders. One study reported that boys with autism were three times more likely to have been exposed to SSRIs in utero, while another said it was twice as likely. But other studies don’t bear this out.

      All of my patients would prefer to be medication-free during gestation, but a few have had to stay medicated because their symptoms were completely unmanageable off meds. This is especially true for women with bipolar disorder, where the risk of severe psychiatric symptoms often outweighs the risk to the fetus. For milder depression or anxiety, pregnancy is a great time to substitute other means of treatment, like psychotherapy, acupuncture, transcranial direct-current stimulation, or light therapy.

      When faced with an impending pregnancy, not only can my patients successfully taper off their SSRIs or ADHD meds, but they also can revamp their diet, exercise more, and stress less. Instinctively, we do things for our children that we wouldn’t do for ourselves, even before they exist. So, yes, our ovaries do hijack our brains, but in a way that helps us to protect and care for our offspring.

      During pregnancy, hormonal levels are actually more static than they’ve ever been in your life. You don’t cycle every month, so there’s no ovulatory horniness or premenstrual bitchiness. For many women, it’s a time of stability and quiescence. I’d been taught that pregnancy was “protective” against psychiatric complaints. Rates of depression are lower during pregnancy than at other times in the reproductive age, though some women may experience an increase in their OCD symptoms. (My assumption is that this is tied into the nesting impulse and its chemistry.) However, in women who are younger, have a history of depression, have fewer social supports, or are ambivalent about their pregnancies, depression may still occur.

      Certain symptoms, like fatigue or insomnia, are seen in typical pregnancies, as well as depression, which can make it hard to differentiate between the two. Many women report the worst sleep of their lives occurring during pregnancy. Insomnia comes toward the end of gestation as your mind races, worrying about everything that may go wrong with the delivery and all the years after, your bladder is being squeezed out by your uterus, and you’re trying to roll over in your bed when you’re the size of a manatee. It may be that your brain is trying to prepare you for what comes next. After delivery, life with your baby is punctuated by interrupted sleep, which may last for months or years. My advice to pregnant insomniacs: read a few books on nursing. It’s not completely intuitive, and there are things that can go wrong that are good to learn about ahead of time, not when your boobs are killing you.

      Birth and Nursing

      The way we give birth now is far removed from nature. It is medicalized, scheduled, and anesthetized, so that we’ve lost touch with the natural rhythm and timing of a normally progressing labor. We’re given oxytocin to bring on an unnaturally acute and painful process that then requires an epidural so we can tolerate it. Or we’re given an epidural that stalls the labor so we’re forced to use Pitocin to accelerate it. Once again, we are out of touch with our own bodies and our intuition of how a completely natural process should unravel, according to earth time, not obstetrician time. A flower’s maximal expression is in the fruiting, and fruit ripens at its own pace. This is why I, as a physician, chose midwives for both of my births. Doctors have a hard time doing nothing. It’s not in our nature.

      I know that medical interventions are sometimes necessary and life-saving, and I also know this is a touchy issue for many women. There is a certain pride in how we deliver, and it’s a shame and a disappointment when it doesn’t turn out the way we planned. I delivered both my children naturally, and while it was intensely painful, things progressed quickly, thanks to my nicely wide “birthing hips,” a part of my body I fully appreciated at least two days out of my life. During my short, sharp “natural” labor, I was pretty darn altered between the endorphins, endocannabinoids, and adrenaline. My pupils were dilated, and between contractions I kept remarking to my husband, Jeremy, how high I felt. (Endocannabinoids help to maintain a pregnancy, and they peak during labor induction.) Because there was no anesthesia involved, both my children were born awake, alert, and calm. I remember not quite connecting with the warm, slimy being placed on my chest in that birthing room. For a moment, I was at a loss. What have I done and what do I do now? But I placed her on my breast; she began to suck, and the oxytocin surge helped kick everything into gear. I was a mother all of a sudden, and I was all set.

      But for many women, nursing is hard, and sometimes painful until you get it right, but it’s important to remember, when you’re listening to your third lactation consultant or reading your fourth breast-feeding book, that it does have tremendous benefits. Breast milk contains everything that a baby needs and many things that