* Do not spend a lot of time alone. Get dressed and leave the house.

* Run an errand or take a short walk.

* Spend time alone with your husband or partner.

* Talk with other mothers, so you can learn from their experiences.

* Join a support group for women with depression. Call a local hotline or look in your telephone book for information and services.

* Don't make any major life changes during pregnancy. Major changes can cause unneeded stress. Sometimes big changes cannot be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

How is depression treated?

There are two common types of treatment for depression.

* Talk therapy: Talk therapy: This involves talking to a therapist, psycholo-gist, or social worker to learn to change how depression makes you think, feel, and act. This involves talking to a therapist, psycholo-gist, or social worker to learn to change how depression makes you think, feel, and act.

* Medicine: Medicine: Your doctor can give you an antidepressant medicine to help you. These medicines can help relieve the symptoms of depression. Your doctor can give you an antidepressant medicine to help you. These medicines can help relieve the symptoms of depression.

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Emotional Concerns and Pregnancy Women who are pregnant or breastfeeding should talk with their doctors about the advantages and risks of taking antidepressant medicines. Some women are concerned that taking these medicines may harm the baby. A mother's depression can affect her baby's development, so getting treatment is important for both mother and baby. The risks of taking medicine have to be weighed against the risks of depression. It is a decision that women need to discuss carefully with their doctors. Women who decide to take antidepressant medicines should talk to their doctors about which antidepressant medicines are safer to take while pregnant or breastfeeding.

Can untreated depression harm my baby?

Depression not only hurts the mother, but also affects her family.

Some researchers have found that depression during pregnancy can raise the risk of delivering an underweight baby or a premature infant. Some women with depression have difficulty caring for themselves during pregnancy. They may have trouble eating and won't gain enough weight during the pregnancy; have trouble sleeping; may miss prenatal visits; may not follow medical instructions; have a poor diet; or may use harmful substances, like tobacco, alcohol, or illegal drugs.

Postpartum depression can affect a mother's ability to parent. She may lack energy, have trouble concentrating, be irritable, and not be able to meet her child's needs for love and affection. As a result, she may feel guilty and lose confidence in herself as a mother, which can worsen the depression. Researchers believe that postpartum depression can affect the infant by causing delays in language development, problems with emotional bonding to others, behavioral problems, lower activity levels, sleep problems, and distress. It helps if the father or another caregiver can a.s.sist in meeting the needs of the baby and other children in the family while mom is depressed.

All children deserve the chance to have a healthy mom. All moms deserve the chance to enjoy their life and their children. Don't suffer alone. If you are experiencing symptoms of depression during pregnancy or after having a baby, please tell a loved one and call you doctor or midwife right away.

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Pregnancy and Birth Sourcebook, Third Edition Section 14.2 Stopping Antidepressant Use May Pose Risks to Pregnant Women From "Stopping Antidepressant Use While Pregnant May Pose Risks,"

by the National Inst.i.tute of Mental Health (NIMH, www.nimh.nih.gov), part of the National Inst.i.tutes of Health, February 1, 2006.

Pregnant women who discontinue antidepressant medications may significantly increase their risk of relapse during pregnancy, a new study funded by the National Inst.i.tute of Health's National Inst.i.tute of Mental Health found.

Women in the study who stopped taking antidepressants while pregnant were five times more likely than those who continued use of these medications to experience episodes of depression during pregnancy, reported Lee Cohen, MD, of Ma.s.sachusetts General Hospital and colleagues in the February 1 [2006] issue of the Journal of the Journal of the American Medical a.s.sociation American Medical a.s.sociation.

Depression is a disabling disorder that has been estimated to affect approximately 10 percent of pregnant women in the United States. Recently there has been concern about the use of antidepressants during pregnancy; however what has not been addressed is the risk of depression recurrence should someone discontinue antidepressant use. This study sheds light on the risk of relapse a.s.sociated with discontinuing antidepressant therapy during pregnancy.

In the study, Cohen and colleagues enrolled pregnant women already taking antidepressants and then noted how many of the women decided to stop taking their medications. They then a.s.sessed the risk of relapse for the women who stopped versus maintained antidepressant therapy.

Contrary to the belief that hormonal changes shield pregnant women from depression, this study demonstrates that pregnancy itself is not protective. Among the pregnant women who stopped taking antidepressants, 68 percent relapsed during pregnancy compared to 26 percent who relapsed despite continuing their antidepressants.

Among the women who discontinued use and relapsed, 50 percent 120 Emotional Concerns and Pregnancy experienced a relapse during the first trimester, and 90 percent did so by the end of the second trimester.

This study demonstrates the importance of weighing the risks not only of antidepressant use, but also the risk of relapse should antidepressants be discontinued. It highlights the importance of women discussing with their physicians their own individual risks verses benefits of continuing antidepressant use during pregnancy.

Section 14.3 Abuse during Pregnancy Affects One in Five Pregnant Women "Abuse During Pregnancy," 2008 University of Pittsburgh Medical Center (www.upmc.com). Reprinted with permission.

Abuse during pregnancy is more common than most people think.

About one in five women may suffer abuse when they are pregnant.

Abuse can start during pregnancy or get worse.

What Is Abuse?

Abuse includes physical hurting, like slapping, hitting, kicking, and punching. But it also can include verbal hurting, like being called names and being accused of doing things you have not done. Abuse can also include being forced to have s.e.x against your wishes or being made to do things s.e.xually you do not want to do.

Abuse can include threats and control. The abuser may try to make you behave in a certain way and may say something bad will happen to you if you don't. The abuser may try to keep you from seeing your family and friends. He or she may make you explain in detail what you do each day, where you go, and whom you see and talk to.

Women who are abused during pregnancy often feel confused and embarra.s.sed. They ask themselves, "How can this be happening to me?" There is nothing to be embarra.s.sed about. The abuser is to blame.

Abuse is never your fault.

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Pregnancy and Birth Sourcebook, Third Edition What Sparks Abuse during Pregnancy?

Adjusting and adapting to a pregnancy and a new baby can be very stressful for both partners. Some reasons why abuse happens during pregnancy may include the following: * Your partner is angry because the pregnancy was unplanned.

* Your partner feels anxious and angry because the baby you are having has come too soon after the last baby.

* Your partner feels jealous of the baby.

Remember: There is no excuse for abuse!

Results of Abuse Abuse affects your mind and body. Here are some of the effects it can have: * You may have anemia (too few red blood cells), because you are not eating right or getting enough vitamins and iron.

* You may have bleeding during the first and second trimesters.

* You may not gain enough weight during the pregnancy.

* You may have more infections.

* Your baby may be too small at birth or may be born too early.

* Your baby may have problems after birth.

* You may feel depressed (sad and blue).

* You may feel anxious, upset, lonely, and worthless.

* You may not like yourself.

* You may be at risk for unhealthy behaviors, such as smoking or abusing drugs and alcohol during the pregnancy.

* You may not receive important regular prenatal care.

Are You Being Abused?

Many women don't want to accept the reality that they are being abused. Many just don't realize that their partner's actions are abusive. Here's how to know if you're being abused: 122.

Emotional Concerns and Pregnancy Does your partner: * physically hurt you by hitting, slapping, grabbing, or kicking you?

* threaten you or talk about killing himself, you, and/or your children?

* seem depressed and hopeless about feeling better?

* keep weapons (guns, knives) in the house?

* keep track of all your time, where you go, and your relationships with others?

* tell you that there will be no future if you leave?

* use alcohol and/or drugs?

* threaten to hurt your pets or destroy your belongings?

* seem to be more violent as time goes on?

If you answered "yes" to three or more of these questions, you are probably being abused. You may be at high risk for being hurt or even killed by your partner.

Planning for Your Safety Consider obtaining a Protection From Abuse (PFA) order. The PFA is a legal doc.u.ment granted by the court that prohibits your abuser from any form of contact with you.

Here are ways to plan for your safety so you can act quickly if you need to get away: * Think of a safe place you and your children can go. Talk to someone you trust about your plans.

* Practice how to get out of your home safely through doors, windows, stairwells, elevators, and fire escapes.

* Remove all weapons from the home, if you can do this safely.

* Learn the phone numbers for the local police and women's shelter.

* Keep an extra set of car keys or money for a bus or cab in a safe place. Make sure you can get to them quickly.

* If you are planning to leave permanently, it will help if you have money, keys, extra clothing, and important papers ready to take with you.

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Pregnancy and Birth Sourcebook, Third Edition At the time of a violent argument: * Avoid a room with only one exit.

* If you are in danger, scream so that your neighbors can hear you.

* If you must leave the children in the home, call police immediately after you get to a place that is safe.

* If you have left after a violent argument, check yourself and your children for injuries, and go to the nearest hospital for care.

Effects on Children Children who grow up in the midst of violence and abuse often are deeply affected by what they witness. Protect your children, and protect yourself. Keep in mind that a partner who abuses women during pregnancy is more likely to hurt children. Seek help for your children and yourself if you are being abused.

How to Get Help Contact your local women's shelter, or talk to your doctor, nurse, midwife, or social worker about what is happening to you. These staff members know about abuse and are trained to help you in this situation. All information you give is confidential.

For confidential help and information, call toll-free 800-799-SAFE (7233). If you are hearing impaired, call (TDD) 800-787-3224.

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Chapter 15.

The Three Trimesters of Pregnancy: You and Your Baby Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters.

First Trimester (Week 1Week 12) During the first trimester your body undergoes many changes.

Hormonal changes affect almost every organ system in your body.

These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant.

Other changes may include: * extreme tiredness; * tender, swollen b.r.e.a.s.t.s (your nipples might also stick out); * upset stomach with or without throwing up (morning sickness); * cravings or distaste for certain foods; * mood swings; * constipation (trouble having bowel movements); * need to pa.s.s urine more often; * headache; Excerpted from "Stages of Pregnancy," by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, March 2009.

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Pregnancy and Birth Sourcebook, Third Edition * heartburn; * weight gain or loss.

As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals.

Fortunately, most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all. If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.

Second Trimester (Week 13Week 28) Most women find the second trimester of pregnancy easier than the first. But it is just as important to stay informed about your pregnancy during these months.

You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!

As your body changes to make room for your growing baby, you may have: * body aches, such as back, abdomen, groin, or thigh pain; * stretch marks on your abdomen, b.r.e.a.s.t.s, thighs, or b.u.t.tocks; * darkening of the skin around your nipples; * a line on the skin running from belly b.u.t.ton to pubic hairline; * patches of darker skin, usually over the cheeks, forehead, nose, or upper lip (patches often match on both sides of the face; this is sometimes called the mask of pregnancy); * numb or tingling hands, called carpal tunnel syndrome; * itching on the abdomen, palms, and soles of the feet (Call your doctor if you have nausea, loss of appet.i.te, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem); * swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.) 126.

The Three Trimesters of Pregnancy: You and Your Baby Third Trimester (Week 29Week 40) You're in the home stretch! Some of the same discomforts you had in your second trimester will continue. Plus, many women find breathing difficult and notice they have to go to the bathroom even more often. This is because the baby is getting bigger and it is putting more pressure on your organs. Don't worry; your baby is fine and these problems will lessen once you give birth.

Some new body changes you might notice in the third trimester include: * shortness of breath; * heartburn; * swelling of the ankles, fingers, and face (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia); * hemorrhoids; * tender b.r.e.a.s.t.s, which may leak a watery pre-milk called colostrum; * your belly b.u.t.ton may stick out; * trouble sleeping; * the baby "dropping," or moving lower in your abdomen; * contractions, which can be a sign of real or false labor.

As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth ca.n.a.l (v.a.g.i.n.a) to open during the birthing process. Your doctor will check your progress with a v.a.g.i.n.al exam as you near your due date.