According to Roni Caryn Rabin of the Times, the report, published by members of the American Psychiatric Association and the American College of Obstetricians and Gynecologists, recommended that doctors try talk therapy first if a woman's depression is mild or moderate. But it also said that the risks of antidepressant use and shock therapy on the developing fetus are low. Dr. Kimberly Yonkers, the lead author of the report, says,

There's not a one-size-fits-all answer. You can't say, ‘Stop medication for all women because it's harmful,' and you can't put all women on medication either.

Most pregnant women can probably agree that there is not a one-size-fits-all answer to their depression (for proof, check out the Times commenter who says she cured her PPD by drying and eating the placenta). But beyond that, the report may not give them much guidance. The authors still caution that because of the lack of randomized clinical trials on pregnant women, research on drug side effect is limited. And four of the report's nine authors had some connection to drug companies, casting all their drug recommendations into a certain amount of doubt.

Paxil, Celexa, and Zoloftall seem to increase the risk that a baby will be born with a hole in the heart. The holes often close on their own, and the risk of the defect is less than 1%, but it increases if the mother took more than one SSRI. SSRIs can also raise the risk of persistent pulmonary hypertension, a condition that impedes blood flow to the baby's lungs, but the risk of this is also low, about 1.2%. Perhaps the greatest risk is that of drug withdrawal, experienced by 15 to 30% of babies born to moms who took SSRIs late in pregnancy. This can cause irritability, hypoglycemia, and even seizures in babies, but usually gets better within two weeks. Untreated depression, of course, has its own risks. In addition to the dangers to the mother, it may contribute to premature birth, growth changes, or irritability in babies.

Not all clinicians even agree with the report's relatively mild recommendations. Dr. Shari Lusskin says,

By the time I get to hear about somebody's perinatal depression, it's usually worse than what can be treated with psychotherapy alone, because women go out of their way not to complain; they don't want to be put on medication, and they feel guilty. We should use a low threshold for treating women aggressively.

And though the report emphasizes the relatively small risk of drug side effects, many women aren't reassured. One commenter on the Times Well Blog, who suffers from bipolar disorder, wrote,

I've been stable for a long time, but going off all my medication might change that. A high-risk perinatal physician recommended that I stay on everything, because depression and manic psychosis may be harmful to the baby. But my psychiatrist recommended ceasing all medication for at least the first trimester, which is the phase where the developing embryo is most sensitive to mutagens. Her recommendation is that I should go off everything and then, if I have a problem, I should use electroshock therapy. I have decided that this is the right path to take. But I'm still putting it off.

Rabin interviews Sherean Malekzadeh Allen, who says, "Every single thing you put in your body when you're pregnant, you wonder, ‘Oh, my God, am I growing my baby an extra finger?' I was worried that I would hurt the baby if I took the pills, and I was worried I would hurt the baby if I didn't." She was so anxious about hurting her baby with her medication that, "I would wait six or seven hours before taking the pill, and just work myself up into more of a state." Ultimately, her son was born healthy.

Given the low risk of serious birth defects from antidepressants, Allen's story — in which the biggest side effect is maternal guilt — is probably the most common. The APA/ACOG report may have its problems, but at least it doesn't issue any blanket pronouncement that might add to this guilt. It may not be a very useful guideline, but it's true that depression, whether during pregnancy or not, should be evaluated on a case-by-case basis, and that what works for some sufferers won't always help others. For those pregnant women who respond well to talk therapy, the choice seems clear. But those who need medication have to balance the risks to their babies with the benefits of having a happy, healthy mother. Like so many aspects of parenting, this balance is individual, and the report deserves praise for acknowledging that.

Image via New York Times.

Depression Is A Dilemma For Women In Pregnancy [NYT]
Coping With Depression During Pregnancy [NYT Well Blog]

Yesterday the Cosmetic Physicians Society of Australasia (CPSA) urged its members not to administer Botox to pregnant women following reports linking a woman's use of the toxin during her pregnancy in 2005 to her child being born deaf and blind. The woman did not use Botox, but a rival botulinum type A toxin called Dysport during her first trimester according to information obtained through Freedom of Information laws. The birth defect was among 46 different adverse reactions to the toxin reported to Australian authorities since 1994. The CPSA said that though "botulinum toxin has a long history of efficacy and a robust safety profile," it should not be administered during pregnancy and breastfeeding, or when the patient has glaucoma or neuromuscular disease. [The Sydney Morning Herald]

• Abortion will cause you eternal damnation, unless you are Catholic and feel really bad, promise your priest not to do it again and say a gazillion Hail Marys.
• Abortion — and particularly multiple abortions, you libidinous, unfeeling slut — will render you infertile. It could be medical, it could be karmic retribution, no one really knows.
• Every woman that has an abortion gets breast cancer. The mere act of sucking a human baby out of your uterus causes cancer cells to start forming in your breasts and there's nothing that can be done.
• If you manage to escape God's retribution for your immoral acts and do get pregnant after an abortion, you'll likely just miscarry or have an ectopic pregnancy. If you actually manage to carry the child to term, having aborted another child, God will visit upon your new baby birth defects or low birth weight, if He doesn't just kill your baby entirely.
• You'll basically want to kill yourself from the guilt after an abortion, and will definitely have a mental breakdown from realizing the consequences of your actions. This will manifest as depression, schizophrenia, alcoholism, or Leslee Unruh.
• Abortion will cause every woman who has one to end up not pregnant.

It's so hard to separate the myths from reality sometimes, I know.

Photo via Amelee/Deviant Art

Abortion Not Seen Linked With Depression [Reuters]

Related: Abortion Myths [National Abortion Federation]
Top 10 Anti-Abortion Myths [Ask.com]
courtesy of Amelee
Abortion Myths: Fact vs. Fiction [TeenWire]
Post Abortion Syndrome [National Abortion Federation]

Earlier: Abortion In New Zealand
The Many Contradictions Of Leslee Unruh, Anti-Abortion And "Purity" Advocate

Two years ago, researchers in Oregon attempted to create homosexual sheep by interfering with the hormones to which they were exposed in utero, which scientists are beginning to believe might be the development factor underpinning human sexuality. The Reverend Joseph Fessio said: "Same-sex activity is considered disordered. If there are ways of detecting diseases or disorders of children in the womb that respected the dignity of the child and mother, it would be a wonderful advancement of science." The Southern Baptist Theological Seminary President R. Albert Mohler suggested that one way to reconcile this information would be to treat homosexuality like an actual birth defect and said, "We should have no more problem with that than treating any medical problem."

Of course, researching and "treating" sexual orientation in utero would take years and untold millions of dollars to develop, but it's great to know that the Catholics and the Baptists are happy to spend the money and/or allow women and their unborn children to risk harm (because there's a risk of harm in every medical procedure) if it allows the mother and father of said unborn child the assurance that they little boy will never fall in love with another man or their little girl will never have the urge to marry another woman. Of course, the first stage in the process would likely be a test to see if the child was eventually going to be gay which would allow women to choose to abort gay fetuses (as they can now choose to abort severely disabled children or girls, if they so desire), so heading down this path might actually lead to more abortions but I'm sure the committed Christians who would be concerned for their gender of their child's eventual life partner totally wouldn't do that.

To point out, there's very little (if any) research done into how to prevent the development of cleft lips and palates, which result in an actual physical deformity that can be severe and, as Operation Smile highlights, repairing the defect is by no means a given in many places in the world. But, hey, no reason to spend money to research preventing a defect that you can just get a little surgery to fix. A cleft palate need only be temporary, but gay is for life.

Cindy McCain Does Charity in Vietnam [Time]
The Gay Culture War Is About To Turn Chemical [Slate]
Southern Baptist Seminary Leader Takes Heat for 'Is Your Baby Gay?' Article [Fox News]

Related: Operation Smile

Here, you can see more clearly that she was basically joined at the pelvis with the headless body of the absorbed twin. Yeah, it was a little disturbing writing that.

Here's little Lakshmi post-up, with only 4 limbs and one pelvis to her name. From my complete non-medical perspective, I am totally impressed with the doctors and not at all surprised that the surgery took 24 hours.

Girl Born With 8 Limbs Conscious, Smiles [Yahoo News]