So you decided to continue taking your antidepressant during pregnancy...which may be paxil, lexapro, citalopram, prozac, zoloft, effexor, cymbalta..or so on.
You may have discussed with your provider that overall, this is safe. And this is true. There is a lot of evidence showing that there are no long term issues with babies exposed to antidepressants in-utero. This includes no evidence of birth defects, learning disabilities, IQ changes, etc.
Ultimately, the risk of untreated depression is significantly worse than the risk of taking one of these medications. Being stable and content during your pregnancy is going to make a bigger difference in your infant. Your baby feels what you feel during pregnancy - and you want them to feel your stability.
But there are still possible effects to your baby of taking these medications. About 30% of babies exposed to antidepressants will end up with some physical effects -- tremor, jitteriness, high pitched cry, poor sleep/suck, exaggerated reflexes, etc.
I recently had my second baby -- and this is my second pregnancy on my antidepressants (Lexapro + Wellbutrin). I love being open about this to defeat any stigma people may have in taking their medications during pregnancy.
With this as my specialty and career, I've done all the research and was aware of the risks to myself and my babies.
My first baby had absolutely none of the possible withdrawal symptoms that can occur.
My second baby, however, did. And I'll be honest - it threw me off.
I expected her to be fussy, irritable, a little jittery, and maybe not do great with eating and sleeping.
But she presented a little different than that. She wasn't fussy, irritable and didn't really cry. She slept and ate well.
Her body was "hypertonic" -- this means that her muscles were essentially all contracted. When she was born, she looked like she was "planking." If you've ever seen the newborn scrunch, she didn't have that. She is stiff like a board. Her feet didn't really relax, they were kind of..bent upward which could have also been position in the womb.
She also had pretty intense tremors to the point of worrying me that they could potentially be seizures. Infantile spasms are a medical emergency, so this was obviously a concern to me. When she slept, her entire body shook violently. Apparently, if you apply firm pressure to the tremoring limb and it stops, its a "myoclonic jerk" which isn't a seizure. It's just a thing that happens. It's a thing that happens to babies exposed to antidepressants -- and the baby is unaware of it. It doesn't hurt.
She had some temperature instability - being very cold followed by fevers. She had a stuffy nose, quite a few sneezes and intense breathing spurts (also called "tachypnea").
Many studies say this typically occurs within a few hours after birth and resolves within 72 hours or so. Her temperature instability, stuffy nose, sneezing and breathing regulated within that time period. Her tremors and tense little muscles continue -- although continue to decrease. We're currently at week 3 tomorrow.
So let's say you have a baby in the 30% -- what can you do to support them?
Humidifier in the room can be beneficial! Don't use a nasal suction bulb.
Hypertonia and Tremors
Craniosacral therapy. This has been a gamechanger for us. It is described as a "massage for the nervous system." It looks like they aren't doing much, but it's like voodoo..I swear. Her body relaxed immediately and it's made a MAJOR difference to helping her. Her muscles are significantly looser after a visit. They also help you learn exercises to do at home to help.
Chiropractic Care. A lot of people swear by this for helping the baby's body to relax. And no, they aren't cracking a baby's neck. It's gentle pressure like a massage on the body for the most part.
Physical therapy could be an option if hypertonia continues. This requires a referral from the pediatrician and would help you learn some exercises to help the muscles loosen up.
Breastfeeding can be beneficial -- I noticed on the one day I forgot my medication, her tremors were significantly worse. A few hours after taking my missed dose, they went back down again. If you think about it, it's like giving them small dosages to wean down from through your milk.
Irritability, Breathing, Temperature, Appetite & Sleep
Skin to skin cuddles. This helps babies regulate temperature to our temperature. It also helps reduce irritability, regulate their breathing and helps them sleep soundly.
Light and sound can be really overstimulating. Keep the baby in a cool, dark, quiet, less stimulating room. You can try lullabies or some white noise. During times Noemi appeared fussy, I'd go lay down in a dark room with her and she'd fall asleep pretty quickly.
Keep a thermometer nearby and keep tabs on body temperature. Adjust clothing accordingly - baby may need to be in a diaper not a thick onesie for a bit if they have a fever.
Swaddling and paci's!
Firm pressure & gentle rocking. Swings can also be helpful. But make sure baby isn't getting overstimulated by this.
Small feeds. Some babies do get reflux/vomiting so go frequent and slow.
Parenting + Guilt
Remember that this is transient. This is not harmful to your baby in the long term. You did the best thing for your baby, your family and yourself by getting care to keep yourself going.
Remember, the risks of not being treated were worse - and things could have resulted in miscarriage, a preterm labor, lower birth weight, etc. etc.
It's easy to feel guilty. Like if I was "normal" and didn't need medication, my baby wouldn't be going through this. I am there with you.
Self-care. Be kind to yourself. Seek support in friends or family.
If you have a parent, in-law, friend or the ability to have a postpartum doula come and help you throughout this time, that could be incredibly beneficial to your mental health.
Remember that this is your time to bond with baby and heal. Your body just went through something crazy and intense. Give yourself grace and space.
If you have concerns about your baby not looking as pink, not eating well, the tremors, etc..it never hurts to go get them checked out at the pediatrician.