Secrets: Fetal Position

TV sports anchor Leslie Gudel expected to be glowing, with her second baby on the way. So why was she crying all the time?

Leslie Gudel was 13 weeks pregnant with her second child. It was a Friday. She was sitting on the couch in her living room in Berwyn, watching her 14-month-old daughter Kendall toddle around and jump up and down, goading her mom to play with her. But Gudel couldn’t even think about playing. All she could think was Please sleep. Please lie down with Mommy. Please let Mommy sleep.

Wanting to sleep wasn’t so unusual; she’d been exhausted during her first pregnancy, too. But not like this. Gudel, now 40, wanted to sleep all the time. All the time. In fact, she really didn’t want to do anything else. She didn’t want to wake up in the morning. She didn’t want to talk to people, which posed quite a problem at Comcast SportsNet, where she worked as an anchor, going on the air every night at 6:30, needing to appear together and peppy and commanding whether she was tired or not. But all she wanted to do was sleep. And cry. And fight with her husband Jamie, who, when he left the house for work that morning, dressed in his state trooper gear, turned to her, utterly confused by her behavior, and said, “You don’t even like me. You have no interest in me at all. You don’t like me.”

Gudel had to do something. This wasn’t just pregnancy hormones knocking her out of whack, as she’d been trying to convince herself for weeks. This wasn’t a momentary dip in her mood. Pregnancy wasn’t supposed to be like this. She was supposed to be thrilled. On top of the world. Glowing. This wasn’t normal. She decided to pack up Kendall and head to the Shore for the night. Get a hotel room. Walk the beach. Sort this out. She could get over this. She could conquer it just as she had conquered everything her whole life, the way she played sports, mentally psyching herself up to run faster, to row farther, to win. She would just put her mind to it, figure it out, beat it down.

But before she called Jamie and told him where she was going, she decided to try one more thing. She turned on her computer, linked to Google, typed in “pregnancy and depression.” Omigod, she thought, as she scanned the results on the screen. One in five women experienced depression during pregnancy. (Why wasn’t there any discussion of this in What to Expect When You’re Expecting?) Gudel had almost all the symptoms — lack of motivation and focus, excessive fatigue, general malaise, though no thoughts about hurting herself or anyone else. At least, not yet.

She called her doctor right away.

“You have antepartum depression,” said Wendy Manko, her ob-gyn at Women for Women at Main Line Health. Firmly. Without hesitation, as though she’d had this call many times before. Because she had. At least 10 percent of the patients in her practice show signs of depression when they’re pregnant. And Manko had suffered from antepartum depression herself.

Of course, all women are at high risk for depression — twice as likely to get it as men — so why wouldn’t it sneak up during pregnancy, just as it does after? It was probably Brooke Shields and her book, Down Came the Rain: My Journey Through Postpartum Depression, as well as her public war in 2005 with Tom “Mr. Anti-Antidepressants” Cruise, that got everyone seriously talking about motherhood and postpartum depression, which actually doesn’t affect any more women than the antepartum type. But antepartum has been largely ignored. Until recently, most physicians simply dismissed any signs of emotional upheaval during pregnancy, which could be anything from severe impatience to loss of appetite to suicidal thoughts, and could be caused by anything from hormones to a history of depression to just feeling ugly and fat. Of course, as with all depression, the line between what’s expected as a part of life and what’s beyond expected is fuzzy.

“Doctors would say, ‘Everyone cries,’” explains Manko’s colleague Karen Kleiman, the executive director of the Postpartum Stress Center in Rosemont. “It’s almost patronizing.” And patients would be left wondering what was normal and what wasn’t, and how bad they had to feel before someone decided they needed help.

Apparently, Leslie Gudel was feeling bad enough. Manko called in a prescription: 50 milligrams a day of Zoloft, an antidepressant that, as a selective serotonin re-uptake inhibitor (SSRI), was considered safest for pregnant women and their babies, though there’s no definitive evidence that any antidepressants are totally risk-free, given that it’s difficult to conduct studies on pregnant women. The Zoloft didn’t kick in right away. The following week, when Gudel and her husband went to a friend’s wedding in Avalon, she sat next to another pregnant woman, a good friend of hers who was as glowing as glowing could be. Gudel couldn’t help but think I hate you right now. Her doctor had warned her it would probably take three or four weeks to get the full effect of the Zoloft. Even so, and despite the wedding incident, she already felt like a huge weight had been lifted off her shoulders. So did Jamie. Depression — that was something they could identify with. Something they could understand. Something that could be treated. And it was. Within a few weeks, Gudel felt like herself again.

Had Gudel called Dr. Manko this past spring instead of in 2005, however, her treatment might not have been so clear-cut. So far this year, two studies have challenged the safety of SSRI drugs for pregnant women. One says that almost a third of babies suffer through a couple days of withdrawal — fast breathing, jitteriness. The other says that taking SSRIs late in the third trimester may increase the risk of a newborn developing pulmonary hypertension, a severe, life-threatening lung disease — though the risk is still less than one percent.

“For the past several months, we’ve been looking at each other, asking ‘Now what do we do?’” says Nancy Roberts, chair of obstetrics and gynecology for Main Line Health. But she’s advising her staffers to do what they’ve always done: thoroughly research their patients’ health, find out if they have a history of depression, counsel them about their choices. Of course, ob-gyns aren’t experts in diagnosing and treating mental illness, which is why physicians at Main Line Health refer questionable patients to mental health professionals for evaluation.

“Obs often miss it,” says Karen Kleiman. “They’re not asking the right questions, because they don’t know what to ask, and moms aren’t telling them.” Conversely, she says, “Some obs are handing out Zoloft like it’s candy.” Kleiman thinks of antidepressants as a last resort (unless the patient is suicidal: “Then we don’t wait five minutes”). She and her staff will meet with the entire family, will try talk therapy, will try hypnosis. But in the end, she’s just as concerned about the fetus being exposed to depression as to antidepressants. Depression can cause premature labor or a low birth weight. Plus, pregnant women who are depressed don’t sleep well, don’t eat well, don’t take care of themselves — and all of that can, of course, adversely affect the baby’s development.

On October 5, 2005, at 8:25 in the morning, Leslie Gudel gave birth to a nine-pound, eight-ounce baby boy. They named him James Chase. He was perfectly healthy, a dream baby, happy all the time. Gudel stayed on the Zoloft for a while to ward off any postpartum, then started weaning herself off the drug when Chase was about seven weeks old — around the time she had drinks with her friend Gail Harrington, who’d given birth to her daughter Kira a month before.

“I was so depressed when I was pregnant this time,” Gudel told her.

“Me too.”

“You too?” Gudel asked. “I went on Zoloft.”

“Me too,” Harrington said, as surprised as she’d been in the doctor’s office a year before when she discovered that, yes, women have an increased risk of depression during pregnancy. Harrington was thinking she was going to have this great, happy experience when she was pregnant. Everyone expected her to have a smile on her face all the time. God forbid she would complain.

But Gudel wasn’t surprised. She was used to it by then. It seemed like everyone she confided in had experienced depression in one way or another; they were all on antidepressants or knew someone who was. No. What surprised Gudel — what continues to surprise her — was the response she got, again and again, when she explained her condition to friends and family: No one knew that antepartum depression even existed.