SSRI's = risking out of homebirth

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Joined: 01/18/06
Posts: 1626
SSRI's = risking out of homebirth

So, WWYD?

We're 2 years away from even deciding if we want another baby, let alone anywhere near ttc, so this hypothetical is more just for conversation's sake.

In Ontario homebirth is contraindicated if the mother is on anti-depressant/anxiety meds.

NEONATAL SIDE EFFECTS: Restlessness, hypertonia, jitteriness, irritability and poor feeding, as well as mild respiratory distress.

It's not cut and dry the seriousness of these effects and likely can be variable. SSRI's are a class C, which puts them in 'benefits for mom outweigh risks to fetus' category, for the most part. Especially in low dose.

So, for you homebirthers, would you opt to discontinue SSRI's, birth in hospital or continue SSRI's and make an informed choice to remain at home?

mommys's picture
Joined: 05/08/06
Posts: 6264

I would attempt to discontinue SSRI's, but if that was not an option or became not an option, I'd opt for the hospital birth with a midwife and doula if possible.

joysiloo's picture
Joined: 09/04/06
Posts: 1054

I think that if I lived in Canada, I'd go for a hospital birth with a midwife. It seems like the hospital system there is much more natural-birth friendly than here in the states. That said, I'd want to be really comfortable with both the hospital and the midwife before committing to the plan.

I imagine you wouldn't be taking the SSRIs unless you really needed them, and pregnancy probably isn't a great time to stop them...it's difficult enough without a chemical imbalance.

Spacers's picture
Joined: 12/29/03
Posts: 4103

I'd be the test case. Blum 3 I was on SSRIs when I got pregnant with Tiven. This was around the time that the first articles were published linking pulmonary problems in newborns to SSRI use by pregnant moms. I asked my NP, and also asked the OB who supervised her, and they both said my low dose was nothing to be concerned about. They said the evidence was that the problem was high doses of SSRIs in the month prior to birth. The HMO's official stance was to encourage mothers on high doses to wean down (but not off) over the course of their pregnancy under the supervision of their primary care doctor. None of the homebirth midwives I interviewed seemed a bit concerned. Pulmonary problems can occur after birth for a variety of reasons, and I trust my homebirth midwife to be able to deal with it, or transfer care. The government doesn't get to make my birthing decisions for me.

Chimmy's picture
Joined: 08/03/01
Posts: 2776

With my 5th child I was on an SSRI - my dosage was as low as you could go before it was pointless to take & my daughter was born with breathing problems, thankfully none of the other side effects were present but her breathing problems were such that they nearly life flighted her to the nearest childrens hospital. It was scarry and much more than what my midwife would of been able to handle. It was an instance where I was genuinley grateful to have access to a hospital.

I am in full support of homebirths but this is an area that I would be very careful with. I wouldn't say completley cross homebirth off of your list, but really look at your options & really look into the side effects of the particular ssri that you are on - if you have a good ped or family doc talk to them too. I know plenty of women who were on all sorts of SSRI's/anti-depressants & had no bad side effects at all - the problem is you just never know when they're going to strike. If I were to be on one again & homebirth I would have a very thorough back up plan should something go wrong once baby was here.

Joined: 01/18/06
Posts: 1626

Thanks guys. It's good to hear both sides of experience. Makes me really realize that it's impossible to predict how it could turn out.

My Fiona was small for gestational age and took some extra time pinking up and working her lungs properly. CPAP machine was used too. So that worries me that the next one might be on the small side too. But like I said, we're still not making a decision on another baby for a few years. Perhaps things will be different then as far as my SSRI situation.

Spacers's picture
Joined: 12/29/03
Posts: 4103

Another thing to consider is that not all SSRIs are created equal. Some (Zoloft & Paxil) are considered safer for breastfeeding than others, so it would make sense for them to be different during pregnancy. It would be worth investigating the particular drug you're taking. Although I just checked Dr. Thomas Hale's website & he says that data from the Motherisk center in Canada in 2010 debunked the Paxil/heart problems theory and he believes that the risk of cardiac problems is no higher with Paxil than with other SSRIs, so maybe I'm wrong. Anyway, for me personally, there doesn't seem to be enough of a potential problem for me to consider risking out of homebirth based on this one factor.

sweetsriracha's picture
Joined: 03/29/11
Posts: 1318

Pregnancy can be really tough. For me, the first couple months (when I was dealing with awful, awful morning sickness) were really emotionally hard. I'd probably *not* discontinue SSRIs, unless I had a great support network (like a really good relationship with my Physician).

Chimmy's picture
Joined: 08/03/01
Posts: 2776

"Spacers" wrote:

Another thing to consider is that not all SSRIs are created equal. Some (Zoloft & Paxil) are considered safer for breastfeeding than others, so it would make sense for them to be different during pregnancy. It would be worth investigating the particular drug you're taking. Although I just checked Dr. Thomas Hale's website & he says that data from the Motherisk center in Canada in 2010 debunked the Paxil/heart problems theory and he believes that the risk of cardiac problems is no higher with Paxil than with other SSRIs, so maybe I'm wrong. Anyway, for me personally, there doesn't seem to be enough of a potential problem for me to consider risking out of homebirth based on this one factor.

Where my concern lies isn't the fact that it's one possible factor, although depending on the ssri/anti-depressant it could be more than one possible side effect that should be addressed. It's the fact that you never know when these effects will hit & to what severity. I was told by two OB's, my Ped and a trusted psychiatrist - all told me I had nothing to worry about, the dose I was on shouldn't even really affect the baby & breathing problems weren't even an issue. Well they were & in a pretty big way - it was a huge wake up call for me when it came to these meds. There is still soo much trial & error - the warnings only cover some of their understanding of the effects that they can have. I needed to be on them going off really wasn't an option at the time & despite my thorough research I was faced with a baby who wouldn't/couldn't breath for quite sometime.