Rodkin had never experienced anxiety before; her pregnancy itself was relatively smooth. But after her baby was born in the spring of 2022, things had taken a turn. “I felt like I was having an out-of-body experience a lot of the time,” she said. When Rodkin, her husband, and their infant had to temporarily relocate due to a gas leak in their home, she started feeling “paranoid.” She feared that someone from the neighboring house would attack her family. She described how she felt as though she was “living in a horror movie.”
Rodkin had always wanted a second child, but she didn’t want to risk the nightmare experience she’d had with her first. Fortunately, her doctor reassured her that staying on Zoloft was safe and that the benefits far outweighed the minor potential risks to the baby. “I think it has been invaluable,” she said. “My second pregnancy was so smooth, the postpartum was so smooth, the delivery was smooth. Everything was easier, and I think a huge part of that was Zoloft.” Her son is now one year old.
“We have a substantial and overwhelming body of evidence that shows that there are risks to both mother and child if you don’t treat psychiatric illness,” said Dr. Lauren Osborne, vice chair of clinical research at the Obstetrics and Gynecology Department at Weill Cornell Medicine and chair of the National Curriculum in Reproductive Psychiatry.
Despite the fact that the American College of Obstetricians and Gynecologists, or ACOG, supports the use of SSRIs during pregnancy for those who need them, some doctors counsel their patients to stop their medication. A large study found that around half of women on SSRIs before pregnancy went off them when pregnant.
Late last month, RFK Jr. took his first major step toward this policy priority. On July 21, the Food and Drug Administration convened a hearing to discuss the safety of SSRI use during pregnancy. Most of the panel’s participants, a mix of researchers and psychologists, presented clear biases and lacked basic knowledge about reproductive psychiatry, according to Dr. Osborne. Some of the panelists wrongly claimed that using SSRIs in pregnancy can lead to higher rates of autism and birth defects.
Whereas typically such a hearing would feature experts from the FDA, this one brought in outsiders, many of whom had clear conflicts of interests. Rather than focusing on the issue at hand, some questioned the validity of depression itself. At one point, a panelist, psychologist Roger McFillin, asked if women simply experience more intense emotions, which are “gifts,” not “symptoms of a disease.” There was talk of issuing a black-box warning on SSRIs for pregnant and perinatal women.
“Limiting women’s access to SSRIs, it will cost lives,” said Rodkin. “I have no doubt about that.”
Cuts to Medicaid and Affordable Care Act subsidies will mean millions of Americans will lose their health insurance—and about a quarter of Medicaid patients are women aged 15 to 49, as of 2023. That’s not to mention the seven million children and hundreds of thousands of pregnant people enrolled in the Child Health Insurance Program. According to the Centers for Medicaid and Medicare Services, Medicaid covers 41 percent of births. And now, pregnant people may be barred from getting Covid shots for themselves or their children.
“We don’t seem to care about the fact that we’re killing moms,” said Osborne.
Christine, a paralegal and parent to an 18-month-old boy in Richmond, Virginia, who asked for only her first name to be used, was very upset by the hearing. She has taken Prozac since she was a teenager for her anxiety, and delayed getting pregnant due to conflicting information she’d heard about its safety in pregnancy.
“We shouldn’t have people who have no medical expertise or have this sort of anti–Western medicine agenda making decisions for people that they’ll never meet,” Christine said of the hearing.
Laura DiNardo, a mom in Pittsburgh and manager at a professional membership association, started taking antidepressants before she got pregnant, and continued using them for her anxiety through her pregnancy. DiNardo said her doctor told her that there was a small risk the baby could go through withdrawal-like symptoms from the drug for a few days after birth, meaning they could be crankier than typical. This “seemed like a relatively low-stakes side effect for me, knowing that babies, especially newborn babies, are prone to be cranky or fussy,” she said.
“The message that I got was … a healthy mom is the most important thing for the baby,” DiNardo said.
In her practice, Osborne tells her patients, “having depression or anxiety in pregnancy, that’s a chronic illness just like having diabetes in pregnancy or having hypertension in pregnancy”—it needs to be treated, and that treatment sometimes includes medication.
“I think the last thing we need is to stigmatize mental health issues,” DiNardo said. “People need to have access to all the tools that they can in their tool box, and people also need the support of their medical team to make informed decisions; to make sure that they’re going to be the best parent they can be.”
And this lack of health care access will disproportionately impact low-income women, women of color, and people in rural areas. But even with a supportive partner and co-parent, good insurance, and a well-paying job, becoming a mother comes with many stressors, explained Rodkin. “It’s hard enough as it is, and we don’t need to make it harder,” she said.
According to KFF, the conflicting guidance on Covid shots has caused widespread confusion among Americans. And casting doubt on vaccines has consequences: Only around 40 percent of the population plan to get Covid shots in the fall, if they even can. And now, RFK Jr. has cut off research funding for mRNA vaccines—including development of a bird flu vaccine.
“Everything [the administration is] doing are things that harm pregnant people, harm children,” Christine said.
“It makes no sense,” said Rodkin. “It’s like, ‘Let us remove the support systems and then expect women to have more children. But like, don’t give them health care, don’t give them access to critical medications, take away funding from schools’. It just doesn’t check out.”
“This is a push to increase the birth rate for certain types,” said Osborne. “It’s not a push to increase the birth rate overall, because we’re already not supporting the families that we have.”
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