Dealing With Preterm Birth and Postpartum Depression

Leila’s first pregnancy was a traumatic one. She had preeclampsia and a preterm birth, and her baby spent 6 weeks in the NICU (neonatal intensive care unit).

Four years later, she was pregnant again. This time, she found herself facing depression during pregnancy, another stressful preterm birth, and postpartum depression.

Leila, now 38 and living in Texas, shares what she went through and what she’s learned in this edited interview.

ACOG: Describe your first pregnancy and the onset of preeclampsia.

Leila: Up until 26 weeks, I was having the perfect pregnancy. Then I went in for a routine appointment, and my ob-gyn told me, “You're spilling protein into your urine and your blood pressure's spiking. I'm diagnosing you with preeclampsia.”

It was like a bomb had gone off in my head. I was more scared about my daughter than myself. I was thinking, “What is happening? What do I do next?”

ACOG: What were the following weeks of your pregnancy like?

Leila: I was keeping a daily diary of my blood pressure readings, in the morning and in the evening. I would talk with my ob-gyn every week – I would do urine tests and she would monitor me. I also had to do nonstress tests between 26 and 31 weeks.

Then I woke up one day, and I just had a very bad feeling. I went to see my ob-gyn, and sure enough – she told me I needed to be admitted to the hospital. I checked in to the hospital Thursday evening, and a cesarean was planned for Saturday morning.

ACOG: At 31 weeks, what was your daughter’s condition?

Leila: She was born at 3 pounds, 4 ounces. Her foot was the size of my thumb. I wasn’t allowed to hold her. The hospital where we delivered didn't have a NICU, so she was transferred to a hospital that was more than 2 hours away. I couldn’t be with her, and that was hard.

She had a machine to help her breathe, and she had trouble learning how to suck. She was in the NICU for 43 days. She was finally sent home with a heart monitor, and by then she was eating.

ACOG: Four years later, you were pregnant again with your son. What was your frame of mind at that point?

Leila: That was so hard. To be honest, I was upset – I didn't want to be pregnant. Ironically, everything was perfectly textbook for most of the pregnancy. I wasn't sick. I had great energy. But emotionally, I just wasn't feeling it.

ACOG: What did your ob-gyn have to say about your stressful feelings?

Leila: She said, “I know you're scared – and this is scary – but you went through it once, and we’re going to get through this.”

She also said that maybe I had a little PTSD [post-traumatic stress disorder] from my first birth experience. She said I might need to start talking to someone about this anxiety I was building up, which I knew wasn't good for me or the baby.

She did recommend counseling, but at that point I was brushing it off. In those early months, I understood that she was trying to help, but I was not ready for that conversation.

ACOG: Looking back, were there any early signs that you might have been depressed?

Leila: I realize now this was a really bad sign, but between 26 and 31 weeks, I started writing goodbye letters for my daughter. I kept thinking, “I'm not going to get out of this. I'm just going to stay in the hospital. Baby would come home and be fine, sister would be fine, but mommy would definitely not be there.”

[Depression During Pregnancy]

ACOG: How did your second pregnancy conclude?

Leila: I kept telling my doctor every time I would visit, “You know, I'm going to have preeclampsia again. This is going to happen.” And she would say, “No, your labs look fine, your blood pressure's perfect. You don't have to worry about it.”

Then one morning when I was 34 and a half weeks, I had the most intense migraine. I didn't think anything of it, but I checked my blood pressure and it was extremely high. Then I started throwing up and having blurry vision, a sign of preeclampsia. I called my husband and said, “I think it's time!” Because of my anxiety, I had already prepacked everything, including baby things, and they were already in the car.

We made it to the hospital, and the doctors spoke with me about having a cesarean. It happened the next day. My blood pressure had to be lowered a little bit before I could have the cesarean.

ACOG: How were you and your son after the delivery?

Leila: He was born at 5 pounds, 5 ounces and went to the NICU for 11 days. He could have come home in a few days, but he needed some time to learn to eat by himself.

I went back to work after 10 weeks, but I wasn't really engaged. I remember during my hour-long commute to and from work, sometimes I would pull over and just sit in my car on the interstate. That didn’t seem off to me at the time. I thought, “Oh, I just need a moment. Just give me a moment.” If I had gotten hit, I don't think I would have cared at that point. Or if I had kept driving past work or past my house, it wouldn't have been a big deal to me.

I just had those moments where I felt, I’ve already said goodbye to my daughter in letters, and I didn't even want my son. I wasn't crying or upset. I was just numb.

[Postpartum Depression]

ACOG: When did you end up getting help for depression?

Leila: My boss finally called me in to a meeting one day. She told me she had gone through postpartum depression and maybe I should look into it.

The next time I went back to my doctor, she also noticed a change in me. She said, “You had built up this anxiety so much over the course of your pregnancy. I think it's time to go get help.”

I found a therapist online and chatted with her. She suggested group counseling and I found a group that was nearby. I only went once, but it was helpful. The group counselor said that I should try therapeutic writing, since I like to write. She also made me check in with her every so often. The writing really did help me. I journaled anything and everything. If I was feeling overwhelmed, I wrote it down. If I was feeling numb, I wrote it down. If I was busy, I wrote it down.

I also learned about an online support group, Postpartum Support International. You can text their help line whenever you need to.

ACOG: Your kids are now 7 and 4. What do you think about all of this now, looking back?

Leila: Sometimes I still wonder why I had preeclampsia. I didn’t smoke, I didn't drink, I worked out, I walked, I ate healthy meals. But I also think about moms who aren’t able to have a baby at all. So in the end, I'm grateful for the way my story played out. I’ve come to realize that we all have different birth experiences, and not everyone's going to have the same story.

ACOG: What do you wish other women knew about postpartum depression?

Leila: Statistically, 1 in 7 women get postpartum depression, and everyone knows more than seven women. We should always strive to reach out to moms. I know it's lovely to just think, “Oh, I want to hold the baby,” but try to at least get in there and see about the mom. Really ask how she is doing.

Postpartum depression is most often temporary and treatable. Almost all women who seek treatment recover fully. Contact the Postpartum Support International Helpline by calling 1-800-944-4773, or by texting 800-944-4773 (English) or 971-203-7773 (Spanish). You also can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or use their live online chat.

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.