I gave birth to my son in September. According to the Centers for Disease Control and the nurses at Prentice Women’s Hospital in Chicago, I wasn’t alone. September is the biggest month for births at Prentice, according to the nurses attending me. The CDC agrees; in 2010, more babies were born in September than any other month.
Do the math and it’s easy to see why September leads the baby birth pack. Nine months earlier the festive holiday mood makes for prime baby-making time. But the choice to bear children can be complicated for parents with mental disorders and other neurodiversities. Some prospective parents choose to go off their meds, a risky choice but one they believe necessary for the health of their child. Others may choose to terminate a pregnancy, believing SSRIs cause birth defects.
Dr. Gideon Koren, a Canadian pediatrician, toxicologist and clinical scientist, believes the risks to pregnant mothers of discontinuing medications—not just those for mental disorders—far outweigh risks to the fetus. Further, the risks to the fetus are far lower than most people believe. He founded and still directs The Motherisk Program, which counsels women, their families and health professionals on the safety-risks of drugs, chemicals, radiations and infections during pregnancy and lactation. His debut novel, Prozac Baby, follows the growth of a fetus—from the fetus’ point of view—from unplanned conception in a woman taking antidepressants through birth. The book’s beautiful and thought-provoking illustrations are by Judith Asher.
Prozac Baby is a quick, easy and often humorous read. There is a large cast of characters including mom, Sarah, the pregnant woman; dad, Matt; Matt’s mother; Sarah’s mother; Sarah’s psychiatrist; and a host of others such as friends and obstetricians. And, of course, the narrator—the baby accidentally conceived on New Year’s Eve. Early on, Sarah and Matt decide not to terminate the pregnancy, despite strong objections from Sarah’s mother.
All is not smooth sailing, though. Sarah goes off her meds and her depression returns. After consulting Motherisk and her own psychiatrist, she goes back on her SSRI and her depression lifts. Sarah’s mother and aunt continue to express their concerns; predictably, this causes Sarah a great deal of anxiety and emotional pain. Even after the baby’s birth, they tell Sarah she shouldn’t breast feed because the baby will get the medication through her breast milk. By consulting with her psychiatrist and the experts at Motherisk, Sarah and Matt gain the knowledge they need to address their own and other’s concerns.
Prozac Baby makes a powerful case for the safety of staying on medication throughout pregnancy. Though it specifically mentions Prozac, Dr. Koren’s research covers a number of SSRIs and other medications. But coming from the baby’s “mouth” (he repeatedly tells us he can’t speak, floating in his “aquarium with a mouth full of water”), some of the book can be very disturbing, particularly when baby expresses his anxieties about an impending abortion.
I had some problems with Prozac Baby, but they are mostly related to continuity of the premise. How, for instance, is it that the baby doesn’t know who god is, but knows to pray to him? And even though Sarah and Matt decide to keep the baby, he reminds us a little too often that they planned to “scrape me from the womb and throw me in the garbage.” By the time we’ve reached that point in the narrative, we’re invested in the baby’s health. Being reminded of the initial reactions to his conception feels unnecessarily cruel. Though, admittedly, he wouldn’t easily forget such a traumatic experience.
It’s obvious Prozac Baby was written to address the misinformation and fear mongering that surround the safety of taking medication before, during and after pregnancy. It’s short enough for most readers to get through in very little time (I read it in less than an hour), but full of enough information to assuage parents and inform well-meaning but worried relatives or friends.
Gideon Koren MD, FRCPC, FACMT is a Canadian pediatrician, toxicologist and clinician scientist. In parallel to his academic career at the Hospital for Sick Children and the University of Toronto, Koren is a well-established, award-winning composer and author in his native Israel. He is a Professor of Pediatrics, Pharmacology, Pharmacy and Medical Genetics at the University of Toronto, a Visiting Professor at Tel Aviv University, and the Ivey Chair in Molecular Toxicology at Western University.
He is the author of over 1,500 peer review papers and 15 medical books. In 1985, he founded The Motherisk Program, which he continues to direct. Motherisk counsels women, their families and health professionals on the safety-risks of drugs, chemicals, radiations and infections during pregnancy and lactation. The research group headed by Koren is studying the fetal effects of drugs and chemicals, as well as the effects of medications and toxins in infants and children. Through over 500 research papers on drugs in pregnancy, Koren has identified drugs and chemicals that are damaging to the fetus (e.g., organic solvents, corticosteroids, lithium, misoprostol) and those that are safe to take (e.g., calcium channel blockers, Prozac, doxylamine-pyridoxine).