The debate about the Protection of Life in Pregnancy Bill has been long, arduous, and bitter, but it seems set to pass through the Oireachtas before the summer recess. Part 2 (9) of the Bill, which covers cases in which the woman’s life is at risk due to suicide, has been the most controversial aspect, but the voices of women who’ve experienced depression or suicidality in pregnancy have been largely absent from the debate.

A 2007 study by the National Office for Suicide Prevention found that 13% of Irish women have experienced a mental health problem, while the World Health Organisation says 20% of people in Europe will experience a depressive episode in their lifetime.

Dr Anthony McCarthy is one of the country’s three perinatal psychiatrists and President of the Irish College of Psychiatrists. He addressed the Oireachtas Health Committee during its public consultations.

He treats pregnant women with an enormous range of conditions, from depression triggered by abuse, bereavement or stress, to clinical depression and even psychosis, where they have obsessive thoughts or hear voices telling them to harm their baby.

Many women are afraid to take anti-depressants while pregnant, although this can be less harmful than no treatment at all, he says.

“If it’s not treated, she’s absolutely guaranteed to have post-natal depression and just at that very critical early stage of life, of bonding with her new baby, she’s been depressed in pregnancy and hasn’t been treated… you’re in trouble, your baby’s in trouble, the future for the two of you is trouble.”

Dr McCarthy cites current statistics for suicide in pregnancy as between one in 250,000 and one in 500,000 “in the context of abortion being available.”

“4,000 Irish women go to the UK every year, and we don’t know how many of those are suicidal. As long as we ignore them that will continue.”

Depression

Elaine McGrath is married with three children. A self-employed professional in her thirties from Cork, she was diagnosed with depression in her final year at university. She has been hospitalised twice during depressive episodes.

“When I had my first child in 2001, I was 27. I just became obsessed with dying. I was convinced I was going to die and leave him, and that I was this dreadful person, and that people would take him away from me.”

She was medicated for post-natal depression. After having her second child in 2004, it struck again, and she was hospitalised.

“My husband has suffered hugely over the years. I persuaded him to go the third time, thinking I was going to have a home birth, I was so much more clued in, I’d had proper treatment, it was all going fine. And I coped better that time. But I got it again.”

Elaine is clear on what it would mean for her if she became pregnant again.

“My husband is wonderful. But I know that if I said to him tomorrow that I wanted another child he would leave. The strain on him as a person is enormous. He’s trying to cope with looking after young children and a wife who’s lost in her own misery, had become suicidal, thinks that even though she loves her children that much that she’s just not good enough for them.”

One pro-life campaigner told Elaine that all she needed was support.

“I told her if I got pregnant again – which couldn’t happen, because we’ve made sure it can’t – but if that happened, I would be the first person [to seek a termination]. I just simply couldn’t go through it again. And I love my children, I love them, but I couldn’t go through that again.”

Treatment

One major difficulty for women with depression includes the disruption to their treatment regime.

Michelle Daly-Hayes is a 33 year old social media consultant based in Limerick, who is expecting her first child. Michelle has suffered from depression since an accident in her teens left her with post-traumatic stress.

Last year she experienced an ongoing stressful situation, which triggered a depressive episode requiring medication.

“The stress had come to an end, I had just finished counselling and I was on medication, I was in a good place, when I found out I was pregnant in February. The medical advice was to cease the medication.”

Michelle is conscious of the stigma around depression in pregnancy and is quick to point out that she is delighted to be pregnant. However, the depression has resurfaced since her pregnancy began.

“Having a baby is wonderful but it’s very powerful as well. It does weigh on your mind, bringing this new person into the world, I get much more emotional, listening to the news gives me second thoughts… it’s not an easy time.”

Her treatment plan – involving her GP, a counsellor she sees regularly, and the mental health team at the Coombe – has been excellent, she says.

She believes the new Bill is misogynistic and stigmatises people with depression.

“To me it seems quite cruel. No woman would make that choice easily. Pregnant women are afraid to say they’re depressed already, because of the stigma and I think they might be more afraid to come forward now.”

‘Why didn’t I go?”

Vicki Kiely is a 38 year old mother of three living in Dublin, who was first diagnosed with depression in her early 20s. After a number of very severe episodes, she will be on medication for life, she says. She went off medication for her last pregnancy.

“I honestly don’t know how I got through the pregnancy. I cried for 8 and a half of those 9 months. I was just so depressed at about 19 weeks I decided I couldn’t have this baby. At the start, I had thought about abortion but I told myself I couldn’t do it, I couldn’t live with it.”

After finding out she was pregnant with twins, then losing one of those twins, she booked an abortion in England.

“At 20 weeks, I decided I couldn’t go, because I could feel him moving and it just didn’t seem right. But from that to the 41 weeks, literally every single day I thought ‘why didn’t I go?’”

Vicki had some anxiety therapy at this time, but she has never been admitted to a psychiatric hospital. After experiencing suicidal ideation during her last pregnancy, she believes she would not survive another one.

“If it happened by accident, I just couldn’t continue with it. There’s no way.

“I mean… I drove to the train station. I had looked up all these ways of doing it, diving into the sea and all the rest of it. In the end I decided jumping in front of the train would be quickest, and I drove there.”

Vicki doesn’t believe the new legislation will help women suffering from depression.

“I know a few girls personally who have gone and I think the ordeal of having to travel and the secrecy around not being able to tell people, and the shame of it all, and all the rest, is still going to be there… but I just think it would be easier than going through the mill here.”

Dr McCarthy agrees.

“The women themselves haven’t been heard because it’s not an easy thing for women to talk about, publicly… For someone to tell me some of the things they tell me is so difficult.”

He believes having to tell three people – one an obstetrician, with no expertise in mental health – makes it almost impossible, while the appeal process, “having to tell that story again to three more people” is an ordeal few will attempt.

“Unless somebody physically can’t leave the country… unless it’s somebody who’s almost physically restricted, in some way barred from doing so, can’t get out of the country… or for financial reasons – even for financial reasons, my god, would she go through all of that? Would we make her suicidal at the end of it?”

The Protection of Life During Pregnancy Bill is expected to pass through the Oireachtas before the summer recess.

An edited version of this piece was first published in the Sunday Business Post Magazine on Sunday 23 June. Many thanks to the brave women who agreed to speak.