While for many the experience of pregnancy is full of excitement, for some first-time mothers, it can be a struggle with the unknown. For newlywed Shannon Toledo, her complicated health issues were adding another variable to the morning sickness, mood swings and the uncertainty with her job during the peak of Covid-19. A part-time martial arts instructor with a third-degree black belt in Taekwondo as well as being a fitness enthusiast—this soon-to-be mum decided she would not sit back and let all the distractions get to her.

Prenatal depression is real

Once the excitement of being pregnant had worn off, fear and anxiety became a part of her daily routine. A lot of it she rationalised to hormonal activity, but she also realised that her fluctuating emotions were affecting relationships and her ability to function and even pray.

“Three months in, and I’m angry, crying for no reason, scared and anxious about the silliest of things that wouldn’t usually bother me. I was all over the place,” Toledo said with exasperation.

“I’d been hitting the gym pretty hard to get in shape for my wedding, and here I was, still lingering in that honeymoon phase, in the best shape of my life and realising I was pregnant. I was afraid of the risk to my baby because of my chronic hypertension, and I would also soon need to find pregnancy pants to wear to the gym. It was depressing. No-one tells you there’s a hump that comes with the bump.”

She is not alone. One of the most common issues that women experience during and after pregnancy is depressionThe American Congress of Obstetricians and Gynecologists (ACOG) reports that nearly 14­­­­­–23 per cent of pregnant women experience depression—be it postnatal depression, antenatal depression or even postpartum depression. The Perinatal Wellbeing Centre in Australia places their numbers at 10 per cent. Perinatal depression is considered a medical condition. There is no single factor, but rather a complex mixture of emotional, physical and sometimes environmental contributors; and certainly not the fault of the mum-to-be.

Some of the depressive symptoms which can arise in the perinatal period can include:

But Toledo stayed upbeat despite the blue moods.

“The funk is real. I cannot explain most of it. It just happens,” Toledo said. “I have started to appreciate praying in an intimate way. My husband Jason is incredibly patient and supportive, I have an amazing little sister, a circle of concerned friends and co-workers who are very understanding. I am truly blessed.”

A pregnancy so soon after her wedding, with the inevitable changes that would bring, was totally unexpected. Then there were the unknowns—the anxiety, the excitement, the expectations and the unsolicited advice. Despite all the well-meaning counsel and the outpouring of advice, the voices in her head were more deafening than the crowd.

How do you shut out that noise? “I have accepted that everyone has an opinion,” Toledo said. “Sometimes it makes me feel like I am an idiot. But I know they all mean well, and I am always desperate for any affirmation that I am not being a horrible wife, or being the worst expectant mum ever, or even becoming a nightmare of a person.”

Having spent many moments in the gym with her and knowing the energy and focus she brings to her sessions, I asked her how she coped with the food cravings and chronic hypertension.

“It’s been a pet project of ours these past few months. [My husband] Jason has seen it as a challenge to be in even better shape.” She purses her lips and suppresses a smile.

“I have, with the help of my doctor, created a pregnancy diet,” she continues, “not only for myself, but because Jason has accepted this journey as his as well, it means I don’t have to feel isolated. He really has embraced this 100 per cent.”

Good nutrition is often the last thing on the to-do list of couples expecting a baby. Healthy eating habits suffer. While weight gain is expected, studies have shown that many women are three times more likely to gain more than is recommended.

“Surely, you’ve had more than a few bad days. What’s the go-to crave?”

“Pizza. It has always been my go-to comfort food.” She has the biggest of grins as she talks about food. “I don’t deny myself anything I want, but instead I am just very careful about portion sizes.”

Coping with high blood pressure

Toledo suffers from chronic hypertension, and for years she had been managing her diet, exercising and taking her medications to mitigate the risks that come with having high blood pressure. One of the major risks for her is pre-eclampsia. Toledo began to have complications just around the middle of her second trimester, which put the life of her baby at risk.

“I have endured things in life that no woman should ever have to experience, yet the thought of losing my baby is more terrifying than anything I have ever faced,” she says, her voice trembling with emotion.

I spoke to Nurse Lawrence, a district health coordinator with more than 10 years’ experience in antenatal care units who has cared for many women with pre-eclampsia. “Pre-eclampsia is a very serious condition that can be life-threatening to both mother and baby,” she said. “It requires extra vigilance on the part of the health care team. Mild cases may be prescribed bed rest and medication, but in more severe cases when the mother or baby is at risk, delivery is expedited, so Shannon’s fears are not unfounded.”

Hypertensive disorders are the second leading cause of maternal deaths in the United States. Nearly a quarter of women with chronic hypertension develop pre-eclampsia during pregnancy and are then at risk for premature birth, restricted growth of the baby, congestive heart failure, renal failure or even the death of the fetus or mother. In Australia, the numbers are slightly lower—15 per cent of direct maternal mortality is attributed to pre-eclampsia and its accompanying conditions. These numbers globally quickly add up to thousands of women and their babies who, sadly, do not make it through pregnancy every year.

Despite the obvious fears and forebodings, Toledo is determined.

“I believe God ordained his arrival. So, this baby is intended to become a part of my life,” she said while rubbing her seven-month bump. “He’s going to be here soon, he won’t be going to term, but I will be there to greet him in the NICU [neo-natal intensive care unit].” She spoke with a tremble in her voice.

Her words could not have been truer. Little Connor James was welcomed into the world four days after we sat down for our interview. We met up two months later at the end of Florida’s typical lukewarm winter for breakfast at a seaside restaurant. Her blood pressure is still off the charts and she is fighting a constant battle to manage it. But she is beaming. Little Connor is enjoying his first glimpse of the Atlantic Ocean while tucked away in his pram and wearing a jumper. 

Nigel Byng is a freelance writer based in West Palm Beach, Florida. A version of this article first appeared on the Signs of the Times Australia/New Zealand website and is republished with permission.