Shouldn't I Be Happy?
Emotional Problems of Pregnant and Postpartum Women

By Shaila Misri, M.D.

Pregnancy and childbirth are a happy and joyous time for some women, but for others the experience can be one of anxiety, fear, and confusion. Because our society cherishes pregnancy and motherhood, many women suffer in silence when their experience is anything less than sublime. How do they explain their unhappiness to spouses, friends, and family, and how can they  know if what they are experiencing are the normal mood fluctuations of pregnancy, or symptoms of a more serious problem?

In the first book of its kind, Dr. Shaila Misri, an expert on the psychology of pregnancy and postpartum, offers specific advice on the wide range of emotional issues that come with parenthood, including the more serious emotional disorders that often cloud a pregnancy and the early days of motherhood. For example, she discusses the serious but very common problem of postpartum depression, showing women how to distinguish between normal postpartum blues and clinical depression and explaining how and when they should get professional help.

She also examines the stages of grief that accompany miscarriage or the loss of a newborn, with comforting advice for all family members on how best to handle this difficult period. In addition, Dr. Misri shows women how to deal effectively with psychological problems, such as anxiety attacks and eating disorders, that my have preceded a pregnancy.

As well as addressing serious emotional problems, Dr. Misri also counsels women on coping with the common stresses that accompany the course of pregnancy and early motherhood, from changing hormonal levels to problems with breastfeeding. In a sensitive chapter on fatherhood, Misri explores the role of the sometimes neglected parent - the father - as he, often silently, struggles with his own adjustment issues.

Finally, Dr. Misri discusses when therapy may be needed as well as the best type of therapy for different problems, and addresses what medications are safe during pregnancy and postpartum. Throughout, she answers the questions women most often have about their feelings and their emotional difficulties during this very precious time.

Table of Contents

Foreword by Carol C. Nadelson, M.D.

PART 1 - Problems New Mothers Might Experience

1. "It Wasn't Supposed to Be Like This" Psychological Problems in Pregnancy

2. "Why Is This Happening?" Medical and Obstetrical Complications

3. "How Could This Be Happening to Me?" Miscarriage, Fetal Abnormalities, and Congenital Defects

4. "I Never Want to Experience This, Ever" Death and Disappointment at Birth or Soon After

5. "I Just Don't Feel Like Myself Anymore" Postpartum Depression and Mood Disorders

6. "I'm Going to Be the Best Kind of Mother" Breastfeeding and Psychiatric Illness

7. "I Just Don't Need This right Now!" Marital Upset After Pregnancy and Childbirth

8. "But I'm Involved in This, Too" The Father's Role During Pregnancy and Postpartum

PART 2 - Getting Professional Help

9. "Maybe I Should See Someone About This" When to Get Help

10. What Should I Expect?" Approaches to Therapy

11. "My Baby's Health is All that Matters" Medications and Their Alternatives in Pregnancy and Postpartum

12. "I Don't Know - It Sounds So Strange" Electroconvulsive Treatment in Pregnancy and Postpartum

13. "Will I Ever be Happy Again?" A General Perspective on Women's Emotional Health


Review from the British Columbia Medical Journal
Volume 38, Number 2, February 1996

The first chapter of this very personal volume describes Dr Misri's journey from obstetrics and gynecology to psychiatry, and her eventual blending of her two interests. Along the way she has clearly developed a feel for the psychosocial problems of women, particularly in the vulnerable pre- and post- partum time. She validates every feeling any pregnant woman may have had, and simply reading this book will be enough for most distressed moms (as waiting lists are long, it's a good job, too). Fathers who are struggling to understand the complex and changing emotions around pregnancy and early motherhood will feel less like outsiders and will be of more help to their womenfolk. No psychobabble in this book - its message is accessible to all.

Throughout the chapters there are boxes that contain useful information such as early symptoms of depression, anxiety, and psychosis. Treatment, from minor tranquilizers to ECT, is described in enough detail to be readily comprehensible to not overpowering.

This is an excellent book to have available in the office or to recommend to patients. Physicians having anything to do with pregnancy will also learn something, and there is a charming photograph of Dr Misri on the back flap to boot.

"In this book, Dr. Shaila Misri has done a remarkable job of presenting the normal and not so normal concerns and difficulties of pregnancy... provides much important information and states it candidly and emphatically."

- Carol C. Nadelson, M.D., former president, American Psychiatric Association, and editor in chief, American Psychiatric Press

"Respect for the autonomy of the pregnancy woman is a critical ethical concern in contemporary obstetrics. Putting the principle into practice requires information that pregnant women and their partners need, so that they can make informed decisions. Dr. Shaila Misri fills this important need with a book that is original, easy to read and use, and substantial. All obstetricians should be aware of this timely book and make it available to their patients."

- Frank A. Chervenak, M.D., Professor of Obstetrics and Gynecology, the New York Hospital - Cornell Medical Center, and Laurence B. McCullough, Ph.D., Professor of Ethics and Medicine, Baylor College of Medicine


Postnatal Depression

Postnatal Mental Disturbance

The Book

Postpartum Depression

Edinburgh Postnatal Depression Scale (EPDS)

Are SSRIs safe for pregnant and breastfeeding women?


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