Supporting Mothers, Supporting Babies: Understanding the Risks and Benefits of SSRIs During Pregnancy
As birth workers, you are trusted partners walking alongside families during some of their most vulnerable and transformational moments. One of the common and sensitive issues you may encounter is the use of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), during pregnancy and breastfeeding. Examples of SSRIs include Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram). This topic is layered with emotion, stigma, and concern — and it’s important that we approach it with both compassion and evidence-based guidance.
Maternal Well-Being Is Essential for Infant Well-Being
First and foremost, we must affirm that a mother’s emotional and mental health is foundational to her baby’s development — both in the womb and beyond. Untreated depression and anxiety during pregnancy can carry significant risks, including preterm birth, low birth weight, difficulties in bonding, and increased risk of postpartum depression. Chronic stress and untreated mental health conditions can also affect a baby's developing brain and long-term emotional regulation.
For some mothers, SSRIs provide critical relief from debilitating symptoms and allow them to engage more fully with pregnancy, childbirth preparation, and early bonding. While we always aim to support families with integrative approaches — such as therapy, mind-body techniques, nutrition, and social support — medications are sometimes a necessary and lifesaving part of the plan.
What Are the Risks of SSRIs During Pregnancy?
No decision during pregnancy is without risk, and SSRIs are no exception. Some of the potential risks associated with SSRI use in pregnancy include:
Slightly Increased Risk of Preterm Birth or Low Birth Weight: Though the increase is generally small, it has been noted in some studies.
Persistent Pulmonary Hypertension of the Newborn (PPHN): A rare but serious condition affecting the baby’s lungs after birth, slightly more common among infants exposed to SSRIs late in pregnancy.
Neonatal Adaptation Syndrome: Some newborns may experience temporary symptoms such as jitteriness, mild respiratory distress, poor feeding, or irritability in the first few days after birth. These symptoms are usually mild and self-limiting.
It’s crucial to remember that these risks must be weighed against the risks of untreated depression or anxiety. For many families, the benefits of medication outweigh the potential harms, particularly when depression is moderate to severe.
Breastfeeding and SSRIs: What to Expect
Many SSRIs are considered relatively safe during breastfeeding, but small amounts can pass into breast milk. Some infants may experience:
Mild Fussiness or Sleep Changes: Some babies may seem a little sleepier or more irritable, though many tolerate exposure well.
Gastrointestinal Upset: Rarely, loose stools or feeding difficulties may be observed.
Long-Term Effects: Current research is reassuring that there are no clear long-term developmental harms from SSRI exposure through breastfeeding.
When mothers feel well-supported and able to continue breastfeeding, the overall benefits of breastfeeding (immune protection, bonding, nutrition) still strongly outweigh the theoretical risks of low-level SSRI exposure.
How We Can Support Families
As a birth worker, your role is not to diagnose or prescribe, but to walk alongside. You can support mothers by:
Listening without judgment. Mothers often carry tremendous guilt about medication decisions.
Encouraging open conversations. Encourage mothers to discuss any concerns with their prescribing providers.
Reinforcing the importance of maternal mental health. Remind families that caring for the mother is caring for the baby.
Connecting them with holistic supports. Gentle bodywork, mindfulness practices, nutrition counseling, therapy, and strong community networks can all help mothers thrive.
Together, by holding a space of empathy and evidence-based knowledge, we can help families navigate these decisions with courage and clarity — always remembering that a nurtured, emotionally healthy mother gives her baby the best possible start.