There is No Greater Loneliness: Pregnancy and Suicidal Ideation

There is no greater loneliness in the life of a human being than being alone with one’s own suffering; and no suffering is greater than the mental torture of impending agony from which there is no escape and of which there is no understanding.” Grantly Dick-Read, 1959, p.50

Grantly Dick-Read was right.  Suffering alone breeds a sense of inescapable despair for which there are few words, if any.  Lack of language is a kind of quintessential, ontological divide between a person’s experience and the observer’s understanding–what Biro (2011) noted as the starting point for change.  Language can “replace isolation with community” (Biro, 2011, p. 15).  This site is testimony to that!  Listening to mothers is both our privilege, our scientific premise (the landmark study by the same name), and our standard of practice as childbirth professionals.  In the spirit of listening to mothers, and learning to replace isolation with community–I would like to share a recent study regarding quite possibly the worst mental torture imaginable: suicidal ideation in pregnancy.

One of the first of its size and breadth, a recent study published in the Archives of Women’s Mental Health (2011) examined prevalence of suicidal ideation in a large sample of pregnant women.  Two objectives were presented: (1) examine the prevalence of suicidal ideation and comorbid psychiatric disorders during pregnancy; (2) identify the risk factors for suicidal ideation during pregnancy:

“Although our understanding of the prevalence and consequences of antenatal major depression has improved, our understanding of suicidal ideation—a common aspect of major depression—during pregnancy is limited.” (Gavin, Tabb, Melville, Guo & Katon, 2011, p. 244)

Comparing prevalence rates of suicidal ideation in a pregnant population with those in general, non-pregnant population could substantiate or refute the commonly held belief that pregnancy is a protective mechanism against thoughts of suicide (Zajicek, 1981; Kendell, Chalmers, & Platz, 1987), offering a fuller vocabulary regarding this rare, yet tragic suffering.  The authors built a strong rationale for their study by reviewing the scant literature that does exist, and its compelling evidence:

  • “Suicide is a leading cause of death among pregnant and postpartum women in the United States” (Gavin, et al., 2011 p. 239; Chang, et al., 2005).
  • The precursor to suicide in most cases is suicidal ideation, and the presence of major depression (Perez-Rodriguez, et al., 2008; Lindahl et al., 2005).
  • Women of childbearing years are at greatest risk for depressive disorders (Perez-Rodriguez, et al. 2008).
  • Pregnant women are less likely to be screened for suicidal ideation during pregnancy (Stallones, et al., 2007; Paris, et al., 2009; Gausia, et al., 2009; Copersino et al., 2005; Newport et al., 2007).
  • Adverse outcomes experienced by women who did report suicidal ideation in pregnancy (Stallones, et al., 2007; Paris, et al., 2009;  Gausia, et al., 2009; Copersino et al., 2005; Newport et al., 2007; Bowen, et al., 2009; Eggleston, et al., 2009;  Chaudron et al., 2001).
  • Suicidal ideation in pregnancy is a strong predictor for postpartum depression (Chaudron et al., 2001).
  • Pregnant women with depressive disorders are less likely to receive treatment for depression (Vesiga-Lopez et al., 2008).
  • Depressive disorders remain under-detected in prenatal settings because most women seeking prenatal care are not screened for depression (Kelly, et al. 2001).
  • Most patients fail to tell care providers of suicidal plans or attempts (Isometsa et al., 1994).

Lack of prenatal depression screening, known risk factors for comorbid mood disorders and their adverse effects are noted:

“Given the risks associated with antenatal suicidal ideation to women and their offspring, identifying effective methods of detecting women with antenatal suicidal ideation is a paramount challenge.” (Gavin, et al., 2011)

Study Design

Authors employed a cross-sectional analysis design of data from a longitudinal study of 3,347 pregnant women receiving prenatal care at a single site university-based obstetric clinic (University of Washington) from January 2004 to 2010.   After exclusion, the final sample size was 2,159 women.  Study protocol mandated screening a minimum of two times, once in early second trimester, (16 weeks) and once in third trimester (36 weeks).  Suicidal ideation was measured using the Patient Health Questionnaire (PHQ-9)–a screening instrument that has demonstrated both high sensitivity (73%) and specificity (98%) for major depression (Spitzer, et al., 2009).   To examine suicidal ideation specifically, the authors measured women’s responses to item 9 of the PHQ-9:

“Over the last two weeks how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?  0 = not at all, 1= several days, 2 = more than half the days, and 3= nearly every day.” (Gavin, et al., 2011, p. 241)

Participants self-reporting a score of 1 or greater (suicidal ideation several days a week in last 2 weeks), were considered positive for suicidal ideation.  With the protocol in place, authors then applied multiple covariate logistic regression analysis.

Study Results

Results demonstrated 2.7% of the 2,159 sample scored positive for suicidal ideation–similar to the prevalence rates for general, non-pregnant populations recorded in both the National Comorbidity Survey 1990-1993 (NCS) 2.8% ; and the National Comorbidity Survey Replication 2001-2003 (NCS-R) rate of 3.3% in general, non-pregnant population:

“The prevalence of antenatal suicidal ideation in the present study was similar to rates reported in nationally representative non-pregnant samples.  In other words, pregnancy is not a protective factor against suicidal ideation”.  (Gavin, et al., 2011, p. 239)

Of the 2.7% prevalence rate:

  • 78.0% reported thoughts of suicide “several days” in last 2 weeks
  • 15.3% reported thoughts of suicide “more than half the days” in the last 2 weeks
  • 6.7% reported thoughts of suicide “nearly every day”
  • 52.5% experienced comorbid antenatal depression
  • 15.7% experienced comorbid antenatal panic disorder

Speak My Language

Consider for a moment a group of 2,159 women attending standard prenatal childbirth education classes at a local hospital over the course of several years.  Generalizing from this study and national statistics, 59 of them are having thoughts of ending their lives.  Of those 59:

  • 48 (78%) have considered killing themselves several days in the last two weeks.
  • 9 (15.3%) have considered suicide more than half of the week,
  • 4 (6.7%) of those moms have contemplated killing themselves nearly every single day.

And those are the women who admit it.  The mothers who speak it. What do we do?  Final recommendations put forth by the authors here included “efforts to identify those women at risk for antenatal suicidal ideation through universal screening” (Gavin, et al., 2011, p. 239).

I think it is pretty fair to say that the majority of childbirth educators and doulas are trained to screen for difficulties in breast feeding.  When problems or risk factors present themselves, or a mom suffers from the agony of mastitis, we use language to help.  We lean over the void of suffering and listen to our mothers.

We speak the language of lactation quite easily,
and have organizational support and training to do so.
Yet, how many of us feel comfortable with the language of suffering alone in major depression? Go to your certifying organization’s website and look for resources for moms, or family members who feel suicidal.  Anything?   For you as a professional certified by that organization to offer emotional support to your clients, are there resources there for you to access, to help your clients?  Consider writing your certifying organization and request they update training for prenatal courses to include screening for depression.  Ask them to post suicide prevention materials for consumers. Your organization(s) should offer assistance in learning how to screen, referral sources in your area, and after care resources for your own healing should you need it.  Not doing so, not having public position papers, not speaking the language, in my mind is tantamount to silencing women’s suffering, and perhaps contributing to the loneliness of those who feel misunderstood. As David Biro (2011) states: “The consequences of silence are unacceptable…if we wish to relieve pain, we must first hear it” (p. 14).
“Listening to Mothers”…I’m in.

Posted by: Walker Karraa, MFA, MA



The Suicide Prevention Life Line offers free buttons, logos and links to add to your websites, and free downloads to give clients/students. You can also call them yourself to ask them how to talk to a mom about her symptoms.

Edinburgh Postnatal Depression Scale (EPDS)


Postpartum Support International (PSI)


Biro, D. (2011). The language of pain: Finding words, compassion, and relief. NY: Norton.

Bowen, A., Stewart, N., Baetz, M., et al. (2009). Antenatal depression in socially high risk women in Canada. J Epidemiol Community Health, 63:414-416.

Brand, S. Brennan, P. (2009). Impact of antenatal and postpartum maternal mental illness: How are the children? Clinc Obstet Gynecol, 51:441-455.

Chang, J., Berg, C., Saltzman, L., et al. (2005). Homicide: a leading cause of injury and deaths among pregnant and postpartum women in the United States, 1991-1999. Am J Public Health, 95:471-477.

Chaudron, L., Klein, M., Remington, P., et al. (2001). Predictors, prodromes and incidence of postpartum depression.  Psychosom Obstet Gynecol, 22:103-112.

Copersino, M., Jones, H., Tuten , M., et al. (2005) Suicidal ideation among drug-dependent  treatment -seeking  inner-city women.  J. Maint Addict, 3:53-64.

Eggleston, A. Calhoun P., Svikis, D., et al. (2009). Suicidality, aggression, and other treatment considerations among pregnant, substance-dependent women with posttraumatic stress disorder. Compr Psychiatry, 50: 415-423

Gausia, K., Fisher, C., Ali, M., et al. (2009). Antenatal depression and suicidal ideation among rural Bangladeshi women: A community-based study. Arch Womens Ment Health, 12:351-358.

Gavin, A., Tabb, K., Melville, J., Guo, Y., & Keaton, W. (2011). Prevalence and correlates of suicidal ideation during pregnancy. Arch Womens Ment Health 14(239-246).

Kelly, R., Zatzick, D., Anders, T. (2001). The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in osbstetrics. Am J Psychiatry, 158:213-219.

Kroenke, K., Spitzer, & Williams, J. (2001).  The PHQ-9: Validity of a brief depression severity measure. Gen Intern Med. September; 16(9): 606–613.

Lindahl, V., Pearson, J., Colpe, L. (2005). Prevalence of suicidality during pregnancy and postpartum. Arch Womens Ment Health, 8:77-87.

Newport, D., Levey, L., Pennell, P., et al. (2007).  Suicidal ideation in pregnancy: Assessment and clinical implications. Arch Womens Ment Health, 10:181-187.

Paris, R., Bolton, R., Weinberg, M. (2009) Postpartum depression, suicidality, and mother-infant interactions. Arch Womens Ment Health 12:309–321

Perez-Rodriguez M., Baca-Garcia E., Oquendo M et al. (2008).  Ethnic differences in suicidal ideation and attempts. Prim Psychiatry 15:44–58

Spitzer, R., Williams, J., Kroenke,  K.,  et al. (2000). Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD patient health questionnaire obstetrics-gynecology study. Am J Obstet Gynecol 183:759–769

Stallones,  L., Leff,  M., Canetto, S. et al. (2007). Suicidal ideation among low-income women on family assistance programs. Women Health 45:65–83

Vesga-Lopez,  O., Blanco, C., Keyes, K., et al. (2008). Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65:805–815


There is No Greater Loneliness: Pregnancy and Suicidal Ideation

February 19, 2013 07:00 AM by B.A. cum laude, minors: psych, world religion
It is important to consider the social condition of any suicidal person, pregnant or not, with or without alleged psych diagnosis. I know one disabled woman, raped pregnant, unable to physically or financially support herself or her baby, who makes logical arguments of why she is better off dead before presenting a child to the same world that broke her back during surgery, raped her in hospital, and blamed her for everything. I can not, with all my experience and training in crisis intervention, contest or disagree with her plans or wishes. All there is to do in such a case is to listen and support her in her emotions and decisions. I encourage anyone in a support role to remember this approach, as no one can clear the clouds in the sky, no matter what hopes or intentions we may have.

There is No Greater Loneliness: Pregnancy and Suicidal Ideation

July 23, 2014 07:00 AM by First time mom w twins on the way
I am 15 weeks pregnant with twins and suffer from suicide ideation. I have a good life with a history of depression. I know I have a lot to look forward to but I am still terrified. I am terrified that I cannot do this. I am terrified to always be sad. I am terrified to have anyone know how I feel when I should be overjoyed. I also do not want to medicate myself as I don't want to harm my unborn children. And so I feel trapped and feel I have no one to share this with as no one understands. I am happy that research is being done because it's horrible to think there are others out there that feel this desperately sad.

There is No Greater Loneliness: Pregnancy and Suicidal Ideation

September 13, 2014 07:00 AM by Mom of 3
@First time mom w twins on the way Hi first time mom, I just wanted to share with you because I don't want you to feel alone, I hated all my fetuses I was a horrible mother to the little miracles growing inside of me, with my first pregnancy I was obsessive, anxious, and slept at least 18 hours a day I refused to answer the phone so I didn't have to answer the house the pregnancy going questions. With our second baby I started with thoughts of self harm and became suicidal, at the time I didn't realize it, but I stopped driving by myself because I would wonder what it would feel like/ what would happen if I was in a head on collision as cars passed me in the opposite lane. I avoided stairs for the same reason as I felt if I could just fall down the stairs I would be able to get this alien out of me. I obsessively walked during the day in order to try to induce labour faster and intensively researched natural methods to induce labour. The reason we knew I was pregnant again with our third baby: I became depressed. Luckily by then I had gotten very close to my sister in law who has suffered from major depression off and on during her life and she recognized the signs and confronted me. The next day my husband and sister in law took me to my GP and had me relate the whole history of my first two pregnancies, during my third pregnancy I choose to be medicated, at that time I really just wanted to be happy while pregnant I wanted to love the little life growing inside of me so badly I was willing to try. I was put on a low dose of a mild antidepressant. I did have to up my medication through out the pregnancy it became easy to recognize and would come on quickly during trimester changes I would all of get anxiety attacks, suddenly hate the changes to my body that fact that I wasn't in control this little thing was. Aside for wanting to be happy, I wanted to be healthy, because of my depression I did not take care of myself during my second pregnancy. I would go out for 3 hour walks and not dress for the weather, I caught pneumonia at 27 week, my only thought is the hospital (after I was rushed there by ambulance with my blood pressure and the baby's heart rate through the roof) yes they will finally get this baby out of my and he is viable! I didn't eat right, I smoked I felt like I couldn't quit because of the stress so did it secretly so as not to look like a bad mother. My second baby was born weighing 6 pounds 11 ounces, so not a bad weight, but I was so scared that because of how I was during the pregnancy he would be damaged some how. He had a weaker immune system then his older brother, he was barely breast fed (I was put on antibiotics), as he grew older he had more tantrums, he has a slight stutter. Even now I catch myself worrying about whether he will had problems because I refused to care for myself while pregnant, because I didn't get the help I needed. He's a bright boy now, he loves mazes, math and learning, he has a better memory then his older brother a lot of the time. My third child was alittle girl, she weighed the most of the three coming in at 7 lbs 13 oz. She was a happy baby from the beginning. She is alittle drama queen reached her milestones on time or early, she can talk and sing like no ones business and is the boss of all the boys in the house. One thing that I remember is that when I went on my medication my GP told me that we know depression can harm your baby, and some medications can be safer then the depression. I would never choose to be pregnant again, I don't know if I could have a normal pregnancy without medication. For years my biggest fear was being raped and getting pregnant, not because of the rape but because I would be pregnant again. I want to reassure you that antenatal or prenatal depression doesn't always develop in to postpartum depression, I became mentally well again days after my children's birth. I came of the medication from my third pregnancy very quickly. I wish you didn't have to feel sad or trapped, but you can do this, set up a support group, tell you doctor/ health nurse about your suicidal thoughts they will all be there for you after you give birth as well.

I feel badly, too. I have suff

February 28, 2015 07:00 AM by Rebecca
I feel badly, too. I have suffered depression my entire life and unfortunately I have lived this pregnancy feeling alone and scared (of people knowing about my baby). I love my baby and I don't want my baby to be hurt. I'm just so scared. I wish that someone would protect us.

I am a 4th time mom, 7 months

February 28, 2015 07:00 AM by Amanda
I am a 4th time mom, 7 months pregnant with a little girl. I suffer from severe depression and have in the past. I have a great life a husband and 2 beautiful kids 4 and 7. I have struggled with suicidal thoughts during this pregnancy much stronger than outside of pregnancy. I have attempted suicide in the past by drug overdose, and once during this pregnancy by hanging(so I wouldn't hurt the baby should I survive. The feelings are so strong that I will go to buy a baby blanket and then decide not to because I am not sure if I will be alive to even use it. I don't feel there is much doctors can do to help, maybe medicine or counseling. I am glad to see this study and I hope more are published in the future with effective methods of treatment for depression in pregnancy.

Deep. Thank you for this!

August 26, 2015 07:00 AM by mizChartreuse
Deep. Thank you for this!

I am 15 wks pregnant after mul

September 20, 2015 07:00 AM by Lowell
I am 15 wks pregnant after multiple harrowing rounds of IVF. I have suffered with depression and anxiety most of my life. I now feel suicidal. After all the trauma I went to to get pregnant, I feel so much shame and profound disappointment that I have no capacity to enjoy being pregnant. I haven't felt normal in my body for more than a year. I have lost hope in my ability to be a joyful person. I have been thinking about hurting myself and/or hurting the baby everyday. My husband is supportive and kind, but he is also at a loss of what to do. I told my doctor I'm depressed, but she's been slow to help and/or offer resources. Medication has never really worked for me in the past (trust me, I've been on them all). And after spending more than half my life in some form of talk therapy or another, I've given up hope that sitting in a small room talking about my feelings to another person is going to fix (or even soothe) the hole in my soul. I am at a loss. I recently moved to a new city (just at the pregnancy started), so I am so profoundly alone and isolated. I have no family, no friends. No one in my life will be coming to stay or help with the baby once it comes. I have never, ever felt more frightened or alone. I've come to hate the baby. I am TERRIFIED about what's happening in my body. I feel fat and unattractive. I have nothing to wear. I'm not sleeping well and I'm just eating crap food. I talk to some girlfriends on the phone, but I know I'll just scare them if I talk about feeling suicidal. I cannot imagine making it through this pregnancy without hurting myself. The isolation is literally killing me. Because of the move, I had to close my business before moving; and because I'm pregnant, I don't know what kind of job to get in my new city. I am lucky that my husband makes enough to support us, but I have nothing to do during the days. Everyday I think about dying as a way to escape the pain. I have truly, honestly lost hope that my life will ever work out in a peaceful way. I'm a prime candidate for postpartum depression. And if I'm so isolated and without help now, how the hell am I going to manage once this baby arrives? Everyday is gritted teeth and white-knuckling. I don't know how I'm going to survive.

Thank you for your comment and

September 21, 2015 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE
Thank you for your comment and sharing your feelings. You are not alone, and your feelings and emotions are not uncommon. I urge you to contact the Suicide Prevention Lifeline ( for support, help and referrals to resources in your area. Postpartum Support International ( will be able to also offer support, for you during your pregnancy. Please reach out today.

Me too

April 16, 2017 11:30 PM by Tired

I'm glad I am not the only one. I am living in a town where I know no one and have been harassed. I told my husband before I was pregnant that I was at the end of my rope in terms of being able to live here. I told my mom I was suicidal and she called him to try to convince him not to stay. But he needs to stay here another year for his job. I am not sure if I can make it. I just want to go home and somewhere where it is not so cold and where I don't have to be scared to go to the store. 

To leave a comment, click on the Comment icon on the left side of the screen.  You must login to submit a comment.  

Recent Stories
SOGC and Canada Embrace Home Birth - Why is the USA So Far Behind?

January is National Birth Defects Prevention Month - What the Childbirth Educator Can Be Sharing

Series: Building Your Birth Business - Google Classroom to Share Resources and Build Community