Why I’ll still be taking pills even if I get pregnant: a follow-up

A few months ago, I shared a post in which I revealed I’m planning to continue taking my ADHD medications even if and when I someday get pregnant. I explained that I literally wouldn’t be able to afford to stop taking my daily dose of CNS stimulants; sans pills, I can barely function, which means I would be unable to work (or even drive to work, for that matter). In short, I would have to risk exposing my unborn child to all manner of adverse health outcomes in utero.

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As it turns out, however, such exposure may be far less likely than originally thought. As reported in a Nov. 29 ADDitude article, “The risks associated with taking an ADHD stimulant medication during pregnancy are real, but quite small,” according to an extensive population-based study published last month in the journal Obstetrics & Gynecology

In the study, the authors examined a cohort of pregnant women “and their liveborn neonates” enrolled in Medicaid from 2000 to 2010. They compared women who took Adderall or Ritalin alone in the first half of pregnancy to unexposed women, and women who continued to take the medication past 20 weeks’ gestation to women who discontinued.

The takeaway? 

Psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. The absolute increases in risks are small and, thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings.

This is an indisputably significant development in the field of ADHD research. Until now, studies of methylphenidate (Ritalin) use during pregnancy were based on cases “not representative of the general adult ADHD population having methylphenidate as monotherapy during pregnancy,” according to a 2014 systematic review published in the British Journal of Clinical Pharmacology. That is because “all the articles reported combinations of methylphenidate with either known teratogenic drugs or drugs of abuse.”

But this new revelation is equally noteworthy for what it represents. In the past, discussions of whether women should discontinue their ADHD medication during pregnancy were cloaked in foreboding language, declaring it should only be done “if the potential benefits to the mother outweigh the potential risks to the fetus.” To me, it seems inevitable any woman faced with such tacit guilt-tripping would opt to go off her daily pill regimen — to, in short, prioritize the safety of her unborn child over her own well-being.

Also, this new knowledge has given me a newfound sense of legitimacy. While I’m an ardent feminist, I can’t deny that in Western society, motherhood is held up as the quintessential state of womanhood. So when years ago I found out having ADHD may mean I could not become a mother — at least, not if I wanted to continue to receive treatment for it — I felt like an essential part of myself was forcibly eroded. It was as though I was no longer a real, full-fledged woman because I probably wouldn’t be able to have a baby. And it wouldn’t be for a legitimate reason, like income or infertility; it would, like so many other things, be dictated by my need to take medication, to engage in preemptive damage control of my disability. In essence, it would have meant a disability I had from birth would prevent me from giving birth, myself. And when that dawned on me, one thought repeatedly ran through my mind: “It’s not fair.” 

I don’t know if I’ll ever end up having a baby. As I said in my earlier post, because of the strong likelihood my offspring would have ADHD as well, I would only want to bring a child of mine into this world if I knew it were a world more tolerant of ADHD than the one in which I grew up. Plus, I couldn’t handle single parenthood, and I don’t know what the future holds for me vis-à-vis finding a life partner. 

But with the publication of this study, for the first time in my life, I know if circumstances do align for me, I’ll be able to do what I’ve always wanted — become a mother — without stigma and without the overwhelming fear of putting my baby at risk in the process. 

That’s an invaluable gift. 

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The lie we need to stop telling women about ADHD

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Girls are less likely than boys to be diagnosed with attention-deficit hyperactivity disorder. The general consensus is this is because for boys this tends to manifest in hyperactivity, which is much more noticeable to parents and teachers than inattentiveness, the type of symptom most common in girls. Luckily, as awareness spreads (albeit sometimes at a seemingly glacial pace), more and more women are eventually finding out the distress they’ve dealt with for their whole lives has a neurological explanation, and it’s called ADHD.

The long-delayed moment of diagnosis is often held up as a new beginning for the diagnosed. But while being diagnosed may very well be the most significant event in an ADHDer’s life, it’s not the be-all, end-all everybody makes it out to be. No, ADHD diagnosis is a new beginning — just not of pure, wholesale relief forever after. Instead, it’s the beginning of a life of newfound clarity about enduring struggles, for enduring they indeed are: Even if she starts an ADHD treatment regimen, pharmacological or otherwise, post-diagnosis, the ADHD woman faces an uphill battle that will continue for the rest of her life.

Nobody ever seems to talk about the extreme fallibility of ADHD medications, at least those currently on the market. In truth, ADHD is often treatment-refractory or treatment-resistant, meaning an ADHD medication may only have potency in a given person for a limited period of time, if at all. Now, there are two primary classes of CNS stimulant medications: amphetamine, aka Adderall, and methylphenidate, aka Ritalin. Most people respond better to one type of stimulant than the other. But many people, for whatever reason, don’t get symptom relief from either.

Moreover, you can have the most positive response possible to a given medication, but still not experience complete ADHD symptom relief, even temporarily. Unfortunately, the neurotypical expect us ADHDers to perform at their neurotypical levels if we’ve been “lucky enough” to be diagnosed and treated. Promised patience tends to run dry.

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This is particularly unfortunate for women, who earn the censure of society for displaying ADHD symptoms that tend to be revered in men. For instance, a man who doesn’t follow directions is deemed an “out-of-the-box thinker,” while a woman gets a reputation for recklessness. And a man who speaks out of turn is viewed as assertive; a woman, lacking self-control.

On top of that, women are tacitly expected to assume and maintain responsibility not only for themselves but also their entire household, both in its upkeep and of its members. Many women discover their ADHD at some point during or after their child’s diagnostic process. The upshot is these women being responsible for a higher than average degree of care for children with ADHD when they, in fact, need to expend extra effort just to take care of themselves. 

Just to put it into perspective, for you, I’ve been aware of and received treatment for my ADHD since early childhood, yet even I have to strive every single day just to avoid falling behind. Getting ahead, excelling almost always feels like a pipe dream — this, despite the fact that I’m on the highest possible dosage of all of my medications; not to mention, I live with my parents, rent-free! 

All of this is to say, it’s time to infuse a little honesty into the adulthood-diagnosis narrative, especially for women. We need to stop leading these ADHDers to believe everything is going to be OK because frankly, it’s highly unlikely that will turn out to be 100 percent true. Again, this is in large part because of the tacit mandate to fulfill traditional gender roles. As Kathleen Nadeau, one of the foremost experts on women and ADHD, explains,

Society has a certain set of expectations we place on women and ADHD often makes them harder to accomplish. … They are supposed to be the organizer, planner, and primary parent at home. Women are expected to remember birthdays and anniversaries and do laundry and keep track of events. That is all hard for someone with ADHD.

Honesty, it seems to me, is what’s called for here — honesty and compassion. And in that vein, there’s also a great need to reconfigure the typical response to a newly diagnosed ADHD woman, which right now is something to the effect of, “Congratulations! You have ADHD. Good luck!”

In this day and age, that kind of MO is unrealistic, and as such, utterly unhelpful.

7 things that DO NOT make you a bad feminist

Between 2015 and 2017, I was a graduate student in the Women, Gender, and Sexuality Studies master’s degree program at Oregon State University. This was one of the most important experiences of my life, primarily because it gave me the strong foundation in the feminist knowledge that I knew I would need if I wanted to become a successful feminist blogger. Yet I also derived essential benefits from the experience insofar as it revealed to me how exclusive modern feminism can be. But as the great bell hooks reminds us, Feminism Is for Everybody.

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1. Being heterosexual

At some point in this long battle for gender equality, we got confused and assumed that meant that female-identified people who love and/or want to bang people of the male persuasion must exist in opposition to the cause of feminism. If the logic here is that it is because men are part of the problem, well, that’s as sexist as the problem itself. 

2. Being privileged

As an upper-middle-class (as long as I live with my parents, anyway) Caucasian, I’m privileged. I know that. What I don’t know, however, is why this has led people in the past to assume I’m “part of the problem.” Those who are not of color and are of wealth have perpetrated some abominable atrocities. But that doesn’t mean all people sharing one or both of these traits must automatically be taken as the enemy. A lot of us have our hearts in the right place and are eager to learn from people who are differently oppressed and work together with them to make things better. The need for sexual equality knows no income or skin color.

3. Being monogamous

Sexual liberation has been a critical element in feminism since the dawn of the second wave. But somewhere along the way, being sexually liberated became a requirement to join the feminist cause, and moreover, the definition of sexual liberation seemed to shift to exclude long-term, single-partner relationships, especially relationships with men (see above). But I call bullshit. True sexual liberation means feeling free to engage in whatever type of sexual activity you want (as long as it’s consensual) without worrying about how others will perceive it. It doesn’t matter if it takes place in the context of a committed relationship. 

4. Being cisgender

Shaving your legs, wearing makeup, or being in any way “feminine” whatsoever is NOT mutually exclusive with being a card-carrying feminist. True feminists realize gender roles are human-made, and so resisting freaking out over whether you’re conforming to said gender roles, by realizing certain traits are merely artificially coded “feminine” or “masculine,” is as feminist an act as I can imagine. As Martha Rampton of Pacific University’s Center for Gender Equity notes,

An aspect of third wave feminism that mystified the mothers of the earlier feminist movement was the readoption by young feminists of the very lip-stick, high-heels, and cleavage proudly exposed by low cut necklines that the first two phases of the movement identified with male oppression.

5. Wanting to get married

I’ve just about had it with the argument that a quote-unquote real feminist activist can’t dream of someday saying “I do.” Whatever your gender identity or the gender identity of your chosen spouse, the institution of marriage has the potential to be extremely feminist. After all, marriage, at its best, is about two people coming together as equals and promising to honor and love each other; and equality is feminism manifest. 

6. Wanting to have kids

It’s okay to want to tie the knot. The same goes for the desire to procreate. Motherhood isn’t inherently feminist, despite what some proponents of breastfeeding might have you believe; but it isn’t actively un-feminist, either: Most of the professors I studied under at OSU are parents, and let me tell you, they’re all veritable paragons of feminism. So, yes, I want to be a mom. I also want to shatter the patriarchy. Luckily for me, a feminist can do both.

7. Wanting to beat men at their own game

Second-wave feminists “rejected the ideal of inclusion because … they would only be vying for inclusion in a world built on men’s values.” This MO has continued to dominate mainstream feminism ever since. But while I am loath to tell anyone to “lean in,” let me just say there is nothing at all wrong with wanting to work in the same institutions as men, e.g., a traditional workplace, and surpass them in excellence. It’s totally OK to wish and demand that there be space for us women in the world we live in now.

Otherwise, in my humble opinion, we’re just letting those who benefit from the patriarchy off the hook.

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Why reproductive justice is routinely jeopardized

As a feminist activist, back in grad school and today, my pet cause has been reproductive justice — not reproductive rights, but reproductive justice, “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” I’m quoting here from the website of the Sistersong Collective; they first coined the term to incorporate the lived experience of WOC

Now, I don’t mean in any way to co-opt this term or downplay the singular struggle of WOC and other marginalized women — especially given that many who share my identity of WWD are always in danger of having their reproductive rights violatedBut as we get further into the new millennium, there has been a unilateral erosion of reproductive rights for all women in the United States. And yes, that includes the college-educated, married, Caucasian ones. 

Contraception

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Our access to oral contraception and other methods of birth control is perpetually under threat, despite the passage of the Affordable Care Act in 2010. (Photo source: Adobe Stock)

Recently, word came down from our Beelzebub-in-Chief that as of Oct. 6, an interim rule was now in effect that, in the words of Aaron E. Carroll of the Times, “weakens the mandate for health coverage of contraception under the Affordable Care Act, giving more leeway to employers with religious or moral objections.” 

Terrific. Moving on.

Sex education 

The following is a passage from an article that ran last week in the Washington Post

 Abstinence-only education — which attempts to teach young people not to have sex outside marriage and often does not include material on birth control and safe sex — began receiving federal funding in the 1980s. Funding increased when George W. Bush was president. His successor, President Barack Obama, attempted to end the program and direct money to comprehensive sexual education, but the Republican-led Congress kept it alive. Now abstinence education gets about $90 million in federal funds annually, and this past summer, President Donald Trump cut more than $200 million in federal grants to scores of organizations that work to decrease teen pregnancy rates, which could affect sex education programs in some areas.

I did a massive research project on sex education during my freshman year of college. And I can tell you that AOSE, as opposed to comprehensive sexuality education, is, unequivocally, the worst thing you can do for your child if you want them to be in good health and stay that way throughout their reproductive lives. Keep this in mind.

Abortion

And that’s not all: Earlier this month, Congress passed a bill outlawing abortion taking place 20 weeks or more post-conception: It “would punish abortion providers with up to five years in prison for terminating a pregnancy after 20 weeks’ gestation.”

What motivates this? An interest in human rights for unborn children? Science tells us that’s not so: To quote a Mother Jones article from 2016, “The majority of the scientific literature on the subject finds that the brain connections required to feel pain are not formed until at least 24 weeks,” i.e., a full month later.

Now, you will recall that Roe v. Wade (1973) solidified legal protection of the right to have an abortion up to 12 weeks into a chronological pregnancy; by that measure, we’re no worse off than we were before. What I find troubling about this is that some of our lawmakers have now gone on the record vis-à-vis their feelings about expanding women’s rights related to reproduction — and they aren’t feelings of support.

It seems to me that this is part of a more significant, more insidious effort to create a culture that responds punitively to the exercising of one’s reproductive rights, which arises from an ultimate desire to revoke such rights — and with it, our reproductive justice — altogether.

A real-life ‘Handmaid’s Tale’

This past spring, my mom and I became obsessed with the adaptation of Margaret Atwood’s novel The Handmaid’s Tale that aired on the streaming service Hulu. Every Wednesday afternoon (she and I both work from home), we’d sit in the family room and watch the newest installment of this jewel of small-screen speculative fiction, pressing ‘pause’ about five times over the course of an episode to discuss the feminist implications of a particular moment or commiserate over how hauntingly close to home the show was hitting.

After watching the first few episodes (the initial ones were released simultaneously), my mom, who read the book years ago, asked me, a newcomer to the story, what I thought.

I told her that I liked it, but, of course, it wasn’t very realistic. In real life, I reminded her, we don’t have to worry about a backward revolution overthrowing the U.S. government, tearing up the constitution, and effectively reducing women to their reproductive function, allowing them neither jobs nor even hobbies requiring any appreciable amount of intellectual engagement.

However, my mom explained how in danger we, in reality, are in the current U.S. political climate of losing our liberty. And last week, she started saying out loud what I think many of us have subconsciously feared for a long time: that these moves to erode our reproductive rights exist to force women out of the market, i.e., the labor market. No pun intended.

By treating each attack on American reproductive rights as regrettable but existing in a vacuum, we inure ourselves to the concept of undermined reproductive justice as a normal fact of life under the fascist regime that is the Trump administration. If we’re not careful, we’re going to end up just like Atwood’s eponymous handmaids: isolated, powerless, and nothing more than glorified incubators

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Legislation by the U.S. government in 2017 is eroding our reproductive rights and creating a real-life ‘Handmaid’s Tale.’ (Source: Hulu via Uproxx)

Pregnancy + stress = public health’s perfect storm

From January 2015 to December 2016, I was a student in the master’s degree program in Women, Gender, and Sexuality Studies at Oregon State University. My time in grad school was instrumentally influential to me. I minored in women’s studies back in college at U of O, but when I realized that my real aspiration was to become a feminist writer, I decided that I needed a much stronger foundation in feminism as an area of study. And that turned out to be true in ways I hadn’t even anticipated: I became aware that my prior feminist education, for all its merits, had failed to incorporate discussions of women of color. But that was about to change.

Lifelong stress → premature birth

One of my primary research interests while at OSU was women’s health. As it turned out, one of the professors, Mehra Shirazi, specialized in that, and I was fortunate to take not one, but two courses from her: Global Perspectives on Women’s Health, in winter of my first year, and Race, Gender, and Health Justice, a year later. Of all the lessons I learned in her classes, one, in the form of a newsreel, has always stuck with me.

Stress during pregnancy → ADHD

WOC aren’t the only ones for whom stress can result in adverse birth outcomes for their childrenIn my last post, I mentioned that women with ADHD who experience stress during pregnancy are more likely to have children with it. Well, I was wrong. The abstract of an article published in the journal Frontiers in Psychology in 2011 states that “maternal stressful events during pregnancy significantly predicted ADHD behaviors in offspring,” i.e., stressful events for any pregnant woman, not just one with ADHD

Furthermore, said Dr. Ian Colman, who led a similar study earlier this year, “Generally speaking… the higher the stress, the higher the symptoms.”

In other words, more children are susceptible to maternal-stress-induced ADHD. And their symptoms vary in severity depending on the level of maternal stress. 

In the announcement of their study on stress in pregnant women and ADHD, University of Ottawa researchers included an infographic of so-called stress management tips and tricks, including:

Portrait of sad and frustrated pregnant woman.

Women with ADHD who experience stress during pregnancy are more likely to have children born with ADHD. (Photo source: Adobe Stock)

  1. Identify what’s behind your stress and address it right away
  2. Talk to your loved ones to help them help you
  3. Simplify your life by shortening your to-do list and learning to say no
  4. Quiet your mind through yoga and mindfulness
  5. Find time to do something you enjoy, such as hobbies or physical activity.

That’s all well and good, but it predicates on the dual notions that (a) stress is situational, and relatedly, that (b) women have the power, i.e., time and agency, to quote-unquote simplify their lives, quiet their minds, and do things they enjoy. 

First of all, it would be ideal  — I’m not saying it would be great, but it would be the best-case scenario — if all stress were indeed situational. But in fact, it’s systemic; there are sociological reasons that women find themselves in stressful situations.

For example, I think we can all agree that in general, men are more amenable to “going the extra mile” for their wives when they are serving as human incubators for their progeny. But this is temporary. Gender roles are so entrenched in our consciousness, exist so much in our understanding of the fabric of society that they’re liable to supersede sudden inclinations toward chivalry. They may wash the dishes occasionally; even assume all responsibility for helping the kids they already have with their homework, etc. — at least after coming home from the office.

But will they assume sole responsibility for cleaning all toilets in the house for the next nine months — and do so without even being asked? Let me put it this way: My dad is a proud feminist, but according to my mom, not even he went that far when I was a bun in his wife’s oven.

The salient point here is that unless a husband* assumes all extant household responsibilities, a wife has no means of wholly and entirely de-stressing. Moreover, in the most extreme versions of our regular social paradigm, women don’t even have time to find out what they enjoy, let alone actually do it. 

Women of color

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Stress resulting from everyday racism in women of color over a lifetime can result in adverse health outcomes for their children at birth. (Photo source: American Psychological Association)

In addition to this paradigm shift between husbands and wives, in order to avoid the adverse birth outcomes of which their children are at risk, WOC would need to retroactively un-experience the systemic (there’s that word again) ‘everyday racism’ they have experienced all their lives. Erasing the sexism that they were forced to endure, well, that wouldn’t hurt matters, either. Unfortunately, none of this is possible. Technically, we can’t do anything for the WOC already of childbearing age, except confer upon them the utmost respect and provide them with any prenatal care that may reduce the likelihood of pre-term delivery.

I have a vision for future generations, though, of my friends’ children growing up without the media suppressing reportage of violence against WOC in favor of the police-violence-against-the-Black-man narrative. In this vision, violence against POC — regardless of gender — isn’t even a thing. 

All in all, I agree with Dr. Michael Lu:

If we’re serious about improving birth outcomes and reducing disparities, we’ve got to start taking care of woman before pregnancy and not just talking about that one visit three months pre-conceptionally; I’m talking about when she’s a baby inside her mother’s womb, an infant, and then a child, an adolescent and really taking care of women and families across their life course.

And I agree, as well, with my former classmate in WGSS and dear friend Amber Moody:

I think it’s brilliant to frame systemic racism/sexism as a public health issue. … [T]hese systems of discrimination still exist; and the effects, which really can be traced back to colonialism and white supremacy, have been genetically embedded into our lives. And until we actually address the source of the problem, these … issues are going to continue to be passed down for generations.


*I say ‘husband’ because I was raised in and hypothetically will enter into a heterosexual family dynamic consisting of a cismale husband and a cisfemale wife. There are, of course, numerous other familial configurations; albeit I doubt very much that the same degree of gender-role pigeonholing would be present in a female-female marriage.