What to do if you're experiencing suicidal thoughts while pregnant

• Meghan Markle was pregnant with Archie when she said she experienced suicidal ideation.
• The thoughts are relatively common in pregnancy, especially among people with histories of trauma.
• Speaking up is critical for your and your future child's well-being, and to break down the stigma.

Meghan Markle was more than halfway through her pregnancy with Archie when she hit such an emotional low that she attended a glamorous event simply to protect herself from herself.

"I can't be left alone," Markle said she told Prince Harry that morning in January 2019.

Markle revealed her past suicidal feelings to Oprah Winfrey on Sunday, bringing attention not just to how people's outward smiles can mask their inner pain, but also to how, for some, pregnancy can spawn devastating, even life-threatening, emotions.

"It's important to normalize [suicidal ideation in pregnancy] so more women can get the help they need, versus stigmatizing or shaming women for something that is common in pregnancy," psychotherapist Ashley McGirt, the founder and president of the WA Therapy Fund, told Insider.

Suicidal ideation in pregnancy is relatively common, and on the rise

It's hard to know just how common suicidal ideation in pregnancy is, as it's not something OB-GYNs routinely screen for. Plus, stigma can prevent pregnant people from reporting it, and the lack of conversations around the topic can prevent them from even recognizing it in themselves.

"Oftentimes, suicidal thoughts are masked in 'not wanting to be here' or 'wanting to disappear,'" McGirt said.

Of the research that does exist, estimates of the prevalence of pregnant women who've thought about taking their lives range from 3% to 33%. Certain populations, like low-income people and those with a history of trauma, seem to be particularly vulnerable.

One 2019 study of more than 700 low-income pregnant women in Central Illinois, for example, found that 4.6% reported having suicidal thoughts, which is about double that of the general population. In another study of low-income women, 23% reported suicidal ideation.

Those numbers are only increasing, psychotherapist Haley Neidich, who's certified to provide perinatal mental health support, told Insider.

"Suicidality in general is on the rise among pregnant women, with self-harm urges and suicidal thoughts tripling among this population over the last decade," she said. "A figure like Meghan bringing this issue to light to fight stigma is a tremendous gift to other mothers who are struggling but are too ashamed to ask for help."

People with histories of trauma are at higher risk

Women with depression seem to be at higher risk, and those who stop antidepressants when pregnant can relapse. Still, about one-third of women in one study experienced suicidal ideation but didn't have to have other depressive symptoms.

People with unplanned pregnancies are more apt to contemplate suicide, and those with current or past traumatic experiences, like intimate partner violence or childhood abuse, are more susceptible to suicidal ideation, too, research shows.

For Markle, her experiences as a woman of color could have played a role.

"My first reaction [to Markle's admission] was this is a culmination of what occurs when exposed to exacerbated racial trauma," or "the physical and emotional reaction that individuals of color have in response to frequent experiences and exposure to stressful experiences of racism," McGirt said.

"Racial trauma like grief is not a mental diagnosis, but a normal response that can develop into depression and or suicidal ideation," she said.

But women with no other risk factors can experience suicidal ideation during pregnancy too, as the experience is constantly changing a woman's body, hormones, and emotions. Plus, the prospect of childbirth can be terrifying.

When you're pregnant, "your body literally becomes 'not your own' as you share space with another living being," McGirt said. "This can be emotional and traumatic and also beautiful and exciting."

Don't be afraid to speak up - there are many resources to support you

The vast majority of pregnant people who've thought about suicide won't go on to attempt it, but addressing the thoughts is important for you and your future child's well-being. Some studies have found that suicidal ideation during pregnancy is associated with low birth weight.

It's also important to learn coping mechanisms for the future, as suicidal thoughts can crop up during the postnatal period, too, making it difficult for women to bond with their babies.

If you're pregnant and having thoughts of, or engaging in, self-harm, call a service like the national suicide prevention hotline or a local organization, like Pacific Post Partum Support Society or NYC Well, both which offer texting services with trained mental health professionals.

Typically, the people on the other side of these calls will make sure you're safe, assess your level of risk, talk to you about sharing your experiences with a family member or friend, and, if need be, talk to your doctor or help you get to an emergency room, according to Today's Parent.

Alternatively or in addition, talk to a trusted healthcare provider like your OB-GYN or midwife, who may offer medication, therapy, or a referral to another professional.

McGirt also recommends making space to do things that feel good to you, like moving your body, meditating, praying, listening to music, or watching a funny YouTube video. It's important to allow yourself to cry, too.

"So many women who experience mental health issues during pregnancy, including suicidality, are silenced by stigma," Neidich said. "Meghan encourages those women to be brave and to use their voices and speak their truth."