My psychiatrist faced me across the Zoom screen as I sobbed.

We’d been working together for years to make my medication regimen—treatment for schizoaffective disorder—safe for potential pregnancy. Under her care, I was tapering off an antidepressant known to cause respiratory distress and hypertension in a newborn. I’d been experiencing wild mood swings, even suicidal thoughts.

My beloved doctor’s eyes were sad. “I’m saying no to a pregnancy, Meg.”

Even in the moment, I understood her priority as a physician was to keep me safe. Still, part of me hated her. Despite my diagnosis and past psychosis, I wanted to be respected—for my journalism career, my master's degree, 10 years of stability, and loving, six-year marriage. Wasn’t this my husband’s and my decision?

Later, specialists at a university perinatal mental health clinic, with training my psychiatrist lacked, advised me to stay on all my medications, knowing my stability would benefit a baby. My husband and I began trying to conceive—only to experience miscarriage. A social worker told me that any adoption agency would turn us away due to my diagnosis.

Management of psychiatric disorders during the reproductive years is especially complex. Fifty percent of pregnancies in the United States are unplanned, and many women face pregnancy and motherhood while psychiatrically ill. More than 10 percent of pregnant women are prescribed psychiatric medications, while 1.6 percent of pregnant women take more than one class of drugs.

Reproductive psychiatry has advanced rapidly in recent years. In 2019, the FDA approved brexanolone to treat postpartum depression, the first medication of its kind. In 2021, the Task Force on Maternal Mental Health was established. Yet the field remains ill-equipped to care for women with mental........

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