You're Wrong About Postpartum Depression
Postpartum depression affects at least 15% of new mothers. Tragically, suicide is a leading cause of death in the postpartum period. Yet we’ve done very little to combat postpartum depression for one simple reason: we insist on blaming it on women’s hormones.
Women have and produce hormones throughout their lives. Numerous life events, from graduating college to going through menopause, can cause long-term hormonal shifts or sudden hormonal swings. Men have hormones, too, yet no one suggests that their hormonal swings are responsible for their mental health. Why is this? Could it be that we would rather dismiss postpartum depression as an individual problem than look at the societal factors? After all, if postpartum hormonal swings were really the primary culprit in postpartum depression, wouldn’t most—or maybe even all—women get depressed after giving birth?
The story most of us have all been told about postpartum depression is wrong. It harms women, lets negligent partners off the hook, presents medication as a panacea for a social problem, and fails to address the intolerable conditions many American parents face after having a baby. Here’s what the evidence actually tells us.
Postpartum Depression: A Familiar Story
The usual postpartum depression story goes something like this:
A woman gives birth, and like a significant number of American women, she experiences birth trauma. Her OB cuts an episiotomy without her permission, or coerces her into a C-section. She returns home to recover from giving birth, often with injuries—stitches from a perineal tear, a major wound from a C-section, or psychological distress from a scary birth.
And unlike what might happen following any other medical event, we expect her to work harder than ever. Her spouse may demand that she keep the house clean and get up with the baby while he sleeps. Her family may criticize her parenting or ignore her wishes. She’ll probably have very little breastfeeding support. She may not have paid maternity leave, which will compound the stress and compel her to return to work earlier than she needs to. She’ll spend weeks sleep-deprived and alone, with no one to support her or help her process the major life change she has just experienced.
If she tells her doctor about her symptoms, her doctor will probably also hear about the many depression risk factors she has, including:
a recent life change (having a baby)
a serious medical event
a traumatic or upsetting birth
an unsupportive spouse
lack of sleep
low quality nutrition because there’s no time to make food and her spouse doesn’t do it for her
financial and job stress
lack of support from friends and family
isolation
plummeting self-esteem
And knowing all of this, her provider will conclude that the problem is….hormones? The environment in which we force most people in this country to give birth makes it a near-miracle that anyone at all avoids depression. But it’s easier to blame women’s hormones than to look at the very real challenges they face. Until we shift that approach, PPD will continue to be an epidemic and many women will see their PPD go untreated or undertreated.
Medication can and does change lives. But the solution is not always a pill. In most cases, it’s more support—and ultimately, a better society.
Failing to Care for New Mothers: Cross Cultural Differences in Postpartum Depression
If postpartum depression were an inevitable and common response to giving birth, we would expect rates to be relatively consistent across cultures. That’s not the case. Cultures that offer more support to new parents have lower rates of postpartum depression. So too do more egalitarian cultures. One study, for example, found that maternity leaves of less than 12 weeks increased the risk of postpartum depression. This suggests that, rather than being a complication of childbirth or a hormonal disease, postpartum depression is ultimately a failure to care for families, and especially a failure to care for new mothers.
Risk Factors for Postpartum Depression
It turns out that we don’t need to speculate about the reasons some people develop postpartum depression. We already have compelling research identifying the risk factors. Numerous studies have arrived at virtually identical conclusions about postpartum depression risk factors. They include:
Marital quality. Married or partnered women who have ongoing conflicts with their partners are more likely to suffer from postpartum depression. Lack of emotional support from a spouse, verbal or physical abuse, and isolation (such as when a spouse returns to work immediately after their partner gives birth) may further increase the risk.
Lack of marital equality. Preliminary research on lesbian couples suggests that their rates of postpartum depression may be lower than that of heterosexual women. Researchers believe this may be because lesbian couples more equally split household and parenting duties. Taken in conjunction with other research that shows huge disparities in household labor in heterosexual couples, it’s fair to conclude that recovering from having a baby while doing more than your fair share of parenting and cleaning is a significant risk factor for PPD.
Mental health history. Many women’s depression actually begins in pregnancy. For some, it even predates pregnancy. Women with a history of mental health issues are more vulnerable to PPD.
Childcare stress. Lack of access to quality, affordable childcare is a major risk factor for PPD. This type of stress also interacts with other forms of stress. For example, lack of access to childcare may mean a woman does not return to work. This can affect the quality of her marriage, trigger economic insecurity, or affect her self-esteem.
Socioeconomic issues. Socioeconomic stress, such as from not having paid maternity leave, not being able to afford housing, or struggling to afford quality healthcare, greatly increases the risk of postpartum mental health issues.
Lack of social support. The United States provide less support for new mothers than any other wealthy country. Culturally, it is not the norm for family to rally around new parents. This lack of support, coupled with the judgment and hostility new mothers often face, can trigger a depressive spiral.
Child health and behavior issues. Having a baby with health problems or a difficult temperament (such as a baby who cries a lot or who does not sleep), can increase the risk of PPD. This is especially true in women who do not have adequate social support, either from a spouse or family or in the form of quality childcare.
Negative or traumatic birth experiences. Birth trauma, especially when a doctor ignores consent, can cause PPD, PTSD, and numerous other mental health issues. Other types of birth trauma, such as stillbirth, miscarriage, catastrophic birth injuries, or lack of access to quality care also increase the risk.
Unplanned or unwanted pregnancies. Having a baby before you are ready is a huge risk factor for PPD, primarily because it increases the exposure to other risk factors, like socioeconomic stress or having an unsupportive partner.
Reducing the Risk of Postpartum Depression
The data on postpartum depression reveal a depressing portrait of how little our society values children and mothers. But we can also change that, which means we may be able to drastically lower postpartum depression rates. Based on the risk factors for postpartum depression, a number of strategies could lower the risk, including:
Better parental leave. When both men and women can take time off of work, childcare issues are less common and women can get support from their partners after birth.
More spousal support. The partners of women who give birth must be prepared to step up and care for their partners as they recover, offer emotional support, and shoulder a fair share of household labor.
Access to quality mental health care. Therapy in conjunction with medication is far more effective than medication alone, but many women with PPD never get therapy. That means they never get the opportunity to process the life circumstances that led to their depression. Further, quality mental healthcare increases the likelihood that women will seek help early, before their depression causes severe symptoms such as suicidal thoughts.
Better obstetric care. Study after study has demonstrated the link between obstetric violence and postpartum mood disorders. We must hold care providers accountable, and make sure that birthing people understand that they are entitled to quality, respectful, consensual care.
Greater social support. This means access to more community resources. A world that is less judgmental of, and more supportive toward, new mothers could also make a world of difference.