Why Postnatal Depression Matters

Mia Scotland, Susan Last

• Publisher: Pinter & Martin
• Year: 2015
• eBook ISBN: 9781780665610
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

You have probably heard of postnatal depression, but did you know that most cases of postnatal depression actually began in pregnancy? And that most people who have antenatal depression have had depression in the past? And did you know that postnatal depression is not caused by women's hormones gone awry; men are suffering postnatal and perinatal depression in larger and larger numbers too? This is why "postnatal depression" has now been renamed "perinatal depression"('peri' means around, as in the word "perimeter").

Why is the seemingly joyful event of new parenthood causing so much suffering? Depression seems to be related to the stresses that a modern couple undertake when they have a baby. The lack of support, lack of celebration, overload of expectations, overwhelming responsibility, isolation, judgment, blaming by the media, tiredness, mixed messages, confusion, high expectations and lack of tender loving care serve to eventually break parents and their relationships. And when we break parents, we break a baby. Babies are our future, and if we break a baby, in the long run, we break society. Postnatal depression takes a high toll on society. Dealing effectively with perinatal depression is about valuing love, connection, calm and stillness, over and above productivity, achievement and acquisition.

1

Understanding Depression

Depression is known as a psychological condition. This means that we think of depression as being something to do with our heads: our mental health, our emotions, our thoughts, our behaviours and our relationships with others. A psychologist is interested in why we do what we do, why we think what we think, and why we feel what we feel. So psychologists spend a lot of time working out why we feel depressed, how depression affects our thinking and our ability to get on with others, and how it affects what we do. We want to understand it. Get to the bottom of it. Work out how to heal people.

Psychologists are interested in what makes us all the same (common universalities of human nature, such as the need for friendship) and what makes us different to one another (such as why some people are happier in their own company than others). They are also interested in why and how we suffer (such as why some people suffer acute and chronic loneliness).

However, understanding what makes us tick is not as easy as it might seem. Understanding humans involves understanding the culture they are raised in. Human beings are a product of their culture. The problem with trying to understand human emotions, is that we can never switch off our own psychology and cultural biases when we study human psychology. So the task of understanding our feelings, thoughts and behaviours is not an easy one.

Culture is incredibly important, and it is what shapes us as humans, but we can’t always see our own culture, because we are in it. For example, we can’t tell that we are spinning through space at 16,000km per hour, because we are in it. A fish once asked a crab what life was like on land. The crab said, ‘It’s sandy, you can walk on the sand, there’s a sun in the sky and there’s no water’. The fish said, ‘Wow, how interesting’. Then he thought for a moment, and added, ‘But what is water?’ Freud famously spent years puzzling over the question ‘What does a woman want?’ He couldn’t fathom why women seemed so lost, restless, unhappy and anxious. He couldn’t see that ladies needed more than polite society. He literally could not see what seems so obvious to us now, that his society treated women as second-rate citizens, inferior physically and mentally, and that this affected their emotional wellbeing. Freud was astute and he did think outside the box, but he never did manage to understand that women were reacting to a society which was not able to meet their needs. Women, like men, need exercise, respect, challenges, equality, and broader role definitions. He was trapped in a culture that regarded women as creatures who just needed to rest in their vulnerability and delicate frames, or their mental health would be compromised and they would get a ‘wandering womb’ in the form of hysteria.

Another reason that understanding human emotion, including depression, is difficult, is because our society has presumed for many years that the psychological and the physical are separate entities. Ever since the philosopher Descartes cemented the growing notion that mind and body are separate in the 1600s, we in the West have used language, made presumptions and behaved in a way that presumes this dualism to be true. Depression comes under the umbrella of ‘psychological’ or ‘emotional’ or ‘in the mind’. However, recent research is challenging this notion that mind and body can be separated. For example, we are beginning to understand that the experience of physical pain is not physical or mental, it is both. It is a combination of the two. We are learning that ‘physical’ conditions have a strong psychological component, including cancer, heart disease and diabetes. Seemingly ‘psychological’ conditions can also have a very physical component, such as depression associated with wheat intolerance. The placebo effect is regarded as ‘in the mind’, but how can this be? The whole point of the placebo effect is that it directly impacts on our physical body, creating very real changes in the form of healing (or in the case of the nocebo effect, creating illness in the body). The dualism between mind and body has led to a complete overlooking of the fact that placebo is a physical healer of illness. When trying to understand depression, I would urge us to move away from the notion that it is a psychological condition. It is not. It is a human condition, wrapped up in our crazy, amazing bodies, and in our unique and bizarre culture.

Thus, the mind and the body cannot be separated. Really understanding this will go a long way to lifting the stigma that is attached to mental health problems. The individual and society cannot be separated either. Society builds individuals, and we are all a product of our society. A human being cannot survive without society (we know that babies die if they don’t receive social interaction).

In trying to understand depression, we need to understand our society. We need to understand what kind of mothers, fathers, and babies, our society is building. Only then can weshed some light on why so many mothers and fathers seem to be struggling with perinatal depression.

Society’s messages – is motherhood blissful, or is it awful?

When you think of motherhood, what do you envisage? As a young woman studying feminism in the 1980s, I was sold the idea that motherhood is a thankless, down-trodden, boring task. I was told that the word ‘housewife’ was demeaning. I was taught that if I had children, I would lose my identity, I would become ‘just’ a mother, and my career, my individuality, my spark and my independence would be taken from me. People would look down on me. I would become used and reduced to domesticity. I was taught that the ‘myth’ of blissful motherhood is peddled by a society that wants to enchain women into the slavery that is motherhood. I was taught that people who believed in blissful mothering were being sold a lie, and that it was just a tool of social control to keep women chained to the kitchen sink.

The opposing view of motherhood is that it is blissful. Motherhood is the ultimate goal in a female’s life – her evolutionary biology is geared to find fulfilment in becoming a mother, and that is all she needs, because that is so rewarding in and of itself. Once she births a baby, and falls in love with it, she finds joy, and fulfilment. She needs nothing more, but to love and devote her time to her baby. She will find this easy and joyful, because it comes naturally to her. This view of motherhood is exemplified by the popularity of natural birth movements, extolling the joy of ecstatic birthing hormones and orgasmic birth. If formula advertising wasn’t so successful, I daresay it would be more mainstream to extol the joys of breastfeeding, idealising the ecstatic, warming bond that mother and baby feel as they connect in a swirl of oxytocined-up loveliness.

I don’t know about you, but I find these stereotypes very unhelpful. I’m not saying that they aren’t true, because there is some truth in each of them. The problem is that they are unrealistically black and white, and leave parents feeling inadequate (because they aren’t ecstatic) or uneasy (expecting the job to be so unfulfilling).

If you think these stereotypes aren’t prevalent, or you think I’m exaggerating, think again. They are part of our society, and they underpin all that we do – our presumptions, our habits and practices, and our legislation. Examples are everywhere. Providing free nursery places so that women can get back to being ‘productive’. Thinking it is okay to leave new mums alone at home weeks after they’ve had the baby, because mothering is natural and easy. I’ve heard fathers use the excuse ‘You’re naturally more patient with the baby than me’ to get out of looking after their own children. I’ve heard women say, time and time again, ‘Why am I finding this so difficult when it comes naturally to others?’, and feel guilty and inadequate because they didn’t fall in love with their baby straight away.

Conversely, women return to work six weeks after having baby because they believe that being ‘just’ a stay-at-home mum isn’t enough for them. Women go back to work so they can feel that they are ‘providing’ for the family, because ‘just’ being at home with the children doesn’t count. And so on. The myths are damaging because they contribute to the rates and severity of postnatal depression in women. In not valuing motherhood, in not helping women meet their biological needs, in not giving women the time, respect and care that they need to become happy, proud, competent mothers, we risk increasing postnatal depression.

Society needs to allow a woman to develop slowly and fully as a mother, not to view birth as a one off ‘event’, in which she went from a ‘non-mother’ to ‘a mother’ in six hours of labour, suddenly equipped and good to go. We need to value and respect the enormous energy that goes into creating a new mother. While the feminism that I was raised with tended to ignore motherhood, there is a new wave of feminism that attends to motherhood, and tries to understand and celebrate it. As Maddie McMahon, doula and feminist, puts it, using the three-day blues as an example, ‘The day three blues will continue if we don’t know how our bodies work and what makes our babies and boobs so damn magical. When no one’s given us permission to love the process of mothering, we forget the joy and just focus on the worries that we are doing everything wrong’.

As a culture, we need to be working together to help the mother grow into a mother. Viewing motherhood as a delicate process that requires the attention of all those around her (the father, her close family, her extended family, health care professionals, her employers) is something that our society does not do, at a cost to her health. Let’s take a look now at how our society differs from others around the globe, and you’ll see what I mean.

Care of mothers in other societies

Many cultures across time and space share a similar form of behaviour. They have inbuilt cultural norms which involve stopping the new mother from doing very much at all after she has had her baby. The length of time that this goes on for is oddly similar in all these cultures. It lasts approximately forty days or six weeks. This practice is so common in other cultures that modern Western culture seems to be the odd one out.

How, as a culture, do we do postnatal care in Great Britain? Mothers generally give birth in a hospital. About thirty years ago, it was expected that mum would stay in a hospital bed for about two weeks, before going home with her baby. Nowadays, mothers are told they can go home six hours after giving birth. This suits the hospitals (which are struggling to cope with the demands that a postnatal ward makes on staffing levels). It also suits the women, who often really want to get home as soon as possible. We sort of accept this: of course you want to get home to your own house, your own things, and your own partner.

But the issue of women wanting to get home as quickly as possible needs to be explored a little more. Why do they want to go home so soon? Researchers have found that mothers are eager to go home early due to a perceived lack of support from midwives on the postnatal ward (Ockleford et al, 2004). Julie Wray found that women were much more satisfied with their postnatal care outside of hospital, than they were with their care inside hospital. The areas they found wanting included cleanliness, visiting arrangements, noise, rest and support for infant feeding and baby care. If women felt cared for, safe, nurtured and comfortable in hospital, would they really want to go home as soon as possible? If their partners could stay with them in the room, would they want to go home as soon as possible? If they had a choice of delicious, nutritious food, would they really want to go home as soon as possible? If they could get a good night’s sleep, would they really want to go home? If there was compassionate and skilled advice and support available in hospital (including feeding, bathing, looking after the cord, how to change the baby and keep the baby warm), would women be as keen to get home? A woman with a new baby needs all of these things. She needs comfort, good food, help with caring for the baby and people she loves around her. If she can’t get that in hospital, it stands to reason that she will want to go home.

Given that women in our culture generally return home quite soon after having a baby, what support systems are in place to help her settle in and adapt to life as a mother, with a new baby? Often the father brings them home. Sometimes, they come back to an empty house. Often the father will have a week or two of leave from work to help settle in with the baby. It is common to have arranged for a grandmother to come and stay for a week or so, to help with household chores and food preparation. They will have some follow-up visits from health workers or appointments at a clinic to have the baby weighed and ‘check’ that all is going well. The mother will have been advised to ‘leave the housework, grab sleep while you can, and don’t accept too many visitors’. But if she is going to ‘leave the housework’, who is going to do it instead? If she doesn’t manage to ‘grab sleep’ while she can, what does she do then? And how does she feel when she has visitors that stayed a lot longer than she had agreed that they would? Is that her fault? Not only is she expected to manage her own time, her visitors, and her ability to learn to live in a dirty, messy house, but she is also being subtly blamed for not getting it right, if she is stressed about the house or taking too many visitors.

The postnatal period is thus full of promise, but can involve much more than the new parents bargained for. They can’t wait to get away from the hospital, to get home, to be together with their baby, to show their baby off to visitors and to ‘play house’ together. But when they get home, the reality can be very different. They have started a full-time, 24-hour job which they were not trained for. They have to start the job suffering from lack of sleep, feeling tired and overwhelmed. They realise the impact of not being able to rest, or think, or regroup emotionally. They feel physically exhausted, emotionally drained and overwhelmed very quickly indeed. In the meantime, the house is getting messier and messier, and dirtier and dirtier, and the baby cries way more than they had realised, and they didn’t anticipate the endless, dark, long and lonely nights.

Other cultures do things differently. They don’t send a couple home alone and expect them to manage the house, the food, the visitors and the long dark nights on their own.

Japan

‘In the Japanese islands of the Goto Archipelago… a new mother is expected to stay in bed, wrapped in her quilt, for one month after delivery. Her baby is wrapped up next to her. Grandmothers, aunts, and relatives come in to take care of her, feeding her and helping her to the bathroom. She is expected to do nothing but feed her baby and recover. While her relatives help her, they speak to her in a form of baby talk. In response, she answers them in a high-pitched voice. For one month, she is a child in their eyes. A postpartum recovery period is accepted and treated as normal in this culture.’ (taken from Brazelton, 2006). Indeed, across Japan as a whole, the postnatal period is given due reverence and is known as ‘satogaeri’. This tradition ensures that the mother gets plenty of rest, and adjusts to her new life and her new baby.

India

In India, the first forty days after birth are also seen as a ‘confinement’ period, when the mother is given time and space to recuperate, gain strength and bo...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Dedication
• Introduction
• 1 Understanding Depression
• 2 Brains and Bonding
• 3 What is Perinatal Depression?
• 4 Fathers
• 5 Everyday Psychological Wellbeing Techniques
• 6 Recovering from Perinatal Depression
• Conclusion
• Further Reading and Resources
• Index