After giving birth, many women experience emotional symptoms which are often referred to as the “baby blues.” These feelings usually last for a few days and subside relatively quickly. However, in some cases, these normal emotions can turn into more serious symptoms. The condition does vary widely from person to person, however, the umbrella term for the condition is Postpartum Depression (PPD). While little is known about the causes and remedies for Postpartum Depression, it is no small issue. Postpartum Depression affects 10-20% of mothers in the United States. Historically Postpartum Depression has not been taken seriously as a mental illness, and this stigma relays over to common day practices. Many people treat Postpartum Depression very lightly, using the term facetiously, and not understanding what they are really saying. Little investigation is done to determine if a parent has Postpartum Depression after the birth, and the screenings that are used are not generally very effective. Even if a parent knew they were suffering from Postpartum Depression, which is unlikely because parents are poorly educated on the topic, they often feel embarrassed to talk to others about it because of the social stigma attached. Because of the history and misconceptions about Postpartum Depression, not enough reliable research has been done on the topic, leading the illness to not be adequately screened for, or treated in the United States.
PPD is a very different experience for each parent who experiences it. PPD is often confused with the “baby blues,” however, they are different conditions. PPD is not only “longer lasting, but it can deepen into a sense of worthlessness, fatigue, anxiety, inability to bond with the baby and even suicidal thoughts” (Starr). Symptoms of PPD usually begin to appear 4-6 weeks after birth. This delayed response is because of the dramatic lifestyle changes a mother experiences following having a child. Hormones returning to normal after birth often spark feelings of depression, and a lack of sleep only amplifies these symptoms.
Misconceptions about PPD have stemmed from thousands of years of medical misunderstandings. Hippocrates was the first to write of PPD in the fourth century B.C. His findings were wildly untrue, however they “became dogma that survived for over a thousand years” (Rysavy). He hypothesized that when too much blood collected in the breast of a woman, onset madness could result. During the middle ages women who experienced similar symptoms following childbirth were often thought of as witches (Rysavy). Accounts were written in local journals and newspapers in the following centuries emphasized the extreme cases of PPD. The public was well informed about cases of mothers who often turned violent toward their newly born child, but not informed that these emotions were normal after birth. The negative undertone associated with mothers having emotional difficulties after birth, led to women who bottled up their pains and taught their daughters to do the same.
While scientists did conduct several effective studies in the 19th century, the data was often misinterpreted. “In 1858, Louis Victor Marcé published the first formal paper devoted entirely to puerperal mental illness” (Rysavy). Louis studied hundreds of women and made statistics based on when mothers were most likely to experience PPD. He also wrote, very clearly, that PPD had its own separate symptoms from other mental illnesses and should be classified as such. This information, mixed with the liberal separation of PPD from other mental disorders, could have made huge strides for the public's understanding of the condition. These findings were not put to good use, though, because Louis’s conclusion stated that “no major features distinguishing the psychoses of pregnancy from those in women in the non-pregnant state.” That is, basically, that women have a mental illness. All possible positive outcomes of this study and other studies like it were overshadowed by sexism.
The 19th century saw many remedies to heal a women with PPD come into the spotlight. Bleeding patients, to reduce inflammation was a common practice, and mothers were often given opium to calm the mind. Separation of the mother and child was thought to help as well (Rysavy). These “treatments” had a negative effect on mothers, and often led to long term problems for the child. Bleeding a patient after a traumatic incident like birth weakens the mother and can deteriorate her health. While opium does “calm the mind” it is addictive and can be passed to a baby through breast milk. Separation after birth has been proven time and time again to be destructive for both parties, mother and child.
While these problems seem removed from our current practices, it must be known how incorrect we were about PPD, even as recently the 20th century. During the 1900’s “three main lines of thought emerged regarding the description of mental disturbance and depression following childbirth”(Rysavy). All of them were equally based on nonsense and incorrect. The first theory, and arguably the most known, stated PPD had very little to do with birth at all. Many people believed this was in fact true, and that PPD was a seperate mental condition that had nothing to do with pregnancy. The second theory was that depression after birth was a direct result of “repressed homosexuality.” The third train of thought, was that other unrelated illnesses and conditions stemmed from PPD (Rysavy). People in the general public began to blame completely unrelated symptoms such as an enlarged thyroid or excessive hair growth on PPD. We now know that while these symptoms may be a result of hormonal changes during pregnancy, they are not caused by PostPartum Depression.
Until the early 1900s women were scarce in the medical field. Male doctors were diagnosing and treating everything up until this point. While first hand experience is not always necessary to treat a condition successfully, having more background about what it is like is always helpful. Another piece of this issue is that many men (and women) thought women were all emotional, dramatic beings. Doctors and society did not take the condition seriously, and often played it off as “women being women.”
Women suffering from PPD have had a tough time in the last few centuries. With men dominating the healthcare system, and the lack of understanding scientifically about the issue, women had many barriers to getting help, if they did seek it. Looking for help was uncommon because of the fear of being judged by their peers, or even fear of being put into mental institutions.
While treatments and scientific knowledge have improved in more recent decades, the stigma attached to the condition has not gotten much better. For much of the past, mothers did not have jobs outside of the household. They could focus on one job, being a perfect mother. Today women still feel the pressure to be a perfect mother, as well as pressure to help provide financially for the family.
PPD is one of the least publicly understood mental issues in the United States. There are two sides of a coin, both being very harsh. On one hand women are often unaware PPD even exists, therefor don’t know they need to seek assistance in treating the condition. If they are familiar with PPD, they then find that the resources available are very limited. Lack of knowledge is sometimes not the only problem.Women who feel less than perfect after birth often think something is wrong with them, and feel as if they will be judged if they do seek help.
While many factors play a role in the pressures mothers feel after birth, there is one clear divide we can make: external vs. internal pressures. External pressures come from society, peers, family and spouses. Expectations to be the ideal mother for the new child often give moms the wrong idea, that recovery should be quick and easy. Often these pressures have been ingrained and are subconscious. Family members of new mothers often push unrealistic ideals of what new motherhood should be like, instead of stepping back and simply offering support. Obviously, all ideas that we as humans have are influenced from and effected by our external environment, very few pressures we feel are actually from within. With this being said,unrealistic personal expectations in new mothers are more common, and often more destructive. While giving birth is a natural miracle, the reality that soon hits is often a let down to the anticipation. One theory that has been proven in several different studies states “the unrealistic expectation of childbirth and motherhood which may cause mothers to be anxious, controlling, perfectionistic, and exhibit compulsive tendencies” (Abdollahi). Mothers want to be the best that they possibly can be for their children, and give themselves little room for recovery after birth.
Lack of sleep plays a huge role in the development of PPD symptoms. Women after giving birth have trouble sleeping for a majority of reasons, the biggest being the baby. The mother is the person who needs to get up every two hours with the newborn child to feed it, regardless of how strong her support system is. While biological factors do play a role in the division of labor, “women are not only more likely to get up at night to care for others, their sleep interruptions last longer” (Arbor). Women are up with the baby a disproportionate amount (Arbor). Childbirth is an extremely taxing process, and when mixed with sleep deprivation it can lead to serious long term effects.
Unlike many other mental illnesses, today's research has not figured out a clear biological reason that women develop PPD. However, new studies regarding stress pathways in mice shed light on a possible biotic reason for PPD. The pathway being studied is called the “hypothalamic-pituitary-adrenal axis” which is responsible for the “fight or flight response” (Starr). During pregnancy the pathway is supposed to be suppressed to reduce stressful factors on the developing fetus. Researchers took mice that completely lacked a stress reducing hormone, and compared them to normal mice. The mice that lacked the reducing hormones were visibly more anxious, and were “more reluctant to mother their pups...spending less time with them” (Starr). This study shows the link between stress and the ability to parent. It is clear to see the correlation: when mice are more stressed they are worse mothers. These effects parallel those seen in humans as well.
Many theories have been made about evolutionary reasons that humans would develop a condition such as PPD, the most widely recognized being in regards to having suitable resources to raise a child. From an evolutionary perspective, “there are situations when it would be in the woman’s best interest to decrease her investment for a baby” (Abdollahi). While this theory seems harsh, in prehistoric times, a woman could not raise a child without social support. Conclusions have been drawn that, opposed to common belief, “PPD is not a dysfunction but rather an adaptive mechanism” (Abdollahi).
Studies in recent years have shown that men are also susceptible to PPD. Obviously the factors causing the issues are different, because the father's role is different than that of the mother’s. Though the condition effects about half the number of men as women, and often lasts for less time, the issue is real. While little research has been conducted, (surprise, surprise) we know that hormones are mostly to blame for the drop in mood in new fathers (Jaworski). Testosterone drops after a child is born, and this is the most likely trigger of symptoms. Because testosterone is a hormone that contributes to the control of aggression and sex drive in males, these changes make sense from an evolutionary perspective. After birth aggression levels lower and the new baby is less likely to be hurt by the males surrounding it. Other external factors play a role for fathers as well, such as lack of sleep and support from family members, much like they do for mothers.
The stigma attached to women with PPD is extremely prevalent in today’s society. Men face even more social judgement, and find it more difficult to seek and receive emotional help. Traditionally, men have been the ones who need to be strong and provide for the family, and when they can not do this they often view themselves as incapable, asdo others.
It has become clear in recent years that many more factors than we previously thought play a role in the development and continuation of PPD. The sudden drop in hormone levels after birth plays as much of a role as anything else. “Quick shifts in hormones, such as estrogen in the puerperium (the time following birth)” can lead to serious mood swings and changes in behavior (Abdollahi). Other elements, often having nothing to do with pregnancy at all are beginning to creep onto the list of causes. Stressful life events, such as parent divorce, mother-daughter conflict and self-esteem “are predictors of PPD ”(Abdollahi).
The historical lack of scientific understanding of the female human body, mixed with misconceptions about the causes of PPD, led to women being treated improperly and even worsening their conditions. These problems caused a natural reluctance of women to seek help, and the vicious cycle worsened. Social stigma led to lack of treatment options and valuable research, so that even if patients recognized their problem and sought help, resources were not available. PPD has caused much suffering throughout the centuries, and unfortunately it has taken hordes of severe cases to push our society into looking more closely at the problem. Medical researchers have a lot of work to do to catch up with treating this condition, and we have our work cut out for us, as a society, in changing our perceptions of PPD as a weakness.
Works Cited
Abdollahi, Fatemeh, et al. "Perspective of Postpartum DepressionTheories: A Narrative Literature Review." US National Library of Medicine, 8 June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4960931/. Accessed 29 Nov. 2018.
Abramson, Anna, and Dawn Rouse. "The Postpartum Brain." Greater Good Magazine, 1 Mar. 2008, greatergood.berkeley.edu/article/item/postpartum_brain. Accessed 29 Nov. 2018.
Arbor, Ann. "Wake up, Mom! Study shows gender differences in sleep interruptions." Michigan News, 17 Nov. 2010, news.umich.edu/wake-up-mom-study-shows-gender-differences-in-sleep-interruptions/. Accessed 21 Dec. 2018.
Fessenden, Jim. "Study Uses Brain Imaging to Understand Postpartum Depression." UmassMedNow, 22 June 2011, www.umassmed.edu/news/news-archives/2011/06/understanding-postpartum-depression/. Accessed 29 Nov. 2018.
Gallagher, Siobhan. "Neuroscientists Shed Light on Causes of Postpardum Depression Using New Research Model." TuftsNow, 26 Dec. 2017, now.tufts.edu/news-releases/neuroscientists-shed-light-causes-postpartum-depression-using-new-research-model. Accessed 29 Nov. 2018.
Michelle Starr. "There Could Be a Biological Mechanism behind Postpardum Depression, Says Study." Science Alert, 29 Dec. 2017, www.sciencealert.com/stress-axis-biological-reason-postpartum-depression. Accessed 29 Nov. 2018.
Rysavy. "Sadness and Support: A Short History of Postpartum Depression." Medicine.uiowa.edu, 3 May 2013, medicine.uiowa.edu/md/sites/medicine.uiowa.edu.md/files/wysiwyg_uploads/Sadness%20and%20Support-A%20Short%20History%20of%20Postpartum%20Depression.pdf. Accessed 21 Dec. 2018.