Ok. This title is misleading. Postpartum Depression and Anxiety are often not something you can prevent. It is certainly not something you do to yourself or your baby.
(Please: read that again!)
Postpartum Depression (PPD) is a ghost. It’s a faint glimmer of something that is difficult to detect in the moment. And: Postpartum Depression is NOT a rite of passage. It’s not something we have to simply endure.
In my (albeit brief) research on maternal mental health, I kept ending up again and again on the screening process for perinatal mood disorders and its shortcomings. How:
- Medical providers don’t see their patients until 6 weeks postpartum (is she supposed to suffer an unknown mental illness until then?).
- Many providers admit they lack training for this specific issue and don’t feel qualified to screen or treat maternal mental health disorders.
- They often don’t have the time and resources to screen women for PPD at all, and:
- If someone does test positive, what then? This can often stump a provider who may not see this mother again, at least not until her next pregnancy.
If there’s no protocol set up to address these illnesses, it can be a scramble of what to do for a woman within her 15-minute appointment. In the end, time runs out.
I’ve taken the Edinburgh Postpartum Depression Scale more times than I can remember and had thorough follow up through my care with Navy Medicine. But – overall – I’m still left with the question: Why is it solely up to providers (who see their patients rarely) to detect something so important in an already-rushed appointment? Why is it about screening and numbers more than about community and relating?
I’ve thought about PPD a lot recently because of our business. I often throw my hands up and think: If only women weren’t so isolated! The fact that we’re a first world country with a high standard of living, it’s surprising how much PPD occurs here. I’m convinced much of it is a result of our suburban sprawl, lack of paternity leave, and the loss of America’s lying-in period.
If we really want to tackle the issue of maternal mental health, we need to stop thinking that our primary care doctor is going to solve all our problems single-handedly. We have to recognize what women need: community and rest.
The first element we ought to embrace is surrounding ourselves with community.
Women need women. Being surrounded by other women – whom you have authentic relationship with – is the first defense against postpartum struggle. There are many reasons this has a significant impact. Having another woman around provides a healthy outlet through the major transition of giving birth to a child. The doubts, fears, confusions, frustrations that are normal, exacerbated by the ebb and flow of hormones, should not be dealt with in isolation. We are social beings and we need others to ground us in reality.
A community of women can also ensure someone who knows you will notice when something isn’t right. Doctors are limited by the ability to expose and assess the information provided to them. If a woman is in denial about her feelings, she may not open up entirely in a short appointment. In my mind, it sounds more reasonable for a woman to approach her provider already knowing something is off and ready to ask for help. Screening and doctors have their place. But primarily? Hopefully not. Currently, our country doesn’t have policy for this and providers have to think on their toes for the most part. They’re not to blame for this lack of structure, but the lack of official policy is another reason we need to be there to support our fellow women.
The second element to healthy maternal mental health is rest.
A woman exerts her body to literal physical limits during labor and loses about 12 pounds of baby, fluid, and after-birth in a single moment. This requires a recovery process. A marathon runner takes up to three weeks to recover from the exertions of a race and after most routine surgeries three to ten weeks for recovery is the norm. What does a new mother get?
Add broken sleep (read: full-on sleep deprivation) and caring for a tender newborn to the mix and rest is a must.
It’s astounding the daily demands of a newborn mother. Without support, a mother must care for herself, her newborn, and her home. Think about all of that. This image doesn’t even include older children or work obligations. Lack of rest and sleep deprivation have huge implications for mental wellbeing. Lose sleep on a continual basis, and your mental faculties will quickly follow.
So, there it is: community & rest.
Community is not easy to find, mostly because it’s not easy to be a part of. It takes work, effort, and heavy doses of intention. But this day in age, we are nowhere without others caring for us and us caring for them. Postpartum Depression and other difficulties women face through the postpartum period are not meant to be dealt with in isolation. Throughout the world, various cultures have developed traditional customs to ensure that no one is neglected: Zuo Yuezi, la cuarentena, Kraamzorgs, etc. People, our tribe, the ones who know us, the ones we live life with, are meant to share our burden; and one day, we can share their burdens, too.