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The Lived Experience of Postpartum Depression: A Review of the Literature

2020, Issues in Mental Health Nursing

Related Papers

Shannon Hennig

Postpartum depression (PPD) is a common yet misunderstood complication of childbirth, effecting between 10% - 20% of women who have recently given birth. This paper employs a ‘problem-centering’ approach that integrates a review of literature from biomedical and social constructivist paradigms with a discourse analysis of popular online news media about PPD. Together these sources demonstrate PPD as a product of competing understandings that situate women’s depression relative to childbirth, and create misunderstandings. While biomedical science suggests PPD is a confluence of hormonal changes and environmental conditions, social constructivist approaches argue that PPD is a construct of reality that positions women as ‘mad’ because of their biology. The lack of a clear medical definition of PPD results in normal emotional changes during the postpartum period being understood and stigmatized the same as serious mental illness. The cultural myth of good mothering leaves little room for emotional experiences that fall outside of motherhood being understood as a time of joy and contentment; physicians and health care providers (PHCPs) provide treatment to women to enable them to resume this socially constructed mythic role as mother while treatment is often informed by cultural biases and preferences. The online media discourse reproduces this dominant biomedical understanding of PPD, and reinforces stigma and misunderstanding, while limiting the alternative voices and agency of many women.

Social Work and Community Practice

Carol Kauppi

Idun Røseth , Per-Einar Binder

The Journal of Maternal-Fetal & Neonatal Medicine

Katarzyna Wszołek

Pranee Liamputtong

Comprehensive Psychiatry

Peter Barglow

silvia cimino

In this contribution the complexity of the clinical picture of post-partum depression will be brought to light, which connects to the deep psychological dynamics experienced by women during the gestation and birth of the child. Starting with some reflections which arose from within a clinical journey of a group of women who suffer from this psychopathology, it highlights how the woman’s pregnancy is a time when childhood conflicts re-emerge, and on the basis of personal experiences with her own mother, she rearranges her new role. There will be various considerations suggested on the usefulness of group intervention to address this pathology and its highly dysfunctional effects, recognized by international literature on the development and growth of the child.

POSTPARTUM DEPRESSION: A LITERARY REVIEW (Atena Editora)

Atena Editora

Postpartum depression is a pathology that affects part of the puerperal female population. Early diagnosis enables rapid and complete improvement of the patient. The main symptoms indicative of depression is crying, lack of energy, feeling of worthlessness and sadness. The damage caused by the disease in the child development of the newborn. The treatment adopted is individualized, since it varies according to the degree of the pathology, capable of approaching from light therapeutic conducts, such as behavioral therapy, to administering medication to the puerperal woman.

Caroline Wyatt

This doctoral thesis explores issues related to postnatal mental health from the perspective of professionals, mothers, and significant others. It comprises a literature review, an empirical paper, a critical appraisal of relevant issues, and an ethics section. The literature review reports a meta-ethnographic synthesis of studies exploring the experiences of professionals working with women experiencing postnatal depression (PND). Five themes were identified: (a) conceptualising the label; (b) using ‘my antennae’: recognising PND; (c) ‘permission to speak’: facilitators and fears; (d) whose role is it anyway: professional confidence and expertise; and (e) ‘we’re not user friendly’: navigating the system. Clinical implications were highlighted, including the fostering of liaison between clinical psychologists and perinatal professionals, the importance of mental health training for perinatal professionals, and the development of clear care pathways for all severities of distress. Th...

BMC Nursing

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Postpartum Depression: Treatment and Therapy Essay

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Introduction

Postpartum depression.

Although for many people the birth of a child is an exciting part of life, for some it may cause adverse health outcomes. One of them is postpartum depression that can be characterized by mood swings, sleep deprivation, and anxiety. This paper discusses a patient that presented in the clinic with these symptoms. It outlines the possible treatment and therapy methods, as well as the implications of the condition.

A 28-year-old patient presented in the office three weeks after giving birth to her first son with the symptoms of postpartum depression. The woman was a single mother; she did not have a strong support system as her former partner refused to help her and her family lived in a different state. She noted that she was sleep-deprived, she felt apathetic, sad, experienced anxiety, and had a decreased appetite.

The patient reported that she was diagnosed with depression seven years ago but underwent treatment and had not had the symptoms for a long time. The woman noted that her mother also had signs of a mental disorder but never sought professional help. The patient cried while talking to me; her emotional state was poor. In addition, the woman admitted that she had thought of harming her newborn son because she felt that she was tired of taking care of him.

The typical signs of postpartum depression include the presence of sleep disorder, fatigue, crying, anxiety, changes in appetite, and feelings of inadequacy (Tharpe, Farley, & Jordan, 2017). The patient has these symptoms, which allowed for establishing the diagnosis. Drug therapy included the prescription of tricyclic antidepressants, as they do not pose risks to infants during breastfeeding (Anxiety and Depression Association of America, 2018). Additional therapies included adequate nutrition with the exclusion of caffeine and herbal remedies, such as 2 cups of lemon balm tea daily (Tharpe et al., 2017).

Moreover, I advised the woman to participate in support groups’ meetings and have a scheduled time for personal care, hobbies, and favorite activities, as well as sleep. In addition, I asked the patient to try to have some time away from her child as it could improve her mental state as well. As for follow-up care measures, I suggested that the woman could document her thoughts and feelings and update me on the changes in her condition by visiting my office in two weeks. Moreover, I invited the patient to participate in an educational session on the aspects of postpartum depression.

The primary implication of the woman’s condition is that it is vital to educate individuals on its symptoms and assure them that this experience is common. Moreover, it is necessary to continue establishing support groups and psychotherapy sessions aimed to eliminate this issue. Postpartum depression may affect not only this woman but her entire family unit as the individuals close to the patient can also start experiencing emotional distress and other related symptoms. In the case of my patient, the condition may affect her relationships with her child, potentially causing a poor emotional bond and behavioral problems in the infant.

Postpartum depression is a severe condition that may affect a patient’s life significantly. It can cause individuals to feel anxious, experience mood swings and changes in appetite, and have thoughts of harming their newborn children. The management strategy for this illness can include drug therapy along with alternative remedies. It is vital to establish support groups and educational training for people having postpartum depression to decrease its incidence.

Anxiety and Depression Association of America. (2018). Postpartum depression . Web.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

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IvyPanda. (2021, July 9). Postpartum Depression: Treatment and Therapy. https://ivypanda.com/essays/postpartum-depression-discussion/

"Postpartum Depression: Treatment and Therapy." IvyPanda , 9 July 2021, ivypanda.com/essays/postpartum-depression-discussion/.

IvyPanda . (2021) 'Postpartum Depression: Treatment and Therapy'. 9 July.

IvyPanda . 2021. "Postpartum Depression: Treatment and Therapy." July 9, 2021. https://ivypanda.com/essays/postpartum-depression-discussion/.

1. IvyPanda . "Postpartum Depression: Treatment and Therapy." July 9, 2021. https://ivypanda.com/essays/postpartum-depression-discussion/.

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Perspective of Postpartum Depression Theories: A Narrative Literature Review

Fatemeh abdollahi.

Department of Public Health, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran

Munn-Sann Lye

1 Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia

Mehran Zarghami

2 Department of Psychiatry, Faculty of Medicine and Health Sciences, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran

Postpartum depression is the most prevalent emotional problem during a women's lifespan. Untreated postpartum depression may lead to several consequences such as child, infant, fetal, and maternal effects. The main purpose of this article is to briefly describe different theoretical perspectives of postpartum depression. A literature search was conducted in Psych Info, PubMed, and Science Direct between 1950 and 2015. Additional articles and book chapters were referenced from these sources. Different theories were suggested for developing postpartum depression. Three theories, namely, biological, psychosocial, and evolutionary were discussed. One theory or combinations of psychosocial, biological, and evolutionary theories were considered for postpartum depression. The most important factor that makes clinicians’ choice of intervention is their theoretical perspectives. Healthcare providers and physicians should help women to make informed choices regarding their treatment based on related theories.

Introduction

The postpartum period is recognized as the time when many women are vulnerable to a variety of emotional symptoms.[ 1 ] The most prevalent mental or emotional problem associated with childbirth is postpartum depression (PPD).[ 2 , 3 ] A latest review reported its prevalence to be 1.9 to 82.1% and 5.2 to 74.0% in developing and developed countries, respectively, using a self-reported questionnaire. Its prevalence has also been reported to vary from 0.1 to 26.3% using a structured clinical interview.[ 4 ]

Given that PPD is one of the psychiatric conditions that is amenable to treatment, early recognition is a significant task for all physicians who are working with women during prenatal and postnatal period and can help them in providing treatment plans to reduce their distress.[ 5 , 6 ]

Despite scholars’ efforts, the etiology of depression after birth is inconsistent and unknown.[ 7 , 8 ] Numerous etiologies have been suggested; however, no single hypothesis can elucidate this phenomenon.[ 7 , 9 ]

Because there is no single etiology for developing PPD, a single modality could not be effective for treatment of all women. Some scholars affirm that theoretical perspectives should be evaluated before taking a decision regarding treatment options. This article is a review of the possible theories proposed for PPD.

Biological Theories

Beck (2002) stressed that one of the theoretical bases of PPD is the medical model which is considered as an illness as well as a medical condition. It is also a personal pathological mood disorder which is not considered to be a result of social or environmental conditions. From this point of view, women are passive individuals in the medical model who are under influence of biological factors.[ 10 ] They suffer more from depression episodes around particular periods during their lifespan.[ 11 ]

Different theories exist regarding pathophysiological hormonal effects on PPD including the withdrawal theory,[ 12 ] interaction among the hypothalamic–pituitary–gonadal system and the hypothalamic–pituitary–adrenal system (HPA),[ 13 , 14 ] and change in the levels of gonadal hormones.[ 15 ]

In the prenatal period, HPA axis and women's reproductive system changes with strong interaction between them. It is possible that the HPA axis functions differently in women who are susceptible to depression through the suppression of corticotrophin-releasing hormone (CRH) during postpartum period in the hormonal pathway for affective disorders.[ 16 , 17 ] On the other hand, other studies have demonstrated that CRH suppression does not correlate with mood fluctuation, and therefore the HPA axis in the physiology of PPD is possibly not well-founded.[ 18 ]

Hormones such as estrogen, progesterone, beta-endorphin, human chorionic gonadotrophin, and cortisol increase during pregnancy and significantly drop after birth.[ 12 , 19 ] Quick shifts in hormones, such as estrogen in the puerperium, changes the levels of these hormones either too high or too low leading to PPD.[ 6 ] Moreover, a sharp decline in reproductive hormone levels that occurs after delivery is assumed to be the main cause of PPD in women by some researchers.[ 6 , 13 ] This modification is said to be a trigger for changes in the peripheral and central monoamine centers.[ 12 , 20 ] Sudden withdrawal of these hormones could be a trigger of depression and women with a history of PPD may respond differently and more sensitively to sudden decrease of plasma levels of gonadal steroids.[ 12 ]

Reduced estradiol plasma levels with depressed group in contrast with the control group was reported.[ 13 ] Estrogen and progesterone have an effect on neurotransmitters which are involved in the emotional and cognitive processes.[ 12 ] The function of estrogen is to keep serotonin stable in order to keep more transmitters in the brain. Furthermore, estrogen has an influence on adrenaline, norepinephrine, and serotonin receptors. The latter interaction could be due to antidepressant function and depression.[ 21 ] Moreover, neuropeptides have various roles in physiological and behavioral parts of the cerebral nervous system (CNS).[ 22 ] Levels of estrogen decrease prior to menstruation, after delivery, and during menopause. In addition, gonadal hormones keep the rate of depression down during pregnancy.[ 23 ] This effect manifests itself during the last trimester of pregnancy. Within a few days after childbirth, gonadal hormones decrease markedly, which demonstrates a probable correlation with an unexpected increase in the development of nonpsychotic and psychotic mental illness.[ 23 , 24 ] However, other research findings did not find hypogonadal levels of estrogen and progesterone to be a risk factor for PPD.[ 25 ]

It has been also suggested that the serotonin (5HT) system has a significant role in prenatal and postnatal depression because depressed mothers respond well to serotonergic antidepressants.[ 26 ] According to this study results, 5HT1A serotonin receptor binding decreased from 20 to 28% in the depressed group in comparison with the control group.[ 26 ]

Even though, many scholars have concluded that physiological fluctuations are the causes of PPD, hormonal cause for the PPD is not supported consistently by the literature.[ 6 ] While the genetic basis of varying sensitiveness to gonadal steroids remains unclear, genetic polymorphisms in genes that regulate reproductive hormones may make some women susceptible to mood disorders.[ 24 ]

A correlation between personality and genetic factors such as Cytochrome P4502D6 (CYP2D6) has been demonstrated.[ 27 , 28 ] The presentation of CYP2D6 is prevalent under the genetic control.[ 29 ] The rate of CYP2D6 metabolism in pregnant and postpartum depressed mothers was more than anticipated in a general population.[ 29 ]

To sum up, the previous studies did not reach a unified conclusion. It appears that an internal abnormal reaction to hormonal changes contributes to PPD.[ 20 ]

Psychosocial Theory

Specific neurophysiological and neurochemical changes in the brain are triggered by psychosocial stressors and interpersonal events that significantly change the neurotransmitter balance. It is considered that depression is related with psychosocial stressors, as described below.[ 30 ]

Psychodynamic theory

The psychodynamic point of view supports the idea that some unfinished business in women's childhood or family may cause more psychological troubles after birth.[ 31 ] Women have a tendency to imitate their own mother's role as soon as they become mother after birth, however, if there is a rejection in accepting their own mother's role, they have trouble coping or adapting to their new role of motherhood.[ 30 ] The outcome of the mother's role conflict can lead to rejecting the female identity as well as threaten her feminism.[ 30 ] Some experts have also noted that childbirth results in loss of their identity and leads to withdrawal of love, affection, and loss of independence.[ 31 , 32 ] Moreover, family's negative attitude affects women's well-being and results in the maladjustment of coping mechanisms.[ 31 ]

Cognitive psychology theory

The cognitive approach instead of postulating internal conflicts in psychodynamic theory emphasizes certain characteristics of personality which predispose new mothers to PPD. It is the unrealistic expectation of childbirth and motherhood which may cause mothers to be anxious, controlling, perfectionist, and exhibit compulsive tendencies.[ 33 ] Beck (1967) postulated that depressed mood is the result of thought disturbances.[ 34 ] Pessimism toward oneself, the world, and the future contributes to a depressive mood.[ 31 , 33 , 35 ] In addition, in the absence of suitable role models, the woman feels loss of control and anxiety resulting in a lack of a capability to cope with infant's demands and care.[ 31 ]

Social and interpersonal theory

Egeline (2008) contends that environment plays a significant role in an individual's life.[ 36 ] Attachment theory says that interpersonal struggles in an individual's life have significant influences on mental health. It is obvious that an individual requires affection which needs to be fulfilled in the initial stage of a relationship. Uncertainties concerning a relationship may result to disappointment and bring about depression and anxiety.[ 37 ] A number of interpersonal factors play a role in women's distress and sensitivity makes them prone to develop postpartum disorders. These include insufficient social support and marital conflicts.[ 38 ] Childbirth is a significant transitional event in life and support at this stage can potentially affect women's mental status after delivery.[ 39 ] Sudden psychosocial fluctuations within motherhood and its challenges coupled with stresses could be other factors that may trigger PPD.[ 20 ]

Behavioral theory

According to the behavioral theory, depressive episode can result from major life events that disrupt an individual's normal support pattern.[ 40 ] Life stressors and psychological problems such as parent's divorce, low parental emotional support, mother-daughter conflict, and self-esteem are predictors of PPD.[ 38 ]

The theory of operant condition paradigm claims that depression is a consequence of a decrease in the positive efficient reinforced behavior and could be a sign of obvious punishment for nonconformant behavior. It is also the result of a decrease in the accessibility of reinforcement events, personal ability to maneuver the environment, the impact of variety of events, or a combination of the above. Moreover, a negative feedback of social reinforcement behaviors may result from unavailability of support from family and other social networks such as social withdrawal. However, a low rate of positive reinforcement for mood-enhancing behavior and high rate of positive reinforcement for depressive behavior may be experienced by people who experience major stress originating from unexpected events.[ 40 ]

Evolutionary theory

Scholars have suggested relevant adaptive functions for PPD which are consistent with ideas of evolutionary theorists. Usually the women experiences negative effects such as gloomy and depressed mood due to problems concerning the infant, marital problems, and lack of social support associated with the social and family environment. Some women, who suffer from major PPD and with symptoms such as psychomotor retardation, weight loss, loss of interest in activities, lack of concentration, and constant suicidal thoughts may sometimes not seek social support. Moreover, actions that women take to reduce these psychological problems predispose her to PPD.[ 41 ]

From an evolutionary perspective, there are situations when it would be in the women's best interest to decrease her investment for a baby, for instance when there is a lack of sufficient social support to raise the newborn or when the child has a problem.[ 31 , 41 ]

According to evolutionary theorists, PPD results from an adaptive function that signals a potential fitness cost to the mother. Thus, PPD is not a dysfunction but rather an adaptive mechanism. It signals a mother who has suffered a social cost motivating her to evaluate whether to continue to or cease to provide care to her offspring. From this viewpoint, PPD is a universal phenomenon that appears in women around the world. As a result, in societies that give rise to the circumstances, its prevalence is reduced.[ 42 ]

There is no common consensus among theorists regarding the nature of PPD. Three theoretical perspectives on PPD have been reviewed in this paper. One theory or combination of theories may be suspected for a postpartum depressed woman. Biological theory, such as physiological fluctuations of hormones, psychosocial theory, such as interpersonal struggles in an individual's life, and finally evolutionary theory that suggests adaptive functions as a model for PPD were discussed.

The most important factor that affects health care providers and clinicians’ choice of intervention (prevention or treatment) is their theoretical perspectives on PPD.[ 10 ] In some cases, combination of these theories may be applied. For example, antidepressant therapy (medical model) along with psychotherapy (psychosocial model) may be employed for treatment. Healthcare providers should inform depressed women about the range of treatment approaches available that are set based on appropriate theories and help them to make informed choices regarding their treatment.

Financial support and sponsorship

Mazandaran University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

The Lived Experience of Postpartum Depression: A Review of the Literature

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Postpartum depression: Causes, symptoms, risk factors, and treatment options

• Women and Girls

What is postpartum depression and anxiety?

It’s common for women to experience the “baby blues”—feeling stressed, sad, anxious, lonely, tired or weepy—following their baby’s birth. But some women, up to 1 in 7, experience a much more serious mood disorder—postpartum depression (PPD). (Postpartum psychosis, a condition that may involve psychotic symptoms like delusions or hallucinations, is a different disorder and is very rare.) Unlike the baby blues, PPD doesn’t go away on its own. It can appear days or even months after delivering a baby; it can last for many weeks or months if left untreated. PPD can make it hard for you to get through the day, and it can affect your ability to take care of your baby, or yourself. PPD can affect any woman—those with easy pregnancies or problem pregnancies, first-time mothers and mothers with one or more children, women who are married and women who are not, and regardless of income, age, race or ethnicity, culture, or education.

What are the symptoms of PPD?

The warning signs are different for everyone but may include:

A loss of pleasure or interest in things you used to enjoy, including sex

Eating much more, or much less, than you usually do

Anxiety—all or most of the time—or panic attacks

Racing, scary thoughts

Feeling guilty or worthless; blaming yourself

Excessive irritability, anger, or agitation; mood swings

Sadness, crying uncontrollably for very long periods of time

Fear of not being a good mother

Fear of being left alone with the baby

Inability to sleep, sleeping too much, difficulty falling or staying asleep

Disinterest in the baby, family, and friends

Difficulty concentrating, remembering details, or making decisions

Thoughts of hurting yourself or the baby (see below for numbers to call to get immediate help).

If these warning signs or symptoms last longer than 2 weeks, you may need to get help. Whether your symptoms are mild or severe, recovery is possible with proper treatment.

What are the risk factors for PPD?

A change in hormone levels after childbirth

Previous experience of depression or anxiety

Family history of depression or mental illness

Stress involved in caring for a newborn and managing new life changes

Having a challenging baby who cries more than usual, is hard to comfort, or whose sleep and hunger needs are irregular and hard to predict

Having a baby with special needs (premature birth, medical complications, illness)

First-time motherhood, very young motherhood, or older motherhood

Other emotional stressors, such as the death of a loved one or family problems

Financial or employment problems

Isolation and lack of social support

What can I do?

Don’t face PPD alone. To find a psychologist or other licensed mental health provider near you, ask your OB/GYN, pediatrician, midwife, internist, or other primary health care provider for a referral. APA can also help you find a local psychologist: Call 1-800-964-2000, or visit the  APA Psychologist Locator .

Talk openly about your feelings with your partner, other mothers, friends, and relatives.

Join a support group for mothers—ask your health care provider for suggestions if you can’t find one.

Find a relative or close friend who can help you take care of the baby.

Get as much sleep or rest as you can even if you have to ask for more help with the baby—if you can’t rest even when you want to, tell your primary health care provider.

As soon as your doctor or other primary health care provider says it’s okay, take walks, or participate in another form of exercise.

Try not to worry about unimportant tasks. Be realistic about what you can do while taking care of a new baby.

Cut down on less important responsibilities.

Remember that postpartum depression is not your fault—it is a real, but treatable, psychological disorder. If you are having thoughts of hurting yourself or your baby, take action now: Put the baby in a safe place, like a crib. Call a friend or family member for help if you need to. Then, call a suicide hotline (free and staffed all day, every day):

IMAlive 1-800-SUICIDE (1-800-784-2433)

988 Suicide and Crisis Lifeline Dial 988 (Formerly known as The National Suicide Prevention Lifeline 1-800-273-TALK)

Other versions

Download this Brochure (PDF, 476KB)

En Español (PDF, 419KB)

En Français (PDF, 240KB)

中文 (PDF, 513KB)

All translations of the English Postpartum Depression brochure were partially funded by a grant from the American Psychological Foundation.

Crisis hotlines and resources

Postpartum Health Alliance   

Postpartum Support International

American Foundation for Suicide Prevention

Health Resources and Services Administration

National Women’s Health Center

• Psychology topics: Women and girls
• Psychology topics: Depression

You may also like

• Patient Care & Health Information
• Diseases & Conditions
• Postpartum depression

Your health care provider will usually talk with you about your feelings, thoughts and mental health to help determine if you have a short-term case of postpartum baby blues or a more severe form of depression. Don't be embarrassed — postpartum depression is common. Share your symptoms with your provider so that you and your provider can create a useful treatment plan.

As part of your evaluation, your health care provider may do a depression screening, including having you fill out a questionnaire. Your provider may order other tests, if needed, to rule out other causes for your symptoms.

Treatment and recovery time vary, depending on how severe your depression is and what your individual needs are. If you have an underactive thyroid or an underlying illness, your health care provider may treat those conditions or refer you to the appropriate specialist. Your health care provider may also refer you to a mental health professional.

The baby blues usually fade on their own within a few days to 1 to 2 weeks. In the meantime:

• Get as much rest as you can.
• Accept help from family and friends.
• Connect with other new moms.
• Create time to take care of yourself.
• Avoid alcohol and recreational drugs, which can make mood swings worse.
• Ask your health care provider about getting help from a health professional called a lactation consultant if you're having problems with producing milk or breastfeeding.

Postpartum depression is often treated with psychotherapy — also called talk therapy or mental health counseling — medicine or both.

• Psychotherapy. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through therapy, you can find better ways to cope with your feelings, solve problems, set realistic goals and respond to situations in a positive way. Sometimes family or relationship therapy also helps. Examples of therapies used for postpartum depression include cognitive-behavioral therapy (CBT) and interpersonal psychotherapy.
• Antidepressants. Your health care provider may recommend an antidepressant. If you're breastfeeding, any medicine you take will enter your breast milk. However, most antidepressants can be used during breastfeeding with little risk of side effects for your baby. Work with your provider to weigh the potential risks and benefits of specific antidepressants.
• Other medicines. When needed, other medicines may be added to your treatment. For example, if you have postpartum depression that includes severe anxiety or insomnia, an antianxiety medicine may be recommended for a short time.

Brexanolone (Zulresso) is the first drug approved by the U.S. Food and Drug Administration specifically for postpartum depression in adult women. Brexanolone slows the rapid drop of certain hormones after childbirth that may lead to postpartum depression. Potential serious side effects require a stay in a health care facility and monitoring by a health care provider while receiving the medicine through a vein over 60 hours. Because of this, the treatment is not yet widely available.

Research continues on an oral medicine for postpartum depression with promising results. The medicine being studied works in a way similar to brexanolone. But it could be taken daily as a pill and may not have the same serious side effects.

With appropriate treatment, postpartum depression symptoms usually improve. In some cases, postpartum depression can continue and become long term, which is called chronic depression. It's important to continue treatment after you begin to feel better. Stopping treatment too early may lead to a relapse.

Postpartum psychosis

Postpartum psychosis requires immediate treatment, usually in the hospital. Treatment may include:

• Medicines. Treatment may require a combination of medicines — such as antidepressants, antipsychotic medicines, mood stabilizers and benzodiazepines — to control your signs and symptoms.
• Electroconvulsive therapy (ECT). If your postpartum depression is severe and you experience postpartum psychosis, ECT may be recommended if symptoms do not respond to medicine. ECT is a procedure in which small electrical currents are passed through the brain, intentionally starting a brief seizure. ECT seems to cause changes in brain chemistry that can reduce the symptoms of psychosis and depression, especially when other treatments have been unsuccessful.

A hospital stay during treatment for postpartum psychosis can challenge a mother's ability to breastfeed. This separation from the baby makes breastfeeding difficult. Your health care provider can recommend support for lactation — the process of producing breast milk — while you're in the hospital.

More Information

• Electroconvulsive therapy (ECT)

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

In addition to professional treatment, you can do some things for yourself that build on your treatment plan and help speed recovery.

• Make healthy lifestyle choices. Include physical activity, such as a walk with your baby, and other forms of exercise in your daily routine. Try to get enough rest. Eat healthy foods and avoid alcohol.
• Set realistic expectations. Don't pressure yourself to do everything. Scale back your expectations for the perfect household. Do what you can and leave the rest.
• Make time for yourself. Take some time for yourself and get out of the house. That may mean asking a partner to take care of the baby or arranging for a sitter. Do something you enjoy, such as a hobby or some form of entertainment. You might also schedule some time alone with your partner or friends.
• Avoid isolation. Talk with your partner, family and friends about how you're feeling. Ask other mothers about their experiences. Breaking the isolation may help you feel human again.
• Ask for help. Try to open up to the people close to you and let them know you need help. If someone offers to babysit, take them up on it. If you can sleep, take a nap, or maybe you can see a movie or meet for coffee with friends. You may also benefit from asking for help with parenting skills that can include caregiving techniques to improve your baby's sleep and soothe fussing and crying.

Remember, taking care of your baby includes taking care of yourself.

Coping and support

The already stressful, exhausting period following a baby's birth is more difficult when depression occurs. But remember, postpartum depression is never anyone's fault. It's a common medical condition that needs treatment.

So, if you're having trouble coping with postpartum depression, talk with your health care provider. Ask your provider or a therapist about local support groups for new moms or women who have postpartum depression.

The sooner you get help, the sooner you'll be fully equipped to cope with depression and enjoy your new baby.

Preparing for your appointment

After your first appointment, your health care provider may refer you to a mental health provider who can create the right treatment plan with you. You may want to find a trusted family member or friend to join you for your appointment to help you remember all the information discussed.

What you can do

Before your appointment, make a list of:

• Any symptoms you've been experiencing and for how long.
• All of your medical issues, including physical health conditions or mental health conditions, such as depression.
• All the medicines you take, including prescription and over-the counter medicines, as well as vitamins, herbs and other supplements, and the doses.
• Questions to ask your provider.

Questions to ask may include:

• What is my diagnosis?
• What treatments are likely to help me?
• What are the possible side effects of the treatments you're suggesting?
• How much and how soon do you expect my symptoms to improve with treatment?
• Is the medicine you're prescribing safe to take while breastfeeding?
• How long will I need to be treated?
• What lifestyle changes can help me manage my symptoms?
• How often should I be seen for follow-up visits?
• Am I at increased risk of other mental health problems?
• Am I at risk of this condition recurring if I have another baby?
• Is there any way to prevent a recurrence if I have another baby?
• Are there any printed materials that I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your health care provider or mental health provider may ask you some questions, such as:

• What are your symptoms, and when did they start?
• Have your symptoms been getting better or worse over time?
• Are your symptoms affecting your ability to care for your baby?
• Do you feel as bonded to your baby as you expected?
• Are you able to sleep when you have the chance and get out of bed when it's time to wake up?
• How would you describe your energy level?
• Has your appetite changed?
• How often would you say you feel anxious, irritable or angry?
• Have you had any thoughts of harming yourself or your baby?
• How much support do you have in caring for your baby?
• Are there other major stressors in your life, such as financial or relationship problems?
• Have you been diagnosed with any other medical conditions?
• Have you ever been diagnosed with any mental health conditions, such as depression or bipolar disorder? If so, what type of treatment helped the most?

Your provider may ask additional questions based on your responses, symptoms and needs. Preparing for questions will help you make the most of your appointment.

• Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision DSM-5-TR. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed May 9, 2022.
• Postpartum depression. Office on Women's Health. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression. Accessed May 5, 2022.
• Depression among women. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/depression/index.htm. Accessed May 5, 2022.
• What is peripartum depression (formerly postpartum)? American Psychiatric Association. https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression. Accessed Nov. 18, 2022.
• Viguera A. Postpartum unipolar depression: Epidemiology, clinical features, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed Nov. 18, 2022.
• Viguera A. Mild to moderate postpartum unipolar major depression: Treatment. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
• Viguera A. Severe postpartum unipolar major depression: Choosing treatment. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
• Faden J, et al. Intravenous brexanolone for postpartum depression: What it is, how well does it work, and will it be used? Therapeutic Advances in Psychopharmacology. 2020; doi:10.1177/2045125320968658.
• FAQs. Postpartum depression. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/postpartum-depression. Accessed May 6, 2022.
• Suicide prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention. Accessed May 6, 2022.
• Postpartum depression. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/postpartum-care-and-associated-disorders/postpartum-depression#. Accessed May 6, 2022.
• AskMayoExpert. Depression in pregnancy and postpartum. Mayo Clinic; 2022.
• American Academy of Pediatrics. Postpartum care of the mother. In: Guidelines for Perinatal Care. 8th ed. American Academy of Pediatrics; American College of Obstetricians and Gynecologists; 2017.
• Kumar SV, et al. Promoting postpartum mental health in fathers: Recommendations for nurse practitioners. American Journal of Men's Health. 2018; doi:10.1177/1557988317744712.
• Scarff JR. Postpartum depression in men. Innovations in Clinical Neuroscience. 2019;16:11.
• Bergink V, et al. Postpartum psychosis: Madness, mania, and melancholia in motherhood. American Journal of Psychiatry. 2016; doi:10.1176/appi.ajp.2016.16040454.
• Yogman M, et al. Fathers' roles in the care and development of their children: The role of pediatricians. Pediatrics. 2016; doi:10.1542/peds.2016-1128.
• FDA approves first treatment for post-partum depression. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression. Accessed May 6, 2022.
• Deligiannidis KM, et al. Effect of zuranolone vs placebo in postpartum depression: A randomized clinical trial. JAMA Psychiatry. 2021; doi:10.1001/jamapsychiatry.2021.1559.
• Betcher KM (expert opinion). Mayo Clinic. May 10, 2022.
• 988 Suicide & Crisis Lifeline. https://988lifeline.org/. Accessed Nov. 18, 2022.

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An Anti-Colonial Feminist Magazine

THESES ON POSTPARTUM

Image: Sarah Burwash

Posted by GUTS on May 22, 2015 --> Comments Off on THESES ON POSTPARTUM

by Madeline Lane-McKinley and Marija Cetinic

for Chris Chitty

• “Postpartum depression” describes an embodied experience of labour.

Postpartum depression takes place in the body. Postpartum is a biological condition for which the scientific or psychological explanation is nevertheless insufficient. Postpartum cannot be anticipated, it cannot be prevented—it is often apprehended at a moment of crisis. The experience of postpartum can be traced hormonally and neurologically, while being immeasurable as a physiology or a psychology. The experience of postpartum consists of psychic and embodied contradictions—of sudden vacillations and bizarre simultaneities of joy and misery, fulfillment and panic, engagement and withdrawal. It is an experience of profound confusion, indivisible affects, and estrangement.

Postpartum depression naturalizes the mother’s body as a site of labour. As a result of this naturalization, the mother’s relation to the infant is mediated by the social conditions of labour. The fact of the child becomes paradoxically both irrelevant to the experience and unavoidably central to it—in the sense that Marx describes “the object which labor produces—labor’s product—confronts it as something alien, as a power independent of the producer,” such that “the product of labor is labor which has been embodied in an object, which has become material: it is the objectification of labor.” This logic forms an epistemological limit between mother and child.

• Postpartum depression demands a discourse of symptoms, rather than a narrative of causation.

The mother is a labourer. As labourer, the mother doesn’t have “permission to feel low or depressed [just] because they are exhausted and disillusioned with the conditions of motherhood”; as Paula Nicolson explains, “they are expected to suffer from a recognised ‘illness’ before they are permitted to have their behaviour ‘excused.’” Postpartum depression is thus a socially necessary “illness,” which serves to further naturalize the mother’s social status through a discourse of symptoms.

The symptoms of postpartum depression include “agitation or irritability,” feeling “withdrawn or unconnected,” experiencing a “loss of concentration [and] energy,” “problems doing tasks at home or work,” or “trouble sleeping.” Such diagnostics contribute to the disembodying experience of postpartum. Postpartum is a set of symptoms that refuse causation. In each instance, postpartum appears individuated and circumstantial—rather than structured by the experience of childbirth. In this sense, postpartum is conceived as a problem with a solution: something personally surmountable, to be managed and controlled by habits and “self-care.” To fail at finding a solution for postpartum becomes a reflection of personal shortcomings, instead of social conditions.

• Postpartum depression is structural to breastfeeding.

While offering a highly variable set of symptoms as a diagnostic basis for postpartum depression, the medical health profession imposes a unilateral set of cultural expectations around the practice of breastfeeding. The American Academy of Pediatrics (AAP) recommends “that babies be exclusively breastfed for about the first 6 months of life,” meaning “no additional foods [or] fluids unless medically indicated.” Along with this recommendation, the AAP specifies that newborns should feed “as often as every 1.5 hours,” between eight to twelve times a day, adding that “if your baby isn’t waking on his own during the first few weeks, wake him if 3-4 hours have passed since the last feeding.”

Facing such expectations of waking as frequently as 1.5 hours, expending 300-500 extra calories a day, the breastfeeder takes on the set of symptoms associated with postpartum depression as part of their continual labour. The labour of breastfeeding can only be an experience of failure in relation to these expectations—to “succeed” is to endure this disembodiment in secret. To meet these expectations requires a particular class status, which allows for breastfeeding to be engaged as a form of labour in the first place.

The end of breastfeeding does not resolve the contradictions inherent in nursing as a form of labour. Weaning the child is neither discrete—even if it is abrupt—nor an isolated act. Regardless of whether the process is sudden or gradual, it remains a process. Weaning is an experience of withdrawing from one form of labour and material attachment, and developing new rhythms and patterns for the labour of feeding, of consoling, of sleep, and of intimacy.

Like breastfeeding, the possibility of and time committed to weaning are contingent on class status. The result is that the process of weaning unfolds as relation between the weaning woman and her child and as a class differentiation among women. While a handful of women exempt themselves from the labour force while breastfeeding, the vast majority of mothers simultaneously labour for a wage and for the daily reproduction of her child’s needs. Woman remains a coherently gendered form of labour, but the class character of gender is further divided.

As it marks a cessation of an activity, weaning is seen as unremarkable, barely registering in the discourse of postpartum. The silence surrounding weaning isolates the mother with what is often an experience of sadness, loss, and ambivalence toward the child. Weaning is a deepening of the mother’s disembodiment rather than the culmination of her endurance of it.

• “Postpartum depression” describes the social conditions of motherhood under late capitalism.

The Canadian Mental Health Association (CMHA) provides a set of warning signs for postpartum depression, including “feeling sad, worthless, hopeless, guilty, or anxious a lot of the time; feeling irritable or angry; losing interest in things; withdrawing from others; [finding] it hard to focus on tasks and remember information; [finding] it hard to concentrate, learn new things, or make decisions; a change in eating and sleeping; physical health problems; not enjoying the baby and having frequent thoughts that they’re a bad parent; having scary thoughts around harming themselves or their baby.” In pathologizing these “warning signs,” postpartum is rendered internal to the mother, severed from external conditions which naturalize motherhood as a “labour of love.” Whereas the mother’s disembodiment remains natural, the mother’s ambivalence toward patriarchy under capitalism is conceived as pathological. Providing an explanation for this ambivalence, the diagnostic of postpartum depression works as a mechanism of disempowerment.

Moving away from a discourse that pathologizes postpartum depression, the CMHA’s description could be pursued as a broader diagnostic of motherhood as a social condition. What is most dangerous about the diagnostic of postpartum depression is the psychologization of social struggle—the isolation of the individual from a collective experience. The dominant culture around postpartum depression moralizes a political problem, approaching what should be a site of shared critique and resistance as a form of competitive self-discipline.

Although the diagnosis of postpartum can feel liberating—providing a relief from self-blame in the form of a psychological disorder—it also imposes a set of challenges to the mother’s self-discipline. In terms of treatment for postpartum depression, the AAP suggests exercise and the help of a licensed mental health provider, and they advise mothers to “try not to worry about unimportant tasks—be realistic about what you can really do,” to “cut down on less important responsibilities,” and to “get as much sleep or rest as you can even if you have to ask for more help with the baby.” Successful treatment is a measurement of class but is coded as a matter of personal responsibility. The advice for self-management directly contradicts the instructions for the devoted breastfeeder; women are at once told to be “perfect” labourers, endlessly breastfeeding, but are also instructed to take care of themselves, to relax from the work of mothering. The solution for one set of “problems” produces a new failure to overcome. The regimen of self-care is nothing but an instrument of self-blame.

The disciplining of the postpartum experience reduces conditions of labour to a matter of individual habit and lifestyle. This disciplining must be understood as masculinizing the conditions of feminization. While describing the feminized, unwaged, immaterialized forms of labour integral to “motherhood,” the cultural discourse of postpartum depression compels the masculinist, competitive, individuating forms of sociality structural to capitalism.

• As a social and medicalized construct, postpartum depression pathologizes precarity and moralizes privilege.

As a pathology, postpartum depression localizes a set of “symptoms” that correspond with social marginalization and economic disparity. The CMHA sets apart “social inequalities like poor housing or inadequate income” and “isolation” as factors that put one at higher risk of postpartum. Postpartum depression renders the labourer’s class and social status an illness. The pathological category of postpartum depression naturalizes the family, such that the labourer’s experience of “family problems” is psychologized and institutionally managed as a diagnostic. The sickness is in the family structure itself.

The retrospective narrativization of postpartum depression on public internet forums, blogs, or self-help books is a privilege of class. While offering a forum for advice and the articulation of common experience, such sites are not a form of kinship. The narrative of postpartum produced and proliferated on blogs is an instrumentalization of it.

The dominant approximation in medical discourse is that “up to 10% of new mothers living in cities in economically developed countries like Canada experience clinically significant postpartum depression. The rate in the rural US and in developing countries is two to three times higher.” In the United States, more than one in seven women do not have access to the health care industry and remain illegible to this discourse. A public health care system, such as that in Canada, does not eliminate the class character of medicine.

• The social condition of postpartum is a feature of the historical processes of precarization and feminization.

As a discourse of symptoms, postpartum depression reproduces the dominant affects of recent capitalist development. The Institute for Precarious Consciousness (IPC) makes a compelling case for anxiety as the reactive affect of contemporary capitalism: “Today’s public secret is that everyone is anxious. Anxiety has spread [to] the whole of the social field. All forms of intensity, self-expression, emotional connection, immediacy, and enjoyment are now laced with anxiety. It has become the linchpin of subordination.” Postpartum depression localizes this affective condition, with the doubleness of what IPC calls a “public secret,” where the system’s violence is individualized such that the subject is made responsible for structural conditions.

Postpartum depression—as an articulation of the social conditions of motherhood—has become generalized with the feminization of labour. This shift can be understood as the diffusion of the woman’s working day, as Silvia Federici and Nicole Cox describe:

For as soon as we raise our heads from the socks we mend and the meals we cook and look at the totality of our working day, we see clearly that while this does not result in a wage for ourselves, we produce the most precious product to appear on the capitalist market: labour power. Housework, in fact, is much more than house cleaning. It is servicing the wage earner physically, emotionally, sexually, getting him ready to work day after day for the wage. It is taking care of our children—the future workers—assisting them from birth through school years and ensuring that they too perform in the ways expected of them under capitalism. This means that behind every factory and every school, behind every office or mine is the hidden work of millions of women who have consumed their life, their labour power, in producing the labour power that works in that factory, school, office or mine.

With the dissolution of the family wage, and the incorporation of women into the workforce, the working day under contemporary capitalism has come to reflect this perpetuity and repetition of housework. Rather than forge feminist solidarity, however, the generalization of feminized labour has only intensified the precarity of motherhood today. The stakes of postpartum depression are most acute once the feminization of labour strips it of its specificity and thus depoliticizing the experience of motherhood, as it is now the outcome of an economic relation as much as it is an embodied experience.

• The intensified precarity of motherhood demands forms of radical kinship.

“Radical kinship” requires strategies of disalienation. Radical kinship does not pose an alternative to the family, but aims to expand and modify the terms of the familial form away from a dynamic of property to a relation of communality. Radical kinship is an immanent critique of the family: it negates property relations through the cooptation of marriage. While the property relation of the family is ideologically legitimated by the state through marriage, this relation can be undermined and reimagined as a form of mutual aid and comradeship.

The practice of radical kinship begins with the expansion of parental responsibilities, the un-imagining of the child as property, and the de-naturalizing of the mother as labourer. In radical kinship, the child experiences love and support from a community that undermines the property relations of the family. In collectivizing this project of loving a child, practices of radical kinship attempt to work out of models of “self-sacrifice” and improvise strategies for communal-care. Increasingly, the practice of kinship can be premised upon love more than labour—in degrees and indirectly, we make contact with a different set of social possibilities. As a practice, this kinship must always insist on more, while meeting the immediate needs of children and their caretakers, and renegotiating the divisions between them.

The project of radical kinship negotiates between different feminized temporalities. On the one hand, radical kinship demands an orientation toward the slow, ongoing temporality of carework—a form of work that captures the past, as generations of labourers. To practice radical kinship means to adopt the repetitions and longevity of reproductive labour. This is an orientation towards time that moves between minutes and generations. Radical kinship takes already existing frameworks of solidarity and communality and seeks to broaden them. This is to inhabit the slow-paced temporality of carework while reaching toward a future of transformed social relations exceeding an individual lifetime.

On the other hand, radical kinship must be pursued with a sense of urgency. The labour of mothering demands a revolutionary practice grounded in the present, as a site of potentiality and futurity. The child’s imagination demands this sense of urgency, as it becomes steadily colonized by the logics of capitalism through experience. The labour of mothering entails mediating this process, while seeking a radical practice that directs the child toward lines of flight and modes of escape. While constrained by the repetitious temporality of carework, the mother also has access to this temporality that insists on futurity through the imagination of radical difference and transformation.

• The distinction between mothers and non-mothers must be radically challenged.

What would it look like to collectivize around postpartum as a social condition? This would require a radical disengagement from current discourses of mothering, which use motherhood as a vehicle of liberal feminism. Instead, this would require reframing postpartum as part of a feminist struggle which includes the full extent of our embodied experiences of trauma under capitalism.

• On postpartum and abortion

To say that abortion is about a fetus and not a child—about “some cells” and not “a life”—has been an important rhetorical instrument to radical feminists in the struggles of the last several decades. However, this distinction reproduces a violence upon the pregnant person who chooses an abortion, who lives through something that, to a great extent, must remain silenced and invisible beyond the experience of the body. It is this silence that is most oppressive, in its control over social spaces and the social relations therein.

The discourse of postpartum fails to make legible the loss of abortion as a concordant loss. These connections exist as arrays of disconnection. Nowhere are these connections between women made visible, or felt as solidarity. We are surrounded by connections that together form the latent possibility of a different social life.

The difference between postpartum and abortion should be destabilized by the diachrony of these experiences. These are not antithetical experiences, nor are they continuous—rather, these are thresholds of transforming radical feminist sociality. At stake is not “choice” but the necessary de-isolation of the woman who chooses. At stake is her location within the commonality.

• On children

The child constitutes the distinction between mothers and non-mothers, and as such the child must be central to the process of forging new kinds of relationships among radical feminists. Too often the child is set aside in radical feminist articulations of motherhood. “Problematically,” as bell hooks writes, “for the most part feminist thinkers have never wanted to call attention to the reality that women are often the primary culprits in everyday violence against children simply because they are the primary parental caregivers.” As a feminist practice, radical kinship must resist male domination of females, but also, as bell hooks contends, “adult domination of children.” To pursue such a practice means to un-work the logic of mother and child: to care for the mother and make visible the mother’s struggles means to care for the child and make possible the child’s liberation from the social conditions of domination. This entails challenging “sacrifice” as the logic of maternal care—a logic which compels the kind of domination always already operative in the labour of caregiving.

• On the abolition of gender

To radically transform the distinction between mothers and non-mothers and between mothers and children is to attempt to think and imagine the abolition of gender in the present. To insist on a solidarity which triumphs over the patriarchal relations of capitalism is to pursue what Shulamith Firestone calls the “ultimate revolution,” of “[freeing] women from the tyranny of their reproductive biology by every means available, and [diffusing] the childbearing and childrearing role to the society as a whole.” Such transformation must subvert the gendering of maternal care, but also the gendering of children. With the diffusion of childbearing and childrearing, the child is not abandoned with the logic of maternal care but instead experiences a fuller form of love—an actually existing communism of which we catch glimpses in the child’s imagination. To have a child in one’s life is to inspire and materialize such imaginings as a practice.

Madeline Lane-McKinley is a writer living in Santa Cruz, California.

Marija Cetinic is a writer and academic labourer living in Hamilton, Ontario.

WORKS CITED

“Breastfeeding Initiatives,” American Academy of Pediatrics.

Silvia Federici and Nicole Cox. “Counter-Planning from the Kitchen.” 

Shulamith Firestone. The Dialectic of Sex: The Case for Feminist Revolution.

bell hooks.  “Feminist Parenting,” Feminism is for Everybody .

Karl Marx. Economic and Philosophic Manuscripts of 1844.

Paula Nicholson. Post-Natal Depression: Psychology, Science, and the Transition to Motherhood .

“Psychology Works Fact Sheet: Post-Partum Depression,” Canadian Psychological Association.

“Postpartum Depression,” American Psychological Association.

“Postpartum Depression,” Canadian Mental Health Association.

“Postpartum Depression,”  MedilinePlus.

“We Are All Very Anxious,” Plan C.

“Theses on Postpartum” is from our MOMS issue (spring 2015)

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