Image by Sergiu Vălenaș via Unsplash
Why do some women get postpartum depression while others do not? Why do some women view having their child/children as the happiest moments of their lives and for others, it is the most difficult and dark period that they have ever experienced?
The media certainly doesn't make it any easier by showing happy mothers with glowing faces whenever motherhood is talked about. (Go on, I dare you - find an image that shows an unhappy, miserable mother after giving birth - it just doesn't exist!). But the fact remains: a quarter of women have anger, anxiety, guilt, hopelessness, loss of interest or pleasure in activities, mood swings, or panic attacks after giving birth and for some, it takes a tragic turn. Postpartum depression can start at any time during the first year following childbirth and can last for a long time, not to be confused with 'baby blues' which is more common and usually fades away two weeks after giving birth. Showing unhappy, depressed mothers at times in the media would be an accurate depiction of motherhood - and will go a long way in normalizing mental health issues during this time.
So, coming back to our original question: why do some women experience postpartum depression and others don't?
Well, there are known 'risk factors' that make some women more prone to developing depression after giving birth. One of the most studied and obvious factors is a history of past experience with depression. The explanation behind this is that women who are more prone to mood swings during hormonal changes (moderate to severe premenstrual syndrome, or PMS for example) or have generally experienced depression before might 'relapse' and experience these symptoms again after childbirth. Severe anxiety during pregnancy also contributes to the likelihood that someone experiences depression after giving birth.
Other social factors, such as recent stressful life events, inadequate social support, and poor relationship with a spouse are also risk factors that can predict postpartum depression. It takes a village to raise a child - there is a lot of truth in this.
Finally, individual factors, such as negative attitude towards the recent pregnancy, a history of sexual abuse in the past, socio-economic factors also play a huge role in whether the woman will likely develop postpartum depression after giving birth.
So, if we know all this, why don't we screen or at least prioritize mental health follow-up for all pregnant women if they fall into one of the above categories so that every mother gets the care they need for postpartum depression? Good question. The answer lies somewhere between lack of resources to implement this kind of prediction at scale and the other being there will be false positives, since not all the women who have these risk factors will definitely experience postpartum depression. There are no biological markers that have (yet) conclusively shown to be predictive of postpartum depression yet, but there are many scientific groups who are working hard at this, and hopefully, in the future, all it would take is a blood test to predict who will experience depression after childbirth and therefore treated accordingly.
At Haplomind, we believe that the benefits of predicting the risk of postpartum depression highly outweigh the risks of false positives, even with the current, imperfect methods. If every woman is screened, especially the ones with a high risk of developing postpartum depression with well-thought paths to care afterward, then there will be less incidence of undiagnosed and untreated depression after childbirth. It will also allow the healthcare professionals to follow up with these individuals more closely after childbirth. And for the women, it will be a relief to know that what they are experiencing is a clinical disorder that is fully treatable.
If you are pregnant and have any of the above risk factors, do bring it up with your doctor and ask to be screened - it might make a world of a difference to you and your childbirth experience.
It is only after every woman has access to this kind of care will we be justified in showing happy, cheerful mothers when discussing motherhood - but not before that.