It seems obvious why you should care about postpartum depression if you are pregnant, want to be someday or was pregnant recently.
But PPD affects everyone. No, really.
Even if you’re never planning on getting pregnant, or can’t get pregnant? It can still affect you? Yes.
It affects you if you have a sister, friend, or loved one who is at risk for developing PPD. With a risk now as high as 35% for pregnant mothers in the US, which is a huge risk, you’re almost guaranteed to be close to at least one person with PPD.
It affects you if you want to have children of your own someday, as the bond and wellbeing of the person who will birth your child (whether that be you or your partner) will directly influence their development for their entire life.
It affects you if you are concerned about the survival of a new baby in your community, since PPD is the single largest factor behind maternal matricide and infanticide.
It affects you if you’re worried about the wellbeing of any child in your life, as PPD can notably affect a mother’s ability to bond with or care for her children, which has lifelong impacts.
It affects you if you care about the upcoming generation having a healthy vs traumatic start to life.
(Indeed, we don’t need to know someone afflicted by PPD to care about whether something bad or painful happening to a fellow human. But if we do need it to be personal — it is.)
May is Maternal Mental Health Awareness month
There’s a huge discrepancy between mothers’ postpartum needs and the care they actually receive in America, even in a town like Ann Arbor with excellent health care systems set up. This discrepancy can be especially high for parents who are queer, people of color (POC), or other minorities, who often face micro aggressions and discriminations medically.
For this article, we spoke with Lisa Kane Low, PhD and CNM Professor in the School of Nursing, Department of OB/GYN and Women and Gender Studies at the University of Michigan. She’s also a midwife, mother of two, and nana to two grandsons and (loving her role as nana beyond words).
PPD isn’t just sadness, crying, and an inability to take care of one’s baby. Low said one of the tricky aspects of PPD is its insidious subtlety.
“A very challenging part of PPD is that someone can be ‘doing the work’ of parenting and are keeping their newborn safe and fed, but they are not feeling the emotional attachment and are staying at that base functional level with a huge amount of effort and strain that depletes them daily. They ‘look” like they are ok, but they are not,” Low said.
Stigma around mothers having PPD still exists. Low says that stigma is a critical barrier to being able to seek lifesaving resources and support: “As a society, we tend to paint things in extremes, so the ‘functional” person who is ‘doing the work’ of parenting is not even a mental image someone might have about PPD, and instead they may hold a mental image of someone incapacitated by their depression. There is a wide range of how PPD might be experienced and if that is not well known, people can get lost in the process of identification and getting linked with support.”
As a mom of pseudo triplets (read about why my wife and I wanted to have pseudo twins here), I was especially likely to develop PPD, since being a mother of multiples is a risk factor.
But it turns out that COVID-19 is a risk factor for everyone. Since COVID struck the U.S., postpartum depression rates have skyrocketed.
Prior to COVID, postpartum depression (PPD) affected 10-20% of new mothers in America. Now, it affects over 34% if not more.
Black, Indigenous and people of color (BIPOC) are more likely to get PPD due to a variety of systemic inequities, and less likely to be able to treat it. Queer parents are also far more likely to suffer from PPD.
With minorities, Low says there is a strong risk of them suffering in silence due to the perception of being labeled as a bad parent. Or they might not recognize their symptoms are actually PPD, and therefore don’t get the resources they need.
“This ‘suffering in silence is further exaggerated in people who may already experience racism, sexism and or homophobia or any form of bias that can serve to restrict their access to resources,” Low said. “It also raises a higher level of fear in asking for or naming PPD or other challenges the person may be experiencing for fear of repercussions, particularly with concerns for losing parent rights or being separated from one’s infant.”
Low notes that the structural approach to assessing parents’ capacities often has many levels of implicit bias potentially present. In such cases, she said, for these parents, “The decision to remain silent vs seeking assistance becomes an act of self-preservation and agency to maintain their family.”
But even if you or your loved one is not a minority, other risk factors that affect people from all walks of life can raise your or your loved one’s likelihood of suffering from PPD:
- Past pregnancy or infant loss
- A baby born at low birth weight
- Preterm births
- A prior diagnosed mood disorder;
- Notable stressors during pregnancy, such as losing your job or a loved one, experiencing severe illness, etc
- Any complications during childbirth, including having a sick baby, experiencing premature delivery, or having interventions at birth (forceps, an emergency c-section)
- Having an unplanned pregnancy, or having mixed feelings about a pregnancy’s impact on your life
- Substance use or abuse
- A lack of support from partner, family, or friends
- And of course, having twins (or even more multiples)
Looking at this list, many of us can probably think of a friend or loved one who has some of these risk factors — if not our own selves!
Maybe you or your loved one gave birth over six months ago, and you’re still doing well mood-wise. Can you breathe a sigh of relief, knowing you’re no longer at risk for PPD?
Actually no. PPD can strike up to a year after giving birth.
Okay, so we know that PPD is a dangerously prevalent problem for families in our community and has a truly concerning impact on families. What now?
For friends and loved ones: “The best way I can say this,” says Low, “is that we need to build the village of resources and support that allow both the newborn AND the birthing person to be cared for and nurtured as a dyad most of the time and sometimes just nurturing the birthing person is what may be needed. Having a chosen support network or having access to others who can serve in that capacity is huge in supporting the necessary rest, recovery and comfort that is required during the process of healing and regaining strength postpartum.”
This can be something as simple as acknowledging the parent. “There is so much focus on a newborn,” says Low, “that the parent becomes a backdrop in many social situations. They don’t get asked, ‘How are you doing?’, but instead is it ‘how is the feeding or sleeping going for the baby?’”
For any pregnant parents with a history of mood disorders, such as PPD, depression, or anxiety, Low said, “Having a plan for care during pregnancy, including access to a therapist and prescriber for medications as needed, should be part of that plan. We also need to normalize the process of screening and early identification of PPD, making it a part of the way we support new families to move through the challenges of this phase of time.”
For our community at large, “There are strong program models that are growing and are showing positive evidence of being a critical resource for people at risk of PPD,” Low said.
“These include the early referral options for care and virtual access to counseling service (MC3 in Michigan is an example). Home visiting models can be a useful tool if the visitors are community members, usually approaching families as a peer support; and then the use of Doulas, particularly postpartum doulas, are another evidence based approach to support families at risk.”
In continuing to pursue this goal, the UM School of Nursing has formed a partnership with Birth Detroit to create the Michigan Maternity Care Traineeship Program. This program, pursuing health equity and midwifery diversity, supports students in the nurse-midwifery program, especially those who live in or serve medically underserved communities.
Ultimately, the goal of fighting PPD is to support new parents in not only keeping their children alive, and healthy, but also to be able to find joy in their role as a new parent to their infant.
“PPD takes a daily toll,” Low said. “There is limited ability to be resilient when you combine that with the high levels of fatigue that happen in those early months. Some parents describe it like they are almost in a dream like state of doing the work, but they are not able to be emotionally engaged or feel any joy or comfort in the process.”
Do you have other local resources for parents suffering from or at risk for PPD? Share them with us!
