Why are natural childbirth and breastfeeding advocates relentlessly looking for a physical cause for a mental health problem?
As part of their ongoing effort to demonize both C-sections and formula feeding, they seem desperate to show that mode of birth or “failure” to breastfeed are risk factors for postpartum depression. But why would anyone think that a mental health problem had a physical cause? And wouldn’t the best place to look for risk factors for a serious mental health problem be psychological issues?
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women who were psychologically flexible and able to be compassionate to themselves were at lower risk of postpartum depression.[/pullquote]
According to a 2016 review in the New England Journal of Medicine:
…Symptoms of postpartum depression often include sleep disturbance (beyond that associated with the care of the baby), anxiety, irritability, and a feeling of being overwhelmed, as well as an obsessional preoccupation with the baby’s health and feeding. Suicidal ideation and worries about causing harm to the baby have also been reported. The strongest risk factor for postpartum depression is a history of mood and anxiety problems and, in particular, untreated depression and anxiety during pregnancy.
We already know factors that impact mental health play an important role:
…including low social support, marital difficulties, violence involving the intimate partner, previous abuse, and negative life events.
“Wait,” I hear natural mothering advocates cry, “what about hormones?”
The rapid decline in the level of reproductive hormones after childbirth probably contributes to the development of depression in susceptible women, although the specific pathogenesis of postpartum depression is unknown.
The impact is serious:
Postpartum depression results in maternal suffering and diminished functioning and is asso- ciated with increased risks of marital conflict and impaired infant–caregiver attachment, as well as increased risks of impaired emotional, social, and cognitive development in the child, and in rare cases, suicide or infanticide.
Given the high incidence, serious nature and profound effects of postpartum depression, we should be doing everything we can to prevent it. A new paper to be published in the March issue of the Journal of Affective Disorders asks the critical question, What protects at-risk postpartum women from developing depressive and anxiety symptoms?
The authors describe the problem:
The adjustment to motherhood is marked by a range of different internal experiences, including negative thoughts and emotions. However, societal ideologies highlight that a normative response to motherhood is the presence of immediate and continuous feelings of happiness and joy. These expectations of motherhood may lead to women having more difficulties accepting their internal experiences, such as negative thoughts and emotions, when they do not reflect such ideals…
They found:
Women not presenting depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion than women presenting depressive and anxiety symptoms. Hierarchical logistic regression showed that women with higher levels of psychological flexibility (OR = 1.06, CI: 1.01–1.12) and nonjudgmental appraisal of thought content (OR = 1.33, CI: 1.15–1.53) had a significantly higher likelihood of not presenting depressive and anxiety symptoms.
They explain:
Consistent with previous studies, our results showed that women presenting no depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion when compared with women presenting depressive and anxiety symptoms. We also found a significant negative association between these variables and depressive and anxiety symptoms… Thus, these findings corroborate our hypothesis that a more accepting and self-compassionate attitude towards private events in the postpartum period for women presenting a risk for PPD is associated with lower levels of depressive and anxiety symptoms.
Women who were psychologically flexible and able to be compassionate to themselves were at lower risk of postpartum depression. Unfortunately we live in the milieu of natural mothering ideology that is psychologically rigid and so far from compassionate as to be cruel:
…[T]he social idealization of motherhood can hinder the acceptance of negative private thoughts and emotions during this period and lead to maladaptive avoidance strategies, which have a significant impact on the psychological adjustment of postpartum women…
The authors conclude:
Our results suggest that a tendency to be more accepting and nonjudgmental of internal experiences might be beneficial and that promoting this tendency could be an important feature of perinatal psychological prevention interventions…
That’s why, for example, the insistence of lactation professionals that breastfeeding reduces the risk of postpartum depression is such an egregious lie.
It is a lie because we know that the risk of postpartum depression depends on intention to breastfeed not on the process of breastfeeding itself.
…[T]he effect of breastfeeding on maternal depression symptoms was found to be highly heterogeneous and, crucially, mediated by breastfeeding intentions during pregnancy. Our most important finding relates to the majority of mothers who were not depressed during pregnancy, and who planned to breastfeed their babies. For these mothers, breastfeeding as planned decreased the risks of PPD, while not being able to breastfeed as planned increased the risks.
Furthermore:
For the majority of mothers who did not show symptoms of depression before birth, breastfeeding … increased the risk of PPD among mothers who had not intended to breastfeed.
When women could not meet their own goal of breastfeeding, the risk of postpartum depression doubled. And the exact same thing happened when women who did not want to breastfeed were pressured to do so even when they were able to successfully breastfeed. If breastfeeding itself were protective, that would not have happened.
The claim that of lactation professionals that breastfeeding prevents postpartum depression is a particularly heartless lie for two reasons. First, they are the ones who have exaggerated the benefits of breastfeeding out of all proportion to reality. Because of their claims of (mostly debunked) benefits, women pressure themselves to breastfeed. Second, when these women have trouble, either because of insufficient breastmilk, pain or other cause, lactation professionals refuse to demonstrate psychological flexibility or compassion.
The bottom line is that while postpartum depression may have physical components, nearly all risk factors are psychological. If lactation professionals cared about women (as opposed to breastfeeding rates) they would stop lecturing, hectoring and shaming them. I’m not holding my breath that will happen anytime soon!
