Feminist perspectives on PND

kinddogs thanks , I have my good and bad days and I love my baby so so much and her smile is an instant mood lifter. I have been thinking about feminism a lot since having this baby particularly. I do feel bombarded with "advice" about SIDS, sleeping, feeding and my mental health (pnd) but it feels like a slap in the face when no support is forthcoming (and I think you could argue that actually being given a load of leaflets that suggest there will be suppport and then finding out there is none is actually very undermining). My postnatal experience is far far worse than with DC1 and I do wonder how much this is it being a 'female' issue and so more prone to cuts and yes, I feel as new mums we are expected to just get on with it and thrive under what can be intolerable conditions. I know I'll get through it, but I feel angry that things have gone so far backwards in such a short time (with DC1 there were surestart centres which were excellent and I felt much more supported in general). I do feel there is an element to which the baby phase is seen as "wife work" and undervalued.

I know a few SAHDads and their wives are constantly being told how amazing they are. I have no doubt the going to baby groups etc can be harder if you're the lone man but I'm always a bit because most of what they do is exactly the same, plus they don't have the physical birth trauma / extreme hormone changes.

Inneedofacup. You are absolutely right, I am sorry and I am sorry you are not OK I agree with Doobius

The more one thinks of it the more it is obvious that very often women are experiencing a natural response to an extraordinarily difficult time which is also emotionally overwhelming.

I had 'PND' with my first child.

It's as plain as day to me now - years and years later - that it was a very reasonable, natural reaction to my life being turned completely upside down and not having enough support.

Within the space of a few weeks, I went from being a full time, full on career-oriented person with a huge social life attached to work, a lot of status, a real 'go getter' identity...to having had a traumatic, emergency c-section and then 'recovering' at home on my own all day with a newborn baby to care for 24/7, with scant support from my partner.

Of course I was fucking depressed!

That may work the way you say, but also stress itself creates odd hormones and chemicals too and that can come from a traumatic birth, too little sleep, too much worry, past traumas, too little to eat, too little help, trouble with BF, stitches, infections etc So where does it all begin and end? The OP thinks, and lots agree, it is normal to feel depressed to some degree, for some people, given what it all is like.

This might be a daft question but is depression a medical thing where there is a chemical or hormonal imbalance?

In which case it would be quite likely that this could be caused after birth.

I am of the understanding that all the stages of labour and birth trigger different things to happen within the body and when that labour doesn't happen in a 'typical' way some of those hormones don't kick in they way they should which is where women are suffering with PND.

OP, hope you feel better soon.

Mum I'm in the same situation as you (except my older dc is school age which helps although hate the school runs!). I think ADs or counselling are what they offer. What they should offer is somone to have the baby for a few hours while you sleep. If lack of sleep is the main problem this is the only real solution. They always glibly imply you can just express off enough milk so your DH can do a bottle in the night but that's actually adding to my daily burden plus DH just does not wake unless shaken as is a very deep sleeper (at which point I'm awake anyway). Plus DH is the only source of income for us so having him super tired (and at risk of getting fired) is not an option. Yes, my anxiety is growing the longer i go without sleep and makes it increasingly difficult to go to sleep and to feel like i can cope. They've closed all the state funded children's centres near me. It's so stupid as a small bit of help now might prevent total breakdown and the huge costs of that. In my ideal world there are children's centres with beds, so the mums can take it in turns to sleep and look after babies, with perhaps one hv supervising. It need only be open 1 or 2 days a week. I bet that would end up cheaper than treating multiple women for pnd with all the gp time / drugs/ counselling that entails.

Hope you're ok OP.

I hope you don't mind me joining in to ask a question about PND... I've got a one month old (my second baby) and a continuos cycle of no sleep teamed with an energetic three year old and trying to cope with life in general has left me completely exhausted and suffering a lot from anxiety (which unfortunately isn't helping me sleep despite being exhausted which makes the anxiety worse...!). I know a main cause is lack of sleep... but should I mention it to my health visitor? Over the weekend I was really struggling and felt so ill with it which made me think it's getting worse.

What happens when you admit you're struggling with anxiety or possible PND? I don't want to be sent to the Drs for ADs, but I guess the main advice or action other than that would be 'get some sleep' (which is easier said than done!) so I'm not sure if there's any point mentioning it?

Sorry to hear that op, hope you feel better soon.

Hope you feel better soon OP.

I agree that we were not meant to be alone with a newborn for hours on end, every day of the week. I think a lot of pnd is a perfectly rational response to stress, trauma, physical pain, and lack of support which many new mums experience.

I was similarly told that I am hormonal and repeatedly asked by the HV if I am feeling weepy or think I have PND. My answer was "I do not have pnd but I do have bleeding nipples, concerns about DS weight gain, and have not slept for 2 weeks". I do think it's perfectly reasonable to be a bit on the weepy side if your boobs hurt so much that wearing a bra is agony. But Noooo!! Women! Hormones!

I also think it's a perfectly reasonable response to, if anyone else mentions that I have a "baby brain" and have apparently gone stupid by the act of giving birth, punch them in the face. I'll use "oh I'm just a poor woman, all hormonal and unreasonable" in my defence.

Interesting.
I wonder if there are any studies looking at the links to birth trauma?

As a linked issue, I've thought a lot about the way in which women are treated after c-sections. I mean I've had friends who've had keyhole surgery on knees etc, and there's an expectation they'll rest for several weeks after. Yet women who've had c-sections generally expected to then cope with no sleep, be in pain etc and that's seen as fine. Or at least in my experience

I think the NHS site actually says most PND is situational rather than hormonal.

kinddogs could not agree more - I just think we're not supposed to be alone with babies so much....had relatives visiting for a week and I was so much better rested and baby was much happier too - plenty of people to hold and cuddle her. Sadly they had jobs to go back to after the week and live a plane ride away.

hrumphing interesting post...do you work in this field? You sound v knowledgeable!

As someone probably currently at risk of PND, although I'd say I don't have depression at the moment as I feel loads better when I get sleep (but as I said before, I wonder if theres no relief if your brain chemistry eventually changes), I find it very frustrating that the HV asks so much about PND but seemingly all the societal support to help Mums and possibly prevent it is being cut. All the children's centres near me were closed shortly after DDs birth - I went to look for support groups like I did with DD1 and basically there are 2 private ones (both of which I have to drive to, both paid) one which runs once a week, the other once a month. Most on the list provided by the hospital no longer exist. Some the phone numbers are no longer even in use. When feeling low and reaching out I felt like a big door was slammed in my face. Only one breastfeeding support remaining is in a difficult place to get to 25 mins away. Why bother asking if there's no support? Do they just offer antidepressants? Also HV seemed really happy when she determined I wasn't feeling dreadful EVERY day and said "I don't think I need to see you again" at about 10 weeks. Things with DD1 were much better.

I think this article is pertinent to this thread. Huffpost

I wonder to what extent the low rates of women describing their care as "satisfactory" or lower, despite the high numbers of people who have reported having fairly obviously pretty atrocious care is because women simply expect to be treated in these ways?

I also agree with KindDogs - there is something psychologically about having a child that reminds you of your own childhood experiences and that can be really hard for women with bad experiences in childhood.

Meant to say Puerperal psychosis looks a bit different to other forms of psychosis - it looks completely different to depression!

I think the clinical focus is more on risk factors rather than the question 'how much is due to hormones vs how much is due to circumstances'. After all, all women have hormonal changes during and after pregnancy. Similarly giving birth and being a new mother with a newborn is always a massive general stressor. I'm sure its no coincidence that of the two, its the hormones that society focuses on as 'the' causal factor in something affecting only women. Although I suppose to be fair, the 'chemical imbalance' explanation is frequently used for depression as a whole so sort of fits in with that line of explanation.

PND isnt thought of as different from other depression in terms of symptoms, nor that it is a separate illness. Puerperal psychosis does often look a bit different. The other thing I wonder that might be relevant is that it is difficult to distinguish any depression from the normal response to stressful life events and the bigger the event, the more difficult it is to detect even more severe forms of depression. So this is always a difficulty in diagnosing pnd. It is also a similar difficulty in assessing for depression in severe physical illness but I think people tend focus more on the 'stress' rather than the physical possibilities as 'the cause' here. If hormones are relevant then cortisol is probably the most likely option and that changes in both men and women under conditions of stress (such as physical illness) as well as in the post partum period for women.

There is lots of evidence about lack of support both from partner but also wider network and other life stress or loss being significant risk factors. Previous history of depression and depression or anxiety in pregnancy are also major risk factors. There is also evidence on tempermental characteristics of babies eg colic and birth trauma or problems increase risks and any number of other, quite logical risk factors.

I think in terms of treatment then the current thinking for all depression is that because the causes are probably all multifactorial in most cases then you should look at all treatment options and individualise, starting with basic, practical support, self help, psychological approaches and adding in antidepressants for more severe forms or later if the first measures haven't worked. Unfortunately the reality is that mental health is poorly funded so these options are not always there. For PND then an particular focus on prioritising women with PND, a recognition of their particular needs and a lower threshold for access to help including specialist perinatal services would be what I would want to see as the difference between treatment for pnd and other depression.

I had prenatal depression and anxiety
caused by infertility and IVF that morphed into PND through a traumatic birth I spent the first few months of my dd's life in a dissociated state.

I now after several months can see how ill I was (we've actually been talking about it this evening.) I'm not better but not as ill as I was.
My PND is not hormonal, neither is it caused by being at home for 12 hours a day with the baby.
I'm mentally ill, it's not a feminist issue it's a human issue, I have a chemical imbalance not a hormonal one.

Post natal psychosis with hallucinations and extreme effects must be a different thing again.

I think that actual PND is quite rare. In most of the cases I have encountered, it has been situational or misdiagnosed PTSD.

Really interesting thread. My PND was in large part due to a hugely traumatic birth and painful complications which are still ongoing; limited support ; recurrent mastitis; colicky baby etc. I think the pnd was a reasonable response to a really awful time. I've also read that in other cultures where the mother is able to really rest for several weeks, pnd rates are far lower.

As Kinddogs says I don't think we're designed to look after babies solo, and where there is trauma/illness other factors, pnd is maybe to be expected? Plus of course very little support for mother's with PND.

This is a very interesting question. I think it may be both hormones and also a natural reaction to circumstances.

At a time when I still did not have periods due to breast feeding, I found my mood became even more terribly depressed around the time when the period would have been there. But also lack of sleep, probably not eating enough, and trying to do too much, losing all the life I'd had before, the feeling of not mattering and a heightened sensitivity to everything made it terrible.

I don't think people were designed to be alone with a baby. In a perfect world there would be a bevy of people around to look after the mother and the baby and the house, with no loneliness.

I also think there may be subconscious difficult memories surfacing related to one's own time a a baby which begin to have an effect.