Earnest, now: American postpartum depression

On October 1, 2010, Kristi Couvillon-Wise committed suicide as a result of postpartum depression. I didn't know her, but it cut me.

I take it very personally when women are knocked down or even let down by what is considered normal in our society. And while postpartum depression crosses all cultures, we have a unique set of variables here in the US.

(Note that when I say "we" and "us" I am talking about the predominant culture of both laypeople and obstetricians. I am not talking about myself, my community of birth professionals, or midwives in general. That "we" does much better, which I'll address toward the end of this post.)

We have high rates of risk factors: cesareans, twins and higher order multiples, cessation of breastfeeding, among others. We have competitive mothering and the desire to continue the illusion of perfection to others (see earlier post). But what came to mind for me the most is a refrain that Mason tells our pregnant mothers frequently: "In this culture, we often worry about the wrong things." Usually she's talking about adequate rest, stress reduction, and nutrition. Reading about Kristi's death, I realized how much it applies to postpartum depression.

We worry about birth emergencies that are not truly emergencies. We also worry about birth emergencies that are extraordinarily rare. We worry about harming our babies with sushi or by lying on our backs. But how often does our society pay attention to the most common complication of the childbearing year?

Can I say that again... the most common complication of the childbearing year. Postpartum depression is the primary complication and it deserves our attention. Women deserve our attention. Mothers deserve care providers and a culture at large that work for prevention, that recognize the signs, that destigmatize postpartum mood disorders, and that make simple management and more in-depth treatment easy to obtain.

As for midwifery care? (Enter new use of "we" - those maternity care providers, including MD's, who provide the midwifery model of care.) We can not prevent all cases of postpartum depression. We can do a lot. We reduce risk factors by ensuring that cesareans are only used judiciously, by enabling breastfeeding to proceed as best it can, and by emphasizing the importance of social support. We promote self-care for all, which acts as prevention and treatment: adequate sleep and rest, good nutrition, sunlight and fresh air, time to honor the self. We offer superior postpartum care, seeing mothers 3-6 times during a span of time in which mainstream obstetric providers only see a new mother once, and we check in with their emotional well-being, not just their physical healing. We refer to professionals who understand postpartum mood disorders, rather than using a single line of pharmaceutical defense.

For harm to come to a mother, her baby, or both as a result of postpartum depression is, thankfully, rare. Suffering is common, and it's time to stop accepting that and change our society's focus to the benefit of women and babies.