Postpartum depression is a psychiatric illness, not a marketing opportunity for natural childbirth advocates


To a hammer, everything looks like a nail. To a natural childbirth advocate, everything looks like an opportunity to push her agenda.

It was ugly when natural childbirth advocates expropriated the tragedy of maternal mortality among women of color — a tragedy largely rooted in socio-economic conditions — to claim, falsely, that these deaths reflect the failure of modern obstetrics. Their solution? Providing the natural childbirth services that privileged women want.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Jennifer Block’s recent piece on postpartum depression is cruel, deadly, self-serving bullshit![/pullquote]

Now it’s ugly when Jennifer Block and Alisa Alpert (a natural childbirth celebrity and doula respectively) are trying to expropriate the tragedy of postpartum depression — a tragedy of serious psychiatric illness — to claim, falsely, that it is the result of the pressures of capitalist societies. Their solution? You guessed it! Providing the natural childbirth and lactivist services that privileged women want.

Referring to the first ever approved drug for the treatment of postpartum depression, Block and Alpert write:

Postpartum depression is a serious problem, affecting, by some estimates, one in nine American mothers. It can be incredibly painful and is believed to be a growing cause of maternal deaths in the year following a birth. Insurers are expected to cover the exorbitant cost of Zulresso, which suggests that there’s finally a will to address our country’s dismal record on maternal health. Hurray!

But if we really want to tackle postpartum depression, we need more than a drug…

The clinical definition of postpartum depression is a “medical complication of childbirth,” but this doesn’t take into account women’s emotional lives, and the fact that the way our culture treats some new mothers amounts to abuse.

That, not to put too fine a point on it, is bullshit!

What is postpartum depression?

Postpartum depression (PPD), the onset of depressive episodes after childbirth, is the most common postnatal neuropsychiatric complication. Postpartum depression affects 10% to 20% of women after delivery, regardless of maternal age, race, parity, socioeconomic status, or level of education.

It is NOT the mild, self limited alteration in mood experienced by many women in the postpartum period:

Postpartum blues occurs in 50% to 80% of new mothers. Signs and symptoms appear within 1 to 2 days postpartum and include depressed mood, anxiety, tearfulness, irritability, poor appetite, and sleep problems. These changes are mild and resolve spontaneously within 10 to 14 days …

In contrast, symptoms of postpartum depression include: persistent depression, persistent loss of interest and pleasure in previous enjoyable activities, changes in appetite, changes in sleep, persistent fatigue, difficulty concentrating, feelings of worthlessness, thoughts of suicide.

In other words, postpartum depression is major clinical depression in the peripartum period.

It is critically important to understand that while any major depression, including postpartum depression, can be exacerbated by socio-economic problems, socio-economic problems do NOT cause major depression including postpartum depression. It is a MEDICAL ILLNESS with an ORGANIC cause, even if we don’t yet know the exact cause. As anyone who has ever loved or cared for a person with major depression learns, no amount of love and support can prevent it, treat it or cure it. Only therapy and medication can do that.

A drug that can treat postpartum depression specifically is a major medical breakthrough! I have no idea how well it works or whether it will work at all, but it marks an important milestone: a recognition that postpartum depression is a disease.

Not according to Block and Alpert:

Pregnant women are often pickled in horror stories about birth, then subjected to unnecessarily intrusive care. Many suffer pelvic trauma; one in three wind up with major abdominal surgery. Then they are sent home with a newborn, typically without support. According to 2015 data, a quarter of women return to work in two weeks. Everyone says that “breast is best,” but new mothers get a decent place to pump at work only if they’re lucky. Most won’t see their doctor again for six weeks. No wonder depression is so common.

As one mother we know who plans to quit her job (because she can afford to) said about the lack of parental support in this country: “It’s just so mean.”

A new expensive drug is not enough; we need humane, evidence-based maternity care, respect for the “fourth trimester,” months if not years of paid parental leave, and affordable child care.

Bullshit! Bullshit!! Bullshit!!!

Postpartum depression exists in every time, place and culture: those with high C-section rates and those without access to C-sections; those in which mothers return to economic employment and those where they are not allowed to work; those with high breastfeeding rates and those with low breastfeeding rates; those with easy access to doctors’ visits and those with no doctors; those with evidence based maternity care and those without; those that provide copious postpartum support and those with none; those that provide parental leave and those that don’t; those that provide affordable childcare and those that provide no childcare of any kind.

That’s because it is a MEDICAL ILLNESS with an ORGANIC cause, not a barometer of socio-economic conditions.

Block and Alpert write:

We’d be foolish to believe that any drug is the magic fix that will once and for all end the metaphysical conundrum of experiencing fear, sadness, anger and despair during the most vulnerable time of our lives.

Bullshit! Postpartum depression is NOT a metaphysical conundrum any more than schizophrenia is.

If insurers are willing to throw down tens of thousands of dollars for a mother’s mental health, we can think of some alternatives that might have a better cost-benefit ratio: Six months paid leave. A live-in doula and a private sleep-training coach. Weekly massages and pelvic-floor rehab sessions. Relocation to a commune in the Bahamas.

Would they dare recommend six months paid leave, a live-in doula, weekly massage and a tropical vacation as a cure treatment for schizophrenia? I doubt it because they understand that schizophrenia is a serious psychiatric illness, not a manifestation of stress. Postpartum depression is a serious psychiatric illness, too, and pretending that a tropical vacation could prevent, treat or cure it is both flip and disrespectful.

In the meantime, we fear that Zulresso is just a stopgap, and yet another instance of pathologizing a very sane reaction to our very insane culture.

Bullshit! Cruel, deadly, self-serving bullshit!