''New parents need to know that Postpartum Mood Disorders are common, temporary, treatable, and that they do not define individuals or their ability to parent.'' -Jaz Wilson, PDCCE, SBD, SN
When one thinks about having a newborn baby, whether they are thinking of themselves or of someone else, many have positive or happy thoughts come to mind. A societal expectation exists that although exhaustion is expected, new parenthood should be the best time of a person’s life- one full of bonding, cuddles, sleepless nights, and love. Yet for many parents, there are hidden struggles beyond sleeplessness, and the weight of this expectation can make it more difficult for new parents to reach out for help. According to Ottawa Public Health (2020), 20% of birthing parents and 10% of non-birthing parents experience some sort of postpartum mood disorder, ranging in severity from baby blues to postpartum psychosis. A postpartum mood disorder (PMD) encompasses a wide range of emotional fluctuations, which can include anxiety, depression, and delusions. Many factors can contribute to the prevalence of PMD, such as a previous history of mental illness, having a partner experiencing depression, socioeconomic status, low social support, and low-quality of marital relationship. This blog post will discuss various postpartum mood disorders, there risk factors, and how the impact of shame can deter parents with PMD from seeking help.
Shame and Parenthood
Brown (2007) shares a personal story regarding the shame of motherhood, which identifies heavy societal expectations that fall on parents of every gender. Shame, according to Brown, ‘’…is the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging’’. Brown explains that she was having lunch with a new friend who, along with Brown, had recently had a baby. Brown shared that she was not expecting to feel so tired and sometimes she just wanted a break. The friend went on to say ‘’Really, I’ve never regretted having my baby’’. Brown explains that she spiraled into deep shame, and tried to convince her new friend that she was just tired, she did not regret having her child- but to no avail. The friend was convinced that Brown’s expression of wanting respite meant that Brown regretted having her baby, and went on to say that motherhood was not for everyone. This story is an example of the pressure that exists on new parents, the idea that it is supposed to be perfect, and that you are supposed to be tired yet always content and in love without the presence of conflicting emotions.
Postpartum Mood Disorders
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM- 5), a postpartum mood disorder is typically characterized by an onset during pregnancy or within four weeks of giving birth, but may occur anytime within the year. It can begin as the common ‘’baby blues’’, feelings of sadness or a fluctuation of emotions that can affect either parent, and progress into postpartum depression or, more severe, postpartum psychosis. Criteria for a depressive episode include the presence of five or more of the following: depressed mood for most of the day that may be observed by others, diminished pleasure in all or most activities, significant changes in weight, insomnia, restlessness, fatigue, feelings of worthlessness, diminished ability to concentrate, and recurrent thoughts of death. Postpartum psychosis involves symptoms such as delirium, depersonalization and misrecognition of individuals, non-auditory hallucinations, and delusions. With the combined shame and stigma that surrounds both new parenthood and mental health, one could see how difficult it could be for afflicted individuals to acknowledge the presence of a postpartum mood disorder.
Risk Factors for Childbearing Individuals
Although many people experience positive feelings towards pregnancy and childbirth, others consider it to be a major life event that may induce large quantities of stress. Matinnia states that adjusting to pregnancy, birth, and life with a newborn can be among the most stressful events in a persons’ life. Risk factors for postpartum mood disorders in childbearing individuals include low self-esteem, low socioeconomic status, marital issues, lack of social support, prenatal depression, high perceived stress, or a history of fear of childbirth. Research also states that once economic and social aspects have been considered, shame proneness is a significant indicator in regards to risk of experiencing a postpartum mood disorder. Dunford also states that being prone to shame decreases the likelihood of individuals experiencing a PMD to seek support. According to Kamperman, the presence of bipolar disorder is a risk factor for postpartum psychosis. Postpartum psychosis (PP) is a distinct and rare disorder that falls within the spectrum of bipolar disorders. It may only occur in episodes in the postpartum period of a person’s life, and for others, it can mark the onset of bipolar disorder. In a qualitative study discussed by Luis, it was discovered that when a birthing person is experiencing PMD, the non-birthing partner (in this study, men) were less likely to encourage their spouse to seek help because they felt pressured to handle these personal family matters on their own. The presence of any mental health disorder is highly stigmatized in our society, and can lead to feelings of shame in any parent.
Risk Factors in Non-Birthing Parents
Male gender-roles can pressure individuals to want to be independent, in control, and able to handle family matters themselves without outside help. According to research, men are not only less likely to seek help for PMD themselves, but they are less likely to encourage their partners experiencing PMD to seek help as well. Luis states that men often fear what others may think about their personal family matters, driven by feelings that familial issues indicate failure as a spouse. It is clear that shame plays a role in partners/men’s aversions to help-seeking. Scarff states that risk factors for PMD in non-birthing parents include a history of depression, unwanted pregnancy, marital/relationship issues, and partner depression. The Edinburgh Postnatal Depression Scale (EPDS) is commonly used as a PMD screening tool for new or expecting parents, and due to male gender-norms leading to the underreporting of symptoms and a potential difficulty in the discussion of emotions, the EPDS score indicating PMD in men is lower than it is for women (Scarff, 2019).
The role of Health Care Workers in Shame and Postpartum Mood Disorders
PMD exists in societies worldwide, and it has serious consequences. Although individuals typically receive more frequent healthcare during pregnancy, PMD is largely undiagnosed. There are various barriers that contribute to this lack of diagnosis, the most common being stigma, constraints on time, and motivation to disclose their symptoms. Many of these individuals in the study discussed by Prevatt et al reported that they faced many barriers to care, which made seeking treatment near impossible. Many new parents are afraid of discussing their symptoms with their care provider, due to the fear of social repercussions or the involvement of child protection services. The idea of acknowledging the presence of a postpartum disorder and having the person they trusted with this information see them as unfit to parent can bring on enough shame and stigma to prevent people from pursuing care.
Prevatt also mentions that insensitive statements from health care providers is another deterrent for new parents with PMD to disclose their symptoms. Research states that universal screening for all new parents is paramount, but they must be willing to disclose their symptoms for it to be effective. It has also been shown that supportive and available social networks help to reduce PMD. Nurses, doulas, and other professionals working with new and expecting parents can have a large impact on PMD outcomes by taking part in screening, discussing support systems and the shame and stigma that surround mental health issues and new parenthood, and educating expecting parents about these disorders. Individuals with PMD need nurses who can utilize relational practice and address the shame and stigma around these disorders without judgement, and to provide patient education before and after birth about signs and symptoms as well as what to expect for support and treatment.
The presence of Postpartum Mood Disorders, ranging from baby blues to postpartum psychosis, is common among new parents of all genders. Although it is curable, PMD is often undiagnosed. Shame, stigma, and societal expectations play a large role in the reluctance of new parents to disclose their symptoms, whether it is due to gender-norms, fear of social implications, or fear of involvement of child protection services. Shame proneness makes it less likely that individuals with PMD will seek treatment, and in these cases, they need nurses or other health professionals who are compassionate and educated about the effects of shame and the impact it has on parents’ willingness to disclose what they are experiencing. New parents need to know that Postpartum Mood Disorders are common, temporary, treatable, and that they do not define individuals or their ability to parent.
This post is a modified form of an original essay, and is written by certified childbirth educator, doula, and RN student Jaz Wilson.
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