Tuesday, October 18, 2016

We Need to Stop Blaming Postpartum Depression on Women's Hormones

Three weeks after I had my daughter, a friend was stunned to learn that I had not yet returned to work, and that Athena was not even close to sleeping through the night. A week later, another friend was shocked when I told her I hadn't yet lost all the baby weight. "But you're so thin, and you were in such good shape before you got pregnant!" she exclaimed. Clearly neither of these women had children.

Veteran mothers may laugh at this ignorance of postpartum life, but it speaks volumes about the lessons our society teaches--and fails to teach--about what it's really like to become a mother. One of the biggest lies our culture spreads is that postpartum depression is just one more example of women's crazy hormones making them, well, crazy. Just as PMS and "pregnancy hormones" allow us to simplify and dismiss women's emotions, the idea that postpartum depression is entirely hormonal allows us to ignore the cultural factors that make postpartum life so difficult.

I'm lucky enough to have had an easy postpartum recovery. I haven't struggled with serious health problems or pospartum depression. Nevertheless, my postpartum experience has helped me understand why the story is so different for many other women. Perhaps even more telling, my "easy" recovery might sound like an utter nightmare to someone who has never had a child.

The Culture of Shame Surrounding Postpartum Difficulties 
Before I got pregnant the new mothers I knew were universally shining symbols of the greatness of motherhood. They each made it look easy and endlessly fulfilling. When I asked how they were doing emotionally, they all reassured me that they had never felt better, that their recoveries had been swift and easy.

When I got pregnant, the floodgates opened. My mom friends told harrowing stories about inadequate medical care, lackluster support, and chronic postpartum health difficulties. One friend tried to kill herself the day she returned to work. Another used her baby's naptime to cry in the bathroom. A third struggled with incontinence, but was so afraid of being deemed "gross" that she told neither her doctor nor her husband. I heard tales of cracked, bleeding nipples, chronic pelvic pain, emotional rollercoasters, and stress fractures.

In many cases, these stories came from the same women who insisted they were thrilled and feeling great just a few months earlier.

Why did their stories change?

Women aren't supposed to struggle after having babies. We're supposed to derive total fulfillment from motherhood, so anything less than perfect happiness after we give birth constitutes failure. Just take a few minutes to read the comments on social media posts about motherhood. Mothers who dare to share stories of anything less than total satisfaction are shamed, told they're bad mothers, dismissed as selfish outliers.

So when we struggle--and all mothers struggle, because this shit ain't easy--we keep it to ourselves.

There's at least one other factor at play here: American mothers receive less social support than women in the rest of the industrialized world. We lack paid leave, and we receive significantly less support than women have been offered throughout most of human history. We don't live in small, reciprocal tribes or communities, and neighbors are more likely to call the police on one another than to show up with food or do one another's laundry.

Ask for this to change and you're lazy, dependent on the government or others, and--there's that cruelest of all insults again--a bad mother. So women keep it to themselves. This feeds the cultural lie that new moms don't really need help, because it's all so easy and natural and wonderful and constantly, ceaselessly fulfilling. Denying that postpartum recovery is difficult allows us to be okay with a society that offers little to no support to women at one of the most psychologically and physically vulnerable times of their lives.

What an 'Easy' Postpartum Recovery Looks Like 
So what does postpartum recovery look like? It depends. I'm one of the lucky ones. I had an unmedicated, uncomplicated vaginal birth, which means I did not have to recover from drugs, medical complications, or abdominal surgery. I could afford to take time off of work, even though I'm self-employed and no work means no pay. I have a supportive spouse who, even after endless nights of no sleep, insisted on keeping up with his share of parental duties. He too was able to take time off of work. He's also a lawyer, so when my hospital began sending me exorbitant bills for services I did not receive, we were able to fight back.

This already puts me ahead of most women who give birth in this country. But things still have not been easy.

I stayed up all night to give birth, laboring through 18 hours of intensely painful contractions. I did not sleep at all the first two nights in the hospital. When I returned home, after three days without sleep, I immediately had to begin entertaining guests. My family and close friends were kind enough to bring food, clean, and keep their visits quiet and short. But many guests expected me not only to entertain and feed them, but also to disrupt my life by not nursing, waking the baby, and allowing them to hang out until they saw fit to leave.

This demand that women entertain visitors and that they like it is a hallmark of our dysfunctional approach to new motherhood, but it's been virtually unheard of for most of human history. Much of the stress placed on new mothers comes from the unreasonable social obligations they face. These demands come from the same people who, in most times and places, would be expected to offer help in the form of childcare, cooking, or cleaning.

There were the endless, relentless, hounding messages from friends: "WHY ARE YOU IGNORING ME?" Texts and Facebook messages began to pile up, mostly from people who have no idea how demanding it is to care for a newborn.

Work became a source of stress almost immediately. A week after giving birth, I was already getting emails from clients about when I'd be returning to work. These clients knew how long I'd be on maternity leave. I guess they thought I'd meet the baby and think, "Nah, I'll go back early because motherhood is JUST SO EASY."

Athena slept about an hour a night for the first week. When other mothers told me they didn't sleep, I thought they were exaggerating. Kind of like how in college, pulling several all-nighters in a row really meant getting only minimal sleep. After all, no one can survive on no sleep, right?

Nope. I literally went days with an hour or less of sleep. I did so while trying to meet the demands of a newborn who needed to be held, nursed, and loved constantly. Oh, and the baby blues? Those are real. Only a small number of women get postpartum depression, but almost all women experience mood swings in the days following birth; that's the emotional stuff that's actually attributable to hormonal swings. So in the midst of everything else, I found myself bursting into tears for no apparent reason.

What about the physical recovery? Like almost all new mothers (and nearly 100% of women who birth large babies like mine), I had a perineal tear that had to be stitched up. Mine was a "good" tear--clean, straight, and small, traveling only slightly into the muscle. It still hurts. If I weren't trying to care for a baby and recover from birth, it might be truly distracting. But mothers press on in the face of pain. It may be the one thing that truly unites us. New motherhood means that pain that would have once been unbearable or distracting is hardly noticeable.

It's not just perineal pain, either. My abs are weak from nine months of stretching, so my back hurts. Breastfeeding has been rough, and meant cracked nipples and breast pain. My organs are still moving back into place, and my body is still attempting to recover from pushing out a giant human.

I texted my wonderful doctor at midnight at least twice, when I was bleeding so heavily that I was both dizzy and convinced I was dying. Late one Sunday, my husband and I scrambled to pack our baby up for a trip to the emergency room because we did not thin the intense pelvic pain I had could possibly be normal. Peeing is still an occasional challenge, and the hemorrhoid struggle is very real.

I'll be going in for my six-week postpartum appointment tomorrow--a grim cultural milestone at which I am expected to be healed. I certainly don't feel that way. And that's not because I'm weak or depressed or exaggerating the challenges of postpartum life. It's because recovery is slow; one study found that it takes a year to recover from childbirth. 

The Cultural Nature of Postpartum Depression
It's no wonder, given the pain, stress, and pressure of postpartum life, that so many women experience postpartum depression. Might it be due to hormones? I'm certain some cases are. To my mind, though, it's surprising that all women don't develop serious depression. We have created a world where women must undergo a major rite of passage without acknowledgment or celebration. We then expect them to immediately know how to care for a child, and to competently do so while recovering from a major medical event. In most cases, we also demand that they entertain guests and return to work in just a few short weeks. And women who fail to return to their pre-pregnancy weight within a few months, no matter how doing so might affect them physically and no matter how much time such an endeavor might take, are just lazy.

We further demand that women accomplish these nearly impossible feats without the full assistance of a partner. Every study ever done on the subject has found that, as a group, men do significantly less childcare and housework than women, and that this inequality increases when a couple becomes parents. We expect that women will gleefully submit to the endless drudgery of parenthood, and that they'll do so without resenting partners who don't pull their weight. How must a woman feel when she gets up at night, in pain and exhausted, recovering from a major medical event, as her partner sleeps peacefully? How must that impact her self-worth?

And let's get real: even when things are "equal," they're not really equal. My husband and I have done everything we can to evenly split parenting tasks. But I'm the one nursing our baby, creating an inherent inequality. And I'm the one who bears the brunt of judgment from strangers, who is expected to lose weight and look perfect and love everything.

Whenever I post a photo of Jeff on social media, people exclaim about what a great father he is. I can count on one hand the number of times people have complimented my mothering. Motherhood is natural, not a skill, the thinking goes. And besides, everything mothers do is wrong anyway. But fathers who manage not to kill their babies? Fucking heroes.

So before we dismiss women's concerns as purely hormonal, maybe we should look at the environment in which we expect them to recover from birth and care for newborns. Until we address the unnecessary cultural challenges we have attached to motherhood, it makes absolutely no sense to attribute postpartum struggles to hormonal shifts. Indeed, doing so puts the blame on the victim, and demands that we accept the laughable notion that stress and environment can affect everyone but new mothers. The postpartum period is one of the most challenging periods of a woman's life. Let's stop pretending otherwise.

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