Is there a “WAY-OUT” from post-natal depression? (also known as PND or PPD)

March 26, 2021

Lets’ breakdown this nightmare of a problem that many women experience during pregnancy with the help of an obstetrician:

written by Martina Manco

How do you envision your life after the birth of your baby? Who will support the mother during the child’s growth?

This is the question I find myself asking to all couples during their pregnancy before becoming parents, and after a brief moment of hesitation the answers I get are various. Every family has their own management plan: The father/husband/partner will take a week off work, the family will move to a bigger house, the in-laws will come to help out, the nanny will work longer hours. For some couples the topic hasn’t been discussed yet, and for some others, they feel the extra help it is not needed at all. Some, with awkwardness, allude to fears of post-natal depression and the hormonal unbalanced experience after giving birth which seems, for most mums is the main ‘discomfort’.

They often ask me “How is it even possible that a new mother is ‘unhappy’ at the presence of their own child?” What kind of help does a woman need, after the birth of her baby?

Before even jumping into some practical suggestions we have to start from the fundaments:

Life is lived into its polarity. Every aspect of life encloses its opposite, for example: after the day, comes night. Rest and relaxation are appreciated after making effort and feeling fatigue, resolving distress brings enjoyment. The woman, with her menstrual period, lives into a polarity every single month due to alternate moments that have to do with life and death: ovulation and menstruation, abortions and pregnancies, receptivity and closure.

Within woman, houses the highest form of creative power: she can open her body to conceive, nurture and bring life to the world; and in its minor form she can destroy and deny nourishment for her baby or to her family.

Which woman never thought “I want to run away from all of this?”

The mother, after the delivery of her child, goes through moments of “crises” in which she re-invents her behavioural patterns and it is thanks to these moments that she develops her natural parental identity or persona.

In this phase all mothers feel confused and feel they are not able to finish any task because the baby absorbs all her energies, time and attention.

Therefore, has nature intended, for those in early motherhood to experience post-natal depression?

Absolutely Not! Nature, to help preserve the species, it maximizes the generative power of the woman thanks to hormonal biology, and to the hormones produced by the cortical area of ​​the brain pushing her to feel the need for social attachment and relationships.

Blaming PND the hormonal drop to be the cause of such discomfort in women that experience it is giving the wrong message, that is, that the woman must necessarily suffer and that her body is a source of the problem.

The birth of a child, yes, represents an event of vulnerability for the mother: There’s a physiological hormone drop connected to the loss of the placenta (which is destabilizing), but there’s also a coping mechanism for compensation. After the delivery the mother produces peaks of sexual hormones: oxytocin, prolactin and endorphins, all hormones that are connected to pleasure and that lead to positive behaviour and attitude, with an impulse of care toward oneself and the baby.

How to establish a safety anchor?

Assistance during pregnancy: Being guided through pregnancy with continuous empathy can give optimal protection from depression. Being led and followed throughout the entire gestational period by an obstetrician (ideally chosen from the couple), allows your ‘birth professional’ to be readily available to not only to care about all the clinical aspects of the pregnancy, but also to consider and  tune in with the emotional mindset of the parents to be.

Assistance during labour & delivery: the physiological birth of a child, with its cascade of hormonal unbalances is the optimal prevention for depression. At the moment of delivery an explosion of hormones occur and these hormones ‘mature’ inside the mother’s body throughout labour: oxytocin, which is the hormone that supports the uterine contractions, together with prolactin, reach their peak in the following hours after birth when the mother meet her child’s gaze for the first time. Oxytocin could be described as a “love hormone” because it increases pro-social behaviours like altruism, kindness and empathy which evokes a feeling of trust towards others. Prolactin not only stimulates the mammary gland but are also responsible for nesting behaviours, i.e. caring for the little ones. Though these hormones manifest when the birth of a baby isn’t disrupted from medical interventions such as c-section without labour, epidural and the use of synthetic oxytocin.

Breastfeeding assistance: recent researches demonstrates that breastfeeding has an extremely positive impact on the mother’s emotional state, in that the suction sensation stimulates the production of prolactin hormones. In order for these hormones to stay at their peak, a precocious start on breastfeeding is needed, best case scenario is if the new-born isn’t separated from the mother after birth and is placed on her chest for ‘skin to skin’ for a natural ‘latch on’ interaction. It’s extremely important that the mother receives informed assistance at these key moments in order to feel encouraged and supported.

What can we offer, in terms of assistance, to a new mother after the birth of her child?

Today’s norm is that a woman is pretty much on her own throughout motherhood. After the delivery of her baby, a mother is only assisted in the next few days during her recovery. Then she goes back home with her baby and often the only reference figure is the paediatrician which it won’t take care of her, but of her child. The gynaecologist that followed the mother throughout her pregnancy, often disappears limiting contact to a check-up visit after 40 days post-partum which will likely last 10-15 minutes. Even when she can benefit from the help given from her own mother or in-laws, she will solely receive suggestions dictated from their own generation’s experiences (and they may not always be respectful of the mother’s wishes) all whilst missing the balancing support of a birthing professional. All of a sudden, the mother enters into a parallel reality feeling excluded from the “normal reality” that distinguishes her social environment. Her needs utterly change, emotions and worries aren’t shared with anyone and she finds herself feeling socially outcast.

If nobody worries and cares about the mother, if no one is listening and attempts to understand her, she can’t help but feel unappreciated and insignificant. It’s from this point that in this woman’s mind, that the destructive emotions, feelings and thoughts emerge: unconscious feelings toward the new-born, nervousness, anxiety and little emotional availability.

The mother doesn’t just need someone that will assist and take care of the daily house chores, feed her baby to allow her rest or to drive her around like a chaperone. She needs someone with true intentions to take care of her, to protect and encourage her daily. She needs someone to honour her like the true woman that she is, never judging but respecting her wishes. She needs a social context within where to raise her child, where she can find solidarity and partnership. The reason why I always ask all the couples this question is because I want all mothers to understand that they need not to label or categorize themselves as “good mother” or “bad mother”. It’s always worth to cite Winnicott, the man that finally affirmed that mothers don’t have to be perfect. Winnicott explained:

do your best, if you are a ‘good-enough-mother’ it is all that’s needed. If you are emotionally available and present, even with all your limits, it is ok, you will in this way convey the good and true values, including human imperfection and how to deal with it anyway

As a social celebration that it is, the birth of a child is an event that involves all the community, not just the mother or the little one’s family and we all have a specific responsibility towards all of them.

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