"For many pregnant women across Canada, questions about their mental health are becoming a mainstay of prenatal visits to the doctor," writes Tralee Pearce in Tuesday's Globe and Mail.
"As recently as a few years ago, pregnant women may not have been treated for depression until it showed up after baby was born — if they were treated at all. Fuelled by new research, experts are now broadening the definition of postpartum depression to include moms to be. In response, new, more extensive treatment programs are springing up across the country to help women during pregnancy and after."
Andrea O'Reilly - an associate professor in the school of women's studies at York University, where she teaches a course on motherhood, and the founder of the Association for Research on Mothering - and Gina Wong-Wylie - a registered psychologist who focuses on pre/postnatal issues with women, couples, and families - were online earlier to take your questions on pre and postnatal depression, from what signs and symptoms to look for to what the latest research tells us.
Andrea O'Reilly, PhD, is associate professor in the school of women's studies at York University where she teaches a course on motherhood (the first course on motherhood in Canada) and the Introduction to Women's Studies course. She is co-editor/editor of nine books on motherhood, including the forthcoming Feminist Mothering (SUNY, 2007).
Prof. O'Reilly is founder and director of the Association for Research on Mothering (ARM). She is founder and editor-in-chief of the Journal of the Association for Research on Mothering. In 2006, as director of ARM, she founded Demeter Press, the first feminist press on motherhood. As well, she is founder of the feminist mothers group "Mother Outlaws
Gina Wong-Wylie is an associate professor in the Graduate Centre for Applied Psychology at Athabasca University and an adjunct professor at the University of Calgary and the University of Lethbridge in Alberta, Canada. She is a registered psychologist and directs a limited counselling and consulting practice focusing on pre/postnatal issues with women, couples, and families.
She is active with the Association for Research on Mothering as a Journal and conference advisory board member. She is a board member with the Status of Women in Psychology in Canada and has published on issues related to motherhood, specifically in relation to prenatal/postnatal maternal adjustments and postpartum depression. She has been recognized internationally and sought as a presenter and advocate for maternal mental health and wellness from feminist and cross-cultural perspectives. Gina resides in Edmonton with her partner and two young children. Her website address http://www.caap.ca/gcap/centre/gina/.
Whatevah D, Canada: Hi, I suffered severe post-partum depression and anxiety. My psychiatrist, who specializes in the field, said there was a correlation between breastfeeding difficulties and PPD. What is your take on this, and if it's true, is there any education being done around this? There is so much pressure to breastfeed, and of course, you want to do what's best for your baby. However, when it isn't working it can be DEVASTATING, as it was in my case.
Andrea O'Reilly: Thank you for this question. IT is an important and timely one. I do not research specifically in this field so I do not know if studies have been done on breastfeeding and PPD. However, what is known is that there is enormous pressure on women to breastfeed and yet little actual support for breastfeeding itself.
Breastfeeding is very challenging for most new moms; however it is presented as easy and natural. The consequences of such contradictory realities is that few moms feel confident or comfortable about speaking truthfully about their difficulties, because in our culture to do so is to 'out' yourself as a bad mother.
Breastfeeding has become another way in which are policed and judged as mothers. What matters MOST is the mother's well-being and if breastfeeding is threatening that health, it is, in my view, best not to breastfeed. In my research I use the metaphor of the oxygen mask on a plane. You know the instructions: put on our mask first and then the child's. This seems to defy common sense...but it doesn't: unmasked, the mother risks becoming unconscious and then of no use to the child. Likewise, a mother needs to tend to her needs to enable, nay empower her to tend to those of her child. Hope this helps.
Gina Wong-Wylie: More and more evidence is suggesting a link between postpartum depression and challenges in breastfeeding. Although obviously not all mothers with breastfeeding problems suffer from postpartum depression, more women with PPD, particularly in cases where anxiety is in the picture, have issues with breastfeeding. I am currently developing a qualitative study to examine the relationship and there are some, although scant, research that connects the two. Thank you for sharing your example and experience as I believe it is women who are not afraid to reveal their experiences that enables others to share their own experiences and for all of us to disclose the reality of mothering which is fraught with a myriad of issues.
Paul Peters, Calgary: Given a higher than normal risk for post-partum depression, what is your best plan for avoiding its onset? And if it does become a problem requiring medication, is it safe for one to continue breastfeeding? Thanks for discussing this important topic.
Andrea O'Reilly: Since there is no 100 per cent way to determine who will experience PPD after birth, it is my belief that is best to set up as much support as possible for the woman prior to birth. ALL mothers need huge support and encouragement after birth.
My suggestions is to set up very real practical support systems before the birth: several times a week the mother has a block of time away from the baby to rest, visit or whatever she wishes, have in place a mothers support group that meets weekly, if she is breastfeeding, phone numbers/meeting times for support, as money and time allows a person to do meal preparation, and/or cleaning the first year, and lots of pro-motherhood books on motherhood: fiction and nonfiction. When i give shower gifts to a mother-to-be I forgo the nappies and receiving blankets and buy the mother some feminist books on motherhood; that speak truthfully on what it means to be a mother. If interested, please visit our website www.yorku.ca/arm for suggestions or email me email@example.com.
Gina Wong-Wylie: Paul, your inquiry focusing on prevention of postpartum depression is an important and timely one. Understanding risk factors associated with PPD are paramount with respect to enhancing awareness of mechanisms and forces by which mothers become depressed, contributing to strategies for prevention, and in furthering treatment for PPD.
In the literature and research in the area of risk factors associated with PPD, many psychosocial factors are indicated. As such, social support, partner support, stress reduction, improving coping skills, and enhancing self-esteem are all worthwhile to attend to in reducing risk of postpartum depression.
Also, if a woman has experienced past episodes of depression, it is highly recommended that she seek counselling support through the process of pregnancy and postpartum to reduce her risk and enhance support as much as possible. In addition, working towards questioning the pressures and stressors on women in our culture and fighting to interrupt the expectations of the 'good woman' and 'good mother' in our culture is also necessary.
Finally, you ask about medication during breastfeeding and currently there has been no identified risk to infants; however, in each mother's case it is important to conduct a risk/benefit analysis and if there are other ways to manage her depression (i.e., counselling has been shown to be equally-- and in some studies more effective in reducing depression than antidepressants alone). However, for more chronic and severe cases of postpartum depression, antidepressants may be indicated for better outcomes for the mother and ultimately, the infant.
D. Kennedy, Edmonton: Hi, my wife had bad PMS, and pre- and post partum depression, which was treated by trial-and error (mostly error) with antidepressants. Counselling helped too. But I couldn't help but wonder about the state of her hormones, i.e., her doctors never did any blood test for hormone balance (I'm not even if sure there is one), and I've never heard of anyone with PPD getting hormone treatment. I'm now worried that she'll be taking the antidepressants for life, with all of their own side effects. Is there any alternative now to the anti-depressant route?
Gina Wong-Wylie: Thanks for your question, which is a common concern of many. Many hormones go through significant fluctuations during pregnancy and early postpartum. One, which has been discussed in research, is Estradiol, which has significant effect on serotonin and dopamine. Estradiol has been used as treatment for hormone replacement; however, the data on estrogen in treatment of PPD is not conclusive, not standard by any means. In some cases, Estradiol has been used in conjunction with traditional antidepressant medication. There have been studies conducted in the UK if you are seeking further information. In terms of other alternatives to antidepressants, natural remedies have been discussed-- including the herbs St. John's wort, lemon balm and Abizzia bark, as well as foods such as oily fish, oats and cabbage. However, women should always consult with medical practitioner in turning to these alternative therapies.
As a psychologist, I also promote counselling either in conjunction with antidepressants or alone to enhance a woman's overall mental health and wellness and to examine underlying and entrenched issues that may be the catalyst to the depression. Finally, if antidepressants are working for your wife, I don't see a need for her to try to get off of them. There is much stigma in our society about antidepressants and so far, the research has not demonstrated significant biomedical issues. The more you can support your wife in what she needs and fostering acceptance for who she is while reducing stress and acknowledging the multiple pressures on women and mothers in our culture, the more you will have provided foundational help to her.
Louise Lafond, Hamilton: Ms. O'Reilly and Ms. Wong-Wylie, thank you for moderating such an important topic. Like women who have a physical disability, women who suffer or who have suffered from mental illness are criticized when they choose to become mothers. In what way would you counsel women in order to counteract such criticism? In addition, why do you think that there is such a dearth of academic research regarding the experiences of pregnant women who suffer from mental illness rather than only focusing (like almost all of it) on issues surrounding medication and management of their illness?
Andrea O'Reilly: Thank you for bringing attention to this important topic. There is virtually NO academic research on pregnancy and/or mothering with a mental or physical disability. What is out there, is largely NOT mother-centred or feminist. As founder/director of Demeter Press ( www.yorku.ca/arm ), the first feminist press on motherhood I am actively seeking a scholar to edit a volume on this essential topic. As for your question concerning what a woman can do to counter-act such criticism, my comment would be: NO mother can measure up to the impossible standards of good motherhood in today's media, so as much as you can ignore such comments. YOU are the expert, you know what is best for your children, so, as much as you can, ignore, shut out, those comments and messages the cause all mothers to feel guilty, anxious about our mothering.
I advise all mothers to set up mother support groups of like-minded women to give us the community, confidence, and conviction to counter such criticisms. And if an actual community is not possible now, i suggest you visit or create yourself a virtual community of mothers with disabilities...and do visit our website for more information on resistant and empowered mothering www.yorku.ca/arm .
Heidi Hartmann, Burlington: How can friends and family support someone who has postpartum depression?
Andrea O'Reilly: Thank you for your email. What women with PPD need is precisely the concern you are expressing. There are many things that can be done. First and most important is that the woman is receiving medical attention that she is comfortable with. If the woman is not happy or comfortable with her physician or councillor assist her in looking for another. And LISTEN without judgment; ideally find her a support group of like-minded mothers. Provide her with concrete practical support: babysit the children once or more a week at an agreed upon time, help with housework, shopping and so forth; go out once a week without the baby for lunch, an event or exercise, enable her to exercise several times a week. And most importantly check in on her, ask her how she is doing. Be aware of signs of worsening depression and respond appropriately and quickly. And tell her often what a good mother she is! Hope this helps.
Gina Wong-Wylie: The very practical and hands on support that Andrea discusses are extremely important as is openly asking her how she is doing and direct, but sensitive questions about whether things are feeling more manageable for her. Allowing the mother to discuss what she is comfortable with and listening is very important. Asking her what she needs or how you can help also allows her to indicate the kinds of support that she needs.
Having said this, it is very difficult for women in our culture to ask for help. Providing ways for her to engage with other mothers and also ways for her to get additional sleep can be very helpful. Also, disclosing personal challenges that you have faced also helps her to feel less like there is something wrong with her and opens up possibilities for her to feel comfortable talking with you. Meal preparation is also wonderful and eliminating suggestions on parenting unless she specifically asks as it can be very confusing and take away from a mother's developing sense of efficacy to parent in the way that is right for her.
Rasha Mourtada:Thanks to you both for taking the time to address this important issue. To our readers, we're sorry we didn't get to all of your questions. Any last thoughts?
Andrea O'Reilly: Nothing will change you or challenge quite like becoming a mother does. As a culture we need to fully and truly support women in this most important work of motherhood.
Gina Wong-Wylie: Thanks very much Rasha. Sharon Hays writes about the cultural contradictions of motherhood and she aptly discusses the competing and conflicting roles for mothers in our society. That is, the expectations and ideology for the working woman is in direct negation to the values and tenets of Intensive Mothering or Attachment Parenting, which is the most widely accepted philosophy of parenting. Such extreme expectations for women in our culture, coupled with the profound lack of government initiatives to recognize and support the work of mothers, and attitudes that diminish the worth of mothers-- or measures worth based on mothering and support and nurturance of OTHERS significantly increases postpartum depression in women. My final comments are around the need for examining the larger societal ethos in treatment and prevention of the individual woman.
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