Reflections on the various dimensions of feminine vocation from liturgical homemaking and child rearing to education and the spiritual life.

Sunday, June 17, 2012

Never the Same

Depression in New Mothers: Causes, Consequences, and Treatment AlternativesPostpartum depression affects 12 to 25% of mothers, reports Kathleen Kendall-Tackett in the second edition of her book, Depression in New Mothers: Causes, Consequences, and Treatment Alternatives. I have been one of those mothers.

For a book addressed primarily to medical practicioners, there are several wonderful gems in this book for the lay and professional reader alike. I found it to be empowering, especially in dispelling myths. For example, we learn that PPD is NOT caused by hormonal changes or imbalances, does not go away with time, and can be as efficaciously treated with exercise and other alternative treatments as it can with drugs.

The most powerful part of the book, in my opinion, is the section describing the rituals surrounding birth and the transition to motherhood in cultures where researchers have found a surprising absence of PPD. I found these descriptions beautiful, moving, and illuminating, especially in the context of the voluminous research summaries that make up the bulk of the book.

Kendall-Tackett describes the social structures that protect new mothers including a distinct postpartum period, social seclusion and mandated rest, household and childcare assistance, and social recognition of her new role and status:
In almost all the societies studied [which displayed low instances of PPD], the postpartum period was recognized as a time that is distinct from normal life. Postpartum is a time when mothers are supposed to recuperate, their activities are limited, and they are taken care of by female relatives. This was also common practice in colonial America, and was referred to as the "lying in" period (Wertz and Wertz, 1989). [. . .]

In cultures where there is a low incidence of the blues or depression, there is a great deal of personal attention given to the mother. This has been described as "mothering the mother." In these various cultures, the new status of the mother is recognized through social rituals and gifts. For example, in Punjabi culture, there is the ritual stepping-out ceremony, ritual bathing and hair washing performed by the midwife, and a ceremonial meal prepared by a Brahmin. When she returns to her husband's family, she returns with many gifts she has been given for herself and the baby. Ritual bathing, washing of hair, massage, binding of the abdomen, and other types of personal care are also prominent in the postpartum rituals of rural Gautemala, for Mayan women in the Yucatan, and for Latina women both in the U.S. and Mexico. Here is a description of one of these recognition rituals performed by the Chagga people of Uganda

"Three months after the birth of her child, the Chagga woman's head is shaved and crowned with a bead tiara, she is robed in an ancient skin garment worked with beads, a staff such as the elders carry is put in her hand, and she emerges from her hut for her first public appearance with her baby. Proceeding slowly toward the market, they are greeted with songs such as are sung to warriors returning from battle. She and her baby have survived the weeks of danger. The child is no longer vulnerable, but a baby who has learned what love means, has smiled its first smiles, and is now ready to learn about the bright, loud world outside." (Dunham, 1992: 148)

There is something very wrong about a culture where we expect and are expected to pop out a baby and get right back on the horse acting as if we are the same person we were before we birthed a new life into the world. We are not and will never be the same.


  1. I agree. I don't think I have had a full-blown case of PPD, but my mother shared with me her experiences with severe PPD. As a result, I sought help when I was feeling quite down and maladjusted, and was willing to try to do anything I could to prevent the same extreme experience she had. I do appreciate that one finds in the Orthodox Church the 40-day period in which church participation, at least, is not required of a new mother. I have found that restful, but it does seem potentially isolating. With it should come an extra dose of support and care. Thank you for sharing your insights and experience.

  2. Glad you were able to proactive, Nikki!

    I think you are right that the idea is not to isolate mothers during the immediate postpartum period, but rather to surround them with in-home supportive care. I am sad that such an option is often a luxury item for the wealthy who can afford a postpartum doula or such—and doula comes without the affection of a friend of family member. It seems we've lost something crucial from the times and places where the local extended family has cared for each other, living together in the same village or town.

    I also think of the churching service as a wonderful way the Orthodox Church honors mothers and motherhood. I've only been churched in the Western Rite. Would you mind posting some of your favorite highlights from the Eastern Rite church service?

    Here's one of my favorite excerpts from the Western Rite service:

    Antiphon: She shall receive the blessing from the Lord, and righteousness from the God of her salvation: for this is the generation of them that seek the Lord.

    P. O Lord, save Thy handmaid.
    R. Who putteth her trust in Thee.
    P. Send her help from the sanctuary.
    R. And strengthen her out of Sion.
    P. Let the enemy have no advantage over her.
    R. Nor the son of wickedness approach to hurt her.

    Almighty and everlasting God, who through the childbearing of the blessed Virgin Mary hast turned the pains of the faithful who are with child into joy: look mercifully upon this Thy handmaid, who cometh with gladness to Thy holy temple to render thanks, and grant that after this life, by the intercessions of the same blessed Mary, she may be worthy to attain with her child unto the joys of everlasting blessedness through Christ our Lord. Amen.

  3. I wonder if a distinction is made for postpartum anxiety. Often it is lumped in with PPD. If it is in this case, I would have trouble beiving the claim that PPD is not caused by hormonal imbalance.

    My evidence is only experiential. I had the help and support of my mother and mother-in-law after both births. Between each mother I had about 4 weeks of support. After both births, I had huge anxiety troubles. (The kind of postpartum where I wanted to leave myself and not come back until I felt ok again.) Really, the irst week after Rebekah, I thought someone should instituionalize me. With Luke I had a night when I did not fall asleep all night long. Even with the wonderful caregivers, I was a total wreck.

    A week and a half after Rebekah, I found a psychiatrist who specialized in the post-partum period. She was recommended by my midwives. With her help, I worked through 2 kinds of meds and felt myself again. I enjoyed Rebekah's infancy tremendously. I weaned off of one medication in 2 months and the next over the course of 8 months.

    I never thought I would turn to meds, but without them I don't know what would have happened. I was not planning on having any more children if I had to endure a postpartum period as intense as Rebekah's was.

    Again, I am not sure if the book addresses my particular kind of postpartum struggles. The support of my mother-in-law was very helpful too. She knew how important it ws to "mother the mother." I suppose I'll just have to read it now :)

    Meds or no meds, I certainly agree that women need to be mothered and helped during the postpartum period. When my kids get older, I would like to work as a postpartum doula or night nurse.

  4. Hi, Katie! I'm sorry if I seemed to be suggesting that drugs are excluded as a viable option in Kendall-Tackett's book. In three of her chapters in Part III: Treatment, Kendall-Tackett summarizes research studies showing that in many instances PPD has been as efficaciously treated with exercise and other alternative treatments as it can be with drugs. However, she has a fourth chapter devoted to antidepressant medications and also acknowledges that to be an effective treatment option when appropriate.

    I really haven't given a full review or overview here of all of what she covers in her three-part book. Part I is an overview of PPD, and Part II, which was fascinating to me, addresses causes.

    I've mentioned only a few points that especially struck me, without trying to convey the full picture of PPD. The full picture of PPD that Kendall-Tackett portrays is definitely more complex than one or two causes/treatments.

    I would definitely recommend the book if you're interested in learning more about postpartum issues. It does address PP anxiety, and there is overlap between that and PPD, but the focus is on the later.

  5. Good post Jen. I love when the findings of research coincide with what the Orthodox Church practices. Although in American Orthodoxy we need to make this work more effectively and fight against our isolationist tendencies - both the mother and the friends. I also thought it was interesting that the Mayan's shave the mother's head at 3 months because most women experience sever hair loss around 4 months.

  6. Fascinating. Yes, its ridiculous that six weeks is considered enough to be maternity leave. We should help take care of new mothers however we can and be aware of all the changes and be sensitive to the realitybof ppd. Sounds like I need o add this book to my ever-growing reading list.