Rethinking PND
The birth of a baby throws some parents into boundless despair rather than exuberant joy. While supports for women now exist in most cities in New Zealand, help for men is still in its infancy.
Harald Breiding-Buss thinks that less stereotypical role expectations on mothers and fathers could reduce the incidence of postnatal depression.
Mental Health services have come a long way since the days when postnatal depression was basically regarded as a woman’s hormones going mental. While hormones may play a role in some cases where women find it particularly hard to recover, this is a bit of a chicken-and-egg issue.
Does a hormonal imbalance cause the depression, or is it a reaction to it?
Both men’s and women’s hormones respond to parenthood in similar ways. During pregnancy, it requires the father to be close to his pregnant partner for an effect to show in his hormone levels, and after childbirth closeness to the baby will raise the level of certain hormones while others drop in women or men.
The “nurturing instinct” so often attributed only to women, is really a baby-induced rise in the hormone prolactin, which even in men can go up by about 50%.
More sinister is the hormone cortisol. Cortisol levels are up in depressed people, and they are also up in new parents.
What makes it complicated is the fact that this is the hormone that most responds to stress. Lack of sleep alone will raise your cortisol levels and make this another chicken-and-egg question: Is it the lack of sleep bringing on the depression, or the depression bringing on the lack of sleep? Some providers have in fact moved towards using the term postnatal distress.
As with depression at other times of your life it is not always clear what exactly triggered it, but the changes associated with becoming a parent is an obvious frontrunner. This consists of more than just disrupted sleep and being ready to comfort a crying baby any time of day or night.
Becoming a parent goes to the core of how we see ourselves.
Today’s society is incredibly inconsistent about its messages to new parents. Women are told they can, and should, be anything or anyone they want to be. There is wide acceptance for a wide variety of choices that women make, possibly even more so than for men.
Once a mother, however, a woman is once again expected to behave along very, very stereotypical lines: On TV, the smiling, loving parent who considers the best potion for her little son’s bruise is always a woman, and children always run to mum to be fed or dressed.
In public imagery there is never a doubt that a mother’s love, worry and concern for her children will come before anything else, and that there is no-one else who can take over that role.
Quite likely, at no time in her life before has anyone ever suggested to a new mother that giving up your life for the welfare of someone else is a desirable or viable option in life. In fact, the messages are very strong that women have to look after their own interests first.
So when baby comes along, some women struggle a little with this whole love and care thing. Imagine how that would rock your understanding of yourself as a woman if you would find that you’d much rather not have had a baby after all.
This, I’m told, is a common theme for mothers suffering from postnatal depression.
Other high risk factors are a difficult or assisted birth, or failure to breastfeed. Both these issues may make a woman feel doubts about her femininity, and on both these issues the pressure has grown on mothers to ‘perform’.
Breastfeeding especially is promoted as the natural mother’s way. A woman who is unable to breastfeed may well feel quite similar to a man who can’t get it up. It’s the kind of thing that runs deep and messes with our brains.
Men have their own issues after childbirth, but they usually have a bit more time to go through the adjustment to parenthood.
For those that are really thrown into the deep end right from the start – because they have to do it alone, for example, or the mother is temporarily out of the picture because of illness – there is much less pressure to succeed than there is on a mother.
In fact, a new father raising a baby by himself would be expected to need the kind of help that many women feel ashamed having to ask for.
And yet about half as many men suffer from similar levels of depression in the early months of parenthood as women, and as our understanding about fathers grows there is also a realisation that this is not always – perhaps hardly ever – merely a reaction to the partner’s depression.
It is probably more of a symptom of our health system that we tend to pick up depression in fathers only if the mother is depressed and gets help.
It is well known amongst health workers in the field that father depression can strike especially after a mother recovers from hers. This is not particularly surprising: men are quite good at shoving their own emotions into some hidden recess of their being if there is a crisis at hand that needs their input.
A depressed mother is such a crisis. Once she recovers and ‘takes over’ the baby again the father is left with the feeling that he has only been a babysitter for this time. Yet, it has changed the man enough that he may find it rather difficult to resume the mantle of breadwinner again as his prime role. Attachment to a baby is a very powerful thing.
Even if a father hasn’t got attached enough to feel grief about his reduction in role, a partner’s depression, and the crisis mode he slipped into, would have delayed his own adjustment. Remember, parenthood is a new role for life, it requires a permanent adjustment.
Help is still few and far between. Christchurch has led the country for quite some time in not only having the only hospital-based ‘mothers and babies’ unit in the country for severe cases, but also the only DHB-funded outreach and group service for all other affected mothers, the Plunket Postnatal Adjustment Programme.
Elsewhere it is usually left to community organisations to provide some sort of help, and to GPs to prescribe antidepressants. No targeted services of any kind exist for fathers, although the Plunket programme will see them.
Given that today’s fathers are so ready to share with mothers in every aspect of raising babies (breastfeeding aside), and that today’s women are not the full-on maternal types of their 50’s counterparts, it seems ludicrous that the health system does not support this partner approach at all.
Rather than helping both parents to share roles and responsibilities according to their own requirements and capabilities, we see anything other than a fulltime commitment by a mother to her baby as a failure that needs to be avoided.
Ironically, even the postnatal depression treatment programmes there are reaffirm the stereotype of mother-needs-to-do-it-all by the very fact that they target only women rather than both parents together.
Imagine the pressures and disappointments that could be avoided if we empowered parents to do this together as partners. My bet would be that doing this would put a big dent into postnatal depression rates for both, women and men.
