An article in this week's Time Magazine asks "Would it help or hurt to screen all mothers for postpartum depression?" The quick answer seems to be yes, of course, why not? But the issue is a bit more complex than that. Opponents of the Mother's Act, a bill before congress that would mandate greater funding for research and education about postpartum depression (PPD), as well as services for women who have it, fear that too much attention given to screening for PPD will result in unnecessary testing for the vast majority of healthy pregnant women, add to the increasing perception of pregnancy and childbirth as a medical procedure rather than a natural process, and cause excessive antidepressant medication prescriptions to postpartum women.
Having just completed a proposal for funding to study whether or not mindfulness training during pregnancy can reduce the acceleration of stress hormones that have been linked to preterm birth as well as increased risk for postpartum mood disorders, I've been steeped in the research literature on these issues for days, which affects my response to this article.
First of all, not to be grim, but there is a heck of a lot of unaddressed psychological distress during pregnancy and postpartum. Rates of depression have been estimated at 7-12% during pregnancy and postpartum, and for those under severe environmental and socioeconomic stress, these rates can skyrocket to 24-27%. Postpartum depression has received most of the attention, in part because several cases of infanticide shocked society into taking notice of this women's health issue, whereas many women's health issues remain shamefully under the radar.
But other forms of psychological distress occur frequently during pregnancy and postpartum as well. Rates of psychological disorders overall during pregnancy are approximately 14%. Over and above the estimated rates of psychological disorders proper, 20-25% of women experience mild to moderate subclinical levels of emotional distress, including anxiety, during the first three months postpartum. Such levels of negative mood are distinct from "postpartum blues," which is characterized by mood swings, anxiety, tearfulness, and irritability and affect between 50-80% of all women in the first 10 days after childbirth.
Mindfulness is about meeting what is, as it is, without evaluation or judgment. It's seeing things as they are, facing them directly, and noticing our thoughts, stories feelings, and behavioral tendencies in response to them. From this platform of seeing things clearly (rather than avoiding them, ignoring them, or making up complicated stories about why they are the way they are or how we might be able to control them) we can make the best decisions about how to respond to them - decisions that are most in alignment with our values and goals.
A natural part of pregnancy and early motherhood is that many women experience lots of emotional ups and downs. Some women experience them at levels that would benefit from getting therapeutic support, and a small minority experience distress at levels which require urgent intervention. But for almost all women, the period encompassing pregnancy, childbirth, and early motherhood is at times challenging. This is what is. This is the natural process of pregnancy and early motherhood, and should carry with it no stigma.
I believe that every pregnant woman and new mom, whether at risk for severe mood challenges or not, could benefit from learning some skills for managing stress and dealing with difficult moments, even if they have never experienced a day of depression in their lives.
It seems like increasing our collective mindfulness about the reality that psychological and emotional changes can occur during pregnancy and postpartum would be helpful. As long as it is done with wisdom and compassion, adding ongoing screening for women's emotional well-being, as well as offering simple stress management and mood regulation skills specifically directed toward the challenges of pregnancy and early motherhood, as part of the routine standard of care would be a relatively easy way to have a profoundly beneficial impact on new moms, their infants, and the people who love them.
Visit www.mindfulmotherhood.org to learn more about mindfulness during pregnancy and early motherhood, and about the Mindful Motherhood book and our upcoming workshops.