13 Sep 2023

Postpartum Mood Adjustment Disorder

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I volunteered at the Postpartum Support International exhibitor’s table at the Psych Congress in Nashville on September 9.  Psych Congress bills itself as “the nation’s number one conference on practical psychopharmacology.. . . This is a conference for psychiatrists, nurse practitioners, physician assistants, psychologists, primary care physicians, and other mental health professionals.”

Our table was on the outskirts of the exhibition hall. The bulk of the exhibits were fancy, large and had multi-media displays and crowds of attendees.  They also took up most of the exhibit hall. We had a table with handouts, and a backdrop that said our name. People walked by us, many interested only in getting their conference passports stamped. When they learned that we didn’t have an entry on the passport, they kept walking. A few did stop to find out more about us, and to chat.

Not one single mental health professional who came by the PSI table knew that PMADs (postpartum mood adjustment disorders) are the number 1 complication of childbirth in the US. Not one was aware of the resources for looking up medications to see if they were compatible with breastfeeding. I must have written out “Lactmed and e-Lactancia” on people’s programs at least 50 times.

Genetics, co-morbidities, hormones, stressful life events, limited access to basics (food, shelter) and physical changes throughout the life course are thought to be causes of postpartum depresssion. Not one major medical website that I found talked about the lack of paid maternity leave and the fact that 23% of mothers are back to work within 2 weeks of delivery as a major contributing factor to postpartum depression.

There are studies about the connection between maternity leave and postpartum depression, many published in major journals such as the journal of the American Psychiatric Association and the Lancet.  Others are published in lesser known organs, such as Human Rights Watch. https://www.hrw.org/report/2011/02/23/failing-its-families/lack-paid-leave-and-work-family-supports-us

“Parents said that having scarce or no paid leave contributed to delaying babies’ immunizations, postpartum depression and other health problems, and caused mothers to give up breastfeeding early. Many who took unpaid leave went into debt and some were forced to seek public assistance. Some women said employer bias against working mothers derailed their careers. Same-sex parents were often denied even unpaid leave.”

A 2023 study, concludes that: “Evidence suggests that longer paid leaves are associated with lower postpartum depression rates, while the opposite creates inequalities among mothers who can or cannot afford a secure income. Thus, universal coverage of maternity leave is essential to minimize inequalities (i.e., including mothers working in the informal sector and from vulnerable populations). Policy should be shaped in a manner that provides accessible and comprehensible maternity leave conditions to the general population, with adequate conditions for working mothers to access the maximum time allowed, with a secure income and employment protection.”   https://link.springer.com/article/10.1007/s00737-023-01350-z

The prominence of postpartum depression as the issue ignores the fact that there are other postpartum mood disorders: anxiety, OCD, PTSD and psychosis. If so many new parents are suffering with these conditions, wouldn’t it make sense to figure out why and do something about it, instead of prescribing medications and insisting the suffering person return to work?  If so many studies are published that repeat the findings that paid maternity leave increases the mental health of mothers, why aren’t policy makers listening?

One heartbreaking story was told by an attendee, who had a PhD and worked in the pharmacology industry. She didn’t know what was wrong with her after her delivery. Why did she keep seeing blood everywhere and hearing screaming inside her head? She spoke with friends who also had had babies, and they shared  with each other stories of misery: of wondering what was wrong with them, why they couldn’t stop crying, why they didn’t like their babies, and why they are still unable to sleep. She eventually figured out that she must have had postpartum depression; it was severe enough to destroy her marriage. She is now a single mother and will never have any more babies because the idea of going through something like that again makes her physically ill. When she told me about her birth, about how she and her baby almost died, and about how she realized that the screaming she was hearing inside her head was her own voice, I suggested that she had PTSD and encouraged her to seek help and attend a free, curated PSI on-line support group for folks with PTSD. She said, after some thought, that she would look into it. She looked so forlorn  that I asked if I could give her a hug. She assented and I folded her, a perfect stranger, into my arms.

My feeling after attending this conference and seeing the enormous difference in the elaborateness and size of the exhibits, is that the US response to PMADs is to give more money to create drugs to treat, instead of putting money into implementing paid maternity leave.

What do you think?


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