Recently, a distraught young mother from British Columbia took her own life while in the grip of postpartum depression, leaving behind a grieving husband and infant son. She was a registered nurse and had been seeking treatment for depression and anxiety. Tragically, the health-care system she worked for was unable to help her.
Her husband wrote a poignant piece on Facebook beseeching baby-friendly hospitals and health-care professionals to reduce pressure on new mothers to breastfeed, since he was sure this contributed to his wife's depression. An outpouring of heartfelt support followed. Women across the country related how their difficulty with breastfeeding contributed to their postpartum depression and experts weighed in.
While this is an important debate, something critical is being lost in the discussion. Research shows that breastfeeding and postpartum depression are linked, but not in the way being debated by parents and experts.
Depressed mothers are at very high risk to stop breastfeeding by eight weeks postpartum. But this is because depression often negatively colours mothers' cognitive perceptions, which interferes with their ability to accurately interpret their baby's cues. This prevents them from breastfeeding successfully. For example, some depressed moms interpret their babies as not being satisfied with breastfeeding, so they stop breastfeeding.
A key goal of treatment for postpartum depression should be to provide positive supports for breastfeeding or healthy alternatives and to help these mothers interpret their baby's cues accurately so mothers can feel successful.
What causes postpartum depression? And how can we best help mothers with postpartum depression?
We know that the biggest predictors of postpartum depression is prenatal depression and a history of depression before conception.
Postpartum depression also often arises when mothers have too many stressors to manage and insufficient support. One stressor may be breastfeeding problems. But many other stressors are also known to contribute to postpartum depression before breastfeeding even starts. For one mother, postpartum depression may arise after a traumatic birth that did not go as planned, for another mother, it may be because she is parenting alone.
Regardless of the stressor that precipitates the depression, there are supports and services that work to prevent and treat postpartum depression – and prevent the unthinkable. We need to make sure they are available to all new moms in an accessible and timely manner. Recognizing the potential seriousness of postpartum depression, to begin with, is the important starting point.
Both the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care recommend screening for depression in both pregnant and postpartum women.
Obstetricians, midwives, family physicians, public-health nurses and pediatricians should be screening across Canada – identification of depression either in the prenatal or postnatal period should not be a postal-code lottery. Nor should the availability of services depend on where you live. The stakes are too high.
Our own research revealed that mothers want to be screened for depression. For many at-risk women, depression can be prevented with simple interventions such as mother-to-mother support early in the postpartum period.
Our program, called MOMS (Mothers Offering Mentorship & Support), provides mother-to-mother support for postpartum depression, in a low-cost, non-stigmatizing way – over the phone, by experienced volunteer mothers, in the comfort of new mothers' own homes. It's been found to be effective.
Interpersonal psychotherapy can also be used to treat many women with postpartum depression over the phone, at home.
Postpartum depression is a family affair and our research shows that fathers want to help and should be involved. We also know that depression in new mothers places the father at risk to experience depression too, so early screening and prevention can help the whole family.
We encourage mothers, their partners or other source of support to see their doctor, public-health nurse or other health-care professionals to ensure mothers at risk are screened for depression, in pregnancy and after the birth and to discuss the range of options available in their community.
Lots of treatments work – but hospitals, public-health and social-service agencies need to provide the programs for mothers and their families to access. Phone-based methods may be one way of making sure programs are available.
Each and every Canadian stands to benefit from a population raised by healthy and happy parents. Recognizing the seriousness of depression in pregnancy and after childbirth will go a long way to ensuring that a range of services and supports are available to families. This will help defuse the ticking time bomb that can be postpartum depression.
Nicole Letourneau is an adviser with EvidenceNetwork.ca. She holds the Norlien/Alberta Children's Hospital Foundation Chair in Parent-Infant Mental Health at the University of Calgary. Cindy-Lee Dennis holds a Canada Research Chair in Perinatal Community Health at the University of Toronto.