After my first daughter was born I had a bad case of the “baby blues”, which is an awfully cute name for the ten days I spent living as an open wound, so emotional that even listening to music hurt. Then I felt anxious and overwhelmed, suddenly in charge of a person so perfect and fragile, burrowed deeper and spent a few months tormented by the same thoughts: Why aren’t you happier? You don’t deserve her.
Postnatal depression – or anxiety, or emotional turmoil – can be hard to recognise because, thrust into a new and unfamiliar role, we feel too keenly the weight of social expectations. Or at least that’s how I see it now: of course I was over-tired, of course I was terrified of something going wrong, of doing something wrong, of course I sometimes wished someone would relieve me – even for a few hours – from the endless breastfeeding, the hours I spent pacing up and down our flat humming nursery rhymes. Why couldn’t I recognise those feelings for what they were? Did I really think that on giving birth I should miraculously transform into an earth mother and bask forever in maternal bliss? Apparently I did.
Fluctuating hormones may play a role in perinatal depression – which can occur just before or after the birth – but it’s far too easy, too convenient perhaps, to reduce the problem to biology alone. To do so ignores that new parents are grappling with the torture of sleep-deprivation as well as with a complete overhaul of their identity, their lives, their family set-up and intimate relationships. They might have experienced or witnessed a traumatic birth, or be contending with health problems: their baby’s, their partner’s, their own. They might still be struggling to form a bond with their newborn, or they might feel obliterated by love. In her forthcoming book, Heartbreak: A Personal and Scientific Journey, the science writer Florence Williams observes that when we fall in love, the mechanisms in our brain responsible for producing stress hormones ramp up, as though we’re emotionally preparing for heartbreak. Falling in love “puts a loaded gun to your head”, she recently told NPR. What a perfect image, I thought, to explain the intertwining of parental love and terror. And then there are the social factors that make new parenthood hard: the isolation (especially during the pandemic), financial uncertainty and precarity.
We can confirm the importance of these non-biological factors because a significant proportion of parents who haven’t given birth – fathers, adoptive parents and non-birth mothers – also experience perinatal depression. Their suffering is often unacknowledged, and support may be harder to access. Researchers sometimes speak of “disenfranchised grief”, the grief that people feel they cannot express, as when a former partner dies. The suffering of non-birth parents can be similarly “disenfranchised”. One adoptive mother of twins who suffered perinatal depression told me that one man had “argued insistently” with her that she “couldn’t have depression because [she] hadn’t given birth”.
The stats are stark: research consistently shows that around one in ten new fathers experience depressive symptoms. This is not hugely different from the rate among new mothers, which is estimated to be between 10 and 20 per cent. Yet while a mother’s wellbeing is routinely screened during pre and postnatal appointments, fathers are not. This leaves men at risk of suffering alone and in silence. We know it can be extra hard, anyway, for men to admit they are struggling. Focusing on mothers alone makes no sense when we understand that a couple’s wellbeing is interlinked. Maternal depression is a risk factor for paternal depression, too. Male depression sometimes goes undetected because it might be expressed as anger or through substance abuse – two things that put mothers and their children in danger.
The rate of depression among new adoptive parents is also high. One study suggested that in the first four months, around a quarter of adoptive parents experience “significant depressive symptoms”. (Estimates vary greatly, in part because there’s no objective measure of depression.) These symptoms were linked to “stress” and “adjustment difficulties”, the study found – in other words, becoming a parent is a massive social and emotional upheaval, regardless of how you become one. “Interestingly, significant depressive symptoms reported by adoptive mothers were associated with higher rates of infant colic, frequent and prolonged screaming, and lack of sleep,” the author writes. No shit.
There is limited research on rates of perinatal depression among LGBT+ couples but it may be higher than among heteronormative ones, in part because of discrimination and higher rates of estrangement from other family members. Same-sex couples are navigating the unique difficulties that stem from creating alternative family formations: in lesbian couples, for example, the non-birth mother may find it challenging to define or assert her role, as “neither dad nor birth mum”.
And yet despite these differences, and the many divergent paths to parenthood, most of the problems faced are strikingly similar: too much screaming and too little sleep, the huge weight of social and gendered expectations, the weakness of our social and familial support networks. If we spent more time considering (and supporting) perinatal depression in all its forms, we’d get much better at understanding the struggles faced by new birth mothers too. And perhaps – and just imagine the world of possibilities and solutions this might open – we’d finally start to see parenting not as an individual task and “problem”, but a communal one.
PANDAS Foundation has just launched the first free text service open to all parents, carers and networks who maybe struggling with their perinatal mental health. For confidential free advice and support text PANDAS to 85258, open 24/7.