by Lauren Porter

Ring the bells that can still ring. Forget your perfect offering. There is a crack in everything. That’s how the light gets in. ~Leonard Cohen, singer/songwriter

“You are the caretaker of the generations, you are the birth giver,” the Sun told the Woman. “You will be the carrier of this universe.” ~Brule Sioux Creation Myth

In 2003, Science magazine published an article that took the psychiatric world by storm. In a groundbreaking 30-year study of 847 people in Dunedin, New Zealand, researchers examined the role of both environment and genes on depression. What they found was this: it is neither nature nor nurture alone that determines depression, but a unique combination of each person’s genetic make-up and life experiences. Some of us are born with genes that put us at high risk for stress and depression; others of us carry quite a low risk; and the majority of us fall in the middle. What determines whether our genetic tendencies toward depression get expressed or not, however, is our life experiences. Our genetic risk shows our level of vulnerability. It is the exposure to stressful events that then interacts with our genes and creates depression. Hence, if a person who is at high risk for depression is largely protected from stressful experiences, depression may not manifest. And since early experiences build the neurological foundations for managing stress, the younger a person is when exposed to stressful situations, the more vulnerable they become.

This has applicability to parenting as well as postnatal depression. We know that a history of depression prior to childbearing is a risk factor for postnatal depression. And we also know that insecure attachment and deficient bonding experiences in childhood are risk factors for adult depression. Now thanks to this latest research, we are also aware that some of us are born at particularly high risk for depressive illness. What this creates is a chain of linked circumstances. How we parent our children affects their mental health: empathic, attuned parenting protects them from depression, even if they are genetically vulnerable. Optimal parenting builds their brains, boosts their psychological immunity, develops their relational and coping skills and creates the ability to better negotiate the effects of stress whenever it comes around. These healthier children go on to become stronger adults who, as mothers, are less prone to postnatal depression.

But what about those of us who didn’t have optimal parenting experiences as children? Who have suffered depression and are at risk for future episodes? Can we use this information to assist us in these situations? The answer is yes. Just as being buffered from stressful life events in childhood builds resistance to depression, the same holds true in adulthood and is vital to understanding the ways in which we can diminish or eliminate the occurrence of postnatal depression in the lives of mothers.

A baby’s mother also needs a mother. ~Erica Jong, writer and poet

New mothers need to be mothered, to be nurtured and cared for by a support network that assists with physical recovery from birth, transition into infant care and the immense psychological leap into a new role. Cross-cultural anthropological data indicates that societies in which new mothers receive holistic and meaningful postnatal support have virtually nonexistent rates of postnatal depression. This is a vast difference from western countries with an incidence of roughly 20%. Symptoms of postnatal depressions include lack of enjoyment or interest in life, feelings of self-blame, anxiety or worry for no reason, intense sadness, crying spells, feelings of fear or panic, hopelessness and thoughts of self-harm. In our western world it is pregnant mothers who receive the focus of our support, interest and attention. Once the baby is born, however, mothers and families are often left to their own devices. Combine this with our more disparate communities, work schedules and demands of day-to-day living, and you’ve got a recipe for depression.

Those babies in my arms, at my breast, clutching my hands, pulling on my hair, teething on my heart, tugging at my sleeve, one child in the stroller, one helping me push, ceaselessly absorbing all my loyalty and love – those children redefined every question of bravery, courage and independence. ~Alix Shulman, writer

The transition to motherhood is more than just the birth of a baby; it is the birth of a mother. Huge psychological and emotional changes occur, creating a completely new landscape of thinking and never-before–seen-lenses through which to view the world. A baby’s intense needs and overwhelming newness is a challenge for even the most serene and strong new mothers. This is a period of heightened sensitivity in which new mothers are easily affected by comments, intrusions and judgments. Mothers need the opportunity to rest and observe, to take in their new thoughts and feelings, to be honoured and nurtured, to be supported in every way possible. Partner support is critical. Studies of new fathers show that if fathers can contribute emotional and tangible support, can stay open in their communications and can work toward emotional closeness, mothers are much less likely to experience postnatal depression. Just as was highlighted by the Science article, this is the buffering of stressful life events. Similarly, midwives, other professionals and friends can do the same.

With the gift of listening comes the gift of healing. ~Catherine de Hueck Doherty, social activist and writer

Sometimes the most powerful thing a person can do is just listen. Listen openly and honestly, allow the mother to speak, or just be. Affirm her struggles and her abilities. In doing so you can shift her perspective from one of weakness to capability. Often in those first weeks and months of exhaustion and confusion, well-meaning people try to ‘fix’ problems by offering techniques and solutions to manage issues such as sleep or feeding. However, these suggestions typically result in distancing a mother from both her instincts and her baby’s needs. Instead, engaging in warm conversation, pursuing what a mother is feeling and thinking, and validating her thoughts and ideas, is a better way to lend real support.

Measure yourself by your best moments, not by your worst. We are too prone to judge ourselves by our moments of despondency and depression. ~Robert Johnson, psychiatrist and writer

At the same time, mothers must give voice to their feelings and needs and ask for support. Studies of new mothers indicate that women who are able to ask for help when they need it suffer far less postnatal depression than women who pretend they are coping or women who wait until they are overwhelmed and resentful. This is often challenging for mothers who have previously been able to do it all and hold things together. Motherhood is an opportunity for a new way of negotiating the world, one that is cooperative and mutual, a strong foundation for family life.

Importantly, research tells us that often postnatal depression is linked to the experience of birthing. Traumatic birth experiences leave an aftermath of fear, persistent worry, undermined confidence, lack of control, feeling overwhelmed and sometimes post-traumatic stress in their wake. Women who have medical emergencies, unplanned caesarians, excessive pain or lack of perceived support during childbirth are at higher risk of postnatal depression. It is vital that mothers who have undergone birthing difficulties be given sufficient opportunities to process and heal from their experiences.

It was from you that I first learned to think, to feel, to imagine, to believe… ~John Sterling, writer and poet

New mothers often lose sight of their competence, focusing on what’s difficult instead of what they’re doing well. Information that implies a new mother should fit into her jeans, have a sparkling house, be full of energy and ‘have her life back’ are harmful and just plain wrong. Assisting mothers to understand the importance of the moment – instead of focusing on the long to-do list – is critical. Those first months and years shape our children, creating not only their experience of being parented, but their ideas about trust, love and the world at large. Babies need us to be there for them. But they also need us to be happy. One source of that happiness comes from the knowledge that what we are doing, as mothers and in mothering, is truly the most important and influential gift we can ever give.

Babies are born wizened with instinct. They know in their bones what is right and what to do about it. ~Clarissa Pinkola Estes, psychoanalyst and writer

Babies of depressed mothers are affected by their mothers’ depression. Their brain activity shows depressed patterns, patterns that mirror their mothers’ sad moods and internal states. However, this is not reason for mothers to give up on their babies or assume that someone else can better care for them. When depressed mothers can manage to interact and play with their infants, their infants respond not only with happy engagement but also with normal brain activity. This can begin a gentle shift toward recovery for many women as seeing their babies smile and relate to them, watching their babies crave their attention and show their delight, often triggers feelings of pleasure for mothers. All too often, mothers who have been struggling with depression have had few, if any, fun and happy experiences with their baby. Once these start to occur, things can sometimes begin to change.

In a similar vein, amazing new research shows us that the act of breastfeeding is protective against depression and its effects. Mothers who breastfeed have brains and bodies with lower levels of stress, despite equally stressful lives. They also have better immunity. Additionally, breastfed babies are buffered from the negative impact of postnatal depression via the breastfeeding relationship. Unlike babies of depressed mothers who are not breastfed, these babies show brain activity that is similar to babies of non-depressed mothers. Thus breastfeeding can assist with avoiding postnatal depression as well as reducing its impact.

Healing may not be so much about getting better, as about letting go of everything that isn't you - all of the expectations, all of the beliefs - and becoming who you are. ~Rachel Naomi Remen, physician and writer

Clearly, support and perspective are not sufficient for all mothers to avoid postnatal depression. For some women, the birth of their baby is a psychological crisis. Children can evoke in us much pain from our past that we were not aware of. For those of us who were not treated sensitively during our infancies and childhood, the arrival of our own baby can be exquisitely challenging and can create an avalanche of emotion. Suddenly, the baby who we believed would fill us with warm, peaceful calm fills us with overwhelming fears, anger or even a total absence of feeling. If we were raised in a home where we could not count on consistent and predictable caring responses to our needs, our brains, bodies and psyches formed unconscious strategies to minimize our hurting and avoid further pain. While these survival strategies may have served us well then, they are not well suited to the task of parenting, where we must be fully present and aware, both of our own needs and feelings and those of our children. When we are flooded with catastrophic emotions and reactions in the weeks and months following birth, we are often confronted with the inability of our old strategies to cope with the challenges of our new situation. With introspection and sometimes professional assistance, mothers can untangle the old messages, make sense of the past and fashion a new way of interacting and relating that is healthy and honours the needs of both mother and child.

Healing is a matter of time, but it is sometimes also a matter of opportunity. ~Hippocrates, ancient Greek physician

Healing from postnatal depression takes many forms and is different for each mother. In addition to what has already been discussed, recent data also indicates that there are several other factors to be remembered:

• Diet is important. Research shows that diets high in complex carbohydrates and essential fatty acids are linked to lower rates of depression.
• Exercise can be very beneficial. As little as 20 minutes a day, 3 times a week has been shown to be sufficient to overcome the symptoms of mild depression and the effects are near-immediate. This also includes exercise like yoga and walking, both of which can be done with baby.
• Mindful meditation is indicated in the research in lowering anxiety, stress and depression as well as raising immunity and feelings of peacefulness. This requires no special equipment, no money and no particular training.
• Seek medical consultation for symptoms. Many cases of postnatal depression go unrecognized and untreated, prolonging the unnecessary suffering for the women, babies and families involved. In addition, new data indicates that roughly 1 in 20 women suffer from postpartum thyroid conditions that often go undiagnosed. Extreme fatigue is one of the common symptoms and can often be misattributed to night waking or other maternal stressors.
• Seek professional care when indicated. Medical and psychiatric support are not just for “crazy” people and can be instrumental in recovery for many new mothers. Should you require anti-depressant medication, doctors can assist you in finding one that is safe for breastfeeding. There is no shame in seeking help, only strength.

The main reason for healing is love. ~Paracelsus, ancient Swiss physician and alchemist

The relationship with our babies – the love they offer us and the love we feel and want to return – is perhaps the key opportunity to heal and make positive change in our lives. When we learn to see the world through the eyes of our baby, we don’t just move down the path of meeting our baby’s needs. We also get the immense benefit of seeing ourselves through their eyes. Once we get a glimpse of their view, we begin to see the truth. Mothers are a source of beauty, comfort and goodness for our babies. We achieve this naturally. Because of who they’ve made us, and who we have become.