Post-natal depression: some causes and prevention


• The psychoanalytic approach to post-natal depression is based on the theory that women who become depressed after childbirth do so because of unconscious anger towards their baby and because of a rejection of the role of motherhood. This overlaps somewhat with a major category of causes of post-natal depression:
• Psychosocial reasons. There is little doubt that, whatever is going on hormonally and physiologically, for many if not most women psychosocial factors are involved. First-time mothers, those who have marital problems, those with money problems, the unemployed, and those who know little about babies, have all been found to be at greater risk of becoming depressed.
The circumstances of the birth itself also play a part, with women who have had unpleasant or interventionist birth experiences faring worse. Many women whose babies are taken away from them to the hospital nursery feel very low and would rather have them with them. Could this be a reason why there are fewer cases of post-natal depression in home-delivered mothers? Women who breastfeed right from the start also have less depression than do bottle-feeders.
Perhaps as important as any of these factors is our society's attitude to childbearing and child-rearing. Many people have so little experience of babies before they have their own (modern families being so small) that first-time mothers are often shocked at the realities of life with a baby when they get it home, and four out of five say that their expectations are unrealistically romantic. It is this gap between fantasy and reality that is the greatest producer of post-natal depression in my opinion.
The vast majority of women get better from their post-natal depression without medical help, but what can be done to prevent it arising in the first place?

• The education of all young people, right from the earliest years, to see babies and parenthood in a realistic light must be the starting point for prevention.
• Greater contact between young people, before they have babies, and older people with children could help get their ideas straight from early on.
• A birthing system in which women (and couples) feel that they have as much say and control as possible over what is happening will prevent a lot of depression.
• Fewer operative and medical interventions in the birthing process.
• A policy of 'breast is best' and good back-up support for it ante-natally and post-natally is essential.
• Babies should normally be allowed to stay with their mothers in hospital. Putting babies into a hospital nursery should no longer be routine. Ideally, all mothers should have their babies with them all the time they are in hospital.
• Supportive staff in the post-natal ward should treat the women as adults and not little girls. This will prepare them for the reality of the world outside when they will be alone with their baby.
• Social workers and other professional helpers should be more readily available for women with real domestic or family problems. This would enable 'at risk' mothers to be identified and helped ahead of the birth to prevent depression occurring.
• Vitamin B6 could be tried in any woman who usually has premenstrual symptoms.


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