Recently some research was published that indicated there is a link between postpartum depression (PPD) and having Pitocin administered during birth. It generated a lot of online discussion about why some of us get PPD and why some of us don’t. Once again, many of us who survived a postpartum mood disorder found ourselves asking “where did this come from and why did this happen to me?”.
This is a tough question to answer. Everyone seems to have a different idea about where PPD/PPA comes from. And that is frustrating because it makes your experience hard to understand and can create confusion about what to do about it – or how to prevent it if you want to have more kids.
Most of the information about the ‘cause’ of PPD centers around a debate between biological causes vs thinking patterns. Karen Kleinman, a big name in the PPD world, sums this up by stating “Some experts believe that the negative thoughts are symptoms of depression. Treat the depression, and you will think less negatively. Others say that negative thoughts cause the depressive thought process. Learn to reframe the thinking into positive channels and you will begin to feel better, these experts believe”.
I don’t think understanding PPD is as simple as choosing one side of this debate. As with most things in my life, I have a hard time putting things into neat little boxes. I like things messy, complex, and hard to wrap my head around. So it should come as no surprise that the way I conceptualize postpartum mood is messy, complex, hard to wrap my head around.
But in response to fears that Pitocin can cause PPD, I’ve tried to bring some clarity to the way I conceptualize PPD (and postpartum anxiety) by playing around with a diathesis-stress model*. I’m hoping those of you who also like messy, complex, hard to wrap your head around issues will find it helpful.
If that is hard to view, click here to download the image
As you can see, there are a few parts to this model. Some of them are flexible and some of them aren’t, but NONE of them are your fault. Let’s take a look, one by one, at how they impact support planning.
Genetics This is just plain luck of the draw. If you have a family history of depression and anxiety you are more susceptible to postpartum depression and anxiety. Often this means you struggled with your mood prior to having children, but not always. If your parents did gift you with a genetic tendency towards depression/anxiety, I hope they also gave you some other awesome genetics traits, like shiny hair or the ability to run really fast.
Hormones/Neurotransmitters** This one is a little bit trickier. I am hesitant to blame hormones for anything because women’s hormones are often used to dismiss a variety of legitimate complaints. I cringe at every “she must be on her period” joke. It’s true that parents who give birth have sudden changes to their estrogen and progesterone levels, and if they are lactating there are additional hormonal changes that can impact mood. It’s also true that low thyroid is a common problem after childbirth. Yet, these hormone changes don’t tell us why partners, non-birth, and adoptive parents also get PPD/PPA.
The other biological influence on PPD/PPA in this bucket are the neurotransmitters in your brain. When brain chemicals, such as dopamine or serotonin, are too high or too low or not firing effectively, it can have a massive impact on our mood. This is the way that most medical professionals conceptualize depression/anxiety, why depression and anxiety are categorized as mental illness, and why doctors use anti-depressants or mood stabilizers to treat PPD/PPA. There are lots of things that can negatively impact your neurotransmitters that affect all parents, regardless if you gave birth, such as sleep deprivation, getting enough nutritious food, and limited time/energy to exercise. Lots of parents with PPD/PPA find it helpful to use medication to try and balance neurotransmitters. I certainly did during my second round of PPD/PPA. But the medication does have side effects and some people take a long time to find the right medication – or never find one that gives them the results that they want.
Thinking Styles If you are prone to negative thinking, worrying, perfectionism, rumination, or heightened critical analysis, you are more prone to depression and anxiety. Thankfully, there is a lot you can do to influence negative thinking patterns. This is why talk therapy helps with depression and anxiety (as well as lots of other things). Counselors use a variety of tools and modalities to help process, cope with, and challenge thinking styles that are negatively impacting your mood. I want to be clear that this is not the same as the ridiculous and insensitive statement ‘just think more positively and you’ll feel better”. If you could feel better, you would feel better, amiright? Changing thinking styles is seriously intense work and it can take some time to find the support professional who is the right fit.
The Culture of Parenting As I have talked about in a variety of blog posts, the culture of parenting changes over time and geographically. The impact of the culture of parenting on PPD/PPA is often underestimated or ignored, and my research in this area is what makes my approach to the work unique. The messages that mothers are currently receiving – and I mean mothers specifically because parenting expectations are still hyper-gendered – about how to be a so-called ‘good’ mother are outrageous, contradictory, and out of reach.
You know the messages I’m talking about. Always prioritize your children’s needs over yours, but somehow also do tons of self care. Never let your baby have formula or you will ruin their health for life. And be sure to make all your baby food from scratch– ideally from organic produce you have grown locally in your own backyard. Never yell or let your children cry, or they won’t be able to create a healthy adult relationship. Be thin but not too thin because that sends a negative message to children about their own body image. The rules are endless. The standards are impossible to meet. And the greater the gap between how important these expectations are to you and your perceived failures in achieving them, the higher the rates of PPD/PPA.
Life Events, Stress, and Personal Circumstances This is the bucket where all of the risk factors for developing PPD/PPA live. This includes things like having a baby who cries a lot or who has trouble sleeping, having a premature baby, being a single parent, financial difficulties… the list of risk factors is really long and anything that you consider an added stress or a barrier to coping belongs in here. This is where having Pitocin administered at your birth belongs, but I suspect that the link between Pitocin and PPD/PPA has less to do with the drug itself and more to do with the fact that it is commonly used during induction, long births, or births with high levels of medical intervention – all of which are already on the risk factor list.
So yeah…. postpartum mood is complex. PPD/PPA can’t be boiled down to one simple thing like Pitocin. All of these factors work together to influence your mood during the postpartum period.
What matters more than pinpointing the exact cause of PPD is what you can do about it. And thankfully, there’s a lot. I briefly wrote about the six factors that contribute to postpartum resiliency in a previous blog post, and I’ve turned it into an upcoming free webinar all about protecting your mood after having a baby.
If you want to want to join us for that conversation, sign up for my mailing list and watch for the registration link.
And if you need support now, you can schedule a counseling appointment with me here. Tele-counseling is available.
* The idea to use this model was totally
stolen inspired by Kleinman‘s model for intrusive thoughts
**If you are a doctor and are thinking ‘hmmm I would describe that differently’, please reach out. I don’t normally try and explain brain science and I’m open to feedback.
Olivia Scobie, M.A., ACC, CPCC, MSP