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Biology 202
2002 Second Paper
On Serendip

Why Do I Have the Baby Blues? An Investigation of Postpartum Depression

Claire Albert

The recent Andrea Yates murder trial brought a firestorm of controversy as the issue of postpartum depression (PPD) became a debated topic throughout the country. Did Andrea truly suffer from psychosis as she drowned her five children in the bathtub or was such defense a scheme to avoid the death sentence? Prosecutors suggested the spousal-revenge theory as a motive for the killings. Could she have committed murder to get back at a possessive and domineering husband? (1).

The outcome of the trial was by no means exceptional as it was a murder case, which resulted in a life sentence conviction. It did however, create awareness within the medical field and mainstream public about the historical connection between pregnancy and psychiatric illness. Unfortunately such dialogue also brought long standing misconstrued notions which must be eradicated.

Mental illness has been a reality not only for Yates but for millions of women throughout the country. Depression tends to be one of the most prevalent consequences of childbearing as 50% of new mothers report slight bouts of depression, 10% have manic depression and .2% suffer from psychosis(2). Yonkers et. al, further investigated postpartum depression rates for minority women in comparison to their Caucasian counterparts. After conducting a postpartum three trial screening which included the Structured Clinical Interview, it was found that depression rates for Latino, Blacks and White racial groups was between 6.5% to 8.5% (3). Regardless of race, all groups of women were susceptible to similar rates of PPD at 3-5 weeks postpartum. Other studies have found that depressive disorders begin even before giving birth. Evans et. al, conducted a study which monitored 12,509 women throughout their pregnancy up to 8 months postpartum. Depression scores were actually higher at 8 months of pregnancy with 13.5% of the participants assessed as depressed. Such percentage lowered to 9.1% at 8 weeks and 8.1% at 8 months postpartum (4).

Postpartum depression is categorized into three forms according to symptoms experienced:

1. Postpartum blues is a common and usually short-lived condition which is characterized by weeping, emotional instability, low-self esteem, anxiety and vulnerability immediately after giving birth (5).

2. Postpartum depression (PPD) is more intense and incapacitating as it can often interrupt with the woman's everyday activities. It can be accompanied by feelings of despair, anxiety, fatigue and irritability which linger and reoccur for months if no medical attention is given (5).

3.Women with postpartum psychosis suffer from insomnia, hyperactivity and hallucinations and delusions about death and possibly hurting the child.

Psychosis is further accompanied with schizophrenia and has an onset of three months but can appear 18-24 months postpartum(6).

Although the three categorizations may be useful for the identification and possible treatment of the illness, there are hormonal, psychological, social and environmental aspects which can also contribute to psychiatric illness.

Fluctuations in estrogen and progesterone hormone levels during pregnancy are considered a possible source of depression. Upon 24-48 hours after giving birth and delivering, progesterone levels fall ten times the levels held throughout the pregnancy. Women who have the highest hormonal fluctuation postpartum, are reported to be the most at risk for depression (6). PPD has further been linked to estrogen's ability to activate the gene for corticotropin releasing hormone (CHR). Once CHR is secreted out of the hypothalamus, it regulates pituitary gland release of adrenocorticotropic hormone (ACTH), which regulate the secretion of cortisol in the adrenal glands. If high levels of estrogen are present, they affect the abundant buildup of cortisol in the blood as negative feedback inhibition is be unable to regulate it. Since cortisol is responsible for activating metabolic pathways, its prolonged presence leads to increased stress levels and depression. Thus, women with increased levels of cortisol have been found to have PPD (5).

Psychologists have further suggested that the patient's psychological construct could make them more susceptible for postpartum depression. Those who with a negative outlook of the world would most likely have low self-esteem, helplessness and disturbed emotional feelings leading to PPD. Such theory is contradictory as optimistic patients are often affected by PPD, while not all women with negative outlooks become medically depressed (5).

The role of social and environmental factors are also considered important links in maintaining and prolonging the illness. For example, new role expectations can bring uncertainty about the future as the woman has additional responsibilities and obligations. There may be added pressure to be a "good mother" while enduring exhaustion, fatigue and extended periods of isolation (5). Social networks composed of family and partner's support are also necessary as they create a support system which facilitate the transition after childbirth.

Is it possible that Andrea Yates lacked a cohesive social network, while suffering from the psychological and physical strain of taking care of her children? There's evidence that Yates suffered from depression throughout her five pregnancies as she attempted suicide twice and was hospitalized four times from 1999 to 2001(1). There is also evidence that gender role expectations left her with a large load of housework. "Man is the breadwinner and the woman is the homemaker" stated her husband in testimony(1). When at the Oprah Winfrey Show, Rusty explained how he and Andrea were planning to have as many children as possible because they loved and valued their family. Multiple pregnancies for a woman with a history of PPD can cause the illness to recur. Yates was undoubtedly at higher risk due to her subsequent pregnancies.

A study conducted in the UK demonstrated that midwifery visits prolonged mental stability and early detection of mental illness. Midwives visited for 28 days and closely monitored the new mothers with mental screenings. The visits further provided structural support as the mothers were able to reach out to the medical establishment and address their fears and concerns. Although the program may be helpful in preventing mental illness early on, it is problematic as it does not provide an outlet for women who may have a later onset of PPD. What can be drawn from such study is the need for changes in the current "drive thru" system of childbirth. Hospital stays have been reduced as new mothers are quickly sent home without medical resources at their disposal(8).

The Andrea Yates trial was significant in that it raised awareness of mental illness under a media firestorm. It made the American public aware of the potential actions such illness can cause a person to do. Dialogue, however, is not a sufficient means in which to properly target and treat PPD. The medical establishment must ensure prevention through mental health screenings and subsequent psychiatric check-ups for new mothers. Through educational campaigns, awareness must be brought to the masses so that the stigma attached to mental illness be eradicated. Hopefully, people will seek proper treatment as there are millions suffering with depression in isolation and silence.

WWW Sources

(1)Newsweek , Psychosis or Vengeance? Prosecutors suggest Andrea Yates may have not have been delusional when she killed her children.

(2) An Introduction to Postpartum Illness , Postpartum Support International.

3. Yonkers, Kimberly. Onset and Persistence of Postpartum Depression in an Inner-City Maternal Health Clinic System. Journal of the American Medical Association. 287: 168-169. Retrieved April 16, 2002 from Bryn Mawr College's connection to Expanded Academic.

(4) Cohort Study of Depressed mood during pregnancy and after childbirth BMJ.

(5) Women and Postpartum Depression ,Office of Women's Health.

(6)Postpartum Depression

(7) Scientific American, Why Are So Many Women Depressed?. 8. Albers, Leah and Williams, Deanne. Lessons for US postpartum care. The Lancet. 359: 370. Retrieved April 16, 2002 from Bryn Mawr College's connection to Expanded Academic

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