Postpartum mental health problems are not “just hormones”
We need to talk about this.
It’s awesome that everyone is becoming more aware of postpartum mental health. Many antenatal classes will discuss mental health, helping expecting parents to learn about symptoms to look out for, and what support is available. As a society, we’re talking more about the prevalence of mental health problems, and that’s great.
What we’re not talking about is why the rates of mental health problems during the postpartum period are so high. And this is a huge problem.
I feel like the impression is that the rates of postpartum mental health problems are so high because of all the hormonal changes that happen after pregnancy. I would like to kindly call bullshit on that, and also suggest that it’s just… really unhelpful to give that impression. Women are far more multifaceted then “just hormones”. This messaging is outdated, unhelpful, and does not account for all the other factors that may be contributing to postpartum mental health problems.
What actually causes postpartum mental health problems?
Let’s start with the basics - what actually causes postpartum mental health problems?
Introducing: the bio-psycho-social model of mental health.
This model helps us to understand how different factors can increase someone’s risk for experiencing a mental health problem.
Biological
This includes issues like hormones, a person’s general health, neurotransmitter chemicals, nutrition, and even things like the gut microbiome and inflammation levels.
Psychological
A person’s thoughts, feelings, and behaviours - this covers what’s going on in their mind, and how that is expressed in the world.
Social
Includes factors like social support, socioeconomic status, environment, relationships, culture, political context - it’s really a catch-all for anything beyond the individual person. It’s all the contextual factors that surround them. In my opinion, this is the most undervalued area that impacts mental health. Most people think of mental health as a problem located within the individual - but there is actually very strong and clear evidence for the influence of social factors on a person’s mental health.
So then, what causes postpartum mental health problems?
We know that when a woman becomes a mother, she is going through a huge change in her life on every level possible, including her psychological, social, spiritual, and political contexts¹. So how can we say that mental health problems are purely biological in nature? Actually, we’re not even saying they are biological - if we were, then we’d still be including all the other biological issues that can also contribute. No, we are saying it is purely down to one factor - the hormonal changes a woman experiences after giving birth.
I also know, having been a mom myself, and also from my work as a postpartum doula, that moms with babies often aren’t even able to meet their own basic needs. Basic things like nutrition, hydration, sleep, and hygiene are practically impossible. This is why support is crucial in the postpartum period. Nowadays, however, women are often living far away from their extended families, with their partners back at work, so they are home alone with their baby all day long (if they are lucky enough to have a period of maternity leave, that is). There is an obvious lack of social support for postpartum moms. Can we, as a society, please stop ignoring the importance of this?
How to actually improve postpartum mental health
Now that we’re on the same page about postpartum mental health problems not being “just hormones”, let’s chat about why it is an extremely unhelpful narrative.
Helping pregnant women to prepare for postpartum
Firstly, how disempowering is it for pregnant women to be under the impression that postpartum mental health problems are an inevitable part of the hormonal shifts that occur after giving birth. We could be teaching them that social support is greatly linked to mental health, so they might really want to build their social support networks before having their baby. We could teach women that breastfeeding and sleep are linked to mental health, so there’s an incentive to create a plan for both. We could teach couples that their relationship satisfaction is linked to mental health, so they might want to work on their communication as a couple, see a couples therapist, and/or discuss realistic expectations for their roles after baby arrives. We could be teaching pregnant moms about the link between nutrition and their mental health, particularly at the time in a woman’s life when the nutritional demand on her body is at its highest. We could be just generally educating women about the different factors contributing to mental health problems after giving birth, rather than leaving them to make assumptions on their own. We could be giving them realistic expectations about what life with a new baby is actually like, which is often noted in research as something that can promote positive postpartum mental health².
Helping postpartum moms to access mental health support
Secondly, I wonder how many postpartum moms are experiencing symptoms of mental health problems, but not seeking support because it’s “just hormones”. How many moms are blaming their “mom rage” on hormones, when we know rage can be a symptom of depression? How many moms are blaming extreme worry or tearfulness on their hormones, when we know these are symptoms of anxiety and depression? I’m not trying to imply that every emotion needs to be medicalised as a ‘mental health problem’. What I am suggesting is that these extreme, and often distressing, mental states aren’t something postpartum moms just have to live with. We can get support. It is possible to feel better. Support exists, and it can help. You don’t need a mental health diagnosis to get support (although you might be given one for your insurance form).
Creating a society that supports postpartum moms
And thirdly, what kind of society are we when we blame a new mother’s mental health problems on her hormones, instead of offering support that would actually help her? Where are our ingrained cultural practices that consider nourishing the new mother to be an obvious choice? Where are the classes teaching friends and family how to promote their loved one’s mental health by bringing her food, holding the baby while she showers, and telling her she’s doing an awesome job? Where are the parental leave policies that actually give mothers time to recover from pregnancy and birth, bond with their babies, and establish their breastfeeding relationship? Oh yeah, they’re hiding behind the idea that postpartum mental health problems are “just hormones”, a “women’s problem” that just has to be waited out, and there’s not really much you can do about it.
As you can see, the main problem with the “just hormones” narrative is that it prevents postpartum moms from actually having the support they need for their mental health. We don’t teach pregnant women what they can do to promote their mental health after giving birth. We don’t teach postpartum women that they might benefit from support to help them cope better with distressing emotions. And we don’t teach society to step the fuck up and treat postpartum moms like they, I don’t know, literally just created an entire new human being.
ABOUT THE AUTHOR
Ceridwen is a postpartum doula and lactation counsellor based in the Cayman Islands. She offers personalised, evidence-based information to help pregnant families prepare for their baby’s arrival. After birth, she helps postpartum families to feel calm, confident, and cared for, with a focus on lactation and mental health.
Learn more about Ceridwen here.
REFERENCES
Athan, Aurelie. (2024, 10, 24). Working Definition. https://www.matrescence.com/
Lazarus, K. And Rossouw, P. (2015) ‘mothers’ expectations of parenthood: the impact of prenatal expectations on self-esteem, depression, anxiety, and stress post birth’ International Journal of Neuropsychotherapy. 3(2), pp. 102-123. Available at: https://www.researchgate.net/profile/The_Late_Pieter_Rossouw/publication/280805759_Mother's_expectations_of_parenthood_The_impact_of_prenatal_expectations_on_self-esteem_depression_anxiety_and_stress_post_birth/links/55c7dab908aeb9756746e5a3/Mothers-expectations-of-parenthood-The-impact-of-prenatal-expectations-on-self-esteem-depression-anxiety-and-stress-post-birth.pdf
