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Postpartum does not equal depression

You hear it in conversations with friends when returning to work. Maybe in clinic visits with your patients. Definitely among celebrities and on mainstream media. And maybe you’ve even said it yourself. ”

“My sister suffered with postpartum.”

“I was just diagnosed with postpartum.”

“My wife had to seek help after we realized she was experiencing severe postpartum.”

Yet the word postpartum simply means: the time after childbirth. In the medical community, “postpartum” most often refers to the first 6 to 12 weeks after birth, to align with the recommended follow-up schedule for health care following childbirth. In colloquial terms, postpartum could refer to a loose timespan of many months or even many years after birth.

In neither of these instances does the definition refer to depression or any other type of mood or anxiety disorder. So why has it become commonplace for the word postpartum to serve as shorthand for postpartum depression, anxiety, or any other mental illness?

In the U.S., 1 in 4 birthing people suffers from postpartum depression. This prevalence has dramatically increased over the past decade for all races and ethnicities, although cases of postpartum depression in Black and Indigenous birthing people often go undiagnosed and untreated. If you google “postpartum,” guess what comes up (other than the equally problematic ads for “getting your body back”)? You guessed it. Articles on depression, resources for support groups, and warmlines to text with someone who has been there.

With all of this in mind, it is unsurprising that postpartum has come to equal depression. But what message are we sending with this subtle yet meaningful cultural shift in language?

It could be argued that this language reflects a positive shift in our culture of bringing mental illness to light in mainstream avenues, thus shedding the harmful stigmas that have led to a lack of treatment and inability to find support. But there is more at stake here than simply a positive normalization of a debilitating condition that affects so many families. By accepting the word postpartum to be synonymous with depression, we are creating a reality where the time after birth is expected to be a time of suffering – where we are accepting of inevitable mental illness.

In fact, postpartum depression is often preventable. This likelihood of prevention is only increasing as more resources are allocated to women’s health research.

Awareness of personal risk factors is a great starting point for prevention. We now have a vast array of markers for those who are at high risk for postpartum depression, ranging from biological to systemic to cultural: everything from a history of intense premenstrual syndrome to being in an abusive relationship can predict whether an individual is more likely to develop postpartum depression.

Cognitive behavioral therapy (CBT) is widely used as a treatment for postpartum depression, but in recent years has also gained traction as a mechanism for prevention. When started in pregnancy, CBT was shown to be effective in preventing postpartum depression in comparison with standard care, educational interventions, or no intervention. The efficacy of even brief and digitally administered CBT in preventing postpartum anxiety is promising for the scalability of such prevention avenues.

Even preventative measures as simple as altering nutrient intake have shown to be effective in preventing postpartum depression. Omega-3 supplementation has long been implicated in the prevention of major depressive disorder, and randomized placebo-controlled trials in pregnancy and postpartum show promising efficacy for perinatal mental health. A healthy and diverse gut microbiome is also critical for mental health, and randomized placebo-controlled trials with probiotic supplementation have shown a significantly decreased risk of developing postpartum depression.

Still, other preventative interventions show promising effects. My own research on mother-infant physical contact showed a decrease in depressive symptomology in a randomized intervention using soft infant carriers in the first six weeks after birth. Systemically, we know that addressing the larger challenges of racism and discrimination, lack of paid postpartum leave, and abortion policies may all play a role in supporting positive mental health in the vulnerable postpartum period.

As Kimi Chernoby, MD, shared so succinctly in a previous article on Medicaid expansion for postpartum support: “As health care workers, we know that the best way to fix a complication is to prevent it from happening at all.” This can definitely be true for postpartum depression, in not all, but in many cases. However, committing to a preventative approach must start with the words we use and the underlying meanings we convey in our language. So the next time you hear someone else (or yourself!) use “postpartum” to mean depression, let’s reframe for semantic and scientific accuracy. Let’s give prevention a chance.

Emily Little is a perinatal health researcher with a PhD in experimental psychology from the University of California, San Diego, and a graduate specialization in anthropogeny (the study of human origins) from the Center for Academic Research and Training in Anthropogeny. She can also be reached on LinkedIn and Instagram @nurturely.

Dr. Little uses approaches from psychology, anthropology, and public health to understand and prevent the root causes of disparities in perinatal and pediatric health. As the founder of Nurturely, she disseminates research to improve clinical practice through equity-centered training programs for health care providers.

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