by
Kathleen
Kendall-Tackett, Ph.D., IBCLC
University of New Hampshire
Social Structures that Protect New Mothers'
Mental Health
Is ours not a strange culture that focuses so much attention on
childbirthvirtually all of it based on anxiety and fear and so
little on the crucial time after birth, when patterns are
established that will affect the individual and the family for
decades?
Suzanne Arms
As citizens of an industrialized nation, we often act as if we
have nothing to learn from the Third World. Yet many of
these cultures are doing something extraordinarily right
especially in how they care for new mothers. In their
classic paper, Stern and Kruckman (1983) present an
anthropological critique of the literature. They found that
in the cultures they studied, postpartum disorders, including the
"baby blues," were virtually non-existent. In contrast, 50%
to 85% of new mothers in industrialized nations experience the
"baby blues," and 10% to 20% experience postpartum depression.
What makes the difference? Stern and Kruckman noted that
cultures who had low incidence of postpartum mental illness all
had rituals that provided support and care for new mothers.
These cultures, although quite different from each other, all
shared five protective social structures.
These are described below.
1. A Distinct Postpartum Period
In these other cultures, the postpartum period is recognized as a
time that is distinct from normal life. It is a time when
the mother is supposed to recuperate, her activities are limited,
and her female relatives take care of her. This type of
care was also common in colonial America, when postpartum was
referred to as the "lying-in" period. This period also
functioned as a time of "apprenticeship," when more experienced
mothers mentored the new mother.
2. Protective Measures Reflecting the New
Mother's Vulnerability
During the postpartum period, new mothers are recognized as being
especially vulnerable. Ritual bathing, washing of hair,
massage, binding of the abdomen, and other types of personal care
are prominent in the postpartum rituals of rural Guatemala, Mayan
women in the Yucatan, and Latina women both in the United States
and Mexico. These rituals also mark the postpartum period
as distinct from other times in women's lives.
3. Social Seclusion and Mandated Rest
Postpartum is a time for the mother to rest, regain strength, and
care for the baby. Related to the concept of vulnerability
is the widespread practice of social seclusion for new mothers.
For example, in the Punjab, women and their babies are secluded
from everyone but female relatives and their midwives for five
days. Seclusion is said to promote breastfeeding and it
limits a woman's normal activities. In contrast, many
American mothers are expected to entertain others-even during
their hospital stay. Once they get home, this practice
continues as they are often expected to entertain family and
friends who come to see the baby.
4. Functional Assistance
In order for seclusion and mandated rest to occur, mothers must
be relieved of their normal workload. In these cultures,
women are provided with someone to take care of older children
and perform their household duties. As in the colonial
period in the United States, women often return to the homes of
their family of origin to ensure that this type of assistance is
available.
5. Social Recognition of her New Role and
Status
In the cultures Stern and Kruckman studied, there was a great
deal of personal attention given to the mother. In China
and Nepal, very little attention is paid to the pregnancy; much
more attention is focused on the mother after the baby is born.
This has been described as "mothering the mother." For example,
the status of the new mother is recognized through social rituals
and gifts. In Punjabi culture, there is the "stepping-out
ceremony," which includes ritual bathing and hair washing
performed by the midwife, and a ceremonial meal prepared by a
Brahmin. When the mother returns to her husband's family,
she returns with many gifts she has been given for herself and
the baby. The following is a description of a postpartum
ritual performed by the Chagga of Uganda. It differs quite
a bit from what American mothers experience.
Three months after the birth of her child, the Chagga woman's
head is shaved and crowned with a bead tiara, she is robed in an
ancient skin garment worked with beads, a staff such as the
elders carry is put in her hand, and she emerges from her hut for
her first public appearance with her baby. Proceeding slowly
towards the market, they are greeted with songs such as are sung
to warriors returning from battle. She and her baby have survived
the weeks of danger. The child is no longer vulnerable, but
a baby who has learned what love means, has smiled its first
smiles, and is now ready to learn about the bright, loud world
outside (Dunham, 1992; p. 148).
What American Mothers Experience
In contrast, American mothers often find that people are more
concerned about them before birth. While a woman is
pregnant, people may offer to help her carry things or to open
doors or to ask how she is feeling. Friends will give her a
baby shower, where she will receive emotional support and gifts
for her baby. There are prenatal classes and prenatal
checkups, and many people wanting to know about the details of
her daily experience.
After she has her baby, however, mother-focused support rapidly
declines. Typically, a woman is discharged from the hospital 24
to 48 hours after a vaginal birth, or 2 to 4 days after a
cesarean section. She may or may not have anyone to help
her at home, chances are no one at the hospital has even asked.
Her mate will probably return to work within the week, and she is
left alone to make sure she has enough to eat, to teach herself
to breastfeed, and to recuperate from birth. The people who
provided attention during her pregnancy are no longer there, and
the people who do come around are often more interested in the
baby. There is the tacit and sometimes explicit
understanding that she is not to "bother" her medical caregivers
unless there is a medical reason, and she must wait to talk to
her physician until her six-week postpartum checkup.
There probably are resources in her community that can help, but
she has no idea where they are and feels too overwhelmed to seek
them out for herself. So she must fend for herself as best
she can. Is it any wonder that many women find the
postpartum period to be extremely stressful? One popular
book written for new mothers (Eisenberg, et al., 1989) describes
this transition as "the reverse Cinderella, the pregnant princess
has become the postpartum peasant" with a "wave of the
obstetrician's wand" (p. 546).
Here are some comments mothers have shared with
me.
I felt like I didn't matter. I felt like they weren't
interested in me after I had my baby. My husband said, "Of
course they are not interested. You've had your baby."
After the birth, I had several people tell me that the most
important thing was that I had a healthy baby. Yes, that is
important. But what about me? No one pays attention
to the fact that you've had major surgery. They would have
paid more attention if you had had your appendix out.
As a culture, we have woefully neglected the needs of new
mothers. But this was not always so. Historically, we
recognized the importance of a community of women helping women,
who provided this much needed practical and emotional assistance.
In so doing, they provided a chance for postpartum women to
recuperate and assimilate the major change that had taken place
in their lives.
Chances are it will be many years before there are organized
efforts aimed at providing care for new mothers. The good
news is that a grass-roots movement has begun that seeks to meet
the needs of postpartum women. The word doula, from the Greek
word for servant, is becoming part of our vocabulary. A
postpartum doula is someone who takes care of postpartum women by
providing practical and emotional assistance (Lim, 1992; Webber,
1992). Friends, family or a woman's partner can be Doulas.
Or women in some communities might be able to hire a professional
Doula. In either case, the Doula movement is in response to
the lack of postpartum care available from traditional care
providers.
In the following account, Doula Salle Webber
describes her care for new mothers and the types of support and
assistance that they need.
In my work as a Doula, my focus is on the mother. I want to
provide whatever it is that she needs to feel comfortable,
nourished, relaxed, and appreciated: to facilitate a harmonious
transition for both mother and child in those profound first days
and weeks after birth. A mother needs someone who cares
about how many times the baby woke to nurse in the night, how
many diapers were changed, how her breasts are feeling. She
may need her back massaged or her sheets changed, or she may need
someone to provide an abundant supply of water or tea, salads
ready-made in the refrigerator, a bowl of cut-up fruit. She
needs to be able to complain about how little her mate
understands what she's going through, and perhaps, some gentle
reminders of all the contributions he has made. She needs
someone to hold the baby so she can take a shower or even go to
the bathroom; someone to answer the phone when she's napping;
someone to water her plants or garden, to clean the kitchen and
bathroom, to keep up on the family's laundry. She may have
many questions and concerns that only an experienced mother can
understand. She needs patience and kind words and a clean
and calm environment (Webber, 1992, p. 17).
While our culture continues to lack supportive postpartum
rituals, the work of individual women can make a significant
difference. Many are surprised that this decidedly
"low-tech" intervention can work. Yet this is perhaps the
most important lesson we can learn from the cultures that Stern
and Kruckman described. We must begin to change the way we
think about providing care for new mothers. This care
should not stop once the baby is born, but should continue
throughout the postpartum period.
In conclusion, we have learned that women can make a comfortable
and peaceful transition into motherhood. Postpartum illness
is not inevitable and in many cases can be prevented. It is
time that we recognize and meet the needs postpartum women.
The health of our families depends on it.
References
Dunham, C. (1992). Mamatoto: A celebration of birth. New York:
Viking Penguin.
Eisenberg, A., Murkoff, H.E., & Hathaway, S.E. (1989). What to
expect the first year. New York: Workman.
Lim, R. (1992). After the baby's birth: A woman's way to
wellness. Berkeley, CA: Celestial Arts.
Stern, G., & Kruckman, L. (1983). Multi-disciplinary perspectives
on postpartum depression: An anthropological critique. Social
Science and Medicine, 17, 1027-1041.
Webber, S. (1992). Supporting the postpartum family, The Doula,
23, 16-17.
Kathleen Kendall-Tackett, Ph.D., IBCLC is a health psychologist
and international board-certified lactation consultant at the
Family Research Lab, University of New Hampshire. Dr.
Kendall-Tackett is the Area Coordinator of Leaders for La Leche
League of Maine and New Hampshire and chairs the NH Breastfeeding
Task Force. She is the author or editor of 15 books on depression
and a wide range of health topics. Her books include Depression
in New Mothers (2005, Haworth), The Hidden Feelings of Motherhood
(2005, Hale Publishing), Breastfeeding Made Simple (2005, w/
Nancy Mohrbacher, New Harbinger) and The Handbook of Women,
Stress and Trauma (2005, Taylor & Francis). Dr. Kendall-Tackett
lectures frequently on how social support and culture can
influence pregnant and postpartum women. Her Web site is:
www.BreastfeedingMadeSimple.com
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