Researching Perinatal Mood Disorders: Science must trump the politics of fear

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The last decade has brought a great deal of attention to the affective disorders that can occur during pregnancy or the postpartum. Many brave women have come forward to share their stories, exposing their struggles so others might hopefully escape a similar fate. Initially, postpartum depression was associated primarily with the period after pregnancy (thus postpartum), but we have since learned that many of these disorders may occur during pregnancy (antepartum). The entire period of pregnancy and the postpartum has come to be described as the perinatal period.

We now know that the approximately 800,000 women who will experience a diagnosable postpartum mood disorder this year after live births are the statistical majority, but not the whole story. Women who miscarry, whose babies are stillborn or who lose their infant shortly after birth are also at risk. Those numbers are in the thousands further raising the population of vulnerable women who are susceptible to such disorders well into the millions. 

It can be easily understood that the psychosocial stressors of loss, combined with the biological shifts of pregnancy, could heighten affective risk following these tragedies, which often result in a disenfranchised grief for these mothers. Well meaning loved ones may attempt to soothe with statements that she can soon become pregnant again, that she will have another child. Such predictions tend to have the opposite effect further invalidating and isolating the mother’s experience. Her womb was infused with the biology of creation, her breasts were preparing to nurse a child, her arms preparing to receive a baby. Her heart and soul were thus attuned and the loss can be grieved forever. Perinatal research is appropriately identifying and including this group in postpartum studies and treatment. We know we need to follow these mothers carefully. After all, they are united with their live birth sisters by the uniquely personal biological and psychosocial influences of pregnancy.

But there is another group of women who have lacked representation in such studies or who are sometimes  presumed to need no such services at all. Women who elect to terminate a pregnancy seem to be missing from the collective statistical data we have gathered on who experiences a perinatal mood disorder.

This commentary is not about a Pro-Life or Pro-Choice stance. It’s not about Roe v. Wade and it’s not about judgment. It’s not politically or socially or religiously motivated. It’s about science and sisterhood and the need to fact gather from every pregnant woman who suffers an affective disorder during or after pregnancy. Women in the difficult position of having to terminate a pregnancy, be it for financial and economic problems, social factors, age, impending divorce, illness of mother, health of the fetus, traumatic impregnation; deportation, impending incarceration, birth control that didn’t work –  are not exempt from postpartum mood disorders but often silenced by judgment. 

Suspend opinion for a moment if you can and simply consider this: These women have become pregnant, their bodies are experiencing the hormonal fluctuations and biological changes of pregnancy which begin at conception. But these women are not yet represented in our studies, perhaps for fear the discussion might be too charged, the research subject selection too scrutinized by funders and too easily politicized by those awaiting the outcome. To not include every woman who becomes pregnant in our understanding of these illnesses is to narrow our perspective and blind science to reality.

Those who fear the possible overturn of Roe v. Wade may worry about giving the Pro Life message fuel for fire if it is acknowledged that there are vulnerabilities associated with every choice a pregnant woman makes. But Pro Choice positions do a great disserve to the very women they are trying to protect when pretending that elected termination is without emotional risk  – the fact of becoming pregnant is the major vulnerability that all women who develop a perinatal mood disorder have in common. 

But so much is in this label that seeks to categorize and define an outcome for one group of women. The term post abortion depression reeks of judgment and separation from compassion. It serves no purpose except to politicize an illness. By implying this is a special form of depression reserved for women who terminate pregnancies, we are adding to stigma and failing to scientifically identify all those who may suffer from these devastating disorders. 

The language in The Melanie Blocker Stokes MOTHERS Act has been amended to include a sense of Congress and pledges to study postpartum depression regardless of how the pregnancy is resolved. This is how it should be. But let’s lose the label of post abortion depression. It’s postpartum depression (i.e. following pregnancy). Unless we want to begin saying post C Section depression or post vaginal delivery depression or post fertility treatment depression. Do we say post smoking lung cancer as opposed to post environmentally caused lung cancer implying the smoker is less worthy of our compassion?

Since when does an action word full of controversy and judgment qualify as an onset specifier for a medical illness?

Whatever you believe, regardless of your stance on this issue – all women stand together as vulnerable targets of these disorders – disorders that do not discriminate based on the length, outcome, disposition or political leaning of the mother. Being female and becoming pregnant initiates the risk. From there it’s a confluence of biological predispositions and psychosocial stressors that determine affective outcomes. All women who find themselves on the sinking ship of perinatal mood disorders need a hitch to land.  Let’s not tell some of these mothers to get to the back of the boat based on how their pregnancy resolved.

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