Great Expectations, Part 2

Pregnancy Blues: What Every Woman Needs to Know about Depression During Pregnancy
by Shaila Kulkarni Misri, M.D.

(Page 2 of 2)

This "lying-in" period is still practiced in many cultures. In Cuba, for example, the new mother and her infant remain inside the home for forty-one days, during which time women from the family and the community are responsible for taking care of them. In India, women are not expected to return to their normal household chores for more than a month. Bedouin women stay home for forty days, are not allowed to cook or do housework, and are expected to rest and eat well. In China the traditional period of confinement is one month, in Malaysia it is forty-four days, and among the Igbo people of southeastern Nigeria it is one lunar month, during which time the mother is relieved of all chores, given special foods, and nursed by her own mother or an older sister.

Although these are certainly periods set aside for mother and baby to bond (in most instances the infant actually remains in bed with the mother and can nurse at will) and for the mother to recover, they also mark another rite of passage - from girlhood to womanhood or, seen from another perspective, from seductress to saint. It should be pointed out, in fact, that in at least some cultures, the period of confinement is also considered a time of repurification following the "pollution" of childbirth.

But how do such practices relate to pregnancy and motherhood in our own culture? Again, I think it is enlightening to examine this question from more than one perspective.

On one hand, although the vast majority of modern Western women deliver their babies in far more sterile conditions, we also miss out on the benefits to be derived from the closeness and care of other women. For the most part, we give birth surrounded not by those who are necessarily closest and most caring but by paid professionals and coldly beeping machinery. Our "lying-in" period in the hospital is barely twenty-four hours, after which we are sent home to cope as best we can. We might have a mother who is both able and willing to help out, but even if we are so lucky, her stay generally lasts no more than a week or two. We might be granted maternity leave by our employer, but we generally spend that time in relative isolation. Our period of transition is spent not being coddled and cared for but in 24/7 on-the-job training. We are expected either to know instinctively how to mother or to learn the ropes by reading books as we muddle along. At the same time, we are undergoing another important - and not necessarily happy - transition with relation to our own sense of self.

It's hard, when we're usually exhausted, still overweight, and often bedraggled, wearing a nursing bra or wiping formula from our clothing, to remember who we were just nine months before. In fact, many of us are undergoing our own personal reassessment and seeing ourselves as no longer seductive, if not quite as saints (although from time to time we might consider ourselves deserving of sainthood).

The messages we receive from the media may suggest that we ought to be self-confidently sexual when pregnant - like Brooke Shields on the cover of Vogue or Demi Moore, nude and in full body paint, adorning Vanity Fair. Then, having given birth, we ought to be "ready for our close-up," as coiffed and composed as Gwyneth Paltrow, as skinny as Sarah Jessica Parker, as coolly elegant as Catherine Zeta-Jones. But do these images really make us feel better about ourselves, or do they just remind us that we are somehow not living up to expectations? Perhaps we'd be better off if, like women in earlier times and more traditional cultures, we had a clearer picture of our new role and place in the world. We'd certainly be better off if motherhood, in and of itself, were looked upon with the kind of dignity and respect it is shown in other cultures.

But then again, is this not just one more of the mixed messages women constantly receive about their value as bearers of children? Even in societies where the mother's role is recognized as intrinsically worthy of respect, girl children - the future childbearers and mothers, it should be pointed out - are afforded second-class status. In some parts of India a boy baby is still welcomed as a future helper and contributor to the family's wealth, while a girl, assuming she is even allowed to survive and remain in her family of birth, is looked upon as a burden and an additional drain on the family's income. And in China the government-mandated one-child population-control policy has led to a precipitous decline in the ratio of girl to boy babies. Indeed, in that country, where for centuries male offspring have represented continuity of lineage and financial support, the abortion or infanticide of girls has created a situation where there will soon not be enough young women to produce the prized male heirs of the future. And the legacy of this centuries-old gender bias is still seen, at least ceremonially, even in Great Britain, where the birth of a male heir to the throne is greeted with a 101-gun salute while a female heir rates no more than 21.

We need to ask ourselves, then, what emotional and psychological effect all these conflicting images of femininity, myths of power, and messages of value (or lack thereof) might have on women, whose sole unique, biologically endowed capability is to bear and nurture children. Yes, of course, we want to think of conceiving and bringing a new life into the world as an occasion for joyous celebration - and for the majority of women, it is.

For a significant minority, however, who may have subliminally internalized the ambiguities inherent in the way society views motherhood, who may themselves be unconsciously ambivalent about the role they are about to take on, or who may become suddenly and glaringly aware of the life-changing transition they are about to undertake, pregnancy and childbirth can - and do - create the perfect emotional and biological climate for the onset of negative thoughts and feelings that lead to anxiety and even major depression. In the pages that follow we'll be looking at the many ways in which societal pressures and expectations, internal stress, and women's unique biology may come together to color a pregnancy in shades of gray and black.

I believe it's time to take off those rose-colored glasses and look at a picture of pregnancy that may not be as pretty as the one that's been painted by the media but which is, for too many women, sadly more realistic. Until we are willing to do that, we are unwittingly sentencing these women to continue hiding in plain sight, unable or unwilling to admit, perhaps even to themselves, that their experience of pregnancy is not what they've been taught to expect, and that what appears to be so joyful for others is for them a time of sadness, fear, and confusion. These women need to know that it doesn't have to be that way, that there is help, and that they cannot and should not be embarrassed or afraid to get the help they need. Indeed, this book is filled with the stories of women who have come out of hiding, and who have, as a result, turned a potentially devastating experience into one that not only was manageable but also ultimately did bring them the joy of bonding with a happy, healthy baby.

Copyright © 2005 by Shaila Kulkarni Misri, M.D.

About the Author

Shaila Kulkarni Misri, MD, Frcpc, is one of the leading reproductive psychiatrists in North America and is internationally recognized as a pioneer in women's mental health and reproductive issues. She is the founder and director of Reproductive Mental Health at both St. Paul's Hospital and BC Women's Hospital & Health Centre in Vancouver, and Clinical Professor of Psychiatry and Obstetrics and Gynecology at the University of British Columbia, Canada.