How Supporting Postpartum Moms Could Boost Our Declining Fertility Rates

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“Our culture literally abandons new moms, and I think that’s really traumatic for people. And if you go through trauma, why would you want to do that so many times?” said Leah, a mom interviewed in the new book, Hannah’s Children: The Women Quietly Defying The Birth Dearth, by Catholic University of America’s Professor of Economics Catherine Ruth Pakaluk.

Pakaluk and two associates interviewed dozens of women about their decisions to have five or more children, particularly amidst a downward-spiraling childbearing trend nationally. Pakaluk sought to identify the “reasons of the heart” that led these women to defy broader cultural trends. While the goal of Pakaluk’s book was to identify the reasons women do have large families more so than the reasons they don’t, one of her interviewees cited a cultural lack of support for new mothers as an obstacle to welcoming more children. 

Grabby headlines like TIME magazine’s August 2013 cover story on “The Childfree Life” sell at the newsstand. But selfishness, hedonism, and narcissism aren’t the only, or even the primary, reasons women are welcoming fewer children than their foremothers. Other top reasons include lack of a suitable partner and economic constraints, but what could we be missing when it comes to the connection between poor social support, postpartum mood disorders, and their effect on future childbearing? 

Post-Birth Care Falls Through the Cracks

Admittedly, it’s difficult to get clear on how many women hoped to have more, perhaps many more, children but were stopped — for a time or forever — by the reality of postpartum depression (note that “postpartum depression” is often used colloquially to refer to depression and/or anxiety during the first year after a woman gives birth. Postpartum psychosis is another, very rare postpartum mood disorder.) 

How many others persist in having children but at a significant cost to their own mental and overall well-being (and hence their ability to care for those around them)? While the connection seems logical, it’s hard to say for sure because these questions are rarely directly studied. Still, we do know enough from indirect statistics to make some reasonable assumptions about the role postpartum mood disorders may play in future childbearing plans. 

We know that somewhere between 10 and 15 percent of mothers experience postpartum depression (roughly equal to the number of women who suffer postpartum anxiety disorders, such as generalized anxiety disorder, obsessive compulsive disorder, or panic disorder), which is more severe and long-lasting than the “baby blues” the vast majority of women experience in the week or two after giving birth.

We know that experiencing postpartum depression after one birth makes it more likely that you’ll experience it after another. We know big life changes, the massive hormonal withdrawal that occurs after birth, negative thought patterns, family history of mood disorders, lack of social support, a complicated pregnancy or traumatic birth, genetics, sleep deprivation, depression during pregnancy, and other factors all contribute. 

The Effects on Mothers and Babies

When we fail to support a new mother and she suffers from postpartum depression, it doesn’t just slow down or stop her future childbearing. It also affects the child or children she already has, because when a mother suffers, so does her child. The children of mothers who suffer from postpartum depression are more likely to experience “delays in language development and problems learning, problems with mother-child bonding, behavior problems, more crying or agitation, shorter height, and higher risk of obesity in pre-schoolers, and problems dealing with stress and adjusting to school and other social situations.”

If all of that isn’t enough to make us sit up and take notice, most disturbingly, we know that postpartum depression can lead to suicidal ideation and attempts, and suicide is the second most common cause of maternal mortality in the year after giving birth. What could be as tragic as the death of a new mother at her own hand, other than perhaps her newborn child (and any older siblings) becoming motherless?

How many new mothers believe “No one’s coming for you?”

In Hannah’s Children, interviewee Leah shed light on the connection between lack of social support and postpartum mental health struggles:

“We are in these individual little boxes and it’s completely unnatural to be alone with a newborn for twelve hours a day. It’s psychologically torturous to not have the support. And I would say the vast majority of women that give birth in America don’t have adequate support, physically, emotionally, psychologically, and medically.”

“No one’s coming for you. You’re literally alone. And it’s not normal, it’s not healthy. It’s not–that is not what we’re programmed for, psychologically. The human is not prepared for that. Nobody can be.” 

How do we ensure mothers don’t feel isolated and abandoned? In my experience as a mom and nurse, we need a cultural shift in the medical field and society at large. Medically, we know that pregnancy is a time of increasingly frequent interactions between OB-GYN or midwife and mother, with weekly visits during the last month before birth. And yet every woman, regardless of risk, is scheduled for just one follow-up visit, six full weeks after birth. 

The medical field would do well to instead follow the recommendation of the American College of Obstetricians and Gynecologists, which urges a postpartum follow-up within three weeks after birth for every mom, followed by a second visit 12 weeks after birth. Better yet, we can get increased eyes-on, hands-on time with new mothers in their home environment, through home visits from postpartum doulas or direct care primary care and family medicine doctors (there are more of them than you might think!).  

Culturally, we must relearn to “mother the mother” as author Heng Ou advocated in The First 40 Days: The Essential Art of Nourishing the New Mother. We must grasp the crucial tethering between her wellbeing and her child’s, as well as that of her whole family. Because a mother’s love is the light of her whole home, we have to care for her first in order to care for her baby (and any other babies that may come down the road).

We must come alongside new mothers (whether it’s their first or twelfth time) in tangible, albeit often prosaic, ways. When we do this, we can help drive down postpartum depression rates and enable women and families to welcome as many children as they hope for.