by Hannah Davidson, 16F
“From Home to Clinic, and Back Again”
The origins of this project are before my time at Hampshire College began. It’s early June, 2014, and I’m driving my beat-up Chevy Lumina towards one of the many hilltowns nestled back behind the more populated Pioneer Valley in Western Massachusetts. These are roads I’m familiar with, sparsely dotted with landmarks from my childhood: the baseball field where my sister played Babe Ruth baseball, the old bar in town where me and childhood friends meet when we find ourselves back home with free time; the swimming holes and river bends where the freshwater is numbingly cold. But though this landscape is familiar, I am here for another, new adventure: that of supporting mothers in early postpartum through a grassroots organization dedicated to providing free care and support to new families.
In my time with this organization, I gained tender, vital glimpses into the minutiae of new parenthood. I swept floors, fed dogs, folded laundry, and prepared meals. I held small newborns while mothers showered, and I served as a careful, compassionate listener to birth stories and emotional distress in the vulnerable postpartum period. On occasion (though I would learn later this was against the rules), I drove mothers without access to transportation into town for grocery runs, or to doctors’ appointments. In these ordinary moments was something that I was never, and don’t think I ever will, be able to release: a fascination with this vulnerable time of postpartum, and the emotional and identity shift that comes with it.
Fast-forward through a circuitous path to Hampshire, which included nursing and medical school pre-requisites, several research positions at the National Institutes of Health, and a summer shadowing physicians in Mexico, and you have me, completing a Division III examining the meanings that mothers and clinicians make of postpartum depression. I entered my Division III project with a desire to bridge the perspectives of mothers and care providers. I felt, and still feel, that there is something interesting about operating at this intersection of clinical knowledge(s) and the personal, subjective experience. What my research, funded by the Ethics and Common Good Project, ultimately taught me was that my early vision of these things as binaristic—clinical knowledge, and subjectivity in the experience of a mental illness—are in fact not as separate as I had previously conceptualized. Instead, these concepts are related on a sort of continuum, where subjectivity, science, structures, and the bodies that both receive and enact care are all interrelated and interdependent. By making visible such a continuum, I feel that this work, my labor of love, also makes visible what can, and needs, to be done to support mothers in postpartum.
Postpartum Depression and Community Impact
Postpartum depression affects an estimated 10-15% of mothers after giving birth, with this value climbing up to 20-25% of African-American and Latinx mothers (1). Postpartum depression became a formal diagnostic category in the 1990s, in part due to a growing body of vocal mental health professionals committed to supporting mothers and characterizing the vast transition inherent in the postpartum experience (2, 3). This clinical recognition also came into consciousness as more mothers joined together to vocalize their distress and lack of social supports in postpartum, frequently through peer support groups (3).
Postpartum depression is principally characterized by symptoms like fatigue, loss of appetite, emotional distress, and irritation (4), and risk factors for postpartum depression vary from a previous mental health history, to complications during labor, to social isolation (5). Sometimes, mothers principally experience anxiety, a reality that has led to a shift in language around perinatal mental health to shift from using postpartum depression as a catch-all and to instead shift the language to “Perinatal Mood and Anxiety Disorders.” No matter how you measure, diagnose, or characterize it, postpartum depression is complex, and imbued with rich social, biomedical, and personal meaning.
“Other Synonyms for Messy”
My research consisted of interviewing mothers, along with care professionals who support them, in a semi-structured interview format. Semi-structured interviews are guided by several prompts, though depending on the responses from participants, the interviewer may ask the interviewee to elaborate on certain themes or concepts that stem from the scripted questions. In total, I interviewed 17 participants—nine of which were mothers, and eight of which were various health care professionals, ranging from psychiatrists, a family physician, several social workers, and a licensed genetic counselor. My shortest interview was around 30 minutes, and my longest interview was nearly 90 minutes.
One of those interviews was with a mother local to Western Massachusetts, named Jessica (per the requirements of the Institutional Review Board, I use pseudonyms to identify my participants). Interspersed through our conversations about the identity shift that comes with motherhood, and notes about her identities as a queer, adopted woman of color, and how they intersected with motherhood and the care she received during her pregnancies, Jessica’s children climb on mine and Jessica’s lap, asking for snacks or simply wanting to listen in on our conversation. I came to enjoy this aspect of my research, and the way in which it reminded me of how grounded this work is in the lives of the people I interviewed. At one point, at the end of one rich answer to my questions, Jessica looks off into the distance, and remarks:
It was just messy, and…other synonyms for messy.
Ultimately, I believe the purpose of my Division III was to characterize the messiness using the knowledges and histories that had become familiar to me during my time in undergrad. The written product consisted of three chapters: in my first chapter, I examined the role that scarcity plays in claims made by mothers and care providers alike about postpartum depression. This chapter also presented a history, rewritten, about the clinical life of postpartum depression, linking the history of psychiatry through deinstitutionalization and beyond to the women’s health movement. My second chapter looked closely at the subjective meanings applied to screening instruments, as I learned quickly that screening for postpartum depression often occupies fraught terrain for mothers while clinicians are simultaneously advocating for screening to be utilized consistently in clinical settings. In my third chapter, I examined how three embodied realities of maternity—breastfeeding, sleep, and hormonal shifts in postpartum—wedge mothers into an often uncomfortable “material reconciliation” between themselves and their infants. By elaborating on the entwined biology and culture underpinning these reconciliations, I highlight how these are unavoidable realities of postpartum experience that mothers must navigate with little guidance or support from the structural powers around them (e.g., hospitals, community resources, and providers themselves).
Towards Better Perinatal Futures
I entered this project as a full-spectrum doula and pre-med undergraduate student with a keen interest in the postpartum experience. A part of my praxis entering this project was my commitment to reproductive justice, coupled with my desire to use my last few months at Hampshire to critically examine the ways in which my chosen profession—medicine—approaches maternal mental health care. What I found was that there is still much to be done, and my chosen interlocutors have lots to say about what is still needed. I deeply valued what came from offering mothers and providers the space to name their dreams and desires for the ideal kinds of support during this time. To me, these possible perinatal futures not only gave glimpses into the mothers and their experiences with postpartum depression; they made visible that which is still necessary to build. At once, their responses were entirely mundane—suggesting social safety nets that should unquestionably exist, like state-subsidized childcare costs and paid parental leave—as well as powerful indicators of the ways in which we need better supports for mothers. Here, my work intersects with a few of the core principles of Ethics and the Common Good: community, equity, the commons (in particular, scientific and clinical knowledge), and collaboration.
To me, this project was, and is, a beginning. As I prepare to transition to a position at the National Institute of Health (NIH)’s Behavioral Endocrinology lab, where they examine mental health conditions related to reproductive health milestones (like postpartum depression), I look forward to turning my eye to the ways in which science and scientific inquiry can hold itself more accountable as a powerful resource in care. I also hope to use my time at the NIH to address some of the gaps left in my research: in particular, those related to gender and race (my sample was ultimately comprised of predominantly white, cisgender women who gave birth and experienced postpartum depression). To that end, I intend to apply to become an NIH Academy Fellow, a rigorous program added on to service with the NIH where postbaccalaureate students design and execute a community-based project related to health disparities in clinical and scientific research, on top of their existing laboratory position. Here, I hope to continue the thread of praxis shaped by values of Ethics and the Common Good in a new community that will be my home for a short time, and make myself available to provide community-based research on maternal mental health needs in a diverse community—the DC Metro Area. Here, I hope my work will be shaped by the values I tried to incorporate into my Division III research: radical empathy, compassion, and a desire to improve the conditions under which people decide to parent.
Hannah Davidson graduated Hampshire College this past spring, where she studied medical anthropology, biology, and reproductive health. Currently, she works at National Institute of Mental Health (NIMH) in the Behavioral Endocrinology Branch, where she is examining the relationship between stressful life events and depression in menopause. In the coming year, she hopes to apply to combined MD/PhD programs and continue the work of blending biological and cultural inquiry on maternal health.
(1) Pearlstein, Teri, Margaret Howard, Amy Salisbury, and Caron Zlotnick. 2009 Postpartum Depression. American Journal of Obstetrics and Gynecology 200(4): 357–364
(2) Dubriwny, Tasha N., ed. 2013. Postfeminist Risky Mothers and Postpartum Depression. In The Vulnerable Empowered Woman Pp. 69–106. Feminism, Postfeminism, and Women’s Health. Rutgers University Press. http://www.jstor.org.5colauthen.library.umass.edu/stable/j.ctt5hjfn.7.
(3) Taylor, Verta. 2016. Rock-a-by Baby : Feminism, Self-Help and Postpartum Depression. Routledge. https://www.taylorfrancis.com/books/9781134716661, accessed September 25, 2018.
(4) Harkness, Sara. 1987. The Cultural Mediation of Postpartum Depression. Medical Anthropology Quarterly 1(2): 194–209.
(5) Nicolson, Paula. 2003. Postpartum Depression: Women’s Accounts of Loss and Change. In Situating Sadness: Women and Depression in Social Context. New York: New York University Press.
(6) Byatt, Nancy, Kathleen Biebel, Rebecca S. Lundquist, Tiffany A. Moore Simas, Gifty Debordes-Jackson, Jeroan Allison, and Douglas Ziedonis. 2012. “Patient, Provider, and System-Level Barriers and Facilitators to Addressing Perinatal Depression.” Journal of Reproductive and Infant Psychology 30 (5): 436–49. https://doi.org/10.1080/02646838.2012.743000.
Image by Jenna Norman