Maybe it’s Not Postpartum Depression. Maybe it’s American Motherhood.

Photo by Christopher Campbell on Unsplash

When I gave birth to my daughter, my mother had dementia severe enough to require constant care. My brother was in and out of jail, and calling me nightly to demand more money. Breastfeeding wasn’t working, and instead each feeding took 2 hours with a supplemental feeding system. The baby did not sleep longer than 45 minutes at a time for the first year of her life. I had a painful tear from giving birth. My husband and I were both self-employed, which meant every day we didn’t work we were not paid. And yet our insurance declined most of the cost of our unmedicated vaginal birth, and our hospital kept sending us a $7,000 bill. I was exhausted, overwhelmed, demoralized. During my daughter’s nightly 45-minute stints of sleep, I was too anxious to fall asleep.

But when my midwife gave me a depression screening, the test asked if I had been anxious or unhappy “for no good reason.” I answered no. Because there was a reason.

With postpartum depression, there is always a reason. And this is what we get wrong when screening for it, when describing it, and when treating it. Did I have depression? No, but I had something. The standard indignities of American motherhood in a society that views mothers as disposable.

Everyone has hormones, and hormonal swings occur throughout life—to people of all sexes and all genders. These shifts are most pronounced during pregnancy, not after, so why is it that so many women seem to get depressed after giving birth? Maybe hormones aren’t the problem. Maybe the issue is that our normal expectations of mothers destroy mental health.

Suicide is a leading cause of death after giving birth. Between 10 and 15% of American mothers are diagnosed with postpartum depression, but many more struggle with depression symptoms. Almost all report experiencing the baby blues after giving birth.

Popular wisdom tells us the problem here is women’s hormones. This is an explanation with a long and rich history, deeply rooted in medical misogyny. Its ancestors include the idea that wandering uteruses cause mental health issues, that women’s pain is not real, and that college degrees destroy fertility. It’s a lot easier to blame something on women’s biology than it is to look at the social context in which a problem arises.

But consider with me what the typical American birth looks like:

A person gives birth. If she’s like 90% of American women, she’ll receive at least one medically unnecessary intervention that increases her risk of complications. Or she’ll be part of the 30% of birthing people who undergo major surgery, then are sent home to care for an infant (and often, an infantile husband). If she’s like nearly half of new mothers, she’ll experience some form of birth trauma. The most significant moment of her life may become little more than an act of abuse and victimization. And if she’s Black, she’ll give birth in a system in which half of doctors believe racist myths about Black pain, and Black birthing people routinely report experiencing racist language and other forms of racist abuse.

She’ll go home. And if she’s like most women, she’ll try to breastfeed. She’ll quickly learn that our culture is not supportive of breastfeeding. Breastfeeding demands time, effort, and support—three things American mothers don’t get. Her spouse may be jealous. He may expect her to make him dinner, to clean the house, to continue doing a disproportionate share of the housework. Her friends will tell her to just give the baby a bottle. If she nurses in public, someone might tell her to cover up. At work, she may face discrimination and difficulty pumping.

Her baby probably won’t sleep well, because babies don’t sleep well. But don’t count on her getting much help. New dads lose an average of just 13 minutes of sleep per night. New moms continue to see their sleep suffer for 6 years after birth, losing an hour or more each night. Even though she’s recovering from birth, she’ll likely be up alone feeding the baby and pleading with them to go back to sleep.

But don’t worry! No one will be there to praise her for her sacrifice. Her partner may start pressuring her to lose weight or get back to sex. Maybe he’ll even verbally abuse her. This piece written by a self-described feminist man suggests it’s totally normal to call your wife names after she gives birth. No biggie! Ask her to push out your baby, force her into months of sleep deprivation because you’re too lazy to get up, then call her a fucking bitch! It’s just for funsies.

She’ll find plenty of mom-shaming everywhere she turns. If she talks too much about her baby at work (where “too much” usually means talking at all), she’ll be deemed unserious. Her wages will likely never recover from giving birth, even though research shows that mothers are more efficient than other workers. And while we’re talking about work, don’t forget that just 12% of private sector women workers have paid leave, so she’s going to have to rush back to work so her family doesn’t starve.

No need to panic, because the safety net will be there to catch her. LOL JK. She’ll get a bill within a couple of weeks for all the stuff her insurance didn’t cover. It will be anywhere from a few hundred to tens of thousands of dollars, and many of the charges will be totally arbitrary, with few realistic options for disputing them. The good new is that she has choices: pay up now, at one of the most expensive times in your life, or ruin your credit.

She’ll get a single postpartum appointment at 6 weeks. Insurance likely won’t pay for the pelvic floor rehab she’ll need. And finding quality mental health care covered by insurance is virtually impossible.

Yet when this typical American woman, after months of sleep deprivation and abuse, starts to feel sad and anxious, we’ll blame her.

Don’t worry. It’s just your hormones. Your body just failed you. Here’s a pill.

And when that doesn’t work, no one will tell you that antidepressants work no better than a placebo for most people, and that more than half of people who take antidepressants get no relief at all. Instead, she’ll be told to try another antidepressant, or a higher dose, or to go to couples counseling or exercise more, or or or…

Maybe the better advice is to tell her to get radicalized and demand something better from the garbage dump society that demands so much from her and which keeps taking, all while gaslighting her into believing that’s not what’s actually happening.

This isn’t just some radical feminist opinion, either.

This study highlights the prominent role of psychosocial factors and life stress, not hormones, in postpartum depression.

This one found that being a housewife was a significant depression risk factor.

This one emphasizes that spousal abuse commonly induces postpartum depression.

This one highlights the role of sleep deprivation.

Yet another study highlights low social support, marital problems, and stressful life events.

There’s a theme here: None of the scientific research I was able to find found demonstrable hormonal differences between women with and without postpartum depression (and almost none looked for these differences, almost as if researchers know this isn’t really about hormones).

But we keep telling women otherwise. What to Expect, the online pregnancy Bible, falsely claims, “It’s believed that hormonal changes that happen after childbirth may trigger symptoms.” March of Dimes tells us that genes and hormones are to blame. It’s a lot easier to blame the things we cannot change or control than it is to place the blame squarely on the shoulders of those who deserve it:

• An entire governmental apparatus that has failed to protect the well-being of pregnant people by ensuring they get time off of work, fully funded healthcare, support to feed their babies, a path out of poverty, or anything else that could improve outcomes for families.

• Men. Men who don’t get up with the babies, who insult and demean their partners, who expect people recovering from childbirth to do more work, not less. Men who benefit from their partner’s labor at work and at home, while either denigrating that labor or pretending it doesn’t exist at all.

• Employers who don’t give time off, don’t respect mothers, offer lower wages, fire people for taking maternity leave, discriminate against pregnant people, and make balancing motherhood and work impossible.

• An entire society built around anti-mother misogyny, built around pretending that mothers’ work doesn’t exist or doesn’t matter.

Get treatment. Get support. But most importantly, get radicalized so that this is the last generation to be told that their socially constructed problems are individual failings. The personal is political, especially when the entire culture is structured around convincing you it’s hormones, it’s all in your head, and it’s definitely not anyone else’s problem.