I sit up and take notice when, I read that Moms are up in arms over something they read online. I read their angry and hurt responses to each other.  Reactions to perhaps another misinformed author splashing unhelpful words through cyberspace, again challenging their collective effort to ensure that accurate information is being disseminated. 

The emotional reaction is understandable. But let me see if I can help clarify things.

The article that Ms Paul has written is a good article. She is articulate and clearly gifted. She specializes in helping people through life transitions, in particular, with respect to marriage, and is an accomplished author on that subject. She is, as she promotes herself, an expert on "the wedding transition". Which, (topic for another day) I think is awesome. She is also quite beautiful, well-spoken and someone I might want to reach out to if I were looking for help during a difficult transition. Watch her video clip on her website and you'll see what I mean. She's fabulous, really.

She is not, however, an expert on postpartum depression.

Here's where she gets into trouble. Although her article is excellent and makes important points about adjusting to motherhood — she makes the mistake of saying (in the article, on her website, and in her video clip): (the bold words are MY emphasis)  "And if you follow this roadmap — which isn't hard to do and takes just 10-15 minutes a day — you will prevent postpartum depression!" She goes on to say "Taking these three simple steps can be the deciding factor that determines whether your normal fear and loss descend into anxiety and depression or transform into serenity and an empowered transition into motherhood."

Wow.  It sounds so good, doesn't it?

So... on behalf of the Postpartum Progress fans who continuously and tirelessly work to find meaning to their struggle and validation from the larger community, and for everyone else who is interested in the delivery of accurate information on PPD, let me say this loud and clear:

No matter how hard you "educate yourself" (and you most definitely should!)

No matter how much you "express the difficult feelings" (and you should)

No matter how much "courage [you have] to explore the hidden thoughts that are lurking in your pregnant or new mom mind" (and you should)

You may not be able to prevent postpartum depression.

All, and I do mean all of the rest of her information in this article is correct. Ms Paul is offering excellent advice for women who hope to smooth into this transition with less anxiety and greater awareness. She does a super job normalizing the anxieties of pregnancy and new motherhood that are so universal. It is certainly reassuring to an anxious mother to read that this is common and to be expected.

But please, could well-respected, highly-accomplished experts stop promising women that they can prevent postpartum depression by buying their books, or taking their course, or by simply seeing things differently?

Don't get me wrong. I do not doubt the efficacy of cognitive reframing as a preventative measure. And I do not dismiss the value of learning how to protect oneself in preparation for such a huge life undertaking. In fact, as I previously noted, I agree with everything Ms Paul has written; the exception being, her unconditional promise of postpartum wellbeing.

But postpartum depression is a true medical condition. It is a clinical depression that meets the diagnostic criteria of a major mood disorder that affects approximately 15 percent of new mothers. With proper intervention, many of us are hopeful that we can reduce the impact of postpartum depression with the combination of support, psychotherapy, self-help measures, and medicine if needed. But prevention? It certainly should be a goal, but it cannot, and should not, be guaranteed.

Those of us who have studied, researched and treated postpartum depression for decades are still unclear as to exactly what causes it. Most experts agree that it is a combination of complex factors, including biological/chemical/genetic predispositions and psychological/social/environmental components. The particular triggers vary from individual to individual. And for any one person, we are not ever completely sure, why one particular woman experienced postpartum depression while another one, with the same risk factors, did not. We are still trying to isolate the variables and better understand the etiology. 

So until we really know, I think it's better not to claim that women can prevent postpartum depression. Tell them to protect themselves. Tell them to educate themselves. Tell them to be their own best health advocate. Tell them to express how they are feeling and what they need. Tell them to spread the word and educate others, particularly their healthcare providers. Tell them to resist the shame and stigma and let other know what they need. Tell them to take care of themselves, by eating, resting and exercising, so they can stay strong and healthy. Tell them to stop paying attention to people that are misinformed. Tell them to surround themselves with people and things that feel good. Tell them to create a plan of intervention, including a team of support people who know, who are watching, who can help.

But do not tell them that if they do all of these things, they will prevent postpartum depression.

It's unfair. And it's untrue.

*after this article was published, access to the article has been denied. For further discussion, see our facebook page 

copyright 2011 Karen Kleiman postpartumstress.com

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