Re the subject of ppd cross-culturally:

I have just had a Master's student finish her thesis on post-partum
depression in evolutionary and cross-cultural perspective.  For her thesis
she did a thorough search and review of the literature, and developed a
protocol for her Ph.D. research.  What she found, in brief:
(1) definitions of what constitutes post-partum depression are hopelessly
inadequate, as different researchers use different check-lists of symptoms,
and fail to distinguish between trainsiet "baby blues" (feeling weepy and
overwhelmed for a few days), from more serious depression, from true
post-partum psychosis (thoughts of killing the baby or oneself, for
example).  In some studies anyone with any symptom at all is consider to
have ppd.
(2) much of the literature on cross-cultural comparisons has found much less
ppd in non-western cultures, and that finding is always explained in terms
of the social support system found in the cultures, such as isolation of
mother and baby for some time after birth (sometimes only 8 days, sometimes
40 days, sometimes 3 months), relieving mother of all other duties, etc.
*However* what these studies have fail to take into account is that there is
another huge biologically-based difference between cultures where mothers
routinely get this special support after giving birth and western
industrialized countries, and that is *breastfeeding.*

She (Kelly, the student) developed a model of what mammalian motherhood is
typically like, in terms of changes in maternal behavior brought on by the
birth process itself and by oxytocin.  Much of this is based on animal
research models, where virgin rats given vaginal and cervical stimulation
*and* shots of oxytocin, will appropriately "mother" newborn rat pups.  I
found this research fascinating, especially in light of what it might mean
for mothers who have C-sections before labor has begun -- the physical
stimulation of the cervix and vagina during the birth process seem to be
required for normal mammalian maternal behavior.  Also, Kelly found that
many of the symptoms that are defined in non-human mammals as "normal,
appropriate, maternal behavior" are the very same symptoms defined as
"post-partum depression" in humans.  These include easy incitability to
protective behaviors, including anger and annoyance at others, being very
touchy about anyone getting near the baby, aggressiveness, a desire to
hide/nest away from others, and shunning social contact with other adults.
Kelly writes that part of the problem with the psychological/psychiatric
literature on ppd is the assumption that a return to pre-pregnancy social
behaviors after birth is the norm, when in fact, you should expect the
mother to be profoundly changed by giving birth, and a return to
pre-pregnancy psychological state would NOT be expected.

She goes on to evaluate the role that breastfeeding might play in these
contexts by looking at the hormonal consequences of oxytocin release.
Again, she reviews the literature on animal models and finds that injections
of oxytocin into rats who have developed "learned helplessness" a widely
accepted animal model of human depression, work just as well at relieving
symptoms of depression as the best pharmaceutical drug available for
depressed rats.  That is to say, oxytocin has powerful anti-depressant
properties, and the absence of oxytocin in bottle-feeding mothers should
therefore contribute to more ppd in bottle-feeding mothers, which is what
one finds.  Studies have shown that the first few minutes/hours after birth
are critical for establishing the presence of a healthy baby through
suckling at the breast -- this triggers permanent changes in the mother's
behavior.

She suggests that part of the difficulty for bottle-feeding mothers is the
conflicting signals that the mother's body is getting -- her eyes, ears,
nose, hands are sending signals that the baby is alive.  Her breasts/hormone
system are telling her that the baby has died (no nursing = dead baby), so
she is experiencing appropriately depressed feelings that her baby has died,
yet here IS this crying, unhappy baby.  So she has conflicting messages.
She also has a baby who is crying and unhappy, but does not have the
appropriate internal hormonal environment that would help her cope with this
baby.  Her body is confused.

Kelly suggests that even in cases where the mother is breastfeeding, the
lack of immediate nipple stimulation in the hour after birth, when the
mother's body is primed to receive a message of either (1) baby is alive and
well, or (2) baby is dead, can result in long-term differences in maternal
affect and behavior.  So when the baby is taken away for "routine
observation" by the nursery nurses, the mother's body gets a loud and clear
signal that the baby has died.  This triggers a series of hormonal events
preparing to shut down the whole system for maternal behaviors.  Then here
comes the baby again, and the oxytocin starts flowing, but some/much of the
critical time period has passed, and again the mother is confronted with
conflicting signals.

Anyway, I find this topic fascinating.  Kelly concludes that to untangle the
mystery of ppd, you need to have valid cross-cultural definitions, separate
out the transient baby blues from lingering ppd from psychosis, not use
"normal mammalian maternal behaviors" as symptoms of illness, and
distinguish between the supportive/nonsupportive effects of the social
environment from the biological effects of oxytocin/no oxytocin due to
breastfeeding.  She predicts a continuum of true ppd, from rarest where you
have continuous contact after birth, frequent breastfeeding and a supportive
social environment to most common where you have separation after birth, no
breastfeeding, and a non-supportive environment.  In between would be the
two cases of no breastfeeding but supportive environment, and breastfeeding
without a supportive environment.

Final note: I am going no-mail for two weeks to attend the American
Anthropological Association meetings in Washington D.C., and then to go
visit my wonderful in-laws (they really are wonderful!) for Thanksgiving.
Will see you all in two weeks.




Katherine A. Dettwyler, Ph.D.
Associate Professor of Anthropology
Specialist in infant feeding and growth of children
Texas A&M University
e-mail to [log in to unmask]
(409) 845-5256
(409) 778-4513