The last decade has brought a great deal of attention to the affective disorders that can occur during pregnancy or the postpartum. Many brave women have come forward to share their stories, exposing their struggles so others might hopefully escape a similar fate.
Initially, postpartum depression was associated primarily with the period after pregnancy (thus postpartum), but we have since learned that many of these disorders may occur during pregnancy (antepartum). The entire period of pregnancy and the postpartum has come to be described as the perinatal period.
We now know that the approximately 800,000 women who will experience a diagnosable postpartum mood disorder this year after live births are the statistical majority, but not the whole story. Women who miscarry, whose babies are stillborn or who lose their infant shortly after birth are also at risk. Those numbers are in the thousands further raising the population of vulnerable women who are susceptible to such disorders well into the millions.
It can be easily understood that the psychosocial stressors of loss, combined with the biological shifts of pregnancy, could heighten affective risk following these tragedies, which often result in a disenfranchised grief for these mothers. Well meaning loved ones may attempt to soothe with statements that she can soon become pregnant again, that she will have another child. Such predictions tend to have the opposite effect further invalidating and isolating the mother's experience. Her womb was infused with the biology of creation, her breasts were preparing to nurse a child, her arms preparing to receive a baby. Her heart and soul were thus attuned and the loss can be grieved forever. Perinatal research is appropriately identifying and including this group in postpartum studies and treatment. We know we need to follow these mothers carefully. After all, they are united with their live birth sisters by the uniquely personal biological and psychosocial influences of pregnancy.
But there is another group of women who have lacked representation in such studies or who are sometimes presumed to need no such services at all.