Does EFA work with post partum depression?

Like any depression, a genuine post partum depression contains a mixture of suppressed emotions—mainly grief, longing, and rage. But sometimes these tend to break through. There is more a state of post partum anguish, in which the woman is swept by waves of longing, often for her own mother; sadness which is sometimes indefinable, sometimes linked to things which have gone wrong during pregnancy and birth; and rage, at the husband for being in some way inadequate, or even more irrationally, at the baby. No wonder these conflicting emotions are hard to endure. Some women have even become psychotic after birth, as a kind of flight from this unbearable vulnerability. Others become dully depressed, in the usual sense of the word. But most often the main characteristic of post partum anguish is the woman's complete lack of defenses against waves of emotion which might ordinarily be under control.

Although emotional distress is sometimes psychologically generated, there are known physiological causative factors, such as hormonal changes, which much not be ignored. It is tempting to look always for emotional causes for emotional distress. But sometimes emotional conditions, even if they are related to problems of daily life, are consequences of physical changes. An example is nausea and vomiting in early pregnancy. Some psychoanalytically oriented researchers claim to have isolated emotional causes, such as that the mother to be is emotionally rejecting the pregnancy, or recalling rejection from her own mother. But there is overwhelming evidence that the condition is physiologically based, and biologically functional in that it causes the woman to take extra care of what she eats and does. Similarly, post partum anguish may be partly functional. The mother's exquisitely raw sensitivity and fussiness may help her take the best care of her baby's needs. When anger is directed at the baby itself, this is dysfunctional, but it may be a secondary result of frustration in the environment—the hypersensitivity of post partum anguish being thwarted and misdirected.

It is not usually realized, in a society where birth is dominated by technology and drugs, that birth is a radically "dearmoring" process, in which the mother's muscular defenses against feeling are dissolved or smashed through. An unmedicated mother (see Chapter 8) may be swept by many emotions during childbirth. Her body is in the grip of a process which seems larger than she. (I suppose the only way a man can understand this is to remember occasions where he has been racked by violent digestive cramps or vomiting: during such episodes the person can muster no resistance, and afterwards feels "weak as a kitten"). A woman after the huge experience of birth literally cannot muster her defenses. Muscular holding in the whole body, but most especially in the abdomen, pelvis, genitals and legs, no longer exists. The old muscular tensions reestablish themselves over the following months, as hormone replenishments return to normal. The hormones released during pregnancy have worked to soften muscles and reduce tonus, and this process is only reversed gradually afterwards. As the woman "armors up" again, defenses are largely re-established, and post partum anguish or depression disappears.

There is, I think, one lasting benefit from the de-armoring process of childbirth: in almost all women the abdominal and pelvic muscles do not completely regain their former state.

They may regain tonus, but much chronic rigidity has been permanently dissolved. Young girls with tight abdomens which suppress feeling, have after childbirth soft abdomens which are open to more feeling, including sexual sensation. And yet the aesthetic dictates of society require that they exercise frantically to get back their adolescent look—not only to "firm up their tummies," but to restore hardness and rigidity. Luckily, this does not usually work. I suspect the emotional depth and maturity of many women who have been mothers is partly due to the de-armoring process of birth. I have seen in therapy some mothers who have reacted to this process with an exaggerated girlishness, enforced by high and anxious breathing to keep above the feelings in the abdomen. But more often the mother's whole personality has deepened. This seems the more so, the less the birth has been medicated. When the mother can live the letting go of the armor, it is more complete because physical de-armoring has been accompanied by emotional release. The positive effects of the mother's letting go of armor physically may be vitiated by the heavily medicated mother's awakening into a sense of anxiety or panic.

There is evidence that post partum depression is more severe after heavily medicated births. The theory to explain this is that the birth has been somehow unreal and unlived, and the baby, therefore, seems more alien. My impression is that after a medicated birth there is more genuinely a depression, in which many feelings are suppressed, and which is long-lasting and chronic. After an unmedicated, natural birth, there is more the anguish I have described, in which a turmoil of emotions is expressed, and which is acute. Also, a mother who breastfeeds is less likely to direct her anger at the baby, but may do so at the rest of her family.

EFA can help greatly in post partum anguish, because as usual by gradually working down through layers of emotion as they present themselves, it moves the person out of the quagmire of mixed feelings and conflict. In post partum depression it may be more difficult to help the emotion flow, since it may be "frozen in." EFA during labor may diminish subsequent post partum anguish or depression. At least it is true, from discussions I have had with doctors and midwives who have assisted at natural births, that when emotions have been freely expressed during labor the mother is in better emotional shape after the birth. Emotional support during pregnancy, labor, and the months after birth is essential. Many mothers are labelled as having post partum depression because they seem to make "unreasonable" demands on those around them, and become upset when these are not met. But this may be a rebellion against the social milieu which may fuss about the birth to come, and the baby itself, but which gives little recognition to dedicated mothering.