After the birth of her third child, singer Alanis Morissette decided to speak publicly about her struggles with postpartum depression. In doing so, she joined other celebrity moms like Brooke Shields, Chrissy Teigen and Drew Barrymore in breaking the silence around this issue.

According to the American Psychological Association, as many as one in seven new moms experiences anxiety and depression after childbirth, with half of those experiencing their first depressive episode. Many of us assume the days and months after a child is born are automatically full of bliss and joy, but these very pressures to be publicly enthusiastic can exacerbate postpartum depression.

In spite of medical advances over the last few decades that have made childbirth much safer than in the past, the experience can still be traumatic for mothers. Many women struggle with the physical changes in their bodies and the hormonal fluctuations that accompany gestation and childbirth. Births that require medical interventions like Caesarean sections can further exacerbate these issues. Perinatal depression is the most common complication of childbirth, and yet it’s very rarely openly addressed. With maternal deaths on the rise in the United States, about 20% are the result of suicide, making it the second most common cause of death in postpartum women. 

The symptoms of postpartum depression, commonly abbreviated as PPD, can start anytime during either pregnancy or the first year after giving birth and include feelings of anger or irritability; disinterest in the baby; feelings of guilt, shame, or hopelessness; and thoughts of harming the baby or one’s self. These symptoms are exacerbated in mothers with additional stressors, such as being a teen or living in poverty. Other risk factors are a family history of depression or anxiety, the recent experience of major life events like divorce or loss of a job, marital stress or inadequate support in caring for the baby. 

The stigma around postpartum depression

Like other mental illnesses, postpartum depression is surrounded by stigma. Unlike a physical diagnosis, it can be hard for friends and family to wrap their minds around a diagnosis of mental illness, and many people are uncomfortable because they don’t know how to react or support those who are suffering. The assumption that people suffering might be unstable, violent or even dangerous often prevents them from being open about their diagnoses or seeking treatment. At worst, the stigmas around mental illness can lead to bullying or violence toward the one suffering and reduced opportunities in one’s work, school or social life.

The combination of sexism and mental illness stigma is particularly perilous for women. In the past, women suffering from mental illness, or just those who didn’t conform to societal expectations, were diagnosed with “hysteria,” believed to be caused by disturbances in the uterus. Difficult women who chafed at convention were even institutionalized, with their behavior attributed to mood disorders or other hormonally related issues. Whether due to undiagnosed mental illness or simply rebellion, many women suffered under the stigma of being “crazy,” a label that still sticks today.

The stigma around postpartum depression is compounded by our cultural expectations of how women should respond during pregnancy and childbirth. Ideally, the period surrounding a birth is one of bliss and joy for a family as they welcome a new child into the world, but that isn’t always the case. Even in the happiest scenarios, having a baby is a huge transition for a family, and transitions bring stress. The sadness and anxiety that many new mothers feel when going through postpartum depression are complicated by the shame of not being unreservedly ecstatic about their baby and the fear of being a bad mother.

Mothers are already subject to a lot of external judgment on the choices they make, from how they want to give birth to whether they will breastfeed or bottle-feed. They’re told that being a mother will come naturally or that they will be overwhelmed by unconditional love for their child. The expectations for what makes a “good” mother are considerably higher than they are for male partners, and despite advances in gender equality, the bulk of the decisions around childrearing still fall to mothers. For a new mother to publicly admit that motherhood is difficult or isolating or anything other than a 24/7 lovefest is to risk further judgment and questioning about her capability. Women with other financial or relational issues might also fear having their children taken away if they seek help. 

How to help

In many churches, a birth results in the mobilization of the casserole brigade in support of the family as they adjust to their newest member. For a pastor, there’s nothing quite like visiting a family with a newborn and marveling at the miracle of life, along with the community’s willingness to assist. But at some point, the parade of prepared meals ends, and the father will likely have to return to work before the mother’s childbirth wounds are even healed. All of a sudden, a woman can find herself isolated from others and overwhelmed by the needs of her baby.

Once the baby is born, our American health-care system also seems to forget about the mother. Since many health plans cover only one postnatal visit, issues like postpartum depression, hemorrhage and infection frequently go unnoticed. Without mandated paid family leave, the economic pressures of taking additional time off of work after giving birth can also cause complications. Nordic countries are famously supportive of parents in the postnatal period, and the Netherlands even provides a home maternity nurse to assist and teach parents for the first eight to ten days after birth. Though some women are fortunate to have assistance from family members, providing these options for all families could help during this adjustment period.

In speaking to CBS News about her own experience with postpartum depression, Alanis Morissette encouraged friends and family members to simply show up — with no expectations — for moms who have recently given birth. Perhaps one of the most important things any of us can do is to be supportive of new mothers without requiring that they perform new motherhood in a particular way and acknowledge that even joyful transitions can be stressful and difficult. 

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