October 29th 2021 – reading time: 5 minutes

The Heavy Cost of the Lack of Postpartum Care

On 10 October, the Secretary of State for Child Protection, Adrien Taquet, announced the introduction of a « baby box » that every new parent will receive upon leaving the maternity ward from February 2022 onwards. The box will contain a sleeping bag for the baby, a picture book for their cultural awakening, a natural soap and… a moisturising cream « to remind [the person who gave birth] to take care of theirself. » 

A measure completely off the mark according to Illana Weizman, a sociologist known for launching #MyPostPartum. In an Instagram post reacting to the announcement, she said that the measures were on the same level as « magical thinking/personal development/low-end motivational coaching » and that postpartum support policies should be completely
rethought. “Take back your cosmetic efforts, […] we want radical changes ».

According to her, one of the priorities when it comes to postpartum issues should be the mental health of the people who have given birth and of their partners. “For eight months after my son was born, I didn’t dare ask for help even when I felt terrible,” she explains to Les Glorieuses. « I felt guilty because nobody talked about these difficulties and I felt like a bad mother. One day my body gave out. I started to cry and I couldn’t stop. » She decided to seek professional help and began therapy. « It took me a year to get over my postpartum depression.| She estimates the cost of her therapy at €3,120 for one session per week.

A global impact

Postpartum struggles are not limited to mental health: “the postpartum period costs the couple greatly in terms of their relationship. In my opinion, it is the end of a couple’s romance’,” continues the sociologist. “Postpartum problems correlate with the accumulation of mental and domestic burdens, especially for mothers in heterosexual couples, which contributes to the breakdown of the couple due to resentment.” According to a British study on the subject, the cost of a poorly managed postpartum period (psychologically and emotionally) could amount to £10,000 for a family over a lifetime. 

Annette Bauer, a researcher at the Care Policy and Evaluation Centre and one of the authors of the study, explains that they used a modelling system to reach this
conclusion. « Through studies conducted over the course of 30 years with postpartum women, we were able to obtain data on perinatal health problems and other long-term issues. » The researchers also added to this data the long-term health impacts on these people’s children, such as cognitive problems. « We were guided by the idea that if people who give birth are negatively affected by the postpartum period, this must have an impact on the mental health of their children, » she says. They then put a monetary value on all this data.  

All the potential costs were included:  »not just postpartum medical and psychological treatments, but also their impact on quality-adjusted life-years, which is calculated annually in the UK and is worth between £20,000 and £30,000 ». She adds that only postpartum
depression, anxiety and psychosis were included in the study, but that many other mental health conditions can affect postpartum people, such as OCD or post-traumatic shock syndrome after a traumatic pregnancy or birth.

Added to these costs are the potential losses related to mental health problems for future children, which may affect their access to employment. “It is important to understand intergenerational relations in economics: our vision of society no longer depends on individuals but also on the family and its community, because we can imagine, for example, that if a child’s main carer can no longer take care of them, another family member will take that carer’s place and this will impact on both of their economic situations, » says Annette Bauer. The researcher also says that there is growing evidence surrounding the
impact of postpartum difficulties on the mental health of the second parent. 

Community support

There is a lot of evidence to suggest that cognitive and interpersonal therapies help people recover quickly from postpartum mental health problems, although we don’t yet have data on how these therapies affect children’s chances of developing mental illness, » the economist continues. But early intervention in this area is not the only thing that needs to be done: postpartum mental illnesses mostly affect the most vulnerable populations, less economically privileged and with a less effective support system. She says it is essential that treatment includes social components, such as financial reimbursement for care.

Support
systems and community are concepts that come up time and time again when talking about postpartum mental health. Alexis Palfreyman, a researcher at UCL Global Health in Sri Lanka, has been researching the Sri Lankan community-based model of maieutics. In this country, suicide is one of the biggest causes of perinatal mortality. Postpartum support is provided by both the family and a midwife. But one midwife takes care of about 750 families; that’s between 2000 and 3000 people. « It’s a huge burden for them. The duration of the visits is very short and they can miss important things, all because of a lack of funding. But it’s not all black and white: these carers look after most of the population. In 1970, when this public health system was introduced, they only cared for pregnant and postpartum people, and children under 5. Since then, they have extended their competences to
contraception, the care of teenagers and an increasing variety of health concerns.”

Midwives therefore have a special relationship with the families they care for: « They know who you are, and if they have been practising for a long time they may have looked after three generations of your family. They know what’s going on in the home, and even if they’re not trained to deal with psychological problems for example, they have a deep understanding of what might influence the mental health of a pregnant or postpartum person. Families trust them with a wide range of issues, giving them significant power in the community, which is very different from Western societies. This community-based model has the potential to help reduce the incidence of suicide and mental illness in the perinatal period dramatically, but the government needs to
heavily invest in increasing the labour force of midwives to reduce their workload, and in the continuity of care.

Globally, the researcher sees much scope for improving the level of public health policies. « We should not be surprised to see such high rates of postpartum depression when many studies show that it is not only caused by hormones, but is influenced by external factors, for which community support is the most important, » she says. 

She points to specifically-trained mental health midwives on maternity wards in the UK, something Illana Weizman also proposed. “Professionals specifically-trained in postpartum mental health issues, instead of leaving parents to get by alone until the sixth-week appointment, when they are vaguely asked how they are feeling. We are
told that it’s normal to cry a lot because of the hormones and then we’re sent home with no advice, despite the fact that depression often begins several weeks or months later. » According to her, a proper physical and psychological follow-up should be reimbursed by the social security system and should last two to three years.

To this, she adds the importance of introducing a leave of absence for the co-parent that is as long as that of the person who gave birth, which would make it possible to balance the domestic and parental workloads. Alexis Palfreyman adds that  »we often forget to think of the postpartum people who go home without a baby due to miscarriage or stillbirth. All of these people also need support and are completely overlooked when it comes to perinatal mental health. »

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