REVIEW: Postpartum Depression in America

Beyond the baby blues

Blue: A History of Postpartum Depression in America by Rachel Louise Moran. University of Chicago Press, 2024. 304 pp., $30.00

In the introduction to her recently published Blue: A History of Postpartum Depression in America, Rachel Louise Moran recounts an interaction with her psychiatrist while pregnant: discussing whether she should stay on antidepressants after birth, admitting she had no maternity leave, feeling the pressure of first-time motherhood. This is a fitting way to begin a book that is held together by stories of individual women, their interactions with the medical world, and their decades of advocacy. 

Conversations around postpartum depression are now common. More women are screened for it than in the past. Women regularly admit to struggling with it. There is a general awareness that sometimes mothers require medical or psychological help during the postpartum period. But this was not always so. When she began research for this book, Moran realised that she would have to talk to advocates who campaigned for postpartum depression (PPD for short) to be recognized as a legitimate medical condition. 

Chapter 1, “Baby Blues and the Baby Boom,” summarizes the history of postpartum-related conditions up to the 1970s. In the nineteenth century, there was an understanding of what we now call postpartum psychosis but was then known as “puerperal insanity.” By the postwar period, however, there was a growing sense that women could experience sadness after birth to a less alarming extent than psychosis—the so-called “baby blues.” Many middle-class women in 1950s America moved to the suburbs and experienced the loneliness and dissatisfaction that we now most often associate with Betty Friedan’s Feminine Mystique (1963). Moran notes that “an expectation of ‘total motherhood’ plagued these women in the sense that raising those children ought to be emotionally fulfilling and a labor of love, never simply a labor.” 

Various suggestions were offered: Some doctors recommended shopping therapy for new mothers. Some blamed the unhappiness of middle-class women on their dreams and ambitions: They were simply too “educated” to enjoy motherhood, and this was a threat to the traditional family. Some feminists thought the medicalization of birth was the source of all evil. At the same time, the natural birth movement started to take off. This is particularly relevant to us now given the growing—and in some ways dangerous—popularity of “natural birth” and even “free birth” in the United States. Others argued that mothers were set up for failure beginning with their stay at the hospital; that women should room with their infants rather than placing them in hospital nurseries; that motherhood was tough, and the quicker women learnt it, the better. We can see in these suggestions the tendency to blame women’s failure to achieve perfect motherhood.

The central chapters of Blue tell a different story: They recount the founding and growth of support groups and organizations in the 1970s-1990s that aimed to help mothers in the postpartum period. The men and women who ran these groups eventually began to collaborate. However, not all organizations were strictly clinical, and not all had the same outlook or priorities. For instance, James Hamilton and Ian Brockington, both part of the Marcé Society and both medical professionals, realized that postpartum depression in the U.S. and U.K. was affected by quite different socio-political circumstances. Having experienced pregnancy in both countries, I would say this is still very much the case. Perhaps the most obvious example is that giving birth without the prospect of maternity leave, a relatively common experience in the U.S.—as Moran herself discovered—adds stressors for a mother that she would not face with the U.K.’s (however imperfect) statutory maternity leave laws.

These tensions were always inherent in PPD advocacy. Should women’s struggle be medicalized? The medical stamp of approval, after all, afforded legitimacy to the condition. Or was society’s failure to support parents the real problem? If that was the case, then PPD could easily be politicized. Anti-feminists like Phyllis Schlafly had already argued that women would thrive and find happiness as long as they rejected careers and stayed at home with their children. This, of course, did not chime well with those who were in favor of government-funded childcare as the solution for easing the pressure on working mothers.

On the other hand, linking PPD to hormonal imbalance could be liberating for women; it made it a medical issue rather than a matter of moral failure. This helped women feel less guilt. Two new organizations that sprang up in the 1980s, Nancy Berchtold’s Depression After Delivery (DAD) and Jane Honikman’s Postpartum Support International (PSI), were intentionally non-partisan, supporting both working women and stay-at-home mothers. They were “grassroots” organizations, but they never put themselves at odds with the medical model. They knew they needed to collaborate with medical professionals to thrive. In Moran’s words, “legitimacy in part came through activist alliances with… psychiatrists.”

The final chapters of Blue focus on the role of mainstream media—especially talk shows in the 1990s and 2000s—in raising PPD awareness. Visibility for associations like DAD and PSI was a double-edged sword. Media appearances had the power to reach a large number of women, but they also sensationalized PPD by focusing on infanticide and suicide. 

One of Moran’s strengths is that she seeks to remain nonpartisan. This desire to avoid alienating those with opposing political priorities in the postpartum context, by framing PPD as both a women’s health issue and a family issue, is laudable. While Moran’s political leanings remain largely unobtrusive, the occasional use of terms such as “pregnant person” or “pregnant people” struck me as an odd choice for a book centered on the “demand that women’s pain be taken seriously.” 

Fortunately, this kind of language is not frequent enough to detract from the merits of Blue. When I started reading Moran’s book, I was in the depths of postpartum PTSD. It helped me make sense of my early experience of motherhood, to articulate its challenges, and to acknowledge the deep need for community as well as for medical help. The success of Blue lies in Moran’s talent for narrative; it is at once a scholarly work of history and a beautiful example of storytelling. 

I am left with the question of what public policy can do, practically, to ease some of the social and political factors that can contribute to PPD, but perhaps that is a matter for another book. Moran’s is not a story of perfect progress, but of increased visibility. I see the result of these women’s advocacy today in my own life. At my daughter’s twelve-month checkup, I was asked how I was doing. Was I experiencing prolonged sadness? If so, had I sought out help? My grandmothers weren’t asked this; neither was my mother. I feel a sense of gratitude for the women and men that made that conversation not only possible but normal and free of judgment. 

Beatrice Scudeler holds an M.A. in English from Oxford University. She is a freelance writer on literature, religion, the arts, and family life.