Postpartum depression to strained ties: Why maternal mental health matters

Experts advocate for a relationship-centred approach to health care: training teams in attachment theory, creating accessible post-natal spaces and providing key figures to support families

Post-partum depression” has been discussed as an identifiable, measurable, treatable disorder for 50 years now. Thresholds, scales, prevalence rates: everything seems clear, even reassuring.

But this binary model — it’s either depression or not depression — obscures a more subtle reality: new parenthood is disruptive, makes us vulnerable and places us all on a spectrum of distress.

The notion of post-partum depression was established in 1968, primarily because it responded to dual academic and medical requirements: to lend scientific legitimacy to the suffering of new mothers and to provide a clear and specific diagnostic framework for a particular period of life.

At the time, emphasis was placed on the atypical nature of this depression, which resembled an anxiety disorder. Its specificity was considered to be solely related to its symptoms, and the challenge lay more in its detection than in its management.

Minimizing lived experiences

Furthermore, this specific characterisation made it possible to distinguish post-natal depression from the “baby blues” (sometimes called “chemical depression”) that occur in the form of brief depressive episodes linked to biological factors, particularly post-partum hormonal changes.

Since then, the debate has been confined to psychiatric classifications and screening tools. But that’s reduced a lived experience to a simple diagnostic category.

In a recent article published in the journal Neuropsychiatrie de l’enfance et de l’adolescence, we proposed, together with child psychiatrist Romain Dugravier, talking about perinatal relational distress rather than post-partum depression.

Far from being unanimously accepted within the scientific community, our approach, which questions diagnoses and labels, attempts to view adjustments to parenthood beyond the sole prism of individual disorders.

A crisis of maturity

Becoming a parent means meeting the needs of a totally dependent child while reorganizing your emotional, marital and social life.

For many, this experience is deeply formative. For others, it reawakens old wounds: emotional deprivation, loneliness or experiences of rejection. The arrival of a baby in that case can become disruptive by reawakening buried vulnerabilities.

Take the case of a woman who has her first child. More than fatigue, she is overwhelmed by the feeling of being trapped: someone who has always defined herself as independent and “not dependent on anyone” is suddenly confronted with an infant who is totally dependent on her.

This confrontation can reactivate the patterns of a childhood marked by the need to fend for herself. A diagnosis of post-partum depression does not address this history or the tension between dependence and independence.

Antidepressant treatment, which in our experience is sometimes prescribed following this diagnosis, will not address the cause of this distress, either. This is in contrast to a space where vulnerability is recognized and where the relationship with the child can be supported.

This leads to a loss of meaning: we diagnose “depression” when what we really need to understand are the interactions and upheavals inherent in the new parent-child relationship. The scales used — such as the widely used Edinburgh scale (EPDS), a 10-item questionnaire designed to screen for depressive symptoms after birth — focus on the mother’s mood, neglecting the quality of the parent-child bond, social support or identity changes.

The result is that symptoms are assessed, but loneliness, family loyalty conflicts or difficulties in investing in the relationship with the baby are overlooked. Having “psychiatrized” the relationship, it is also difficult to treat it beyond medicating. 

Dependence, independence

Our article offers another interpretation, this one inspired by attachment theory: the tension between the baby’s dependence and the parent’s independence.

Parental independence is not always synonymous with autonomy. It can be a survival strategy learned in childhood, when relying on others proved too risky. However, becoming a parent brutally confronts one with the absolute dependence of a newborn: one must be there, all the time, unconditionally. For those who have learned never to owe anyone anything, this experience can be disorienting.

This relational interpretation helps us understand why perinatal distress cannot be divided into two groups — depressed or not — but forms a gradient: from normal fatigue to severe anxiety and depression, including loneliness, loss of confidence and feelings of parental incompetence.

Containment and continuity

Unlike a categorical approach, which can be restrictive, attachment theory opens up new perspectives. It is based on two essential principles: containment and continuity.

• Containment: First and foremost, offering parents a space where their emotions are welcomed, without judgment, to help them make sense of what they are experiencing. Interventions such as parent-child interaction therapy or relational intervention with video feedback show that confidence and security can be restored by valuing existing parenting skills — rather than by correcting supposed deficiencies.

• Continuity: Too often, parents are passed from one professional to another, having to repeat their story and experiencing breaks in continuity of care. But dealing with issues continuously over time (from pregnancy to the early years of the child’s life), in terms of location (maternity ward, home, health services) and in terms of language (between medical, social and psychological disciplines), is important. Ensuring a chain of relational security means avoiding assistance that is limited to isolated, one-off interventions with no common thread.

Rethinking the organization of care

Our criticism is not only aimed at concepts, but also at the consistency of the various interventions with families.

Perinatal care remains fragmented: between adult mental health, child psychiatry and social services, each speaks its own language and follows its own priorities, sometimes leaving parents alone to piece things together on their own.

We advocate for a relationship-centred approach to health care: training teams in attachment theory, creating accessible post-natal spaces and providing key figures to support families through transitions. Because if “there is no such thing as a baby” on its own, there should be no such thing as isolated parents, either.

Human-centred vision

Replacing post-partum depression with perinatal relational distress is not just a question of vocabulary. It means refusing to limit ourselves to an approach that classifies disorders into diagnostic categories according to fixed criteria, to the detriment of a psychopathological consideration that views parenthood as a universal, relational and evolving human experience.

This is not about denying suffering or dismissing treatment when it is necessary. It’s a reminder that perinatal mental health cannot be limited simply to screening, prescribing and referring. It must also contain, connect and accompany.

In short, it’s time to move from a logic centred on individual disorders to an approach that treats the parent-child bond, not just the symptoms. Prevention and care must be organized around families, not around diagnostic categories.