(Re)constructing Postpartum Depression (PPD) via Cross-Specialty Analysis and an Anthropological Lens of Subjectivity Restricted; Files Only

Abstract

Postpartum depression (PPD) and similar maternal mental health conditions often go undiagnosed due to individual and systemic barriers, along with an overall lack of identification in this unclear classification system of ranges of postpartum experiences that are grouped in with generalized depression despite the unique biological and psychosocial changes that arise with the aftermath of birth. To explore the existing gap in the care of PPD, under the theoretical framework of subjectivity, this thesis explores the dynamic institutional relations via policy measures and the responsibility of care cross-specialty in our healthcare systems and societal perspectives. Controversies of ideations and expectations of emotional processes and formations opposed to the subjective and personal memories of mothers themselves are further assessed via ethnographic interviews of providers across pertaining specialties to PPD: obstetrics & gynecology, pediatrics, primary care, psychiatry, and midwifery on their postpartum encounters professionally inside the healthcare system and personally outside the healthcare system. Summary templates on Microsoft Excel were used to evaluate patterns in such subjective experiences. The results indicate common themes of subjective findings like cultural variations, systemic flaws, and the medicalization of PPD. Overall, it was found that the emotional states of postpartum are all on a spectrum and hard to identify due to the difficulty in the classification of emotions and barriers of care. Through provider narratives, this ethnography illustrates considerations of PPD to illustrate the critical considerations of subjectivity to ultimately better identify, treat, and prevent PPD.

Table of Contents

Table of Contents

Chapter 1: Introduction: Establishment of the Barrier……………………………………………1

1.1 Personal Statement and Motivations………………………………………………….2

1.2 Relevance: What is PPD?..............................................................................................3

1.3 An Anthropological Critique of PPD…………………………………………………4

1.4 Researcher Positionality/Subjectivity………………………………………………..11

Chapter 2: A Review of the Literature: PPD Policy and Classification…………………………14 

2.1 Subjectivity in terms of the Classification of PDD………………………………….14

2.2 Existing PPD Policies………………………………………………………………..16  

Chapter 3: Challenges to Crossing the Barrier at an INTRASpecialty Level……………………25 

3.1 Introduction and Methodology………………………………………………………25

3.2 Overview to Seats at the Table……………………………………………………....32

3.2a OBGYN……………………………………………………………………..32

3.2b PEDS………………………………………………………………………..41 

3.2c Primary Care………………………………………………………………..45

3.2d Psychiatry…………………………………………………………………...51

3.2e Midwives……………………………………………………………………61

Chapter 4: Challenges to Crossing the Barrier at an INTERSpeciality Level…………………...75 

4.1 Subjectivity Considerations and Implications of PPD……………………………….75

4.2 Social Support……………………………………………………………………….76

4.3 The Doctor Response & Provider Subjectivity……………………………………..77

4.4 Medicalization of PPD via Intersubjectivity………………………………………..79

Chapter 5: Conclusion: Breaking the Barrier and Beyond……………………………………...81

5.1 Potential Solutions (Systemic vs Individual).............................................................81

5.2 Study Limitations…………………………………………………………………..84

5.3 Concluding Remarks……………………………………………………………….85 

Bibliography.…………………………………………………………………………………….87

Appendix ………………………………………………………………………………………..92

About this Honors Thesis

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School	Emory College
Department	Anthropology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Anthropology, Cultural Anthropology, Medical and Forensic Health Sciences, Public Health
Palabra Clave	postpartum depression maternal mental health mental health healthcare specialties subjectivity medical anthropology
Committee Chair / Thesis Advisor	Dr. Jessica Ham, Emory University
Committee Members	Dr. Chikako Ozawa-de Silva, Emory University Dr. Sarah Blake, Emory University

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