The Potential Link Between Abortion and Postpartum Depression by Angela Taylor Shields, M.A., LCPC
Postpartum depression has gained increasing exposure in recent years as a mental illness impacting millions of women worldwide. According to the Centers for Disease Control, 11 to 20% of women who give birth each year have postpartum depression symptoms. If an average of 15% of 4 million live births annually is considered, this would mean approximately 600,000 women suffer each year in the U.S. alone. Given that 3 in 10 American women will have an abortion by age 45, it is possible that many women who experience postpartum depression may also have an abortion experience in their history. Could having an abortion put a woman at a greater risk for developing postpartum depression with a future pregnancy? What if there is a percentage of women whose postpartum depression struggles are related to unresolved abortion trauma?
While the prevalence of postpartum depression has garnered much attention, one area that would benefit from further analysis is the relationship of an abortion to the psychological experiences of women following the live birth of a subsequent pregnancy. In a 2013 issue of The Journal of Women's Health, a study of 192 women is described. Of the 192 women, 49% reported a prior pregnancy loss of miscarriage, stillbirth, and/or induced abortion.In this study, researchers found that women with prior pregnancy loss, irregardless of type, were more likely to be diagnosed with major depression. Multiple losses increased the likelihood of depression as well as post-traumatic stress disorder. In 2011, a study of over 13,000 mothers was published in The British Journal of Psychiatry. While this study only considered experiences of miscarriage and stillbirth, its findings suggest that prenatal loss is associated with a significant increase in depression and anxiety, particularly in a subsequent pregnancy.
In my years of experience as a therapist, I have counseled numerous women with postpartum psychological struggles. A significant number of these women have had prior pregnancy losses...many have had abortions. While there is limited research regarding the link between abortion and postpartum psychiatric disorders, the connection for many of the women I have counseled has been evident. One such case that comes to mind is a woman whom I will call Kate*. Kate sought out counseling after a questionnaire given at her 6-week post-birth medical appointment indicated she was experiencing a moderate degree of postpartum depression symptoms. Kate expressed confusion at her sadness. She shared how she had been so excited when she learned of her pregnancy and how she was "totally in love" with her newborn daughter. It wasn't until Kate's history was explored and a prior abortion was revealed that Kate began to see more clearly the roots of her postpartum emotional pain. Kate had not consciously dealt with her abortion occurring nearly a decade prior. She would also assert that she felt it was the "only real choice" at the time of her unplanned pregnancy. Nevertheless, Kate identified a sense of previously-unearthed trauma as she reflected on her abortion and the angst she was realizing was triggered by the now-chosen, new little life in her home. Kate wept as she described the beauty of her daughter...her "satin-soft skin," her "tiny perfect fingers," and the joy of first smiles. Kate cried in anguish, "I can't believe what I gave up." Kate was able to recognize that her postpartum sadness was a form of grief...a heartache that reflected sorrow at the potential that ended with her previous abortion decision.
Kate's story is simply one story from my own clinical practice. She is actually one of many women whom I have personally encountered whose postpartum difficulties seem to be connected to past abortion experiences. It causes me to wonder about the prevalence of abortion in the stories of the multitudes of women who present with postpartum psychiatric conditions. Others who have wondered about this potential link include CF Bradley who published a study in The Canadian Journal of Psychiatry reporting findings that "higher levels of depressive affect" were found in women with past abortions following a later live birth than in women who had no abortion history.
In the late 1970s, researchers also developed a theory of "reactivated mourning," indicating the belief that women suffering mental health issues during pregnancy may be triggered because of a
past abortion where grief was previously suppressed. Contributing authors to the aforementioned 2013 Journal of Women's Health summarize well by stating, "It is easy to imagine that some women may have conflicting emotions in the postpartum period following a live birth when they have a history of previous loss...while a woman may not have sought mental health treatment at the time of her loss or termination, or believes herself to be fully recovered, a future pregnancy could put her at risk for mental health complications."
Obtaining a complete reproductive history is good practice for a thorough clinical evaluation, and mental health clinicians should be mindful that presenting postpartum depression and anxiety disorders may be related to pregnancies other than simply the one at hand.
REFERENCES:
Prevalence of self-reported postpartum depressive symptoms - 17 states, 2004-2005. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report, April 11, 2008.
Miller, S. , Chu, C., Gollan, J., and Gossett, D. "Obsessive-compulsive symptoms during postpartum period." Journal of Reproductive Medicine. April 2013.
Blackmore, E.R., Côte-Arsenault, D., Tang, W., Glover, V., Evans, J., Golding, J., and O'Connor, T.G. "Previous prenatal loss as a predictor of perinatal depression and anxiety." The British Journal of Psychiatry. May 2011.
Paul, I.M., Downs, D.S., Schafer, E.W., Beiler, J.S., and Weisman, C.S. "Postpartum anxiety and maternal-infant outcomes". Journal of Pediatrics. February 2013.
Giannandrea, S., Cerulli, C., and Chaudron, L. "Increased risk for postpartum psychiatric disorders among women with past pregnancy loss." Journal of Women's Health. September 2013.
Bradley, C.F. "Abortion and subsequent pregnancy." Canadian Journal of Psychiatry, March 1984.
Casey, P.R. "Abortion among young women and subsequent life outcomes." Best Practice Research Clinical Obstetrics and Gynecology. August 2010.
"Induced abortion in the United States." Guttmacher Institute. July 2014.
www.postpartumprogress.org
Postpartum depression has gained increasing exposure in recent years as a mental illness impacting millions of women worldwide. According to the Centers for Disease Control, 11 to 20% of women who give birth each year have postpartum depression symptoms. If an average of 15% of 4 million live births annually is considered, this would mean approximately 600,000 women suffer each year in the U.S. alone. Given that 3 in 10 American women will have an abortion by age 45, it is possible that many women who experience postpartum depression may also have an abortion experience in their history. Could having an abortion put a woman at a greater risk for developing postpartum depression with a future pregnancy? What if there is a percentage of women whose postpartum depression struggles are related to unresolved abortion trauma?
While the prevalence of postpartum depression has garnered much attention, one area that would benefit from further analysis is the relationship of an abortion to the psychological experiences of women following the live birth of a subsequent pregnancy. In a 2013 issue of The Journal of Women's Health, a study of 192 women is described. Of the 192 women, 49% reported a prior pregnancy loss of miscarriage, stillbirth, and/or induced abortion.In this study, researchers found that women with prior pregnancy loss, irregardless of type, were more likely to be diagnosed with major depression. Multiple losses increased the likelihood of depression as well as post-traumatic stress disorder. In 2011, a study of over 13,000 mothers was published in The British Journal of Psychiatry. While this study only considered experiences of miscarriage and stillbirth, its findings suggest that prenatal loss is associated with a significant increase in depression and anxiety, particularly in a subsequent pregnancy.
In my years of experience as a therapist, I have counseled numerous women with postpartum psychological struggles. A significant number of these women have had prior pregnancy losses...many have had abortions. While there is limited research regarding the link between abortion and postpartum psychiatric disorders, the connection for many of the women I have counseled has been evident. One such case that comes to mind is a woman whom I will call Kate*. Kate sought out counseling after a questionnaire given at her 6-week post-birth medical appointment indicated she was experiencing a moderate degree of postpartum depression symptoms. Kate expressed confusion at her sadness. She shared how she had been so excited when she learned of her pregnancy and how she was "totally in love" with her newborn daughter. It wasn't until Kate's history was explored and a prior abortion was revealed that Kate began to see more clearly the roots of her postpartum emotional pain. Kate had not consciously dealt with her abortion occurring nearly a decade prior. She would also assert that she felt it was the "only real choice" at the time of her unplanned pregnancy. Nevertheless, Kate identified a sense of previously-unearthed trauma as she reflected on her abortion and the angst she was realizing was triggered by the now-chosen, new little life in her home. Kate wept as she described the beauty of her daughter...her "satin-soft skin," her "tiny perfect fingers," and the joy of first smiles. Kate cried in anguish, "I can't believe what I gave up." Kate was able to recognize that her postpartum sadness was a form of grief...a heartache that reflected sorrow at the potential that ended with her previous abortion decision.
Kate's story is simply one story from my own clinical practice. She is actually one of many women whom I have personally encountered whose postpartum difficulties seem to be connected to past abortion experiences. It causes me to wonder about the prevalence of abortion in the stories of the multitudes of women who present with postpartum psychiatric conditions. Others who have wondered about this potential link include CF Bradley who published a study in The Canadian Journal of Psychiatry reporting findings that "higher levels of depressive affect" were found in women with past abortions following a later live birth than in women who had no abortion history.
In the late 1970s, researchers also developed a theory of "reactivated mourning," indicating the belief that women suffering mental health issues during pregnancy may be triggered because of a
past abortion where grief was previously suppressed. Contributing authors to the aforementioned 2013 Journal of Women's Health summarize well by stating, "It is easy to imagine that some women may have conflicting emotions in the postpartum period following a live birth when they have a history of previous loss...while a woman may not have sought mental health treatment at the time of her loss or termination, or believes herself to be fully recovered, a future pregnancy could put her at risk for mental health complications."
Obtaining a complete reproductive history is good practice for a thorough clinical evaluation, and mental health clinicians should be mindful that presenting postpartum depression and anxiety disorders may be related to pregnancies other than simply the one at hand.
REFERENCES:
Prevalence of self-reported postpartum depressive symptoms - 17 states, 2004-2005. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report, April 11, 2008.
Miller, S. , Chu, C., Gollan, J., and Gossett, D. "Obsessive-compulsive symptoms during postpartum period." Journal of Reproductive Medicine. April 2013.
Blackmore, E.R., Côte-Arsenault, D., Tang, W., Glover, V., Evans, J., Golding, J., and O'Connor, T.G. "Previous prenatal loss as a predictor of perinatal depression and anxiety." The British Journal of Psychiatry. May 2011.
Paul, I.M., Downs, D.S., Schafer, E.W., Beiler, J.S., and Weisman, C.S. "Postpartum anxiety and maternal-infant outcomes". Journal of Pediatrics. February 2013.
Giannandrea, S., Cerulli, C., and Chaudron, L. "Increased risk for postpartum psychiatric disorders among women with past pregnancy loss." Journal of Women's Health. September 2013.
Bradley, C.F. "Abortion and subsequent pregnancy." Canadian Journal of Psychiatry, March 1984.
Casey, P.R. "Abortion among young women and subsequent life outcomes." Best Practice Research Clinical Obstetrics and Gynecology. August 2010.
"Induced abortion in the United States." Guttmacher Institute. July 2014.
www.postpartumprogress.org