Abstract and Introduction
Abstract
The period following the birth of a child brings many transitions into a woman's life, which can effect major psychological and social changes, including feelings of loss. If new mothers experience negative thoughts at this time, when societal expectations are of happiness, this may lead to feelings of unacceptability and guilt. This study aimed to investigate the prevalence of negative thoughts after childbirth in nondepressed mothers. Following the identification of negative thoughts experienced by women who had suffered postnatal depression, a quantitative survey was conducted, which asked nondepressed mothers to indicate how often they experienced the negative thoughts or images identified by depressed mothers. One hundred and fifty-eight returned questionnaire packs were included in the analyses. The 158 nondepressed mothers acknowledged experiencing all but one of the 54 negative cognitions. Negative cognitions usually associated with postnatal depression are also experienced by mothers who are not considered depressed. This information provides evidence for reassuring new mothers that negative thoughts after childbirth are common. This, in turn, may help to reduce feelings of guilt associated with experiencing negative thoughts in the postpartum period.
Introduction
The transition to motherhood is marked by a range of psychological and social changes, some of which may be experienced as loss. Nicolson suggests that such experiences can lead to sadness and low mood. However, because the expectations of motherhood are usually associated with happiness, the discussion of negative aspects is often avoided. Mothers may not express negative thoughts because of personal attributions or fear of the perceived consequences. In a study by McIntosh, mothers reported a fear of acknowledging any negative thoughts or feelings, as they perceived it might lead to being labeled mentally ill or being regarded as an unfit mother. Furthermore, less than half the mothers who expressed feeling depressed (18/38) sought any kind of help, with only 10 seeking professional help. The main reason cited for the reluctance to seek professional help was that the mothers did not perceive the problem as medical; rather, they saw themselves as suffering from a normal reaction to abnormal stresses.
Although much research has been conducted in relation to postnatal depression and other postpartum disorders, the experience of women following childbirth has been largely neglected in nondepressed populations. Studies that focus on normal psychological reactions after childbirth have predominately relied on qualitative methodologies. While such studies offer valuable information about women's responses to motherhood, a potential advantage to using quantitative methodology may include better comparison of thoughts experienced by depressed mothers versus nondepressed mothers. Such comparison would enable an investigation into whether negative cognitions usually associated with postnatal depression, are, in fact, a "normal" reaction to abnormal stresses.
One of the few quantitative studies to examine thoughts and feelings after the birth of a baby was conducted by Jennings et al. This study compared the thoughts of nondepressed mothers with the thoughts of mothers with clinical depression. The authors found that 7% of nondepressed mothers reported the occurrence of extreme negative thoughts of wanting to harm their infant. Although the study looked at other negative thoughts, such as fear of being alone with their infant and inability to care for the infant, these items were measured in the depressed group only. The study failed to conduct the full diagnostic interview with nondepressed mothers; thus, no information is known about other negative thoughts in the nondepressed group of mothers. The authors suggested that other negative thoughts, such as passive thoughts of harm (e.g., the infant falling out of a window), might be more common than the extreme thoughts of active harm that were investigated. According to these authors, the prevalence of these thoughts has been underestimated, as shame and/or fear of being reported to authorities prevents disclosure.
It is known from research in other domains that negative intrusions about harm and other "unacceptable" themes are common in the "normal" population. In addition, it is known that experiences usually considered indicative of a clinical disorder are also experienced in "nonclinical" populations. For example, a seminal experiment conducted by Romme and Escher found that hearing voices, an experience usually associated with schizophrenia, was also experienced by nonclinical individuals who were not considered to be suffering from psychosis. Such findings led to the argument that some psychological "symptoms" that are usually considered abnormal, are, in fact, prevalent in nonpsychiatric populations.
It may be similarly hypothesized that a continuum of normal experience exists in which some negative thoughts, which are characteristic of postnatal depression, are "normal" after the birth of a child. If negative thoughts are common, and new mothers are not told about them, they may increasingly experience negative emotions, such as guilt and sadness. Perceived unacceptability may further trigger attempts to suppress such thoughts and maintain the lack of disclosure, thus ultimately serving to maintain and perpetuate the distress. The aim of this study is therefore to explore whether negative thoughts derived from women suffering postnatal depression are also experienced by a nondepressed postpartum sample.