Today is International Women’s Day 2022, and I’d like to address what is still, even in @MeToo Australia, a fundamentally gendered scandal.
Babies are passionately loved and cared for by parents and carers who are male or of non-binary gender, not only by mothers. But the way our health system cares for a new mother tells us a lot about what is valued in our society. As the planet burns, floods, melts; as COVID-19 exposes the ugly gap between rich and poor; as war devastates Ukraine, I ask: just how much are we willing to invest in a woman’s mental health after the birth of her baby, for her own sake, and for the sake of our children and our children’s children?
In the first months of human life, and especially in the first one hundred days, environmental experiences sculpt neural and stress-reponse settings with life-long impact upon mental health and capacity for secure emotional attachment. Relaxed delight in a baby supports the flourishing of that child’s emotional well-being and development. Immune and metabolic templates are laid down in this window of exquisite cellular plasticity, too, with life-long effects.
I’ve spent many years of my professional life as a GP looking closely at this problem. Many of the skills taught to our health professionals for helping with breastfeeding, sleep and cry-fuss problems are experience or opinion-based, an influential group of well-meaning people’s perspectives.
There are many reasons, biological and psychosocial, why 20% of new Australian mothers and 10% of new fathers experience postnatal depression and anxiety. As if it wasn’t hard enough before, the lockdowns of 2020-2021 have made baby-care even tougher. But our health system doesn’t yet acknowledge that one fundamental reason women suffer so much worry and distress after the birth of their baby – the one thing that could be changed, actually, with minimal cost – is that we as health professionals lack the clinical skills required to help make a family’s life with their baby more enjoyable.
We don’t have these because gendered bias remains a serious problem in healthcare and medical research institutions, and results in less research into women's health. Moreover, for many years now, COVID aside, our advanced economy’s research resources have been disproportionately channelled into biomedical and technological initiatives focused on downstream health challenges such as chronic disease. The research that does occur into clinical care of breastfeeding and unsettled baby problems continues to be dominated by hospital and university-based researchers, even though research generated there often proves unhelpful in the community.
Problems of breastfeeding, sleep and unsettled infant behaviour are not peripheral to postnatal depression, but often at the heart of a new mother’s distress. Today many researchers and health leaders, unconsciously echoing the mother-blaming that was prominent throughout the twentieth century, suggest that these problems arise from a woman’s vulnerable or anxious personality, that baby is fussy because the woman is stressed, that the new mother should develop better coping skills.
Health professionals have been trained to expect babies to cry for hours, or for breastfeeding to hurt. They’ve been trained that if a woman is barely getting an hour’s sleep at night before the next wake-up, she should hold off responding to her baby’s cries. These provider beliefs compensate for a lack of training in the skills required to help parents repair the factors which underlie infant distress or disruption of the circadian clock or breastfeeding.
It’s not surprising then that providers and parents alike, in desperation, turn to medical or surgical interventions or unproven complementary therapies in the first months of a baby’s life. Overdiagnosis and overtreatment are serious and growing international problems. Patients and health professionals alike overestimate the benefits of interventions and underestimate side-effects.
As unregulated market forces increasingly infiltrate healthcare, the well-packaged product, the promise of the biomedical or pharmaceutical or complementary therapy quick-fix sells. This is why women and their babies are subjected to astonishing amounts of unnecessary and unproven medication, surgery, or exercises in the first months after the birth. This would not be tolerated at any other time in the lifespan.
In recent years, hospitals have opened parenting centres offering multi-disciplinary help for mothers and babies. These tertiary outpatient services are popular because they are free for parents. Yet they continue to offer women more of the same conflicting advice, and large amounts of state government funds are poured into this successful business model for financially stressed hospitals. For example, hundreds of dollars are received for a single consultation or service that would cost the health system many times less in primary care.
In the meantime, strangulation of funding to multi-disciplinary general practice services, which are not only so much cheaper for the health system but often demonstrated to be more effective, and failure to prioritise funding for primary care research, continue unabated.
The climate crisis lays it bare: for decades, voracious market powers which care very little for the sensitive, trembling human heart have been gobbling up the future of the world. In one small but critically important corner of our society, community-based health providers caring for parents with babies scrabble to remain financially viable in a largely unregulated market. Midwives, lactation consultants, child health nurses, GPs and paediatricians can hardly begin to comprehend the extent to which our training and knowledge base when it comes to breastfeeding or unsettled babies has been impacted by the highly medicalised lenses promoted by market forces, by a profound devaluing of clinical primary care research, by historical gender inequity.
During the pandemic we’ve been protected by the great strengths of our Australian health system, including through substantial investment in both biomedical and public health research. On International Women’s Day 2022, I look forward to the time (which surely must come) when we prioritise research which helps a woman enjoy breastfeeds and sleep and peaceable days and nights together with her baby.
These things shape us, body and soul, from the very beginning of life, after all.
9 March 2022
