Like many others, I suffered with postnatal depression. Was it because I had a boy?

Researchers have linked the gestation of male foetuses with a greater incidence of depressive symptoms in a staggering eighty per cent of new mothers. Photo / 123RF

There's often an unspoken alliance between us mothers of boys. A wry solidarity and understanding when we talk about parenting sons. My wild and beautiful creatures are now six and seven years old. They break my heart in their peaceful sleep yet the sheer physicality that comes with raising boys often has the power to overwhelm me.

It has always been so. From the moment my first son was born, the paradox of love and joy, tempered with the exhaustion and struggle that goes hand in hand with caring for a newborn child, followed what was a frankly traumatic birth.

With the benefit of hindsight I suffered with symptoms of depression, anxiety and stress corresponding to PND (postnatal depression) in the months and years after childbirth — both times. I was well, my baby boy was healthy, I had a supportive family, a job, a roof over my head; what did I possibly have to get worked up about? And yet, this maternal mental health disorder remains chronically undiagnosed.

In a study published last week, Sarah Myers and Sarah Johns from the School of Anthropology and Conservation at the University of Kent found a surprising new link in looking at causal risk factors for postnatal depression. Their research paper has potentially significant implications in identifying women who might struggle, because for the first time they link the gestation of male foetuses with a greater incidence of depressive symptoms in a staggering eighty per cent of new mothers. Even more potently, they claim that those who had complicated births — with extended recoveries and not just complications per se — were up to 174 per cent more likely to experience PND.

Whilst no one of childbearing age is particularly surprised by the scale of depression in society anymore, the idea that, at least in part, it might be linked to the male sex of a baby is previously unexplored. According to Myers and Johns, this can be added to the peri-natal conditions that are more likely to occur with male foetuses such as pre-eclampsia and gestational diabetes mellitus.

These claims build on the growing body of literature that correlate depression with biological inflammatory immune response. In other words, the body's reaction to a threat. According to these studies, depression can therefore be seen as an evolutionary protective mechanism from the external, be it stress, illness or injury. Looked at in this way, it seems hardly surprising that women undergoing possibly the most stressful and physically demanding and transformative experience of their life would be at risk should there be complications or indeed physical trauma.

But would it have been different — or better — if I'd had a girl?

The truth is that I will never know. Giving birth the first time, I felt prepared as I possibly could be with the help of a doula. I'd ticked off antenatal and hypnobirthing classes. On paper I had a normal delivery with no prior interventions leading up to the birth. But the reality of the experience was quite different. At ten centimetres things started to go awry. My son was in distress and I had to push him out, fast. In the panic and speed that preceded his delivery, I lost two litres of blood and sustained the worst kind of third degree tear.

What followed only compounded the shock of the physical. I spent several days in high dependency unable to move, but once on the normal ward, my son was moved to an intensive care unit. The experience of needing to go several floors during the dead of night to feed my baby when I was too weak to walk properly will never leave me.

Post-natally, my anxiety soared and feelings of being able to cope shrank. I felt isolated, removed from my contemporaries. It took months before I was able to feel any kind of normality.

Hannah Pain, 34, mother of Freddie, 5, and Jemima, 3, also had a difficult birth with her first born son, labouring unmonitored for ten hours on a desk in the midwives' office when the hospital unit was already at capacity. "The pain was unbearable," she recalls. She didn't know but she was experiencing back labour and despite begging for pain relief early on she was left in the cubicle suffering. Finally, a midwife discovered her son's dangerously low heart rate and said to her husband, "See that red button? Press it."

Hannah sustained a dural puncture from the epidural she was given by a trainee doctor, and agonising headaches — "morphine didn't touch it". Back home she was anxious and overwhelmed. "I wasn't prepared for Freddie screaming for the first six months." She looks back and wonders whether her experience reinforced his neediness. "I was definitely depressed." Traumatised she spent every night googling symptoms. "It's only now they are older that I have time to process it. I've had a delayed realisation of how bad it really was."

Hannah's experience with her daughter Jemima, 18 months later, was a contrast: "She was an easy baby, a twenty minute birth. I felt so relieved."

Clinical psychologist Emma Svanberg (makebirthbetter.org) agrees that further studies into possible risk factors can only be a good thing.

"It's the well-informed professional women who are most at risk of suicidal thoughts," says Svanberg. "They expect to be 'fine' and may have the means to pay for support, but it isn't the same as emotional support. They are used to feeling competent and don't necessarily understand what is normal in this instance."

Svanberg's analysis is backed up by the new study in its retrospective examination of 296 women from Western, educated, industrialised, rich, and democratic (WEIRD) contexts. Where mothers had pre-natal mental health issues, low social support or socioeconomic status, the incidence of PND was bizarrely no higher. In fact, where mothers had a known mental health history and went on to have complicated births, the odds of getting PND were lower, suggesting that the health service net was working to catch the vulnerable at that point in time. It supports the idea that middle class women who are used to juggling complicated lives are often the ones who slip through the net.

In Svanberg's view it is hard to pin down the specific causes of perinatal distress when there such a vast range of influences that could be at play. But as she says, "Whatever the factors are that might increase the likelihood of PND, actually having people to recognise any symptoms and support you is so lacking these days." In her view, mental health screening should continue after six weeks when mothers are feeling more confident with the task of parenting and are possibly more aware about whether they are struggling.

Another US study last year disclosed that one in five new mothers would not disclose their mental health concerns to a professional, demonstrating the extent of women suffering in silence.

My son is due to turn eight this weekend, and finally I can look back at my experience and see the frightening inconsistency of post-natal care for what it was. It makes sense that women in eastern cultures who are less isolated in receiving support from women around them don't tend to experience PND as widely. Of course what pushes the individual over the threshold for depression is surely an individual experience; but if as the report suggests, mothers of boys — those who are less likely to self-diagnose depression — are even slightly more at risk, then adding another safety net and getting people talking can only be a good thing.

Follow Estelle on Instagram: @mrsestellelee