Postpartum Depression: Standardizing Motherhood? by Pamela J. Regus Under the Direction of Wendy S. Simonds ABSTRACT An expansion of the medicalization of Postpartum Depression (PPD) is evident in increased screening for maternal depression that begins in pregnancy and continues in the postpartum period, and in the growing number of medical professionals alerted to watch for signs of maternal distress. Although a definitive etiology ofPPDremains elusive, the scientific and medical fields – highly imbued with authority to create knowledge in Western society – promote essentialist views of motherhood that espouse “natural” attributes such as maternal instincts and tendencies to nurture. Mothers who struggle with these standards of motherhood are then defined as being ill and become patients under the care of the medical profession until they can perform adequately in their motherhood roles, or they face social condemnation and legal repercussions for being “bad” mothers. Because characteristics of the “normal” postpartum period are said to be similar to symptoms of general depression, how do some women come to identify their postpartum experiences as depression while others do not? Does the choice of traditional obstetrics or an alternative, such as midwifery, make a difference in the incidence of postpartum depression? And what changes in the social support network occur in a woman’s life as a result of a diagnosis ofPPD? Using Foucault’s theory of docility, critical constructionism, and postmodern feminism as the theoretical focus, and in-depth interviews as the research method, I compare the postpartum experiences of mothers who have been diagnosed with postpartum depression with mothers who have not been diagnosed. The sample includes mothers who gave birth with the assistance of obstetrics and mothers who gave birth with the assistance of certified nurse-midwives. In order to examine the differences in approaches to and treatment of postpartum depression, I also interview a sample of obstetricians and certified nurse-midwives. Findings show that medical professionals use gender-normative assessments, such as physical appearance, language, and nurturing tendencies to determine whether the mother is performing as expected; if not, she is defined as ill and treated with antidepressant medication. Although the majority of mothers in the sample experienced feelings of depression in the postpartum period, many resisted diagnosis and medication. Mothers found the greatest support in their peers, rather than those closest to them, citing the ability to talk candidly about the struggles they face in their motherhood roles as the way to avert or heal from PPD. This finding highlights the enforcement of normative motherhood within the social institutions of the family and medicine; thus, cultural change from ideological representations of motherhood may come about through peer relationships. INDEX WORDS: Postpartum depression, Motherhood, Medicalization, Expansion of medical control, Maternal behavior, Childbearing years, Normative motherhood

This study explores the relationship between ideals of motherhood and heterosexual normativity, from the perspective of women at the margins of these discourses. The title, In the shadow of Motherhood, illustrates the overriding power of the image of motherhood to marginalise alternative experiences. The concept of motherhood, like that of Family, has traditionally signalled the reproduction of the normative; it does not usually encompass the critical scrutiny that would allow for diverse experiences of mothering. Theoretically, the study is located within the fields of feminist sociology and inclusive family studies in productive dialogue with queer notions of gender and sexuality. Methodologically, it is inspired by narrative analysis and consists of in-depth interviews with eight lesbian, bisexual and heterosexual women grappling with different experiences of motherhood and mothering practices. Some of them identify as mothers while others do not, but by not being biogenetic mothers within a heterosexual relationship they share the position of being outside of what is often considered normal, natural and desirable. The analysis reveals a considerable variation in the positions, experiences and identities of the participants, particularly in regards to changes over time, which cannot be reduced to binary categories such as heterosexual/lesbian, biological/non-biological, mother/childless or voluntary/involuntary childlessness. The analysis also exposes a deep tension between ideologies of motherhood and lived experiences of care practices. Furthermore, from the perspective of the participants, the boundaries between inclusion and exclusion reinforce and challenge each other, creating spaces of both individual and collective resistance. The study illuminates the need to shift the location of these experiences from the margins to the centre not only in sociological research of family and gender, but also within feminist sociology.