Motherhood and Mental Health

Here’s a book I wish I could make required reading for all criminal prosecutors, lawyers, journalists and legislators in the United States. To be even more thorough, I would add the morally self-righteous, whatever their job description, to the foregoing list.

The author is a professor of psychiatry at the University of Birmingham in England. He has drawn upon literature of both the present day and the past to document what is currently known about women’s mental health as it relates to pregnancy, birth and its aftermath.

The section of the book I would particularly want everyone on my list to absorb is that which deals with the psychopathology of parturition, which discusses delusional states, depression associated with pregnancy and childbirth, and one of the social problems we like least to think about: infanticide. The psychopathology of parturition includes everything from prenatal depression to postpartum depression, postpartum psychosis, imagined pregnancy, unnoticed pregnancy and unnoticed birth. That’s right – as hard as it may be for most of us to believe, there is such a phenomenon as unnoticed birth. Several cases are documented in this volume. Related topics include infanticide and neonaticide, whether it is the customary kind that has existed in societies all around the world where reproduction outstripped food resources, or the type most often found in urban areas after industrialization fractured previous social compacts and networks. Brockington instructs the reader that “the murder of the new-born, hugger mugger by a desperate mother who has concealed her pregnancy,” was a major public health problem in Europe throughout the nineteenth century.

His research turned up a figure of 3,000 cases of neonaticide a year during the last century in England. When he relates that to the number of illegitimate births estimated then – 40-60,000 per year (yes, this was the reality of Victorian England), he comes up with a mortality rate of at least 5 percent from infanticide among children whose mothers were abandoned by their fathers. In France, too, infanticide was a huge problem; after theft, it was the most frequent crime committed by women.

As recently as 35 years ago in England, one authority claimed: “The finding of dead newly-born children in sewers, alleys, incinerators, trash dumps, streams, lakes, parcel lockers, women’s public lavatories and the like is a frequent occurrence.”

Brockington documents several cases of mothers who concealed not only pregnancies but their first deliveries, even while sharing a room or a bed with someone else. “In a series of three cases, one woman gave birth without her room-mate knowing, another in the same room as her employer’s daughter, while a third delivered in the same room as both her parents.”

Sometimes newborns die at birth because their mothers are so wild during the birth process that they are standing as the baby is emerging. Skull fractures may be the immediate cause of death in these cases.

On the subject of how society ought to deal with these terrible events, Brockington poses the question: Given the “anxiety mothers feel in the run up to a normal delivery aided by modern obstetrics with its negligible mortality, is it possible to imagine the terror, anguish and despair of an ignorant girl facing such an ordeal alone, and the ruin which would follow discovery?”

One of the more enlightened doctors of the nineteenth century, Dr. Hunter, in an address to the British Medical Society, wrote:

“Women who are pregnant, without daring to avow their situation, are commonly objects of the greatest compassion; and are generally less criminal than the world imagines. In most of these cases the father of the child is really criminal, often cruelly so. He thinks no more of his promises. The mother is weak, credulous and deluded; she is left to struggle as she can, with sickness, pains, poverty and infamy.”

Some infanticidal mothers were burned in Europe after the Middle Ages. Russia was the first European country to take a humane view of infanticide. England and Wales “at last came into line, as late as 1922,” by making a distinction between infanticide and other forms of murder. The statute was further revised in 1938, this time defining infanticide as the killing of a child under the age of 12 months. The English Act was then copied in several Australian states and in Canada. In the United States, however, as the author frankly understates, “the distinction between infanticide and other forms of murder is not universally recognized.”

Clearly, we in the United States have a lot of work to do on this tragic issue. Curricula of midwifery education should certainly include the area of mental health as it relates to pregnancy, birth and motherhood.

Motherhood and Mental Health can serve as a much needed resource for those who find themselves bewildered about how a “nice” girl from a “nice” family or neighborhood can end up putting her newborn baby in the trash. Since we in the United States seem to have a greater problem with neonaticide than other countries of similar wealth and industrial status, it seems quite appropriate that we study what it is that we are doing wrong in this area and what they are doing right.

Reviewed by Ina May Gaskin