What Causes Postpartum Illness?
 
The bottom line is that there is no conclusive evidence pointing to any single, isolated biological, psychological, social, or cultural cause or variable as the source of postpartum illness. Postpartum risk factors are difficult to isolate, and much of the research is conflicting.
 
Biological research includes inconclusive hypotheses around hormonal drops (estrogen, progesterone and cortisol), declines in endorphins, as well as lowered prolactin in non-breastfeeding mothers during the postpartum period. Also under investigation are the possible relationships of premenstrual syndrome (PMS), obsessive compulsive disorder (OCD), and sleep and anxiety disorders to postpartum illness. Despite many theories, the biological origins remain unknown.
 
Studies have shown that women who have had obstetric intervention (such as Caesarian delivery or instrumental involvement in vaginal deliveries) were more likely to experience deterioration in mood and a drop in self-esteem.

Another theoretical line focuses on psychological factors playing a role in postpartum disorders. Research in this area has identified a relationship between low self-esteem and depression, particularly in women who report lowered self-esteem due to their weight.

Some social studies correlate broad social upheaval (such as war, economic depression and poor living conditions) with an increased prevalence of postpartum difficulties.
 
Other social research has shown that the majority of postpartum women express concerns about levels of support. Anthropological studies point to a characteristic lack of kin support in Western cultures as a major contributing factor to the onset and persistence of postpartum depression (not psychosis). These theories target western cultures as being deficient in adequate social structure to meet the needs of postpartum events. This includes a lack of social recognition of the transition period required by new mothers as well as a lack of meaningful assistance and physical, educational and emotional resources.
 
Non-western, rural cultures tend to have lower reporting of postpartum depression, and garner regular, reliable, and predicable physical support from family members and the community as a whole. They also direct focused attention around the emotional needs of new mothers, reassuring them and celebrating their new status. While western societies have rituals, they are typically related to activities leading up to the birth and care of the baby, and often fail in providing spiritual, physical, and emotional support for the mother beyond the birth.  
 
Treatment
 
Most experts agree that social support is a critical component in easing a woman through postpartum illness; many new mothers turn to mutual groups where they can meet with other women who have experienced or are in the midst of similar problems. Many women cite feeling alone and abnormal as and aggravation to their despair and one of the reasons they do not seek help; support groups help them realize that emotions that seemed scary and unusual are actually normal.
 
Women can heed prevention strategies from new parents, which include: 

• Don't be afraid to ask for help
• Seek assistance from your spouse, family, and friends
• Make friends with other couples who have children
• Don't preoccupy yourself with unimportant tasks
• Don't plan a move too soon after the baby arrives
• Stay rested, as much as possible
• Make room for your pre-baby interests in your new schedule
• Find a good babysitter early
• Find a good family doctor    
  

Alternative treatments include nutritional and/or hormonal therapy options.
 
Most of the controversy surrounding postpartum disorders at present is focused on the use of drugs in treatment. Since a definitive biological or biochemical cause has yet to be defined, more research into the cause and safe treatment of postpartum depression is still required. However there are women who have found that psychopharmacologic treatment with drugs such as Paxil, Zoloft, or Prozac has provided the only effective for their postpartum depression.
 
Each woman's pregnancy, birth, and postpartum phase is unique, and mothers should be proactive about seeking advice from knowledgeable health-care providers to identify what options are best for them.