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The case of poor postpartum mental health: a consequence of an evolutionary mismatch – not of an evolutionary trade-off

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Abstract

Postpartum mood disorders develop shortly after childbirth in a significant proportion of women and have severe effects. Two evolutionary explanations are currently available. The first is that poor postpartum mental health is a consequence of an evolutionary trade-off – a compromise of neurological changes in the maternal brain during pregnancy which, on the one hand, maintain pregnancy, and on the other, increase the likelihood for postpartum women to develop psychopathology. The second explanation is that poor postpartum mental health is a disease of civilization. This theoretical paper demonstrates that both explanations ignore the crucial event of childbirth. I elaborate on environmental features of childbirth, a physiological process that is substantially different in the current versus evolutionary childbirth and postpartum setting, and argue that maternal brain neuroplasticity and biochemical alterations are not an evolutionary trade-off, but an adaptation. Additionally, the incidents of poor postpartum mental health are better viewed as a maladaptation of the typical modern environments – an evolutionary mismatch. Thus, the potential to suffer from poor mental health in postpartum is an external, contingent happening, dependent on contemporary childbirth and postpartum environments, and not due to any essential property women possess as a result of evolutionary compromise. In fact, women are probably adapted to feel like superwomen right after birth, a state of mind that is an aid in adapting to motherhood. Distinguishing between evolutionary concepts in the context of pregnancy, birth, and motherhood is vital for developing more accurate preventions and interventions.

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Notes

  1. In discussing weaning behavior in human evolution, Humphrey (2010) concludes that the evidence suggests that the ‘natural’ age for beginning weaning in modern humans is roughly 5–6 months.

  2. Although the issue of anemia is beyond the scope of this article, it is worth noting that the history of iron deficiency anemia reveals the overlooking of its impact on women’s health and the consequent importance of investigating iron deficiency in women rather than accepting the dogma of normality (see Dugan et al. 2021).

  3. I acknowledge that there are women on the spectrum between the extreme ends of the birth experience who experience fewer intense sensations during birth and less significant consequences.

  4. Most people recognize the term dystocia because of the common phenomenon of shoulder dystocia, but shoulder dystocia is only one kind of dystocia.

  5. Women take epidurals for a very understandable reason – to reduce labor pain. In this sense, an epidural is the most efficient labor pain medication. However, as I demonstrate here, a potential side effect is causing an escalation of other interventions. Thus, an epidural is not a harmless pain medication as often described to birthing women (see Reed et al. 2017).

  6. I note that a fitness riddle might arise concerning the evolutionary mismatch account for the mental health outcomes: The overall evolutionary fitness, that is, reproductive (biological) fitness, of women, is most likely increased by medicalized births, even as birthing women’s mental health is compromised. In modern times, more mothers and babies survive the event of delivery. They are physically healthy enough to lead productive lives, even if they are occasionally compromised in mental health because of these phenomena discussed in this paper. However, this evolutionary puzzle is not unique to the subject of childbirth – it is relevant to many of the traits approached by evolutionary psychologists and human behavioral ecologists. If it is a puzzle concerning the issue of childbirth and PPMH, it is also a puzzle relating to other health problems explained in terms of evolutionary mismatches. For example, also people with diabetes or allergies manage to live and reproduce due to modern medicine, even if they have a lower quality of life because they have health issues. People with these kinds of health issues would probably not survive in evolutionary times. In other words, if an evolutionary mismatch is only discussed through the prism of current mortality and reproduction - then almost no modern health problem could be labeled an evolutionary “mismatch” because, in contemporary culture, life expectancy has increased significantly as a result of current developments such as medicine, sanitation, hygiene, etc. Still, it is crucial to investigate and understand our evolutionary traits and their interrelations with past and present environments. In the next section, I will detail why such an understanding is essential.

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    Orli Dahan

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Dahan, O. The case of poor postpartum mental health: a consequence of an evolutionary mismatch – not of an evolutionary trade-off. Biol Philos 38, 23 (2023). https://doi.org/10.1007/s10539-023-09910-4

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