Navigating the shifting landscape of “good” motherhoods: Exploring the everyday experiences of women experiencing postpartum depression in urban China
Thanks to the valuable SPA / Robert Lemelson Foundation Student Fellowship, I finished my preliminary fieldwork at one of the best Obstetrics-Gynecology hospitals in Shanghai, China, from June 13th to July 20th, 2023. I obtained women’s narratives about their experience with early pregnancy and perceptions of prenatal depression and mental illness in general via three interviews and 90 surveys; their families’ knowledge and attitude toward prenatal depression; and the obstetric and psychiatric practitioners’ perception and treatment of prenatal depression. I also observed the doctor-patient interactions and medical practices related to pregnancy in the clinical context from Monday to Saturday, dedicating five hours each day for six weeks.
The results of this fieldwork provided me with a deeper understanding of motherhood and prenatal depression in urban China, which allows me to further identify significant research questions. It also helps me construct a good relationship with obstetric practitioners to help me with my future dissertation fieldwork. My paper, drawing on the results of this fieldwork, titled “‘I do not have these problems’: An ethnographic study on early pregnant women’s perceptions of perinatal depression in urban China”, has been accepted by the 2024 SfAA/SMA 84th Annual Meeting. The specific fieldwork and results are as below.
Before the formal fieldwork started, I met with my collaborator Dr. Liang, a public health professor in Fudan University whose project also focuses on prenatal depression, several times to plan my project, which was nested within her own. We had a project launching meeting with the obstetric doctors and nurses at this hospital on June 2nd.
In the formal fieldwork, every day from 7:30 am to 12:30 pm, I worked with Dr. Liang’s graduate students as interns in the initial prenatal record room to conduct surveys about prenatal experiences, ideas about mental health during pregnancy, and knowledge on mental illness with women who were in their early pregnancy and so initiating prenatal care at this hospital. The survey includes geographical information and several scales to evaluate these women’s mental health such as Edinburgh Postnatal Depression Scale (EPDS), Modified Social Support Survey (MSSS), General Anxiety Scale-7 (GAS-7) and Self-rating Anxiety Scale (SAS). I will have access to these data as part of Dr. Liang’s team and will be an author on papers resulting from this research.
In addition, I engaged in observation of these women’s interactions with doctors, nurses, their families, and with each other in the initial prenatal record room. I also observed the obstetric outpatient clinic for five days during which these women conducted regular pregnancy care, screening, tests and examinations, including while the doctor explained the results to them and arranged their examinations for next time. I observed the mental health outpatient clinic once, during which the doctor conducted counseling with three women, one in early pregnancy with career issue, one in postpartum period with suicide thoughts, and one in postpartum period with a physical issue-high blood pressure. In addition, I observed a multiple-department treatment of a woman experiencing postpartum depression as the obstetricians and a psychiatrist from the Shanghai Mental Health Center worked together to treat this patient.
Beyond the survey and participant observation, I also conducted semi-structured interviews with three women in their early pregnancy to learn about their pregnancy experience and clinic interactions and knowledge on prenatal depression. I also had an informal interview with the psychological nurse at this hospital and short conversations with pregnant women’s families–mainly husbands– and two mothers.
The results of this preliminary fieldwork show that nearly 20% of 500 women who created the initial prenatal record in June screened either positive in depression or anxiety scales, or had a mental illness history. These women paid much attention to their physical conditions but spoke sparingly of their mental and emotional experience. When I introduced the project to them, they said, “I do not have these problems” and even when the doctors told them they screened positive for depression or anxiety, these women and their families only cared whether it would influence the fetus. The doctor or nurse suggested these women visit the mental health clinic, but only a few (according to staff) would likely follow the referral. In addition, the psychological nurse told me that the notion of “postpartum depression” is to some extent misleading, since it makes pregnant women think only after giving birth, one could get depression.