“Sometimes the strength of motherhood is greater than the natural laws.” Barbara Kingsolver
Many of we women grow up with notions of becoming mothers some day. It is how we are socialized; we play with baby dolls and tenderly feed the pretend bottle to our dolly. We visualize what it will be like to be a mother someday, setting a table for tea while zooming off in our tricycle to work. Conceptualizations of motherhood morph and change with the times, and yet here we are, biologically, and in many cases sociologically and psychologically, primed for motherhood.
Enter real live baby, full time job, and perhaps other children and a spouse. There are many pressures on the modern mother to not only attend emotionally to her child(ren) but to also provide for her family. In essence, so many pressures and expectations of motherhood can add tremendous stress to the new mom.
1) In actuality, potentially over 20% of child-bearing women develop the most common complication of childbirth, during the childbearing year: perinatal depression/anxiety clinically termed perinatal mood and anxiety disorder (PMAD) (PSI, 2017). No woman is immune from this complication. A convergence of hormonal fluctuations in combination with sleep deprivation, genetic susceptibility, and life stressors (trauma/loss, financial, relational, etc) all create the perfect storm of events to plummet the serotonin (neurotransmitter that regulates mood) after childbirth. Although over 80% of all new mothers have the “baby blues” (a non-clinical condition that includes overwhelm, tearfulness, fatigue, and mild mood swings lasting up to two weeks), women whose symptoms of baby blues intensify and elongate after two weeks should be evaluated for a PMAD.
2) Symptoms of PMADs (Perinatal Mood/Anxiety Disorder) can include: generalized or extreme anxiety (including panic attacks), pervasive feeling of overwhelm, extreme fatigue, deep sadness and worry, feelings of guilt and worthlessness as a mother, intrusive thoughts, insomnia, appetite changes (usually reduction), hypervigilance and tenseness, inability to relax or connect with baby, problems focusing/concentrating, among other symptoms. PMADs is an umbrella term for a number of clinical conditions that fall under that category, which can include postpartum depression, postpartum anxiety/OCD, postpartum bipolar disorder, postpartum PTSD, and postpartum psychosis (the latter of which is very rare and is considered a medical emergency). It is never a woman’s fault that she developed a PMAD. Again, PMADs are more common that pregnancy-induced hypertension or gestational diabetes.
3) What many medical practitioners and patients don’t know is that women are vulnerable to developing PMADs during pregnancy. Ideally, a newly pregnant mother will be regularly checking in with her OB/Gyn regarding mood health and receive screenings for PMADs at her clinic. Unfortunately, not all health practitioners are savvy to maternal mental health. That’s why it’s so important for new moms and her family to be aware that this most common complication of childbirth is treatable, and help is available. Organizations like Postpartum Support International (PSI) have extensive resources and volunteers to help link up new moms with psychotherapy, support groups, and other community resources. (postpartum.net).
4) Treatment for PMADs generally incorporates psychotherapy, self-care, social supports, and when necessary, medication management. Clinicians who are trained in maternal mental health can be located through PSI (Postpartum Support International postpartum.net). Psychotherapy generally blends interpersonal and cognitive behavioral approaches, also addressing any trauma or loss circumstances (traumatic birth, baby in NICU, etc). The transition to motherhood is addressed and supported through psychotherapy and connecting the new mother with essential social supports (support groups, extended family, community support) to reduce feelings of isolation. Coordination of care to stabilize acute symptoms is paramount with Ob/Gyn. Addressing self-care practices including sleep hygiene, nutrition, and exercise are all vital to instigating the beginnings of a remission of a PMAD. The good news is that PMADs are very treatable, and with help, a woman recovers.
Postpartum Support International
(* a version of this article first appeared in the author’s own blog, From Andrea’s Couch*)