A few years ago I co-facilitated a postpartum depression group. Each week 20 to 30 women pushed their mammoth strollers into a large conference room and sat either on the floor crisscross applesauce or in chairs arranged in a circle. Some of them brought their babies as young as three weeks old, others had small toddlers take their first steps in the room. I liked to call the group “Mommy and Me but with Feelings.” Many of the participants had satisfying professional lives, some had older children. Some had both. There was the occasional 18 or 19 year old woman in the group but most were in their 20’s and 30’s and 40’s. Many, but not all, were in relationships with a significant other. Some of these women had a history of either anxiety or depression. But most of the women were taken by surprise to experience feelings of anxiety, depression and general unhappiness during what they expected would be the most joyful period of their lives.
Almost without exception the women I met on their first week were exhausted, both from the rigors of pregnancy and labor and delivery but also from the sleepless nights that followed. I grew accustomed to the expressed or unexpressed shame and self recrimination that many brought with them into the room. Almost every week someone would share the thought, “This should be easy. Women have been doing this for thousands of years. Why is this so hard for me? Am I not a good mother?”
An important part of our group was defining what we were talking about. Postpartum depression, Postpartum Anxiety and the “Baby Blues” are connected, have some elements in common but are not the same. And like in most mental health conditions, the symptoms manifest in a spectrum of severity from mildly concerning to fully debilitating.
Signs and symptoms of the “Baby Blues” which generally only last up to two weeks after birth might include some but not all of these: Mood swings, Anxiety, Sadness, Irritability, Feeling Overwhelmed, Crying, Reduced Concentration, Appetite Problems, Trouble Sleeping.
Postpartum Depression is similar to the Baby Blues in many ways but the symptoms generally last much longer and are more intense. For some people calling what they experience “Postpartum” depression is really a misnomer as the symptoms may begin during the pregnancy itself therefore it is often referred to as “peripartum” covering both the pre and post birth periods. Some women do not experience these symptoms until weeks after birth and they may last up to a year. Peripartum depression signs and symptoms may include some or all of these: Depressed mood or severe mood swings, frequent crying, Difficulty bonding with your baby, Withdrawing from family and friends, Change in appetite (either more or less), Change in sleep (either more or less), Exhaustion, Decreased pleasure in activities you used to enjoy, Irritability and Anger, Worry, Feelings of Hopelessness, Worthlessness, Shame, Guilt or Inadequacy Decreased Concentration, Restlessness, Panic Attacks and in the most severe cases thoughts of harming yourself or your baby.
In rare cases people experience Postpartum Psychosis which includes delusions, hallucinations, distorted thinking, paranoia, agitation and thoughts and or attempts to harm oneself and her baby. In these cases immediate help is vital for the health and safety of both mother and child.
Often women would come to the group experiencing not depression but Peripartum Anxiety. The symptoms might include: Constant worry, Strong feeling that something bad is going to happen, Racing and ruminating thoughts, Disturbances of sleep and appetite, Inability to sit still and Physical symptoms like dizziness, Hot flashes, and Nausea.
While women often feel like they are the only ones struggling with these issues it is much more common than most of us are aware. According to PostPartum Support International, “Approximately 15% of women experience significant depression following childbirth. The percentages are even higher for women who are also dealing with poverty, and can be twice as high for teen parents. Ten percent of women experience depression in pregnancy. In fact, perinatal depression is the most common complication of childbirth... Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. Sometimes they experience anxiety alone, and sometimes they experience it in addition to depression.”
When these symptoms begin to interfere with and impact the day-to-day functioning of life or with ones’s relationship with one’s partner or other friends and family or if it seems that there is less joy in life than one was used to or expects it may be the time to consider reaching out for help.
This understanding that other women share similar struggles was often one of the greatest paths to healing in our group. Women would arrive that first week tentatively, often with dark circles, red rimmed, downcast eyes. Often the first session would pass and the only time they spoke up was a brief introduction of themselves and their baby as we went around the circle. Over time though, it was wonderful to watch the women sit up straighter and make eye contact as they heard stories that mirrored their own or when they shared a victory from the prior week. After a few weeks of attending the group they often swapped tips about a nice park they liked to walk in, a different type of pacifier they found or what brand nursing bra, nipple guard or baby bottle worked for them. For women who were used to being out in the world, working collaboratively in meetings at work or socializing on “girls nights out” with their friends many did not anticipate the loneliness of being home full time with baby, especially after her partner’s parenting leave was up and he or she returned to work. Many women talked about how they didn’t have the energy or desire to brush their hair, shower or get out of their pajamas since they didn’t leave the house most days. The weekly structure of coming to a group motivated some to put on their more “fashionable ath-leasure-wear”, brush on some makeup or even just brush their teeth.
It was always interesting to witness how women who were incredibly accomplished in so many areas of their lives before baby were often the most flummoxed by the challenges they faced after the baby’s arrival. Woman would share how they were well regarded as the most prepared and efficient manager at work or the top salesperson in their company and yet they were often so self critical over challenges such as getting baby to latch on well while nursing, calming her baby during episodes of croup or just getting baby to sleep with any regularity. These were women who were learning the limits of what they could and could not control while dealing with a newborn.
Frequently I would hear stories about other women in their circles, a sister in law, college roommate or colleague who was coping so much better than they were. Often the perspective was skewed by Instagram and Facebook posts showing baby looking serene, houses looking tidy, and the other mother back in her pre-pregnancy jeans. It is hard to remember when scrolling through those posts that the near- perfection is often staged for the camera. In the moment before the picture is snapped, baby may have pooped all over the sofa or spit up on mom’s sweater. Generally those are not the moments that we post for posterity on our news feeds, but might be more typical than what we see though these social media windows into each other’s lives.
Perfectionism can be the enemy of contentment, particularly in regards to parenting. Aspiring to do well is admirable. It is a huge responsibility to care for another human life. But allowing ourselves some grace and understanding when we are struggling or inevitably make mistakes is both crucial for our own wellbeing and great modeling for our children. Being able to leave a sink full of dirty dishes so that mom can take a blissful 20 minute nap while baby is sleeping is an act of prioritizing our basic needs and knowing what can wait until later. It is self-care at its most basic.
Sleep was often a big topic of discussion in the group. Who was getting it and who wasn’t. How many hours at a time. How it would change from day to day or night to night. Some moms would share that their babies slept like champs and yet they were exhausted because even if baby was sleeping they could not. They would lie in bed worrying about all the things that might go wrong, checking multiple times a night to see if the baby was breathing. They would worry about going back to work or if they should stay home, worry about day care, worry about finances, worry about being a good enough mother, worry about her husband, her mother coming to visit, about global warming, about earthquakes… just worry. When one is feeling anxious worry often feels protective. One believes it helps prepare us for every eventuality, every worst case scenario. The challenge is in finding the difference between productive planning and rumination. It is important to plan for childcare before you go back to work or figure out how the family budget might need to change if one decides to stay home. But this differs from worry in that planning is done during a finite or even a series of finite sessions where one can be productive and come up with solutions and move forward. Worry often resembles a hamster in a spinning wheel, exerting a tremendous amount of energy but not actually getting anywhere at all. Worry is often characterized by a feeling of being out of control, which as I discussed earlier is often turned upside down by the entrance of these small people into our lives. There is always an infinite number of “what ifs” that could go wrong. Even if in the midst of a 3 am worry session we decide on a logical plan for one worry a new worry will always be waiting in the wings to take its place.
When the subject of worry would come up in group someone would usually express something like, “Telling me not to worry is not helpful. It is not something I can just turn on and off. If I could stop I would.” And there is a lot of truth in that statement. No one wants to stare at the ceiling all night long wondering if the carbon monoxide detector is working. The good news is that there are things one can do to learn to quiet the mind. Strategies such as working with your individual therapist to develop a mindfulness practice, Cognitive Behavioral Therapy and even scheduling a time to worry, can help with time. For some people discussing anti depressant or other medication with your psychiatrist or other physician can be helpful.
The common thread of every woman who crossed the threshold into that group was that each desperately wanted to be and worried that they were not a good mother. When one’s vision of a “good mother” is actually a “perfect mother” we are destined to fail right out of the gate. My goal, both in group and individual therapy sessions is that each woman can learn how to be a “Good Enough” mother. One who is loving and fallible, who is learning on the job, who does the best she can with the resources she has. Paradoxically, once we get the support to understand that perfection is unobtainable, no matter what societal pressures may tell us, it is a stumbling block that can be removed which can lead to greater mental health for both mother and child.
The more we as a society move towards removing the stigma of peripartum mental health issues the sooner we can allow new parents the vulnerability of open discussion about the challenges in this unfamiliar and often messy stage of life. Perhaps then, each mother can work on a path of healing and acceptance of the limitations we each have as human beings regardless of the Instagram-perfect image of motherhood.