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Riding the Emotional Waves of Motherhood: The Postpartum Experience

» Mental Health Library » Disorders & Conditions » Postpartum Depression » Featured Article

By Cynthia Shaw, M.A., LMHC

Cynthia Shaw, M.A., LMHC

Dear Diary,

Day 1 - O was BORN today! I am ecstatic! She is perfect and LOVELY!

Day 3 - I am exhilarated, exhausted and not a little overwhelmed! Why am I crying so much? She is the sweetest baby in the world... even if she doesn't know what sleeping is.... and she's really hurting my breasts when she nurses... owwww... is that supposed to happen?

Day 5 - crying... wants to be fed... sometimes I feel angry with her and so frustrated... is this normal? or am I losing it?

Day 8 - my heart has been pounding really hard lately... what's that about? I keep feeling driven to make sure she's always comfortable etc... and everything's clean etc... I'm feeling obsessive!

Day 10 - ok... I'm sort of getting into a routine even if I haven't been out of the house yet... this is intense! She cries and cries and cries and cries... I feel like I don't know what I'm doing... Excuse me? who said I'd be a competent mother? I get so anxious and guilty about whether I'm doing the right thing... will I harm her if I make a mistake?... what a RESPONSIBILITY!... I used to feel like a competent person... what happened to her?... now I seem to just worry or cry...

Having a baby -- often a long-desired wish but sometimes a startling surprise -- often brings a mix of contradictory feelings. Pregnancy and childbirth are a happy and joyous time for some women, but for others the experience can be one of anxiety, fear, and confusion. Because our society cherishes pregnancy and motherhood, many women suffer in silence when their experience is anything less than sublime. This life change, this transition to motherhood, is all encompassing yet many women are unprepared and in todayís society, find it difficult to explain their unhappiness and confusion to spouses, friends and family. It can also be difficult to know whether those anxieties are the normal mood fluctuations of pregnancy and the postpartum period, or symptoms of a more serious problem.

The journey to becoming a mother is just that, a journey with glorious highs and scary lows. We are not helped with this journey by the myth that there is a special and all-powerful maternal instinct, that motherly love is limitless and unwavering, and that the baby is supposed to provide the mother total fulfillment. These myths set mothers up to feel ashamed for the doubt, anxiety and self- recrimination that can contribute to the baby blues and postpartum depression.

Some might find it easy to relate to the diary entries above, for example, while others may think this woman has gone off the deep end. Some women may also have an easier time admitting to their feelings, be they new-mother joy or utter frustration over a toddler who wonít get dressed in the morning. I'd like to propose that the Diary Mom is a compilation of us all -- somewhat more anxious and depressed than some of us, yet somewhat less than the rest of us.

In my personal and professional life, I have experienced the ambivalence that can come with motherhood. The contradictory feelings that can be confusing yet make it all a wonderful, fantastic, complex, life-enhancing, growth inducing journey. In words from her book Fruitful, Anne Roiphe states:

"The baby's needs are endless, consuming, and often boring. The ideal mother may always be smiling through the sleepless nights, through the curtailed days, through the milk that comes and the diapers that need changing, but most of us, far short of the ideal, survive with a mixture of pleasure and exhaustion. Tedium is hardly rare, and the metamorphosing of the selfish self into the care giver is a slow and painful process, varying in difficulty from woman to woman, but never a pure delight, never a Hallmark greeting card, always a recall of long buried feelings, always a hostile thought or two directed at the child, directed at one's own parents, drifting just behind the lullabies."

Roiphe dares to speak to the depths of the conflict between self-preservation and maternal feeling. I believe that it is when we feel that we can't or shouldn't express the negative feelings of this journey that trouble looms. It is also my experience that this happens too often. There is a strong wind of cultural expectation that becoming a mother should be the happiest time of life for a woman. The taboos surrounding the darker part of the experience -- the ambivalence, the struggles with selfishness, the baby blues, the postpartum depression, the anxiety and possible postpartum psychosis -- are powerful deterrents to freely speaking about and wrestling with the fullness of this experience.

It can be healthy to wrestle with the ambivalence and doubt and to mourn all the losses; our independent selves, our singular relationship with our partner, time to think and put two sentences together, time to read or paint or walk alone, and the freedom from worrying about anyone but ourselves. But by acknowledging all of this, we can also celebrate the enormous gains of unfathomable love and the glory of a child's trusting smile.

For each of the conditions listed below, treatment is not only available but also usually highly successful. In some cases, it may be as simple as finding another mother who will listen. Other cases may require more involved counseling and medication. It can also be good to get a full medical exam including a full thyroid screening. Fatigue and depression could be a sign of postpartum thyroiditis.

What can be tricky is identifying mothers who are afraid to come forward. If you feel a friend is having trouble, or if she says, "oh, I'm fine" yet you feel in your gut that she may not be telling the truth, you can make a difference. Sharing a "taboo" feeling or experience of your own may help. You can also let the mother know that anxiety is not uncommon for any new mother and suggest a motherís group or other support services.

Baby Blues

Studies show that 60 to 80 percent of women experience what is commonly known as the "baby blues." The blues can occur during the first few days after delivery. Symptoms may include crying for no apparent reason, over-sensitivity, impatience, irritability, restlessness, anxiety, and possibly some lack of feeling for the baby. The blues are often attributed to the severe drop in hormone levels, which take place during the first postpartum days. New mothers also recount feeling let down after the emotionally charged experience of birth. The symptoms of baby blues usually let up after a few days or weeks and are never severe in nature.

Postpartum Depression

A more debilitating postpartum reaction is postpartum depression. Although as many as one in 10 new mothers experience varying degrees of postpartum depression, it still remains one of the least identified and diagnosed reactions. Although itís treatable, many women suffering from postpartum depression do not recognize that they have it. A study of postnatal depressed women showed that over 90 percent realized something was wrong, however less than 20 percent reported their symptoms to a health care provider. It is estimated that only 20 percent of the women with postpartum depression receive mental health treatment.

Postpartum depression can occur within days of delivery or appear gradually, sometimes up to a year later. This is a good fact to keep in mind when listening to friends throughout their postpartum year. They may be depressed and benefit from more help even though their child is 10 or 12 months old. Although postpartum depression does not take the same form for every woman, all of the symptoms can be equally distressing and often leave the woman feeling ashamed, guilty and isolated. Different women may experience any combination of one or more symptoms, which range from mild to severe. The woman may also be changeable, with good days alternating with bad. Some of the most common symptoms are: nervousness and anxiety, uncontrollable crying, sluggishness, exhaustion, sadness, hopelessness, appetite and sleep disturbances, headaches, poor concentration, memory loss, confusion, feeling "out of control" or like you are "going crazy" over concern for the baby, lack of interest in the baby, feelings of guilt and inadequacy, and fear of harming oneself or the baby.

Some women may not feel depressed, but may feel very anxious. This is postpartum anxiety, and/or panic, and it is characterized by intense anxiety and/or fear, rapid breathing, fast heart-rate, palpitations, sense of doom, hot or cold flashes, chest pains or discomfort, shaking, dizziness, insomnia, and feelings of wanting to run away.

Another variation can also occur, which is obsessive-compulsive thoughts and behaviors. A woman may have thoughts that are scary and perceived as being out of character for her. These thoughts, things that one would never want to happen, are symptoms of the illness. Other symptoms include: intrusive, repetitive thoughts (may include thoughts of harming baby or others), obsessive thoughts and behaviors (e.g., the baby being harmed by germs and obsessive cleaning), avoidance behavior, anxiety and/or depression, and ruminating on obsessive fears.

There is one more postpartum reaction, which is the most severe. This is postpartum psychosis, which has come to light recently in the case of Andrea Yates. It is the most severe postpartum mood disturbance, involving a loss of touch with reality. About one in 1,000 women suffer symptoms, which usually occur within the first two weeks after delivery. Symptoms are very exaggerated and may include insomnia, refusal to eat, excessive energy, agitation, hallucinations, and bizarre feelings and behavior such as suspiciousness, irrational statements and preoccupation with trivia. At the furthest end of the spectrum, untreated postpartum psychosis can lead to the horror of suicide, infanticide or both. As it sounds, postpartum psychosis is a serious emergency and requires immediate medical attention.

Conclusion

What mothers and fathers want is to be able to give their best to their children. An important part of realizing our parenting goals starts with pregnancy - understanding and being able to recognize the range of pre and postpartum symptoms. For each of these conditions, some women experience symptoms not only after childbirth, but also during pregnancy, following miscarriage or stillbirth, or termination of a pregnancy, and also after adoption. At whatever time these difficulties are encountered, knowing when and where to get help can make an enormous difference in a familyís experience of becoming parents.

About the Author...

Cynthia Shaw holds a Masters in Counseling Psychology and specializes in reproductive mental health. She has a private practice in Nyack, New York.

Last Update: 5/6/2009



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