The Unspoken Struggles : Therapeutic Insights into Postpartum Care
Have you noticed that we’re programmed to yelp an excited “Omg! Congratulations!” anytime someone announces that they’re pregnant? Having a child is universally painted as a momentous, happy occasion. In this happy, pastel-y setting, there is no space for ambiguous or sad emotions. It’s pretty black and white. But what if ‘mixed feelings’ are as integral a part of the motherhood journey as happiness or excitement?
Most, if not all women, experience “baby blues,” or generalized feelings of sadness, worry, unhappiness, and exhaustion in the initial days after giving birth. The rollercoaster changes and emotions can be disorienting and isolating to go through for any new mother. More often than not, these mood fluctuations tend to resolve within the first two weeks following delivery. In contrast, postpartum depression manifests as symptoms persisting over more extended periods, at times lingering for a couple of years after giving birth.
The motherhood journey begins well before birth. Every culture has its own myths and traditions around childbirth. These cultural beliefs have a strong, pervasive influence over many aspects of a new mother’s life like medical decisions, diet, familial relationships to birthing and much more. In many East Asian cultures, for instance pain is seen as a necessary part of childbirth and pain management is declined. Many of Japan’s hospitals for instance have limited anesthesiologists on board for childbirth pain relief as there’s very limited uptake for it. In India, pregnancy can have the involvement of the larger family which can limit the mother’s autonomy when it comes to important decisions. These have ripple effects well post delivery. As therapists, exploring themes related to autonomy, support structures and experience with health care providers becomes critical as they have big mental health implications.
Post-pregnancy, many women experience changes such as sadness, worry, and exhaustion; however, these need to be differentiated from signs of depression – feeling low most of the day every day, feeling shame, guilt, or like a failure, and having severe mood swings. The mother may also feel like she has less interest in things she’d normally enjoy, changes in appetite, weight fluctuations, sleeping too little or too much, trouble concentrating, difficulty bonding with one’s baby, and in more severe cases thinking about hurting oneself or the baby. Normalizing the broad spectrum of the emotional experience will go a long way but assessing risk is also imperative. Addressing severe distress through timely diagnosis, safe pharmacological interventions, psychoeducation of family and friends are significant steps to take. It is thus, crucial for therapists to recognize the risk factors for postpartum depression, such as history of depression or other mental health disorders, experiences of physical, sexual abuse or intimate partner violence.
Research suggests that a huge proportion of women may not be asked about their symptoms of depression during prenatal visits, making it easy for the condition to go unnoticed and untreated.
Another common experience many new mothers go through is this sense of fading into the background as conversations begin to focus increasingly on the baby. This can elicit a range of reactions: Is it okay to feel resentful or lost, or guilty all at the same time for feeling this way? The pressure to fit into the “ideal mother” archetype who is selfless, devoted and loving can be overwhelming. Ironically this pressure can further contribute to the disconnect. Therapy can be a powerful space for a new parent to authentically (re)connect with themselves and make sense of this new role. “Loving it!” isn’t the only option.
A relational lens looks at how the client’s mood and emotional well-being are influenced by their interactions with others, be it their partner, family, or friends. The massive role shift has the potential to bring to surface long-running conflicts such as the client’s pre-existing challenges with advocating for themselves, difficulties with conflicts, etc. This form of therapy can directly address these concerns, and can equip them to adjust to the new role as a mother from a more empowered place while dealing more effectively with partner or family conflicts.
Cognitive Behavioral Therapy (CBT) can also be highly effective in treating postpartum depression. Addressing self-doubt, feelings of inadequacy or fears of meeting the demands of motherhood can be helpful. The new mother who catastrophizes about the baby’s well-being, their parenting abilities, or the future, may experience heightened anxiety. The constant comparison with their own mothers or other mothers – believing that others are coping better, enjoying motherhood more, or are more competent, further maintains the feelings of inadequacy.
Grief also sneaks into the therapy room as one mourns their past life that was a life well-known and loved. There might be sadness in taking a break from work, letting go of one’s free weekends and spontaneous plans. In the safe space of therapy, the worries about changes in the body (which can feel threatening and ever-looming) and sadness over loss of certain aspects of one’s previous life can be addressed and worked through.
Lastly, couple’s counseling during the postpartum period can also serve as a valuable intervention, providing a structured and supportive platform for partners to navigate the challenges associated with early parenthood.
As therapists, we continue to strive to provide a safe and empathetic space for new mothers to express their thoughts and emotions about this new, testing phase of their life. By fostering open dialogue, understanding the unique challenges, and embracing the collaborative approach, therapists can support mothers by fostering a path toward recovery and adjustment to the demands of motherhood.