By Brooke Laufer, Psy.D.
Motherhood, Not What You Thought
Mental health issues are among the most common complications related to childbearing, and yet it is still a topic that is largely misunderstood. A conversation I had with my dentist recently reminded me how little the general public knows about perinatal mental health issues. “Oh,” she said, “I just thought women cried a little bit, but you know, they’re usually just so happy to be mothers, right?!” We want to believe becoming a mother is an absolute joy. Motherhood is expected to be a fulfilling time for a woman, when a woman is in her most natural role–the role she was meant to play as suggested by film and other media–when her true purpose is determined. In reality, having a child is a profound, frightening, and exhilarating experience at the boundary of life, from which one comes back a transformed person. Most women bear this monumental transition to motherhood with some hardship. Experiences range from tearfulness, exasperation, and nervousness to more extreme feelings of obsessiveness, helplessness, and even murderous fantasies. While many women will have what is labeled the Baby Blues, 20% of women will have a Perinatal Mood and Anxiety Disorder, a debilitating psychological experience that interrupts their lives. With a growing amount of research and education, we begin to clearly see what distinguishes a true Perinatal Mood and Anxiety Disorder from the non-clinical experience of the Baby Blues.
10 years ago I was as unaware as my dentist of what could happen to a woman’s state of mind when she was faced with childrearing, so after my daughter was born I learned in a shocking and destabilizing way–the way most women learn–what a Perinatal Anxiety Disorder was. For me, it started with anxiety attacks while in my third trimester. I shook uncontrollably in the evenings and experienced an overwhelming sensation of claustrophobia during the day. I found a good psychiatrist who helped me understand that taking an SSRI (the one I’d gone off when I got pregnant) would relieve my anxiety and would not hurt my baby. Then after a fairly uncomplicated birth, I was supposed to be thrilled, but I had a new baby who didn’t sleep well. I loved her, but I wasn’t completely attached to her; I was also ragged and jumpy. When she was 4 months old, I started having intrusive thoughts that deeply disturbed me. At first they were like small blips on a radar, like thoughts from the periphery of my mind that I could barely hear. But then the blips grew larger and included images. I could clearly hear thoughts telling me that harm would come to the baby. I could see my baby being sexually violated. I had thoughts that my husband and I would be the ones to sexually harm our baby daughter. I could barely tolerate these thoughts as they began popping in with greater frequency. Luckily, my psychiatrist answered his phone the day I called beside myself in tears. He calmly told me that what I was experiencing was Postpartum OCD, he told me about Karen Kleiman’s book This Isn’t What I Expected, and he raised the dosage of my Sertraline. I was a therapist, a clinical psychologist, and I was learning for the first time what a Perinatal Mood and Anxiety Disorder was; this was not the Baby Blues. I recovered from my Postpartum OCD, but my life was changed forever. Since that time I have done what I can to research perinatal mental health, to immerse myself in the literature and new information we have on this condition, and to talk about it. Talk to women, to friends, to family, and especially to my clients, letting them know they are not alone, they are not crazy, and they can still be the mothers they want to be.
The term ‘Baby Blues,’ first used in Nicholson J. Eastman’s 1940 best-selling baby care book Expectant Motherhood, is an umbrella term referring to any emotional experience a woman has in the period after bringing home the baby. It is no surprise this massive life transition, along with sleep disturbance, disruption of routine, and emotions from the childbirth experience itself will contribute to how a mom feels. Her experience is also affected by the hormone changes that occur first during pregnancy, and again after a baby is born. The levels of progesterone and allopregnanolone rise during pregnancy and plummet after childbirth, and this drop is thought to contribute to emotional dysregulation. These short-term postpartum symptoms include weepiness or crying for no apparent reason, impatience, irritability, restlessness, anxiety, fatigue, sadness, mood changes, and poor concentration.The informal diagnosis of Baby Blues requires that these symptoms last no more than 2-4 weeks, occurring for a few minutes up to a few hours each day, and typically going away with rest, support, and time. Baby Blues rarely get in the way of daily life or need intervention from a medical provider.
“A baby opens you up, is the problem. No way around it unless you want to pay someone else to have it for you. There’s before and there’s after. To live in your body before is one thing. To live in your body after is another. Some deal by attempting to micromanage; some go crazy; some zone right the hell on out. Or all of the above. A blessed few resist any of these, and when you meet her, you’ll know her immediately by the look in her eyes: weary, humbled, wobbly but still standing. Present, if faintly.” Elisa Albert, After Birth (2015)
Perinatal Mood and Anxiety Disorders
When a disturbing emotional state lasts beyond 2-4 weeks, clinicians should start to assess for a perinatal mood and anxiety disorder (PMAD). Formerly referred to as Postpartum Depression, or simply “postpartum,” we now use the term “Perinatal” because the symptoms can occur not only one year postpartum, but also during pregnancy, or after a pregnancy loss. We say “Mood and Anxiety Disorders” instead of “depression” because it more accurately covers the range of experiences women have. These include major depression, generalized anxiety, OCD, PTSD, and postpartum psychosis.
Although there is no clear indicator of who will experience a PMAD, previous mental health issues, trauma, and lack of resources are some of the risk factors. Important to note: PMADs do not affect just biological mothers. Growing research shows us that men experience postpartum anxiety and depression. In fact a client of mine came in a few weeks after her baby was born and reported that her husband was acting strangely: yelling a lot, throwing pillows at the wall when the baby cried, uncontrollably crying, and openly fantasizing about leaving the baby out in the snow. We were able to get him in for a session with her and help him understand that he needed help. The couple was surprised that he was having postpartum rage, while she was adapting well. He actively resented his child for destroying their former life, while she’d become protective of the child. Eventually, with months of treatment, he was able to love and attach to his daughter.
Similarly, adoptive parents may report symptoms of PMADs: it can be particularly confusing to resent or feel disconnected to an adopted baby whom you wanted and planned for and possibly spent much or most of your savings on. Likewise, LGBTQ families who may have worked for years on fertility treatments or with a surrogate to finally bring home a baby are also vulnerable to PMADs and should not be ignored as a population worth assessing.
Perinatal depression mimics that of a major depressive disorder but with certain symptoms specific to mothering. A woman may be withdrawn from the baby and her family, not want to hold the baby or have difficulty bonding, have a flatness of facial expression and voice, exhibit excessive tearfulness, or severe self loathing. She may have a belief that she can’t handle motherhood or be a good mother, she may be unable to enjoy most of her life, or she may believe her family would be better off without her.
A client of mine described feeling like she couldn’t see herself in the family picture. She vacillated between dissociation and depression. This mom had twin baby girls with whom she was not bonding. She felt like a machine part going through the mechanical motions of caretaking. After her first session of unburdening herself of the sadness and shame she carried, she was able to start to locate herself. Her experience points to the invisibility some women feel as mothers. The erasure of self to motherhood is well noted by the poet Alice Notley:
“For two years, there’s no me here….
Two years later I obliterate myself again
having another child” (1972)
Perinatal Anxiety and PTSD
Perinatal anxiety, or anxiety during and after pregnancy, has received little attention compared to its well-known cousin, postpartum depression, yet anxiety symptoms are more frequently reported. Worrying, of course, is a normal part of new motherhood–checking that the car seat is secure or that the baby is still breathing, for example–but if it interferes with a woman’s life so that she cannot think about other things or take care of herself or her baby, then it verges on mental illness.
For women who are prone to anxiety, the information-saturated era we live in is loaded with potential stressors about conceiving, being pregnant, and parenting, requiring women to be vigilant about what information she is exposed to. An anxiety disorder can be spotted in the repetitive fears and questions moms have, in extreme over-protectiveness such as not letting anyone hold the new baby, or in the too well put-together mask some moms wear, hiding an internal world out of control.
Post-Traumatic Stress Disorder (PTSD) in the perinatal period refers to past trauma resurfacing during the perinatal period, including flashbacks and nervous system responses (freeze, flee, fight) that can interrupt caring for a new baby. What many doctors do not realize is that women who have experienced sexual trauma may have fear of a baby coming out of the vaginal canal, a fear of male providers, and/or a fear of being alone with baby.
Perinatal Obsessive-Compulsive Disorder
Obsessive compulsive disorders are possibly the most insidious of the postpartum conditions because they include the intrusive thoughts that haunt many mothers. Intrusive thoughts are thoughts that happen frequently and randomly, feel uncontrollable, and are often disturbing. These disturbing thoughts, or obsessions, can lead moms to engage in repetitive behaviors, or compulsions, to try to ease their anxiety. Many moms with OCD are plagued by repetitive fears of harm coming to their babies, possibly due to the extreme helplessness of a newborn baby. It is horrifying for mothers to have uncontrollable thoughts and images of their baby tumbling down the stairs or falling out a window, or images of themselves smothering the baby or sexually abusing their own child. Because of the disturbing nature of these thoughts, it can be the most difficult disorder to admit, yet, as was my experience, by breaking the silence women can find tremendous relief in the normalization of Perinatal OCD.
Postpartum Psychosis is the most rare of perinatal conditions, occurring in .1% of moms, but it is the most dangerous. Psychosis is a break from reality that can happen over time but can also become a medical emergency very quickly. As with Postpartum OCD, a mom may experience intrusive and paranoid thoughts, but instead of being disturbed by them, she may begin to identify with them. For example, a new mother may have the thought that someone is going to steal her baby, so she acts on it by hiding the baby or running away with the baby. Unfortunately, it is typically after a postpartum psychotic episode has ended badly that the media gives it attention. Just a few years ago a woman who I know from my hometown was arrested for the death of her 14 month old boy. After months of working full time, bad day care experiences for her baby, an unstable partner, and increasing symptoms of OCD and paranoia, she came to believe she and her son would be better off dead. After she suffocated her baby she attempted to overdose on medications, but she survived. Even though the she had an expert forensic psychiatrist diagnosed her with Altruistic Filicide, deeming her Not Guilty By Mental Defect, she was sentenced to 25 years in prison. Unfortunately, there is still little understanding or mitigation done for mothers convicted of infanticide, resulting in excruciating treatment and excessive sentencing.
Women may find it difficult to reach out for help, as it is taboo to admit you are unhappy or unnatural at motherhood. To the extent that women in our society are still seen as playing their most natural role as mothers, to acknowledge unhappiness or discomfort may have high stakes relating to women’s own identities and how others may see them. A mom may fear being seen as a “bad mother,” which would ostracize her from mainstream society. With more education and awareness around the frequency and epidemiology of perinatal mental health issues, much of this silencing can be alleviated. What is essential to understand is that a woman herself should not be blamed–not by her providers, her family, or herself–for a perinatal condition. We often have little control over the occurrence of a Perinatal Mood and Anxiety Disorder, but we can do much about its treatment.
Psychotherapy and Medication
With a proper diagnosis of a Perinatal Mood and Anxiety Disorder, good treatment can support a full recovery. The best form of treatment is individual psychotherapy that reduces stigma and shame and normalizes the client’s experience. Besides reassuring women that it’s normal to feel ambivalent during pregnancy and motherhood, I also educate each woman about her particular diagnosis. Women often feel desperately alone and deeply ashamed when they experience PMAD symptoms, especially ones that are less talked about like rage or intrusive thoughts. I reassure my clients that these inner experiences don’t indicate their worthiness as mothers but are instead treatable symptoms of common disorders. Women express tremendous relief when they realize that their scariest and most shameful symptom is something others also experience–and something we know how to treat. Helping women accept all the parts of themselves will reduce symptoms of anxiety and depression. One important goal I look to when working with PMADs is helping women regain a sense of self. It may not be the self they knew before the baby but a new self that emerges in the transformation. Questions we consider: How does having a baby disrupt a mother’s sense of who she is, of her body, her understanding of life and death, her relation to the world and to her sense of independence, her experience of fear and hope and time, and the structure of her experience altogether?
Therapy may include the new baby, so that I can support a secure attachment and help the mom experience the infant’s behavior without insecure projection and negative interpretation. I may recommend infant massage or, inversely, setting the baby down for an extended period. Therapy may also include the partner or other family members. Marital disharmony is the most commonly cited non-biological cause and consequence of PMADs, so by bringing in and educating the partner on PMADs, a mom is more able to be understood and get her needs met at home. Group therapy, such as a moms support group, can be an excellent way to reduce shame and isolation, as it can provide universality, catharsis, socialization, and good information.
Additionally, psychopharmacology is an effective form of treatment for Perinatal Mood and Anxiety Disorders. Current research and an updated classification system (no longer the A, B, C labels for medications that were often misleading) suggest many medications are safe during pregnancy and breastfeeding. There is still damaging stigma around medication and pregnancy that needs to be fought with accurate information. Reducing a previously prescribed medication for pregnancy or changing a medication during breastfeeding are potentially misguided recommendations that can put a women at risk of relapse. The American College of Obstetricians and Gynecologists and the American Medical Association agree that treating the mother’s health is the priority; the trace amounts of medication that a fetus or nursing baby will receive should not keep a mother from the medical treatment she needs.
Although public awareness of postpartum depression has increased in recent years thanks to celebrities like Brooke Shields and Serena Williams, many people–including therapists–are still learning that PMADs are serious and pervasive experiences. When I started talking about my Postpartum OCD experience one of my aunts told me the story of my grandmother, who had three children in four years. The day after they brought home the third baby my grandfather got in his car to go to work, as he started to pull out of the driveway my grandmother came running outside and threw herself on the hood of his car. She spent the next 7 months in a sanitarium, a nicer version of an asylum in a neighboring state, and came home to her children who were being cared for by a strict German nanny. It’s possible my grandmother was experiencing depression or anxiety or even psychosis, they sent her away and no one discussed it. Although awareness and treatment have improved since the harsh days of my dear grandmother, perinatal mental health is still overdue for the attention it deserves, considering women are doing some of the most laborious and important work of our world.
Brooke Laufer is a Clinical Psychologist who has been practicing psychotherapy since 2005. Brooke began her clinical work in psychiatric wards and then in schools with adolescents and their families. After having her first child Brooke had a disturbing Postpartum OCD experience, which inspired her to begin researching, understanding, and specializing in the treatment of perinatal mental illness. She has a private practice in Evanston, where she continues to treat adolescents and adults, specializing in perinatal mental health issues.Brooke Laufer, Psy.D.
The night before you were born, there was so much lightning. It wasn’t raining though, just hot– the hottest night of the year. Sitting on the big blue birth ball, rocking from side to side, I’d rest my head on the hospital bed during the in-between. When a contraction came, I’d sit up, open my eyes and watch the jagged stabs of light through the window as they punctuated the clear, distinct pain in my body.
Later, the white haze of high noon would blur the edges of the clouds. By then, nothing would be clear for me. The pain and the urge to push or not push and the exhaustion and the panic would all run into and over each other, a hot, foggy murk, and I would not know when or if or how you were coming, or what my body was doing, or if both or either of us would survive.
Everyone said it would be a snap. A breeze. A walk in the park. There will be nothing to it, they said. They said, he’ll slide right out. Nothing is like the first one, after that, it’s all downhill. Your body is ready, they said. Your body knows what to do. Your body will take over. You’ve been through it all already.
Everything they said should have been true; but nothing could have prepared me for birthing you.
I cannot say your birth tore me open. My body did not literally tear. Somehow, I managed to expand beyond my own capacity to accommodate not only your body, but also the hands and wrists and forearms of the midwife who reached inside to turn you and free your shoulder from the umbilical cord that had wrapped and twisted its way around you.
And yet, later, I needed to mend.
It’s hard to know what happened to me afterwards, where I went. I thought I knew how to have a baby – how to birth a baby and then how to mother an infant back at home. I’d done it before – I knew how.
But I didn’t know anything. I didn’t know how to handle you, the colic. Who could blame you for being so fussy! You had swallowed so much amniotic fluid, having descended into the birth canal, then waiting there for much longer than you should have. The fluid was in your ears and eyes and belly. You needed to recover from your own birth. You needed to be held all the time, and of course I wanted to hold you, but you have a brother too, and he also needed my love and attention.
It’s not like things ever got That Bad, really. I was not incapable of joy, because I did laugh and love with you. I could never not get out of bed. I did not want to harm myself or others. I never fantasized about abandoning you or dropping you out of the upstairs window. I said “no” to many of the criteria on the doctor’s checklist when I finally went, nine months later, to get some medication.
It was hard to describe, other than to say that I didn’t quite feel like myself. But then again, it was hard to know who my “self” was anymore. There was a dark heaviness, an anger and sadness and loneliness. There was a feeling that nothing was wrong, but everything was wrong.
I slept upstairs for months, on the guest futon in my office. I did not know how to be married. I had no space. I felt so empty and hollow and heavy, there was no way anyone could meet me where I was.
It was, and still is, vague and blurry and hard to understand.
Maybe I just needed time to breathe, to mend my overstretched ligaments and allow the holes in my psyche to close back up again, after experiencing what was beyond my comprehension, to replenish the reserves of energy and fortitude that had been used up in birthing you.
Maybe if I had been allowed to stay in the hospital for another day or so I would have been okay. Just some time to collect myself before heading back out into the world where so much would be asked of me.
Maybe it’s because I felt so inept.
Maybe it’s because the only ways I knew to love were suddenly limited by time, attention, and energy.
Maybe it’s because your birth was so difficult but maybe it’s because that type of difficulty is not recognized as trauma.
Maybe it’s because I wanted to tell my story – the story of your birth – over and over and over to make sense of it, to find a context, but once everyone knew the basic details – 20 hours of active labor, the cord around your shoulder, no c-section, nine pounds, two ounces, everyone’s fine – they had heard enough.
Maybe I had post-partum depression. Maybe I had a chemical imbalance.
Maybe I just needed help. Everyone had told me – 2 kids is more like 10 kids, the workload increase is exponential, etc. etc. But no one ever said, you will not know how to handle it. You will not know how to love so much, so separately, at the same time, and this not knowing will tear you apart.
Maybe it was simply that I was an almost-40 year old woman who spent many long days alone with a toddler and an infant, and I could have used some time to myself.
Maybe it was nothing more than that.
My water broke first. That was a surprise. It hadn’t been that way the first time. Later, I was told that that there is much lore and myth around births where the water breaks before contractions have begun because contrary to common portrayals on TV, this sequence of events is actually rare.
I had just gotten your brother into the bath and I bent down to kneel beside the tub and there it was, as if the bathwater had overflowed onto the floor. Of course I knew, but I still wanted to be sure. I waited. Soon, there were puddles of amniotic fluid all over the house. We called your grandparents to come for your brother. I stood on the front porch, waving until the car disappeared around the corner into the clear evening light. My heart ached, saying goodbye to my “only” son, bursting to welcome you.
Back home again when everything was over, I was nostalgic for the hospital. There was a hippie deli down the street, and I missed the tuna sandwich on thick, soft, grainy bread, with tomato and sprouts brought to me on my one day of convalescence. I would miss the quiet, the solicitude, and that single night, alone with you, in the bed beside me, swaddled, nursing, as we figured out how to be together with you outside of me.
Afterwards, I wanted to do it again right away, which was crazy, given what I’d just been through. I thought it was the post-partum euphoria, the hormones and dizziness. But the feeling lasted. I wanted a third. A girl. I felt myself clinging to the hope that I would go through it all again. I knew that if I was going to do it, it was going to have to be now, that I could not make the transition in and out of this space again. I needed to keep the momentum going. As the months wore on, though, I knew I could not handle more. This was plenty. We were enough.
But first I had to be sad.
I had to be sad that I am not younger. I had to be sad that I didn’t do this sooner. I had to be sad that I’m someone who needs a lot of solitude in order to feel fully whole. I had to be sad that I will never have a daughter, a Violet or Ruby. I had to be sad that your birth marks an ending for me. I had to mourn the loss of possibility, that while it is still technically possible, it is not actually desirable, given our circumstances, our lives, to have more children. I had to actually say the words to myself, No, I can’t handle more. And then I had to be sad that I can’t handle more. I needed to be sad that this will be all, and I had to go through all of that to recognize that this is plenty. That you, I, we are enough.
Last time, I had birthed naturally, as I had wanted, but in a traditional hospital, with an O.B. With you, I was going to have a water birth. We had switched OB practices so that I could employ a midwife and use the Alternative Birthing Center and give birth in the giant bathtub. I could labor in water, which was said to be so relaxing and warm and peaceful. Floating took pressure off the joints and alleviated the affects of gravity and you would not be shocked by the sudden change from water to air and I could catch you myself as you slid out.
But the night you were born was the busiest of the year in the birthing wing. Someone said it was because of the lightning, the way it pierced the pressure of the atmosphere which induced labor. The tub was not available. It’s rare that so many women are laboring at the same time that those who desire the tub suites cannot have them, but as I breathed through my contractions in the triage room, I was told that there was a chance we might not be able to have a water birth.
There was much confusion then, and conferring with various staff members. But I left that to the trusted others to handle, your father and godmother, who were with me in the hospital. I was busy, breathing, focusing, rocking, turning further and further inward in preparation for the work I would do later.
The lightning began to fade as the first signs of daylight appeared in the sky. There was a shift change for the staff, and once my regular midwife showed up, I knew we would be alright. She was taking charge of the situation and said that yes, we could get into the tub room because I had been there longer than the others. I only had to be dilated 5 cm before I could get into the room but that surely that would not be a problem because I had been there all night.
But when she checked, I was only at 2.5 cm, still. I didn’t know why it was taking so long, what was wrong, what I was doing wrong.
Even at this hospital, with all their alternative methods, there were still rules; they followed the standard hospital protocol which allowed no more than 24 hours to elapse between when one’s water breaks and when the baby is delivered. Without amniotic fluid, the theory goes, the baby has no protection from harmful germs and bacteria and is potentially exposed to danger of all kinds.
5 cm to get into the water, 24 hours without water.
5 cm to get into the water, 24 hours without water.
5 cm to get into the water, 24 hours without water.
Later, somehow, in the space between trying to return to normal and recognizing that my notion of normal had vaporized – during the time when I tried to show your brother how much I still loved him and how much attention I still had for him, how much I could still dance and romp and play and be silly, and how much it was okay for him to be mad at me for having a baby, and how it was okay for him to not want me to sit next to him, or tuck him into bed at night, all while trying to figure out what would make you happy, not the car nor the stroller nor the bassinet, only my arms, my breast – somewhere in there a part of myself became dormant, as if stunned into stillness. It felt as if nothing within me was growing, that I had shed all the life I had.
I was already a mother when I had you, so your birth was not the dramatic transformation into something else that had occurred the first time. One birth revealed to me how much I was capable of, was for me about capacity; the other illuminated my limitations, the point where branches can bend no further, the point of breakage. Both showed me to myself. Both were necessary for me to be whole. At the time I did not know that. At the time I did not recognize that anything was growing or alive, that deep underground, my roots were stretching, absorbing nutrients from the rich soil of my life, of our lives together.
By now I’m Tired. I’ve been having steady contractions for 14 hours already. The tub is open. We are moving. We parade down the hall, carrying pillows from home and clothes and bags and cups of coffee and cups of ice. I feel that I’ve earned this and here we are, the large room with the queen sized bed with the flowered spread and oak headboard. The tub. The tub is full of water and waiting for me, for us. Through the window I see the blue sky and white, puffy clouds. Late morning light. I sink into the tub. Getting close to transition now. The contractions are coming quick and hard and I am breathing and the water feels so good, I lay back, rest, so that only my face and the apex of my belly with its protruding navel are not submerged in water. And then I wait. And nothing happens. When a contraction comes, several minutes later, it is weak, and barely a moan escapes my body. I wait some more. It’s afternoon now. We’re close to 20 hours now. I’ve gotten to 8 cm and now my contractions have stopped. I’ve reached transition and now I’m going backwards. I am closing back up.
Out of the tub and into the shower. Out of the shower and on to the bed. A walk down the hall. Nipple stimulation to get contractions going. We’ll try a breast pump. This works; the contractions are back and they are quick and hard and we are ready to go and they are in my back now. There is no water inside me and no cushion. I’m having back labor now and I’m on all fours on the bed and I have never had pain so deep and hot that it pushed me to the edge of consciousness. I do not know who I am. I do not know what I am.
Then back in the tub and do I feel pushy now?
I’m not sure; I can try to push but I don’t know how. I don’t know how to push anymore and it’s not time yet. It should be time, but it’s not time yet. We’re not ready yet. Back into the shower and down the hall and back and nipple stimulation and now I feel pushy. I want to push in the tub but that doesn’t work. We’ll try the bed and now the pain the pain the pain. On my back and I am screaming and I can’t take it. I can’t do it any more I am done. The contractions are too much, it’s too fast now. It’s happening too fast and too slow and it’s not over yet and it should be and out the window is only white haze and my eyes are blurry. The room is flooded with light and I scream into the light it’s too much I’m pushing now. I’m pushing now. My body is on fire and you will be here now.
I am in and out of that place within me that I have never known before, that I will not remember afterwards, that place that allows my body to take over. That place that pushes me out of itself, that is myself. That is fluid. I will need this later. I will want this later. But my moments here are so fleeting I will not know how to come back and this is not a place to return to, only to bring back with me. But there is no time to come back here, like waking from a dream and wanting to remember it before the day begins.
I am pushing now for you to come but you do not come. You move down but then back up and something is wrong. It is not supposed to happen this way. It’s not supposed to be this way. I am to push and you are to emerge but you are not coming out. You have descended. You can’t stay there too long but you stay. Your head is moving now your head is out. Your skull your brain your mouth your eyes are here but now your body is stuck. We’re both stuck. There is nowhere to go because of where you are and where I am and I am done but you’re not out and there is nothing to do but scream and sob and push and breathe and pray and beg to be cut open but they cannot cut because your head is out and the only way out is through me. It’s not supposed to be this way, your body should slide right out now, but there is the cord. The cord is keeping you here, part of my body holding strong to your body, not letting you out and this is when we could die. Like a flash of lightning, I suddenly know, in my bones and skin and fluid and a new kind of scream, that something is very wrong, that you or I or both of us might not survive this. Darkness descends now. But now there are the hands and wrists and forearms, reaching in and turning. I don’t know what is happening, only more pain but there you are now you’ve been turned and you’ll slide out now, and I’m pushing and just like that there you are. You’re out. You’re out now and I’m done. My shaking sobbing body is done. But you’re quiet. There is no sound from you yet, not yet not yet and I am waiting for you still and I don’t know I don’t know if-
Here you are. You’re on me now, blue and slimy and crying too and mine. You’re here and you’re okay and we both made it we’re both alive and you’re out and both our hearts are beating and you’re fine and you’re here.
Oh my God – you’re here.
“Waiting for Elijah” appeared in the Winter 2010 issue of Calyx Literary Journal and is republished here with the author’s (Christine S, Massage Therapist LMT) permission.
Historically, there has been a lack of attention to the full range of women’s emotions. The typical woman is presented as having a limited response to stressors or negative experiences: she is sad, helpless, and inwardly focused. Anger, in contrast, may be seen as unusual and/or inappropriate for a woman. This may be especially true for women during the postpartum period, as the emotion of anger suggests there is something to be angry about, which starkly challenges stereotypes of new motherhood.
There are a number of reasons why it is important to protest those stereotypes and recognize women’s experiences of anger during the postpartum period. For one, normalizing the response is important in helping women to recognize their own emotions and feel less isolated. Unless it represents a chronic and debilitating pattern, anger in and of itself is not pathological, and may be an entirely appropriate response to a negative occurrence. Expression of the emotion can be constructive and help to remedy aspects of a new mother’s life that may be working against her.
The reasons for feelings of anger postpartum are numerous and surely varied for each woman. They range from societal (insurance company frustration, hospital bureaucracy, poor maternity leave policies at work) to relational (not enough support from friends or family, waking up constantly while your husband sleeps through the night, having your instincts questioned by the pediatrician) to the personal (poor birth experience, negative feelings about body/appearance, sleep deprivation, lack of time for self). The list could go on and on. I once had a client who denied her own angry feelings for months after her child was born. One day she was in the library, and found that her stroller could not fit down an aisle. It was the last straw for her, and she began to feel overcome by an incredible amount of rage and frustration that she could no longer ignore. She realized then that she needed an outlet.
Be it therapy, mom’s groups, or talking with our own mothers or sisters, being able to express the frustrations, injustices, and indignities of motherhood can be crucial for our mental health. It also can be the first step to creating societal change, helping us organize and question why we and our babies are not better supported. It can validate other women’s experiences, sending the message “It’s not you, it really is just that tough sometimes.” Finally, it can serve to help us enjoy all the amazing aspects of parenting because we are not carrying suppressed negative emotions.
One of my main goals for the therapy room is make it a taboo-free zone. Women are so often shocked when I tell them that their feelings or experiences, be it anger or whatever else, are not uncommon. Because we are so trained to keep a smile on our faces, make it all look easy, and not make others uncomfortable, we may have the illusion that we’re the only ones faking it. The struggle is real, mamas. As real as the love and joy and delicious chubby thighs. By moving toward authenticity and the acknowledgement of our full range of emotions we can achieve greater fulfillment as well as push for changes that can improve our experiences as mothers. Maybe a campaign for wider library aisles?
Dr. Erika Yamin is a clinical psychologist with a long-term focus on women’s reproductive mental health (issues relating to pregnancy, motherhood, postpartum, infertility, adoption). She has extensive clinical, academic, and advocacy-based experience in this area, and previously worked as a birth doula. Erika completed her doctoral coursework at The Chicago School of Professional Psychology and her master’s degree at the University of Chicago. She sees her work as a tremendous privilege and is continually awed by her clients.826 Madison StreetEvanston, IL 60202847-461-8905
By Margaret Eich, MS, RDN
Imagine this scene. You worked late to finish a project at work. You ordered in some takeout while you were working, and now it’s finally time to go home. You’re exhausted and stressed. When you get home, you start raiding the fridge and cabinets for things to eat. You really aren’t hungry at all since you ate dinner at work, but you’re looking for comfort in the cupboards.
I think most people can relate to this, and I would venture to guess that most of us have been in this or a similar situation before. In times of stress, we tend to turn to food as a coping mechanism. Food is readily available and processed high sugar, high fat foods tend to give us a quick, but very short-lived, boost that often leaves us feeling worse or just simply that we haven’t acted in a way that is consistent with our long-term goals. No matter how good our intentions are, stress from a variety of sources can tend to deplete our resolve and decision-making capability. In addition to the daily stresses of work, family, and finances, struggling to conceive adds significant stress. People have varying degrees of stress or emotional eating, and these habits can take significant effort and time to change. Here are some tips to help get you started:
1) Check-in with yourself to determine whether you’re feeling physical “stomach” hunger or “head” hunger. Sometimes our head is telling us to eat even though our stomach isn’t hungry. Physical hunger comes on gradually and is felt in the stomach, and can be satisfied by most foods. In contrast “head hunger,” tends to come on quickly with very specific cravings. In addition with “head hunger,” it may not be very long since you last ate, and your stomach isn’t giving you any hunger cues.
2) Find alternative coping mechanisms to manage stress and find comfort other than eating. It’s helpful to make a list of things you can do when you want to eat when you’re stressed, but not actually hungry. There are a wide variety of options including ways to simply distract yourself or ways to actually help you unwind and manage your stress. Examples include: go for a walk, take deep breaths, meditate, do a few yoga poses, take a bath, call a friend, read a book or magazine, go outside and get some fresh air, etc. It’s helpful to make your own list of 5 things that you can do when you find yourself turning to food for comfort.
3) Be kind to yourself. In those moments when you eat something that you wish you hadn’t or feel uncomfortable because you ate too much, practice being kind to yourself instead of berating or beating yourself up or feeling guilty. As much as we think our guilt about our eating habits helps us do better next time, it actually holds us back and keeps up trapped in the cycle of stress eating. Instead, practice being kind to yourself as you would to a dear friend or family member. Then move on, and return to your healthy eating instead of letting it spiral out of control or deciding to restrict at the next meal. Restricting at the next meal only causes the cycle to repeat, as becoming overly hungry combined with stress makes it much more likely that we have a harder time making healthy choices moving forward.
Reducing stress and emotional eating takes time, so be patient with yourself. Know that progress often comes in fits and starts, and we often take 2 steps forward and 1 step back along the way.
Need to take a break? Try a four week nutrition, yoga, and coaching dextox program! Learn more about “Spring Cleaning: Using Nutrition and Yoga to Cleanse” and all our community events here .
Have you recently given birth and noticed that you are having issues with your supply of milk? Did you know acupuncture can help with insufficient lactation?
Breast milk is the main food source for infants and breastfeeding has been shown to provide many benefits to both the mother and baby. Breastfeeding benefits the baby by increasing the baby’s immunity while decreasing the risk of respiratory tract infections and diarrhea, lowering the risk of asthma, food allergies, type 1 diabetes, and leukemia. Breastfeeding may also help with cognitive development and decrease the risk of obesity in adulthood. Breastfeeding also benefits the mother in a number of ways including better uterus shrinkage and less postpartum depression. Long term benefits that have been seen for mother’s that breastfeed are a decreased risk of breast cancer, cardiovascular disease, and rheumatoid arthritis.
While breastfeeding has many benefits to both mother and baby, there are many women that suffer from a lack of sufficient milk supply. Insufficient lactation usually occurs 2-6 weeks after birth. A decreased amount of milk supply can be caused for a number of reasons. Some examples are a difficult birth, excessive bleeding after birth, history of miscarriage, IVF treatments, multiple children, high levels of stress and tension, and age. The great news is that acupuncture can help increase milk supply. Acupuncture restores the normal breast milk production by nourishing and regenerating the body’s blood supply and fluids that are lost during the birthing process. Research conducted at the Hanzhong Shanxi Hospital demonstrates that specific acupuncture points significantly boosts lactation quantities. This study showed that women who had acupuncture successfully increased breast milk secretion from an average of 49.63 ml to 115.21 ml. In addition to the increased milk quantity, the lactating mothers receiving acupuncture had improvement in levels of prolactin (the hormone that stimulates milk production).
If you have any questions regarding how acupuncture can help with your breast milk supply or to schedule an appointment feel free to contact the office at 312.321.0004 or you can contact me directly at firstname.lastname@example.org .
Christina is available in Chicago Wednesday mornings, Buffalo Grove Wednesday afternoons and Saturdays, then starting on May 22nd, she will be available in Highland Park on Tuesday and Thursday evenings.
Christina Livas L.Ac.
by Anna Pyne, L.Ac., MSOM, FABORM
Acupuncture and herbs can help mitigate or completely resolve many signs and symptoms associated with pregnancy during all trimesters. I have treated numerous patients for nausea, vomiting, headaches, any type of pain, skin problems, lung issues, depression, anxiety, miscarriage prevention, placenta previa, swelling, labor preparation, hemorrhoids, and constipation. The frequency and duration of acupuncture treatments will vary depending upon which ailment we are focused on and its severity. Another wonderful attribute to acupuncture therapy is you know that it is a safe and natural treatment. It can be used alone or in combination with a medication to help reduce the frequency and intensity of the problem. Current research supports acupuncture’s efficacy with helping treat depression*, nausea and vomiting**, and labor preparation*** to name a few. I do recommend herbs as needed, in conjunction with acupuncture when necessary. Both acupuncture and herbs can be used together or separately, as each is its own stand alone therapy.
For new patients, to make an appointment for acupuncture please call the office at (312)321-0004 or click this link to book now with Mind Body Online at your convenience. Please make sure to complete your intake form online prior to your appointment here .
Acupuncture for Depression: * https://www.ncbi.nlm.nih.gov/pubmed/20177281
Acupuncture for Nausea and Vomiting: ** https://www.uptodate.com/contents/nausea-and-vomiting-of-pregnancy-beyond-the-basics/abstract/2?utdPopup=true
Acupuncture for Labor Preparation: *** https://www.ncbi.nlm.nih.gov/pubmed/9692336
by Anna Pyne, LAc, MSOM, FABORM
Acupuncture and herbs are the main treatment modalities in traditional Chinese medicine (TCM). I have helped treat a myriad of postpartum women struggling with insufficient breast milk using both therapies. It is important to establish a good supply at the very beginning so that it is easier to maintain it. That is not to say however that TCM is not an effective treatment at a later date.
There is one particular acupuncture point that has the single function of enhancing breast milk. This is quite unusual as typically each point is useful for treating a multitude of different issues. Needling this point is the most potent way of stimulating it. The location is on the outer corner of the nailbed on the pinky finger. It is typically tolerated by most patients quite easily, however for those few that are a bit needle sensitive I have placed a small gold pellet that sticks to the point which does not penetrate the skin. Doing this makes it portable as well, meaning the patient can walk out of the office and continue the treatment outside of the acupuncture session every time the patient presses the gold pellet. Of course there are many other points that help enhance breast milk supply and when a number of these appropriate points are used together with this especially specific one, it greatly impacts breast milk supplementation. Patients have reported starting to feel engorged while lying on the table with the needles placed during treatment. I have also heard feedback (and personally experienced) that more milk is produced at the next pumping session.
There are a number of wonderful single herbs as well as formulas that benefit the breast and support breast milk supply. I typically use herbs with acupuncture when treating this problem for optimal treatment results, but have seen great benefits with using herbs alone without acupuncture, and vice versa. I also teach a class at Pacific College of Oriental Medicine (PCOM) on traditional Chinese herbs for postpartum care, which includes the topic of breast milk insufficiency.
If you have any questions or to learn more please email me at email@example.com or any of our other acupuncturists.
Call our office to schedule an appointment (312)321-0004.
Anna Pyne LAc MSOM FABORM
Anna’s News: New Research Supports Acupuncture for Postpartum Depression
Now that your miracle baby has arrived you might surprisingly find yourself feeling less than thrilled. The postpartum period is typically its own emotional roller-coaster ride, as there are great hormonal changes that come with the readjustment of your pregnant self to your newly non-pregnant self. It is normal to feel the baby blues directly after however some women have a harder time. Postpartum depression is an overwhelming condition that includes feelings of extreme fluctuations in mood, loss of appetite, intense irritability and anger, lack of joy, difficulty bonding with your baby, exhaustion, loss of interest in sex, feelings of shame guilt or inadequacy, and withdrawal from family and friends. Thankfully acupuncture is a safe way to treat postpartum depression.
Typically only a few acupuncture sessions are required for rebuilding the body and mind postpartum assuming there are no complications from labor and delivery, however when dealing with postpartum depression treatment will need to be extended. Acupuncture frequency will directly relate to the intensity of the presenting symptoms. I have helped many patients with postpartum depression using acupuncture in conjunction with a psychologist. Current research supports acupuncture used simultaneously with psychological intervention has the same high success rates as taking an oral medication alone, with the benefit of not experiencing any of the drug’s negative side effects such as nausea, dizziness, and lack of appetite.* For more information feel free to email me or call us to schedule an acupuncture appointment!
Anna Pyne LAc MSOM FABORM
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