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The Postpartum Experience by Dr. Tamara Hanoski

posted Dec 30, 2010, 1:14 AM by Tascheleia Marangoni   [ updated Jan 1, 2011, 12:22 AM ]

Becoming a parent can be one of the most awe-inspiring and beautiful transitions in a person’s life, but it can also be one of the most challenging. As a new mother myself, I had my own difficulties adjusting to being a mom, particularly after my firstborn, as I had a tumultuous mix of experiences, with many extremes from high to low. This carried on for over two months, and was much more difficult than I could have anticipated.

In addition to experiencing a major life change, new moms are subjected to a number of physiological, social, and emotional influences, which can have a significant impact. According to research, 80-90% of new moms will experience some level of postpartum adjustment difficulties, ranging from being relatively short-term and transient (the “blues”) to a very serious psychotic episode.  The “Baby Blues” typically lasts from two to six weeks, and is characterized by tearfulness, irritability, exhaustion, anxiety, moodiness, and difficulties sleeping. Some researchers have identified a second level of difficulties, which has been referred to as “normal post-partum adjustment”, and is similar to the “blues”, but lasts for a longer period, typically about two months. Additional symptoms have been identified as body image issues, doubts about one’s parenting abilities, appetite changes, and loss of sexual interest. In addition, many women feel societal pressure to present as a serene and blissful new parent, which can lead to additional feelings of confusion, stress, and guilt when they do not see themselves as meeting this ideal.

For 10-15% of women, symptoms worsen and persist to the point that they become a “Postpartum Depression”, which has a pervasive, negative effect on a mother’s daily life activities. In addition to the symptoms of the “blues”, women may experience problems with concentrating, feeling lonely and isolated, having little energy, feeling overwhelmed, and having a sense of hopelessness or emptiness. Many women will also experience intrusive thoughts, such as that they are a “bad mother,” and may have thoughts regarding harm to themselves or the baby. In addition, they may reach a level of depression that makes it difficult to get out of bed or tend to their baby’s needs, and they may feel extremely guilty and embarrassed due to feeling as though they are not able to cope. In a small minority of cases (1 out of 1000), women may experience “Postpartum Psychosis,” which is very serious and requires immediate attention. These women experience unusual or disturbing thoughts; appear agitated, confused, and disoriented; have a loss of contact with reality; experience delusions and hallucinations; and are at risk of suicide and/or harm to the baby.

Many people have questioned what leads to so many women experiencing postpartum difficulties. Some of the risk factors include a previous episode of depression, suffering from Premenstrual Dysphoric Disorder, being an older or younger parent, depression or anxiety during the pregnancy, and having a history of sexual abuse. In addition to these pre-existing risk factors, there are many aspects about having a baby that can have a significant impact on the new mother. Physically, she will be struggling with recovery from childbirth, immense fatigue, potential breast feeding struggles, and body image issues, as well as possible thryoid issues. Hormones also play a significant role, as there can be tremendous physical upheaval as hormone levels plummet after giving birth.

Social and emotional factors also play a major role in a woman’s postpartum experience. Often, women have unreasonably high expectations for themselves, and are ill-prepared for the reality of motherhood, by believing that parenting is “easy” or “innate.” In many cases, women do not feel immediately bonded to their baby, or they experiences difficulties with breastfeeding, which they had believed would be “natural.”There are many cultural messages that tell women that they will automatically know what to do, when motherhood really requires a great deal of education and help along the way. A woman may also have expectations of what the baby will be like, or what life will be like, and when she encounters struggles or discrepancies with her expectations, she feels disappointed and disillusioned. Another significant social aspect is the sheer number of changes that have occurred in the mother’s life. There will be constant demands from the baby, which leads to changes in routine, loss of independence and control, change in social circle, and financial demands. In addition, a new mother often suffers from “intimacy overload” due to an infant’s constant demands to be in her personal space, which can lead to a sense of the loss of self.

Other factors that can have an effect on a woman’s functioning after giving birth are difficulties within the spousal relationship, a perceived (or real) lack of support from others, disconnection or distance from the woman’s own parents, ambivalent feelings about having a baby, stressful life events, and certain personality characteristics, such as being perfectionistic, submissive, or dependant. In addition, becoming a mother can trigger many personal issues for the woman, whether it be unresolved grief, past abuse, or family of origin issues. Many women also place undue pressure on themselves to be a “perfect” parent, often missing the fact that in order to be good for their children, they must be good to themselves. It is impossible to work at any job constantly, without any sort of break or time to look after oneself, without suffering the consequences. Despite this, there is a societal belief that to look after oneself is to be selfish, which leads many women to completely neglect their own needs.

There are many things that can be done to help a new mother cope effectively with the challenges she is facing. Early identification and intervention are very important, with appropriate prenatal education regarding realistic expectations. Support through one’s spouse, family members, and friends is essential. Assistance with childcare and housework would also be very helpful. There are many activities for new moms to take part in, such as exercise classes or new moms’ groups, which allow women a chance to venture out of the house and gain the support of others who are at the same life stage and experiencing the same challenges. Counselling can be beneficial in allowing women the opportunity to express their feelings, deal with past issues, have their experiences validated, and work on strategies for stress management and self-care. In some cases, particularly with regards to postpartum depression or psychosis, medication may be warranted.

Due to the multitude of factors involved, many researchers have noted that becoming a mother is often the most challenging period of a woman’s life. Despite this, there is a cultural myth that parenthood represents a state of bliss and extreme happiness, which is impossible to attain. The “supermom” myth is very damaging to healthy adjustment, and women need to be taught that parenting is not only an acquired skill, but can be inordinately demanding. Due to these societal pressures and expectations, many women are reluctant to be honest and forthcoming about their struggles, leading to increased feelings of guilt, stress, and isolation. In order to help women, society needs to adopt a more realistic view of motherhood as a time of ups and downs, which carries much joy, but also many challenges. If this were to occur, then women would not only have the opportunity to be appropriately educated before having a baby, but might also be provided with essential supports afterwards. In most cases, the biggest obstacle for women to seek assistance is the belief that their own health is not a priority, or that they do not have permission to look after themselves. Thus, our society needs a shift so that women see how their mental health and well-being is an essential aspect of being a good parent. If women are educated in the realities of parenthood, then they may be less critical of themselves and more willing to accept assistance and support, which would lead to increased health and happiness for our mothers, as well as our babies.



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*This article was also published in the November/December 2009 issue of Edmonton's Child Magazine