Part 2: In the Minds of Mothers: How Mental Health Impacts Mothers Worldwide

Though postpartum depression is discussed, reported, assessed, and treated, the stigma and confusion around embracing one's difficult feelings as a nascent mother is of grave concern.
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Part two of a two-part Q&A between Christy Turlington Burns and Dr. Jessica Zucker about motherhood and mental health around the world. To read part one, click here.

CTB: We often talk about the upside of the global maternal mortality tragedy as being the fact that pregnancy and childbirth are not diseases. We are not waiting for a cure and there is no single silver bullet. But mental health is a disease and there are effective treatments out there. Do we really understand the relationship between pregnancy and mental health?

Dr. Jessica Zucker: Culture's impact on how women talk about their mental health in new motherhood is noteworthy. Though postpartum depression is discussed, reported, assessed, and treated, the stigma and confusion around embracing one's difficult feelings as a nascent mother is of grave concern. Coming to terms with feelings of ambivalence, anger, anxiety, or outright misery -- a sampling of some of the feelings that can accompany postpartum depression -- at the exact moment you are attempting to navigate a new identity, a relationship with your newborn, and a shifting experience with your partner can feel earth shattering. Women are ashamed and shocked by feeling the antithesis of what they thought they might feel upon becoming a mother.

With a newborn reliant on the mother for care, consistency, and nurturance, the pressure for women to feel strong and present in their newfound role as mother is that much more pressing. Knowing this and feeling able to do this are two very different things, especially when suffering from postpartum depression. Women report blaming themselves, feeling like a failure, worrying they are "bad" mothers, sequestering the depth and range of labile feelings, all the while gritting their teeth, getting from one day to the next hoping sunrise will yield a metamorphosis of their maternal landscape.

Unfortunately, hope and time do not squash the hardship that is postpartum depression. In fact, left untreated perinatal mood disorders can be insidious and intractable. The stigma remains steadfast in this country and many others, even though there are resources available to women suffering.

Mood disorders during and after pregnancy can affect any woman, regardless of age, income, culture, or education. We understand that there are risk factors for postpartum depression that can be addressed during pregnancy and in the postpartum period. We know that postpartum depression is a temporary illness that is fully treatable with professional help. Frequently in the context of my clinical work I hear the question, "Why didn't anyone tell me motherhood was going to be this hard?" Our culture is wedded to upholding the "glowing" new mother as an idyllic icon. This Super Woman image leaves millions of women feeling that much more isolated and stymied by the reality of parenthood, particularly when she is deluged by the symptoms that pervade postpartum depression

CTB: There has been a lot of media attention around the dangers of drugs used to treat mental illness on the fetus. Where do you think this information puts women?

Dr. Jessica Zucker: In an article I wrote for your vital organization Every Mother Counts titled "Considerations of Antidepressant Use in Pregnancy and the Postpartum Period" I explored the complexities involved in this media discussion. The issue is not black or white. From a clinical perspective, I witness countless women struggling with this very quandary -- to be or not to be on medication during pregnancy and/or while breastfeeding. I'm less inclined to choose a side in this debate, but rather support women in making informed choices that are the most advantageous for them and their burgeoning families. Given all that we know from the attachment literature, it is quite clear that the mental state of the mother directly shapes the evolving worldview of the infant. A child comes to understand the building blocks of connection -- trust, love, and relationships -- through the caregivers' responsiveness and attunement.

When a mothers' mental welfare is compromised she is less likely to have the wherewithal to meet the everyday challenges and nuanced needs that parenthood requires. The informational debate all too often leaves women who are suffering with a perinatal mood disorder feeling unsupported, under-resourced, misunderstood, terrified, or self-blaming. Medication during pregnancy needs to be gracefully thought through on a case-by-case basis, weighing the costs and benefits for the mother and developing fetus/baby.

CTB: What should all women considering becoming mothers know about maternal mental health?

Dr. Jessica Zucker: The experience of motherhood is not one-size-fits-all. The emotional spectrum is wide and varied -- ranging from immensely gratifying, deeply challenging, and everything in between. What all women considering becoming mothers should know about maternal mental health is that anything you might feel during your journey throughout motherhood, others have felt. You are not alone. Speaking up and asking for help reveals strength of character and courage -- two core ingredients that we should all aspire to model for our children. I often ask my patients the following question, "If your young daughter came to you and shared that she was struggling emotionally with something, how might you respond?" Unequivocally the pregnant or parenting mother sighs with relief and says something like, "I would probably embrace her and let her know that I will help her navigate through the difficulties she is facing. I would praise her for identifying the issue and talking about it openly with me." The next layer of inquiry is inevitably about how important it is that we explore the layered answers to why it can feel nearly impossible to advocate for ourselves the way we are certain we would do for our children.

Being the role model we hoped we had or were fortunate enough to have had is always possible. Striving for perfection is an impossible conundrum that results in feelings of deflation, ineptitude, and isolation. Our children do not need perfect mothers. They need a "good enough" mother who is wise enough to know when something is emotionally astray and takes action on their own behalf. Women need to be tender with themselves as they enter into uncharted territory -- learning about and getting accustomed to their new identity in motherhood.

CTB: I like that as bottom-line advice -- Women need to be tender with themselves. Imagine a world where mothers take as good care of themselves as they do their children and a world where mothers are so supported they're able to do that. That's the world we all need to create because our children, families and communities are depending on us.

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