"Am I ever going to want to hold and nurture my baby?"
"Do these feelings mean that I'm a bad mother?"
Paradoxical emotions amalgamate as motherhood emerges. The convergence of biological changes, a shifting identity, and a lifestyle metamorphosis galvanizes a spectrum of previously foreign feelings. It's customary to traverse a continuum of emotions during the initial moments of this rite of passage.
"Is my partner disappointed that I'm not the mother he thought I would be when we decided to start a family?"
"Are these deadening feelings payback for my ambivalence about getting pregnant in the first place?"
Attachment and bonding are involved in the establishment of the burgeoning mother-infant intimacy- setting up the framework for future relationships and inaugurating baby's worldview on love. But what happens when complicated feelings serve as a blockade to the initiation of bonding and attachment or if initial parental enthusiasm recedes or is altogether absent? Postpartum adjustments come in all shapes and sizes. Uneasiness may perseverate, developing into intractable feelings that seem insurmountable.
"Why didn't anyone tell me how hard breastfeeding would be?"
"If my baby can't attach to my breast, can I cultivate a healthy attachment with her?"
A majority of postpartum women experience fluctuations in mood within the first few weeks after giving birth. Postpartum blues are considered an expectable result of new motherhood, lasting up to two weeks, estimated to impact as many as 80 percent of women. Postpartum depression affects approximately one in five mothers. Symptoms of postpartum depression can be relieved within one to six months when addressed promptly. If left unattended, postpartum depression may persist for up to one to two years.
"Is my apathy going to deleteriously impact my child, leaving little possibility for healthy attachment and deep connection?"
"Why do I feel so disengaged? I expected that when my partner placed our baby in my arms for the first time I would light up and my uncertainty about becoming a mother would instantaneously dissipate."
The juxtaposition of pregnant hopes and maternal reality is often quite shocking- resulting in an unearthing dizziness, leaving new mothers wondering who they are, if they have "gone crazy", and if they will ever feel "like themselves again".
"Why can't I sleep?"
"Why don't I eat?"
"Why do I ruminate?"
"Why am I somewhere in the background?"
Postpartum depression is a quiet epidemic. The glaring statistic that one in five women suffer during the postpartum period begs society to reflect on the need for preventive public health measures. Diagnosis of depression and anxiety in pregnancy are often overlooked, ambivalence around becoming a mother is frequently culturally muted, and unmet hopes or expectations may result in a roller coaster of regrettable feelings.
"When will I get a reprieve? I was exceedingly depressed after my first baby was born but I thought it would be different this time. We are more financially stable and I somehow made my way through the darkness without any help. But here I am again, drained. I feel colorless most of the day, the week, the month."
"Why do I feel this enormous chasm between us? My baby feels so far away. The labor and delivery process was so far from what I hoped for, so different than what I had planned--I expected a calm birth, no pain medication, no medical interventions. I ended up having a c-section. I don't feel connected."
Hormonal shifts, depression during pregnancy, history of mood disorders, previous episodes of postpartum depression, family history of depression or bipolar disorder, tendencies toward perfectionism, eating disordered behavior, lack of social support, marital discord, financial instability, unplanned or unwanted pregnancy, obstetrical complications, traumatic birth experience, and a history of early loss, trauma, or sexual abuse can be contributing factors associated with the development of postpartum depression. Risk factors are associated with creating an increased sense of vulnerability to the illness -- they are not directly causal.
"During childbirth I was flooded with haunting memories I had pushed away, thinking that I had resolved these issues and was free of the shame and rage. But during the delivery I was pocked and prodded and uncomfortable and at times felt helpless and out of control- this is when memories of being sexually abused during childhood emerged. Now I can't get these images out of my mind. Do I have the energy right now -- the stamina -- to manage the pressures of new motherhood?"
"Is it because of the losses? All of the miscarriages I had before this last pregnancy created a sense of dis-ease and lack of attachment to this pregnancy. I thought that once my baby arrived a feeling of permanence would envelop us. Will we bond?"
These clinical vignettes are a sampling of maternal concerns and internal excavations my patients have journeyed through as we work toward a gratifying and connective parenting experience.
The best thing a woman can do for her baby is to take care of herself. This will likely entail widening her community of wellness practitioners and other social support networks with the aim of helping her reach optimal health.
Harnessing helpful resources in a timely fashion can aid in the prognosis of this painful mood disorder. All too often, a new mother and her surrounding family and friendship circle hope that these precarious symptoms will diminish on their own. Early intervention promises to ease the course and severity of postpartum depression whereas denying the despair may yield a more complicated recovery.
Bonding is a process, not a finite event. A healthy attachment relationship can be procured over time, even when postpartum mood disorders infiltrate early motherhood. Elevation in maternal mood, lessening of overwhelming anxiety, and (re)finding pleasure will lead to a satisfying mother-baby relationship.
This Emotional Life is a two-year campaign to foster awareness, connections and solutions around emotional wellness. Join our community at www.pbs.org/thisemotionallife.