It is 11 a.m. on a Wednesday morning and the members of the Circle of Parents: Postpartum Distress Support group start to arrive in the virtual space that the group has grown accustomed to since the start of the COVID-19 pandemic. 

They greet each other, holding coffee mugs and sleepy-eyed babies. The topics of discussion, as always, center on whatever these mothers are needing and wanting that day. We celebrate the mother whose baby has finally slept six hours, allowing her to feel more human today; we share frustration at the grandparent who made unsolicited and unwanted remarks about one mother’s postpartum body; we collectively grieve the loss of expectations and of identities. We find meaning in the new season in which we find ourselves. These mothers don’t come to group to get advice and find answers to magically make the challenges of new parenthood disappear; they come to group to be heard, to hear themselves in others and to know they are not alone. At 11 a.m. on a Wednesday, these mothers are doing one of the bravest things a new parent can do: talk about how they actually feel.

Parenthood is marked by both immense joys and immense challenges. Similar to other periods of life transition, the perinatal period — the time spanning from pregnancy through the postpartum period — is often a time of significant changes in social and emotional development. While a lot of attention is paid to the development of the infant and child during this time, we often overlook the development of the parent, which includes shifts in roles, responsibilities and identity.  This transition can impact parents’ mental health, affecting both the individual and their relationships with spouses, their own parents and families, work and friends. And this dynamic can work both ways. A lack of support in these relationships can also affect a person’s emotional well-being as they work to meet the demands of parenthood. 

The spectrum of mental health concerns that affect a person during pregnancy and the postpartum period, referred to as Perinatal Mood and Anxiety Disorders (PMADs), can be wide and varied. A new parent experiencing any form of perinatal mental health concerns may feel anxiety, irritability and anger, sadness, feelings of guilt, helplessness, a lack of interest in activities, disturbances in sleep and/or appetite and sometimes thoughts of suicide. PMADs are the most common complication after childbirth, affecting approximately 21 percent of new mothers and 10 percent of fathers and partners. Rates are even higher in certain populations, including 38 percent of mothers of color and up to 50 percent of teen mothers.  

There is no single factor that contributes to the development of PMADs. Instead, a constellation of biological, personal and environmental factors collectively influence a new parent’s mental health. Biological factors, such as neurological changes in the brain that occur during pregnancy and the postpartum period, as well as a personal and/or family history of mental health concerns, can make a person more susceptible to PMADs. Personal and environmental factors, such as a parent’s experience during childbirth, challenges with breastfeeding, the presence or absence of spousal and familial support, can also greatly impact one’s mental health during this period in their development.  

 The current pandemic has created some immense challenges for parents who have been expecting, birthing, adopting and raising babies during the past year and a half. With many families facing financial hardship, social isolation and limited access to valuable community resources, the risk for PMADs has increased for many new parents. Many parents have had to forgo familial and peer support soon after the birth of a baby as a precaution to protect the health of their family. Many mothers faced a difficult transition out of maternity leave as they balanced working from home with having their children at home as well. 

A study out of Brigham and Women’s Hospital found that in a sample of postpartum mothers rates of PMADs during the pandemic increased to 36 percent. The village that new parents need with the arrival of a baby has been largely absent and continues to be limited for many. 

While there is a lengthy list of biological, personal and environmental factors that may contribute to the development of perinatal mental health concerns, there is a common underlying emotional factor that often perpetuates the distress and keeps a person from reaching out for the help they need: shame.  

 

In a recent discussion in the Circle of Parents: Postpartum Distress Support group, group members identified that shame was often a response to the unrealistic cultural expectations of motherhood that they held for themselves and/or were placed on them by others. While June Cleaver may be a relic of the past, her ghost still haunts motherhood, littering it with expectations of perfection that are neither realistic nor appropriate for the modern world that mothers and parents occupy today. 

 

Nods of agreement met one mother’s recollection of her early postpartum experience: “I’m not where I am supposed to be and I don’t feel how I am supposed to feel.” For many, comparisons with other parents who seem to “have it all together,” promote feelings of self-doubt and inadequacy. Expectations about one’s ability to effortlessly balance learning the new tasks of parenthood with other life responsibilities also adds weight to the shame under which many new parents stay hidden. Instead of reaching out for help, many parents attempt to push ahead, which often leaves them feeling more stuck. However, just as we cannot make our children master walking before they are developmentally ready, we cannot force our way through our own development and the mental health challenges we may face along the way. 

 

We know that PMADs are treatable and that the sooner a person is able to get the support that they need and deserve, the sooner they are able to feel better. In our community, there is a growing effort to meet the needs of new parents. Family Connects, a home visiting program for parents of newborns up to 12 weeks old residing in Watauga, Avery and Ashe counties, provides support and referrals to the resources families need in the postpartum period. At the Children’s Council there are a number of parent support programs for expectant and new parents, including Circle of Parents: Postpartum Distress Support, which provides a safe, nonjudgmental space for biological and adoptive mothers and trans and gender non-conforming birth parents to share their experiences and receive support from others going through similar challenges. 

 

The first step of getting support is recognizing that help is needed. As one mother in group put it: “It gets easier faster when you are honest with yourself.” Recovery from PMADs also starts with honest conversations between new parents and their partners, family, friends and medical providers. Parents are more willing to push back against shame and be vulnerable and truthful about their experience when speaking to those who are willing to listen and validate their struggles. Just as children need care and support to thrive in their development, parents do too.

If you or someone you know is experiencing any kind of perinatal distress, such as postpartum depression or anxiety, please reach out. In addition to the resources in our community, Postpartum Support International offers more information about PMADs and resources for mothers, new parents and their support systems.

For more information on Postpartum Support International, visit www.postpartum.net or call the Support Helpline at (800) 944-4773.

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