Maternal mental health awareness

So who is going to look after the mother?

The month of May begins again. Some might be thinking about Mother’s Day in many Western countries. But this year, perhaps it’s equally if not more important to consider maternal mental health awareness month. It’s been almost 1.5 years since the start of the global pandemic and it’s clear that mothers across the globe are in dire need of some extra support. This is the case now more than ever before. 

The statistics for postpartum depression are soaring. They now (May 2021) reveal that 1 in 3 women suffer from significant levels of depression. Whereas the statistics used to point towards 15-20% of postnatal mental health struggles, we now see a number closer to 40% in high income countries. In middle to low income countries, the number is even higher.

It’s clear that we have been massively ignoring and overlooking mothers’ needs. Of course, this rarely happens consciously. We all feel we’re supporting new mothers and doing our best, but it seems our best hasn’t been quite enough.

The following article unfolds some of the aspects of maternal mental health struggles. We all need to work together to abolish taboos and expectations on motherhood, the world over. Lastly, it’s important to find out how we can all provide more support in our community.

No-one is to blame but everyone can help, too

Postpartum health struggles are complex. Most risk factors occur in combination with each other. In other words, a mother struggling with depression or anxiety during pregnancy might or might not develop postpartum depression (PPD) after the birth of her baby. However, she is much more likely to do so, if she is also a victim of the following: stressful recent life events, lack of social support and depression before pregnancy. Research also shows that suffering from the burden of childcare (or lack of childcare to give mum a break), general low self-esteem, maternal neuroticism and having a newborn with struggles of their own (e.g. colic) are potential catalysts for mental health issues (WHO). Couple this with social isolation due to something like a global pandemic and it’s surprising the statistics are not higher.

Looking at this list of potential triggers, it’s shocking to see how many different elements of modern-day mums’ lives need to see a change. A mum’s social circle is ultimately going to be one of the deciding factors. How much support she gets from family and friends is going to determine how stressed a mum feels whilst caring for her newborn. Furthermore, if she also struggles with stresses unrelated to her baby, such as worrying about financial security, she is also more at risk. However, having a newborn that’s struggling too, such as babies suffering from colic or babies born with an illness – could potentially be enough to trigger mental health issues in a mother. This is where extra, regular support from a midwife or health professional, alongside more support and awareness amongst close family and friends could be extremely beneficial.

How we can make a difference

  • Don’t ask if you can bring food round in the early days of postpartum, just do it! (…but don’t stay!)
  • Whilst you’re there, make sure you put a load of washing on, empty the dishwasher, take the dog out for a walk…
  • If you’re in her immediate circle, a few gentle words of encouragement for her to keep the weekly midwife visits – and not to take too much on too quickly – might be a good thing to try
  • Help her organise some extra help for a while. It might even be a great idea to gift something that truly supports a family during this time – a subscription to a food delivery service for new mums if they live close to a city, or chip in with some friends to pay for a postpartum doula and/or someone to help with household tasks.
  • Hold space for your friend who has just become a mum (even if it’s not her first baby). Practice actively listening to what she wants to share, without turning it into a conversation, without interrupting or giving her advice. Avoid jumping in and rescuing her, instead maybe ask her what she needs right now.
  • Check in with a mum a few weeks after the initial honeymoon phase of having a new baby has passed. Visitors often snow in as soon as theyre welcome, and the general wave of excitement has usually passed after about a month. Be the person to touch base with a mum after these weeks have passed. This might be when she is feeling at her lowest. Dropping round a tray of cookies or sending a loving voicemail might really make her feel supported again.
  • If you’re a midwife or a doula, don’t stop your visits just because your mum says she’s fine to go it alone now. Schedule at least one more appointment a few days down the line, even if it’s just for a quick cup of tea and a chat. There’s a 1 in 3 chance that cup of tea will be an island for your mum to cling to in a sea of worry, anxiety and isolation that she maybe doesn’t even see for herself yet.

If a mother says she had a great birth, that doesn’t mean her mental health is going to be great

Maternal mental health is just not that simple. Just because a mum looks happy and comfortable on the outside, doesn’t mean she’s happy on the inside. Many mums are experts at going about their daily lives juggling everything motherhood demands of them and putting on a brave face. The problem is, society expects mums to be happy. They got pregnant and now have their baby in their arms, surely life is just peachy, right?

Perhaps it’s because of these expectations that mums feel they can’t speak out about things that are actually bothering them. They might feel there’s no reason to feel bad. They feel ashamed, guilty and question feeling so low when something so good has just happened. They also assume it’s better not voice these thoughts to friends and family. This is of course not the ideal approach – but unfortunately, many mums don’t have access to other mums showing up from a vulnerable standpoint. It can make a world of difference to hear another mum voice these same thoughts. Likewise, it can mean so much if anyone just holds space for a new mum’s feelings – without judgement or input.

So, having a great birth doesn’t necessarily mean that a mum won’t suffer from mental health struggles later down the line. We know now that there are a few risk factors for an illness such as PPD, and these only partially link to a traumatising birth experience. 

Don’t assume that a mum should be ok, if she didn’t suffer from trauma at birth. However, if she did suffer from trauma at birth, assume that she is at a greater risk. 

Experiencing trauma at birth can develop into post-traumatic stress disorder (PTSD)

According to numerous studies, there are 3 main categories that determine whether or not someone is more likely to develop PTSD after birth: 

  1. Risk factors that exist before birth
  2. Aspects of the birth itself
  3. Quality and type of postnatal support

Looking at the evidence over the past few decades, we know that women can suffer severe distress and subsequent mental health struggles as a result of negative experiences made at childbirth. 

When we speak of negative experiences though, many will immediately assume we mean events that are “commonly perceived” as traumatizing. Experiences such as miscarriage, stillbirth, severe complications or invasive medical surgery without effective pain relief. 

However, women can have seemingly positive births and still feel traumatized by their experience. According to Dr Elizabeth Ford, if women sense they are loosing control, their dignity or being subjected to dismissive and negative attitudes of their caretakers during birth, they have a higher risk of suffering from postnatal PTSD later down the line.

Mothering the mother has never been so important

Mothering the mother is a concept well-known to doulas, but it’s high time we share this knowledge with everyone. New mothers need mothering, they need someone to take care of them. To gush over them, to care for them physically, to be there emotionally and to dote over them, as much as we can. 

I still look back on my early days postpartum – with both my children – and remember feeling ambivalent towards visitors. People would come round to see the baby, which was lovely, but I often felt myself screaming internally BUT WHAT ABOUT ME? Can someone please dote on me a little, too? 

Hannah Ladda, Doula and birth worker

There are cultures across the world that already do this. In South Korea, samchilil is a 21 day practice of rest, being cared for and receiving nourishing soups. After this time, the mother returns back to her home.  In many parts of Latin America, the mother is showered with household help and nourishing foods during a 40-day period of cuarentena. One of the main aims is to ensure she doesn’t become ill from exhaustion. Across many islands of Indonesia, a midwife visits the mother on a daily basis for at least 40 days – she is massaged, bathed, fed with a wonderful health tonic called jamu and her baby is cared for. After the 40 days, her circle of family hold a ceremony to bury her placenta, which when kept close to her in this postpartum period, is believed to protect her from becoming ill later in life.

So perhaps many parts of the Western world could profit from deceleration during postpartum? Women are feeling pressured to be back working only days after birth. Fathers barely have any leave and return to work quickly after the initial few days of postpartum, sometimes well before breastfeeding is properly established or the mother has had time to rest a little. If we add older kids into the mix, mothering the mother is completely neglected. Mothers often do not give themselves the time or self-love to recuperate and feel under pressure to jump back in to mothering their older children. In many cases, they also don’t have a choice. With financial commitments to hold, external childcare lacking, many grandparents still working and many young families not able to afford extra help around the time of a birth, it’s simply a mother’s fate. But it shouldn’t be that way.

Social media and online options are becoming the replacement for mothering the mother

I’ve been there too. Reaching out via social media platforms to other mums – many of which I’ve never met before in person – to ask for advice or just get some support. So many mothers are resorting to asking other mothers online for their opinions or advice – sometimes even on medical questions. 

Social media platforms have become the new circle of women we imagine and idealise. We reach out to an almost ancestral, spiritual healing group that we ourselves don’t really know any more, but still so desperately yearn for. 

In these social media messages and posts, mothers are looking for other mothers to virtually hold their hand. To tell them they’re doing a great job and what they’re experiencing is normal, and will pass. Online mothers are mothering us through postpartum. It takes a village takes on a whole new meaning – maybe it actually takes a social media network.

Where are the friends and family who have done this before?

If you are a millennial (Gen Y), then your parents are Gen X or baby boomers. Many baby boomers have not yet retired, and are therefore still working – many of them in full-time jobs. This doesn’t leave much room to mother the mother. It also leaves many mothers exhausted come the weekends, often with barely any time to recuperate. The same goes for friends. Everyone is in a similar situation and therefore barely has the capacity to support other families too. In a way, it seems everyone is at their maximum capacity.

Ultimately, these mothers are mothering motherless. No-one is really making sure the mother is surviving, whilst she cares for a newborn – or multiple children – 24 hours a day. Partners and dads are of course the main care givers for mums and do a great job. But mothering the mother very quickly turns into a weekend luxury good. The stay at home mum gets little support during weekdays and during the nights, as the family depends on the working parent getting half-decent quality of sleep to keep the ship afloat. Even though the other parent takes on tasks such as caring for older children or the baby whilst straggling work commitments, this still leaves the mother without anyone directly caring for her. 

This is potentially the case in any family, whether its a hetero or same sex relationship. Ultimately, someone takes over the role of primary care giver, whilst the other becomes the main breadwinner. Many families reach the conclusion that the care giver parent can only rest at weekends. This means the working parent gets less sleep and takes over a little more on weekends. This might also result in both parents burning out, though, as neither ever really have the time or space to recover. In practice, these weekend promises don’t always work out the way they were intended. Whatever the reason for it, these kinds of set-ups can quickly lead to many mothers burning out in a matter of weeks. 

Maternal mental health doesn’t just mean postpartum depression

This is a really, really important thing to bear in mind. Mothers that have suffered through months and years of isolated parenting, a dangerous level of sleep deprivation and lack of time for themselves or their health find themselves emerging from these early years with a bunch of issues to face. 

We aren’t talking postpartum depression in every single case, although we know the cases are far too high. Once a mum finally gets a short break with an older child through a playgroup or preschool, they also find themselves lost in a sea of health issues, mental health struggles, daily anxiety, loss of identity and a lack of strong friendships to rely on. Friendships can die too, when mothering motherless doesn’t work out.

So maybe it’s just up to us – whether we reach out at 1am to a perfect stranger over an Instagram DM, or plonk our kids infront of an ipad for half an hour to get a quick mental break – it’s up to us to give ourselves the love and care we deserve on a daily basis. 

To normalise parenting, to speak openly about taboo topics, to make sure no mother needs to feel judged for how she manages her struggles – or lonely in the process. To collaboratively refuse society’s expectations on mothers and fathers, to modernise the standards that we still seem to be following but which are massively outdated. These standards came to be at times very, very different to today.

It’s time we modernise and normalise how we all parent – and start finding new ways to give mothers the mothering they need.

Sources

Brigham and Women’s Hospital, news release, Dec. 1, 2020

-https://www.mothermag.com/postpartum-care-traditions/

-https://www.romper.com/p/mothering-the-mother-is-great-in-theory-but-in-reality-moms-are-all-alone-8445726

-https://midwifethinking.com/2017/01/11/childbirth-trauma-care-provider-actions-and-interactions/

-https://midwifethinking.com/2011/05/13/guest-post-when-birth-is-trauma/

-https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13784

1 thought on “Maternal mental health awareness”

  1. Great article and tips for raising awareness, and how we can help support mothers as they bring in the next generation. “Mothering the mother” – love it. Thanks so much Hannah! 🙂

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