Let me start by quoting Dr. Alexandra Sacks and Dr. Catherine Birndorf from their book WHAT NO KNOW ONE TELLS YOU: A Guide to your Emotion from Pregnancy to Motherhood. “You don’t have choose between motherhood and your mental health.”
*Note – all of the quotes in this letter are from this same book, unless stated otherwise.
When I was pregnant with my daughter, I suffered from depression and anxiety disorder. I was familiar with postpartum depression, but I didn’t know that depression and anxiety disorders were common during pregnancy as well. The statistics suggest that 1 and 5 women experience these symptoms during the perinatal period. The maternal mental health field calls it Perinatal Mood & Anxiety disorders aka PMADS. But call it spaghetti, call it whatever you want, I felt the worst I have ever felt in my life and I was about to have a baby for the first time.
I had nausea, hemorrhoids, heart burn, basically all of the other pregnancy symptoms, but the depression and anxiety took me to a very dark, insufferable place. I had debilitating panic attacks on a daily basis: a giant weight was on my chest and had me pinned to my bed type of sensation. And let’s not forget the general feeling of self hatred. This was not what I was expecting to feel while pregnant!
My PMADS started around my fourth month of pregnancy, just when I stopped feeling nauseous all the time. I’ve always been an anxious person, as many of us are. And I understand excitement and the uncertainty of pregnancy can naturally cause anxiety and panic. It’s likely that becoming pregnant increased my anxiety and could have led to my depression. “Sometimes anxiety alone causes you to start feeling depressed – living in that constant state of tension can become so depleting that it may burn out your pleasure system. Anxiety and depression become disorders when they interfere with your ability to function and experience any forms of pleasure.” There were days I didn’t want to exist anymore. I didn’t go as far as planning my death, but I wanted to die. The question was, why was I feeling this way when I wanted a baby and planned this pregnancy?
I’ll start by sharing with my anxiety symptoms (although many anxiety disorders and depression symptoms are interconnected.)
Symptoms of perinatal anxiety disorders manifest differently for everyone. I’ve heard women talk about how they have compulsive thoughts surrounding hurting their baby or fears that something bad will happen to their baby. For me, my compulsive thoughts had to do with a fear that I wouldn’t be “ready” for the baby. I had a fantasy that I would have it “all figured out” before she arrived. “If you’re used to finding comfort in control and planning, childbirth (and motherhood) is going to take you of your element.” I’d constantly be adding to a TO DO list (research how to use a breast pump, what kind of infant bottles to buy, etc.) “The nesting urge is an example of this impulse working well. Perinatal anxiety may be that impulse gone awry, or an exaggerated fight or flight reaction.” I’d just stare at the TO DO list like it was a death threat. But because I’m quasi-sadomasochistic and I had this disorder, I couldn’t stop putting things on this list and trying to get it all done. I felt like something would go terribly wrong if I didn’t complete it.
The baby doesn’t need much of anything when they arrive, right? But because I felt I had to be “ready” that included buying stuff for my baby. I took an early trip to Buy Buy Baby with “the list.” As soon as I walked into this baby mecca, my heart felt like it would explode out of my chest. You learn about different strollers and its’ attachments, accessories, on and on…. And it didn’t help that those registry devices NEVER work right. I was overwhelmed by all the choices out there for all the gear and every little gadget. The walls started to close in around me and l felt like I was going to die in there. So, yeah, I never went back. But that didn’t stop me from thinking about what “needed” to get done. I had this unrealistic fear that I wouldn’t be prepared for my daughter’s arrival.
It was strange. I wanted to know everything about being a mom and what I needed for my daughter, but at the same time the idea of doing it all created sheer panic. Using my phone and opening my computer gave me heart palpitations. The “click click click” and “scrolling” of work emails and social media is anxiety provoking as it is. The plethora of information and choices were debilitating.
I’ll never forget feeling utter dread to leave my apartment, and even leaving my bedroom took effort. I walked around NYC aimlessly and thought “Why does everyone look so happy and like they have their shit together? How did they put that outfit together and do their hair?” Even during rush hour on the 6 train people seemed happy. I had this dark cloud following me like those antidepressant commercials. So, I stayed home a lot to avoid these comparisons with people (I work from home, so that made it much easier to do.) And because of my anxiety disorder symptoms, I stayed far away from Instagram. I knew that would send me down a spiral of shame and panic attacks.
For those of you who’ve had depression, you know how excruciating it is.
“You feel ‘flat’, as if the world- and your emotional life- has gone from color to shades of grey. It’s has if the machine that runs your natural pleasure system is broken.” On the really bad days, I would crawl in a ball on my bathroom floor and cry uncontrollably. We’ve all had that bathroom floor moment, right? I knew it took a turn for the worst when my main thought was “I want to die.” It was really scary place to be, especially because I was growing a human inside of me.
I felt numb even when the doctor told me that my daughter was healthy as we looked at her little body and big head on the sonogram screen. My husband, on the other hand, was beyond excited. There was a stark contrast between our experiences through out the pregnancy. He did everything he could to help and support me. But, we both knew that I needed help from a medical professional.
I had been paying a therapist to listen to my problems for years and she kindly told me I needed more help than she could offer. She knew it was bad just by looking at me. (An interesting observation she told me was that I only referred to my daughter as “it” not “she”, or another cute name like “muffin.”) She recommended a few reproductive psychiatrists/psychologists who specialize in PMADS. I didn’t know then that doctors specialized in this field.
I called one right away. We had one long session where she asked a lot of questions about my history and then an hour and half in, she decided it would be beneficial for me to take medication, an antidepressant. She informed my husband and I of the research behind the safety of taking lower doses of SSRI’s (antidepressants) while pregnant. And how it was actually healthier for the baby if I was on medication than being in a constant state of depression and anxiety for the rest of my pregnancy.
I had mixed feelings about taking medication, so I walked away from that session even more confused. I knew taking a pill wasn’t going to make these symptoms all disappear. But also knew that my current state was really unhealthy for my daughter. “When mom is healthy, it’s not only better for her, it’s better for her baby too.” We are connected. It sounds like common sense, but I didn’t know how damaging a mother’s mental health could be for the growing baby inside of her.
A few nights later during a “I don’t want to exist anymore, please GD end it all” moment, I went to trusty google to search for a chat group or facebook page where women discuss suicidal thoughts surrounding pregnancy and motherhood. Post Part Support International popped up. I found a number on there and called as if it were 911 and asked to speak to someone. I was directed to a volunteer based in NY. I texted her and she called me within a few minutes.
I was very straight with her and told her the nitty gritty of my experience with my pregnancy. She told me that it was common for pregnant women to feel this way as well, not just postpartum. Again, that was news to me. She had me write down two things: that I wasn’t alone and that it would pass. Of course, I didn’t believe her.
A complete stranger was consoling me on the phone from my bed (reminds me of that new show DEAD TO ME on Netflix.) It was nice. It was hard to talk about it with people that knew me. Maybe they would think I was being dramatic, hormonal, or ungrateful? “Complaining doesn’t cancel out gratitude.” I try to remember that statement even now. She suggested contacting The Motherhood Center in New York. I went the next morning.
The Motherhood Center is a clinical center that specifically helps women suffering from PMADs. I showed up for one of their ongoing support groups. The moderator/clinician of the group was a woman named Paige. She had fiery red hair and a bohemian, warm, maternal vibe. It was nice to be with other women even for an hour. “When you are isolated from others, your sense of shame may be amplified and the cycle continues, less a circle than a miserable spiral.” I felt better around these women even though it took a lot for me to show up. I had to get on the 6 train after all.
Since I felt better sitting in the support group, I asked if I could be in the day program (a more immersive out patient program) there. I knew I needed to come back every day, all day. I couldn’t bare another moment in bed wishing this would all be over. And so I went to The Motherhood center for four weeks.
I would come in at 9am, Monday – Friday and sit (on these ridiculously comfortable recliner chairs, with blankets!) in a circle with other women who were also suffering from PMADS. Moms can bring their babies to the center. And if she needs some time alone, there is an onsite nursery. It was very difficult to see mothers suffering with their babies in their arms. I definitely thought that would be me in a few short months.
We would start the day by checking in with one another and there was always a clinician (a social worker, psychologist, psychiatrist) in the room. Through out the day, we would step out to meet with our personal psychologists and/or psychiatrists. We also had group therapy, restorative yoga classes and meditation practices. But, if we wanted to just sleep on our recliner we could (most of us had insomnia). It was a depressed person’s “heaven.” It was so warm and welcoming; a safe haven for what we were all going through.
During lunch, if it was a rough day the mothers and I would just eat in silence. On more lighthearted days, we’d talk about peeing unintentionally, leaky boobs, celebrity news, and how we wished it was pizza day. Either way, we stayed in constant support of each others’ experiences. If someone wanted to cry, we gave each other permission to do that. Because “tears are just tears, they don’t cause any permanent damage.” We could let it out and be held.
The group therapies primarily used at the center were Cognitive Behavioral Therapy (CBT) and Dialectal Behavior Therapy (DBT). CBT looks at habitual thought patterns that can lead to troublesome feelings and behaviors. We would find techniques to gain some control over those negative thoughts. One major conversation topic was radical self acceptance – I wanted to punch a wall every time they brought that one up because it was difficult to accept the pain.
Dialectal Behavior Therapy (DBT) helps manage painful emotions through mindfulness and come up with ways to decrease conflict in relationships. Most of us were having troubles with our partners, since it was hard for them to understand what we were going through.
When I left the program, I had tools and practices to help with my anxiety disorder and depression and I was putting them into practice. In the moments of panic and anxiety, I would try to pause and be kind to myself by just observing and accepting what I was thinking and feeling.
I felt better, when I “graduated” the program, but I wasn’t 100%. The great news was that I felt better. I was even able to go to the beach and hang with family and friends on 4th of July weekend. Watching every else drink rosé really sucked, but I actually had some fun.
I am extremely grateful I was able to go The Motherhood Center. The Motherhood Center team were incredibly helpful and supportive. I wish there were more centers like this specifically for mothers. (If men got pregnant would there be centers like this everywhere? Probably. Just saying!)
Sometimes depression and anxiety aren’t taken seriously enough or they are considered less medically critical. Maybe because it’s so common all over the world? Maybe because we tell ourselves to “get over it, tough it out, it’s not like you have cancer?” That’s what I told myself.
PMADS shouldn’t be taken lightly. Project Teach reported that “depression affects up to 15% of women in the perinatal period. Yet it remains largely under-treated despite significant risks. The risks include higher exposure of the fetus to alcohol and drugs, less adequate prenatal care, higher rates of preeclampsia and low birth weight, and more.” Dr. Sacks and Dr. Birndorf phrased it by saying, “untreated depression and anxiety raise mother’s stress hormones, which may lead to physiological changes that may impact the developing fetus.” Hopefully, there will more research in this field that leads to more treatments and centers like TMC.
My OB asked me, “how is your mood?” as I laid back in my crinkly, paper gown, but she asked after I gave birth at my six week check up. I didn’t open up to her because I was ashamed to be depressed during pregnancy and I thought I was being dramatic. Dr. Sacks and Dr. Birndorf say, “we believe that if women started sharing rather than keeping secrets about their bodies during pregnancy, it could normalize (and revolutionize) an experience that’s been viewed as a source of embarrassment or shame.” I think doctors should offer more than a nine question survey about how moms are feeling during pregnancy and postpartum, but that’s a whole other issue.
I love that Dr. Sacks calls the perinatal period matrescence. “It sounds like adolescence, a well described developmental phase (puberty). Also a time when bodies morph and hormones surge.” Estrogen is thirty times higher when a women is pregnant and many other hormones increase including, cortisol which can cause irritability and anxiety. Remember being a teenager? These hormones can f*ck your shit up. Dr. Sacks further explains, “Everyone understands that adolescence is an awkward face, but during matrescence, people expect you to be happy while you’re losing control over the way you look, feel, and relate to everyone around you.” There are so many expectation on mothers, when we are going through major changes in our bodies, mind, and spirit.
I “should” be happy and blissful during my pregnancy, right? It’s the “bliss myth.”
Why do women experience PMADs? I’m sure hormones play a big part in it. “We believe that more studies need to be done to learn about brain changes during pregnancy and parenting, taking into account the hormonal shifts as well as associated changed in behavior and emotions.” For me, I think I also had a lot of pain that wasn’t fully processed and erupted once I got pregnant. My lesson through that time was to surrender and let go of a sense of control. You can eat healthy and exercise and take all your vitamins, but there is still so much uncertainty during pregnancy. When will the baby come? What will my birth be like? What will my child be like? Will I be a good mother?
I had to be kinder to myself and to stop telling myself that I was a bad mother before my daughter was even born. TMC repeated to us that “good enough is great” and “accepting the fact that you can only do your best.” Even when your best is taking a shower that day!
Luckily, there are more people sharing the truths about parenting and parenthood instead of only the blissful and joyful moments. “Consider the Instagram image of the pregnant and postpartum supermom: a nurturing, organized, sexy-but-modest multitasker who glows during prenatal yoga and seems unfazed by the challenges of leaking breasts, dirty laundry and sleep training. This woman is a fiction. She’s an unrealistic example of perfection that makes other women feel inadequate when they pursue and can’t achieve that impossible standard.” As a mother, there are so many moments of awe and joy, but as we all know there are also really sad and frustrating times as well. And I’d like to keep sharing these truths, so women don’t feel they need to meet this unrealistic standards of “I have it all together” and I’ve got kids!
Becoming a mother is taking on another identity and for me it was an identity crisis. I was living with the fear of whether I could handle being a mother. It’s a huge transition for us women. When we become mothers we shed an old self (it’s a mini death) and a new self is born. It’s a loss as well as a gain.
I’ve learned that the “bad” feelings are signals for transformation or an awakening. If you aren’t well, listen and surrender. We don’t need to be fixed and your feelings aren’t facts. Life is truly a rollercoaster. One day you’re on that bathroom floor hoping it will swallow you, and soon after you can feel peace again. My journey was that I needed to hit bottom and learn how to mother myself in order to become a mother. Mother yourself. That’s a lesson for us all.
actress, producer, maternal mental health advocate
Learn more about The Motherhood Center here.