Disclaimer: This piece includes my experience and perspective as a cis white woman in a heterosexual relationship. For the purpose of this piece, the terms “maternal/mother/mom” and “paternal/father/dad” are used.
However, at Grace Advertising & Consulting, Inc., accessHealthNews, and our nonprofit arm, Altruism Media, Inc., we recognize that race, ethnicity, gender, sexual orientation, income status, and other determinants can enormously impact the pregnancy, birth, and parenting experience.
We support birthing people of all genders, their partners and support systems. Support resources for parents whose identity may impact their ability to receive quality care are included at the end of this piece.
The arrival of a little one, whether carefully planned or completely unexpected, begins a complete transformation of every aspect of new parents’ lives. Daily routines and schedules are suddenly upended — even the freedom to use the bathroom or shower as you please – and no amount of birth classes or pregnancy apps can fully prepare you for the transitional journey ahead.
The postpartum period, generally defined as the six to eight weeks following childbirth, brings a slew of overwhelming challenges for new parents, and the cost can be deadly. According to Postpartum Support International (PSI), reports from maternal mortality review committees (MMRCs) across 14 states show that mental health conditions were the leading underlying cause of preventable pregnancy-related deaths, with 63% of these deaths occurring between 43 days and one year postpartum.
Perinatal mood and anxiety disorders (PMADs) are depression and anxiety disorders occurring anytime in pregnancy or in the first year postpartum. PMADs replace the narrow definition and scope of postpartum depression and affect all new parents, not just mothers and birthing parents.
The prevalence of PMADs and the resulting harm done to affected parents and children highlight an urgent need to rethink our current delivery of postpartum support. Postpartum support is not one-size-fits-all and while there is no clear solution, one thing is certain: new parents need to be leading the conversation about what they need to overcome mental challenges, succeed in their new roles, and thrive as a family.
Postpartum Support Around the World
Globally, different countries and cultures have unique approaches to helping new parents prevent and manage PMADs. The Impact of Cultural Factors Upon Postpartum Depression: A Literature Review examines studies from around the world that explore postpartum support methods in an attempt to find links between forms of support and improved (or worsened) PMADs.
In many Eastern cultures, there is a popular ritual of “doing the month” where elder women in the family take over caring for the baby and house, allowing the mother to focus on recovering for at least the first month after giving birth. In some instances, this hands-on support was helpful and positively impacted the mother’s mental health. For other mothers, though, this was not the kind of support they wanted. Some reported feeling stressed by having in-laws or elders constantly around, and this attempt to support potentially contributed to PMADs.
In other cultures, where new mothers are not surrounded by their family or female elders, women reported wanting more hands-on support from their partners, the lack of which contributed to PMADs. In a study of Jordanian women residing in Sydney, Australia, the lack of nearby family support contributed to their feelings of being overwhelmed by all the new responsibilities and feeling like they were failing at being a perfect mother and wife.
Guilt stemming from the feeling of failure is a global problem for mothers, especially for women whose identities carry societal pressure to be perfect. One study examined in this review found that African American women felt pressure to live up to the image of being “strong Black women,” and that postpartum depression only happened to white women. They reported feeling ashamed of struggling with their mental health, which pushed them to rely on faith, religion, and their own selves, rather than seek external support or professional help.
Each study reviewed had limitations and methodological flaws, highlighting the need for improved data collection surrounding PMADs, types of support received, and the impact of this support throughout and beyond the postpartum period. However, one common thread was discovered. Ultimately, postpartum support had a positive impact if it was wanted and needed by the mother. If the woman valued a certain type of support that was not offered, such as support from a husband or partner, she was more likely to have PMADs, regardless of other traditional, social, cultural, and ritual supports in place.
Navigating Motherhood Without a Mother
When I became pregnant, everyone in my village made a point to become educated on postpartum depression and deem themselves allies, ready and equipped to support me. I have a long history of mental illness including trauma, complex PTSD (C-PTSD), depression, anxiety, and borderline personality disorder (BPD). Because of this my support system was, lovingly, prepared for and expecting the worst.
In addition to my struggles, I lost my own mother to cancer halfway through my pregnancy. My mom was a nurse, an advocate for mental health and substance use recovery, an artist, a spiritual being, and a seemingly infinite source of wisdom, love, and guidance. When I lost her, I didn’t just lose a parent, I lost my best friend and the person I could come to with any problem and know that she would have exactly the right thing to say.
She wouldn’t coddle, but she wasn’t cold. She wouldn’t give you a direct answer or tell you what to do, and she wouldn’t judge or punish you for doing differently than she would. She’d turn the question back to you, imploring you to reflect and find the root of what it was you were seeking. Often, I’d find that I already knew what I wanted or needed to do, and some internal guilt or external force was in the way. With one conversation she could stop my spiraling, validate my pain, and set me back on my path with regained confidence in who I am, what I want, and what I’m capable of.
Losing this type of confidant during the most overwhelming, challenging, and transformative experience of my life felt – and still feels – impossible. Having passed the six-month postpartum mark, I’m only just now realizing the depth of her loss and how much I needed her all this time, as much as I might try to convince myself I’m doing fine. I am privileged to have an enormous support system ready and waiting to step in and save my day. The problem is, they are not her.
The village that my partner and I have around us is incredible and we have been offered hands-on support in many forms since we arrived home from the hospital with our bundle of joy. However, because they cannot do what my mother did or be who she was, I struggle to accept their help as, well, helpful.
I am not a leftovers person, so a fridge full of more casseroles than I could eat became a stressor during my first month home, with much of it ending up in the trash. I find cleaning to be therapeutic, so offers to tidy up while I rested fell through when visitors noticed my house was already spotless. Though I desperately needed sleep in the early postpartum weeks of recovery, as a new mom, I couldn’t stand hearing my baby cry and not immediately run to soothe him, so I turned down invitations to nap while others held him.
It’s not that I don’t love, trust, or value the people around me offering help. I am so lucky to have my entire family, my partner’s family, our friends, fellow new moms, family friends, and more waiting for the green light to support me. I recognize that many new moms aren’t as fortunate. But what I’ve found, which is validated by the previously mentioned study, is that when support doesn’t match up with what I need, it ends up not feeling much like support at all.
As a work-from-home mother, I am working two full-time jobs simultaneously — three if you count household management, four if you count the strict breastfeeding and pumping regimen that I was on for the first few months. I am extremely fortunate to have a job that is flexible and an employer who is understanding and reasonably accommodates my new needs, a luxury many new parents don’t have. When work is done for the day, however, I need a partner who can seamlessly take over parenting and allow me a much-needed break.
I’ve always heard the sentiment that women become mothers when they get pregnant and men become fathers when they hold their child for the first time. However, I never fully understood the message somewhat hidden between the lines here until it impacted me directly. Women are given a tremendous wealth of resources, education, advice, research, apps, journals, and so much more from the day they find out they’re pregnant until well through the postpartum phase. Men, however, are not.
A Disservice to Dads
Leaving dads out of the loop does a disservice to the mother and family unit as a whole, but also to the dads themselves. What I’ve discovered between my own experience and that of my friends, therapist, and midwives who are all moms, is that many times dads don’t step in to take over because they aren’t as equipped as us moms are.
They see the exhaustion in our sagging eyes, the grease in our day-five unwashed hair, the spit-up-stained mountain of laundry piled on the floor, and they want to help. But they weren’t taught how to hold their baby while feeding, or change a diaper, or the thousands of tricks to soothe a baby to sleep.
As mothers, we’ve been reading the latest research on all things baby since we saw our first positive pregnancy test. As we physically transform, we grow more curious and anxious about the arrival of our little one and how to continue nurturing and protecting them once they’re outside of our bodies. Fathers, however, don’t have the luxury of undergoing this journey or the psychological intuition from being connected to their children. As a result, they are relegated to the information given to them, which turns out to be sparse.
Societal pressures on men to be strong and self-sufficient have historically prevented them from seeking support. This pressure, combined with the lack of support readily available and given, leaves many new dads struggling with their new life with no healthy outlet to help them cope. As a result, fathers experience paternal depression, the risk of which is increased if the mother is also experiencing maternal depression.
According to PSI, fathers’ depressive symptoms begin to spike between three to six months postpartum. These symptoms are often “masked,” appearing as increased irritability, aggressiveness, hostility, and substance use, rather than sadness. Fathers experiencing paternal depression may also self-isolate or find something to distract themselves, especially if they do not have a strong social support network outside of their partner.
Factors that contribute to paternal/partner depression include:
- Feeling burdened or trapped.
- Financial responsibility as a burden.
- Feeling outside the circle of attention.
- Missing sexual intimacy.
- Sleep deprivation.
- Isolation and loneliness.
When both new parents are experiencing postpartum PMADs (or postpartum depression), it is easy to fall into a cycle of resentment from which it feels impossible to escape. Mothers who become the default parent in charge of the child feel they have taken on the lion’s share of new responsibilities, while fathers who spend all their time at work to afford bills and health care costs feel the financial burden is even greater. Both are right, and both are wrong, and both are too overwhelmed, overstimulated, and hopeless to see room for compromise.
Different Parents Need Different Solutions
What new parents need more than anything is to be seen, not to be given unsolicited advice or sent research to review, or have visitors pop up offering to take care of things they weren’t asked to take care of. But to be seen, and heard, when they’re asked how it’s going. New parents need their support systems to lean in and truly acknowledge what they are going through and do the work to find out what would actually help.
In my experience as a mother, the guilt I feel for not being a superwoman able to do it all is crushing. All of the information on how to parent was given to me, and none to my partner, so I feel responsible not only for figuring it out myself but then teaching it to someone else. When I can’t do that – whether because I’m too tired, too busy, or just can’t mentally handle one more responsibility – I feel like I’ve failed myself, my partner, and my child.
I wish that throughout my pregnancy, my partner had been reached out to by his friends with children the way my fellow new mom friends wrapped around me. I wish that when I spoke about my plans for my birth, my support system did not doubt or argue. When I was immediately recovering from birth, in the same hospital in which my mother battled cancer, where I lie barely awake, bleeding, crying from pain and grief and overstimulation, I wish that my care team had taught my partner how to feed and change his new baby so that I didn’t have to retain a new lifetime’s worth of information when I could barely see straight.
When a new parent says they’re doing fine, trust that they likely aren’t. Maybe their home is clean, but have they showered? Maybe they’re cooking dinner every day, but are they keeping up with bills? Maybe they don’t need or want advice or hands-on support. But they can certainly benefit from someone acknowledging how much they have taken on, validating how difficult it can be to take on a new identity and responsibility for a new life, and reminding them that the baby blues don’t last forever – unless they’re a sign of something more severe.
“Baby blues” are not a mild form of depression. They are caused by extreme hormone fluctuation at the time of birth and last from two days up to two weeks. If symptoms of depression and feeling overwhelmed with parenthood are severe and/or last longer than two weeks, it is important to be screened for PMADs (or paternal depression, for dads).
If left untreated, or if combined with other mental health challenges, maternal and paternal depression and mood and anxiety disorders can result in child abuse and neglect, family dysfunction, psychosis, or in some cases lead to parents harming themselves or their baby.
Resources for New Parents
The Maternal and Infant Health Project, or The MaIH Project, is a free program that serves pregnant and birthing people in Kansas and Missouri. A community health worker (CHW) and doula team work with program participants to assess any and all needs, including financial assistance, food security, transportation to doctor visits, and more. They then refer and connect patients to care, so patients can simply focus on caring for themselves and their baby.
The CHW and doula team will continue to follow up with parents and their support systems throughout the pregnancy, birth, and postpartum journey to ensure they have the help and support they need – and want — to have a safe, healthy, positive experience. To learn more and get connected to help, visit https://altruism-media.org/the-maih-project/ or call/text 844.860.0111.
Postpartum Support International (PSI) offers a wide range of support resources for new parents, including information for moms, dads, partners and families, queer and trans parents, military families, people experiencing loss and grief, people experiencing postpartum psychosis, adoptive and birth mothers, and more. They also offer resources in Spanish.
For non-emergency support, new parents can call the PSI HelpLine at 1.800.944.4773 (#1 for Spanish or #2 for English). Parents can also text “help” to 800.944.4773 (971.203.7773 for Spanish).
The National Maternal Mental Health Hotline is also available as a non-emergency support for new mothers: 1.833.943.5746.
For new parents experiencing a crisis or thoughts of suicide, dial 988 to reach the National Suicide & Crisis Lifeline.