“Mental health issues do not tend to occur in a vacuum and this is particularly true for postnatal experiences which are so coloured by societal expectations,” says Dr Johanna Clancy, a senior clinical psychologist with Cradle Psychology which offers pre- and postnatal supports for new parents.
Mothers experience post-partum support falling away as the proverbial village is more commonly absent. Added to this, the upheaval of motherhood does not allow the time and space for mothers to process the dynamic changes in their lives, and motherhood is an incredibly juxtaposed period of life with contradictory experiences and emotions. The absence of space, support and understanding has encouraged the silent experience of maternal mental wellbeing.
Maternal wellbeing is “a complex psychological picture which will look different for every woman and parent,” says Dr Clancy. “But we know that the transition to motherhood, known as matrescence, is comparable to adolescence in terms of the enormous physical, emotional and neurological shift that occurs and shifts our psychological profile. There are significant psychological and emotional demands that pregnancy, childbirth and parenting place on parents, including sleep disruption and deprivation, lifestyle change, the physical impact of pregnancy and childbirth and shifts in identity.”
There may be a societal sense that new mums have permission to be ‘emotional’ for a period of time after having their baby but that there is expectation of going back to ‘normal’ once this passes
— Dr Johanna Clancy
How we understand postnatal depression (PND) is quite limited, even by today’s standards with the conversation of mental wellbeing and the transition to motherhood becoming more open. The conversation remains muted as the lived experience is broad, nuanced, and often misunderstood. It is not simply a case of overcoming baby blues, settling into a routine, or adjusting to the new rhythm of parenthood. There is no timeline to PND, but because mothers are often expected to hold their experiences in silence, the timeline is rushed, and the mother neglected in her psychological needs.
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“The reality is there is an emotional messiness to matrescence or new motherhood that can go on for much longer periods and in some cases can manifest in more significant distress which meets clinical criteria for postnatal mental health difficulties,” says Dr Clancy, “but the many societal narratives about mums can unfortunately further reinforce the sense of isolation and potentially shame that can come with experiencing mental health difficulties. There may be a societal sense that new mums have permission to be ‘emotional’ for a period of time after having their baby but that there is expectation of going back to ‘normal’ once this passes.”
Despite the positive shift in approaching and opening these difficult conversations surrounding mental health and being more aware than ever of the psychological transition of this period, the vulnerability of new motherhood lends itself to greater difficulties in opening up when mothers are expected to be happy and grateful amid the anxieties and stresses of new motherhood.
“It is an incredibly vulnerable period for a woman, and we find this to be universal,” says Dr Marese McDonnell, also a senior clinical psychologist with Cradle. “The way we talk about motherhood should be shaped around what the current research tells us, which is a detailed story about a continual process of brain change which is heavy on our resource system and does not fit with cultural assumptions about innate maternal instinct or automatic feelings of deep connection with baby. We need this science to be in the mainstream to change the conversation about what maternal mental health looks like.”
Dr McDonnell reiterates that pregnancy and early motherhood include physical and emotional experiences that have the potential to contribute to psychological distress in almost countless ways. “Body changes, heightened emotional responses, sleep disruption, lifestyle changes, increased interaction with healthcare services, brain changes, relationship changes, and the list goes on,” she says.
We need to dispel the black and white view that mothers are either all thriving or all suffering – the reality is much more complex and nuanced
— Dr Marese McDonnell
“These are the more obvious factors but for many people there are also other concerns related to work, finance, housing, family relationships and more. We know that many women also experience challenging internal experiences during the perinatal period such as increased self-criticism and anxiety, as well as deeply challenging emotional responses including maternal ambivalence, anger and guilt. Further complicating this picture for some women is the experience of birth trauma or accumulations of other stressful and potentially traumatic experiences during pregnancy, childbirth, and the postnatal period.”
As 15 per cent of new mothers may experience symptoms of PND, the silence and stigma surrounding maternal mental health can heavily complicate recovery. A key factor in normalising the experience of PND is to understand the fact that “maternal distress exists on a continuum,” says Dr McDonnell.
“We need to dispel the black and white view that mothers are either all thriving or all suffering – the reality is much more complex and nuanced. It would be much more helpful to recognise that the transition to motherhood is a non-linear process tied to a complex web of factors where at some points those experiences of distress may begin to interfere more and more with life and may mean that specialist support will be helpful.”
“It’s also crucial to acknowledge that emotional distress can show up in mood, anxiety levels, intrusive thoughts, intense anger, and experiences of psychosis,” says Dr Clancy. “We need to normalise this plethora of experiences that might occur in the perinatal period and recognise that it is the duration, frequency, and intensity of these difficulties, as well as the impact on day-to-day functioning, that helps us to understand where specialist support is needed.”
Mothers recognise the opposing and stereotypical narratives of the good mother and the struggling mother. These long-held beliefs have created a damaging imbalance to how and when women seek out support for mental health issues. Anecdotally, women have relayed their fears of being judged, their children taken from them, or being silenced, ignored, or rebuffed in their attempts to get help. Shame, low confidence, and embarrassment have been cited as further reasons for not sharing their distress. An apparent lack of healthcare support further diminishes a mother’s ability to properly address concerns about her mental wellbeing.
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“While we have fantastic healthcare staff in this country, current resource levels often mean that services can be limited for most mums after six weeks post-partum, even though a comprehensive recent Irish study, the MAMMI study (Maternal health And Maternal Morbidity in Ireland), suggests that this is probably not sufficient to meet the mental health needs of post-partum women,” says Dr McDonnell.
“This might give the unintentional message that, unless your difficulties have been identified by that six-week point, that you should be doing fine. We do know however that there are many public health nurses, maternity teams, midwives, doulas, and other grassroots organisations that are working hard to promote conversation and support around maternal mental health which is hugely promising.”
Self-compassion, social support, developing an awareness of stress and emotional responses, developing coping mechanisms, and normalising the understanding of maternal mental health can all be vital in optimising wellbeing.
“We place a huge emphasis on the importance of normalising that a certain degree of overwhelm and emotional turbulence is expected,” says Dr Clancy. “Show yourself compassion if you are experiencing distress. Part of that self-compassion is seeking support through the avenues available – your GP, maternity team, and/or public health. Taking stock of those support systems – whether that is family, friends, a service like Cradle, your GP, maternity team or PHN – is a good thing to do even before baby arrives.”
