Postpartum Tragedy in Massachusetts & Why We Continue to Fail Mothers

Warning: This post contains information and discussion about postpartum psychosis, postpartum suicide attempt and infanticide. If you aren’t in a place to read this, please prioritize yourself and don’t read on!

Last week, news broke that Lindsay Clancy, a mom and nurse, someone’s wife, daughter, and mother, is accused of strangling her children, resulting in the death of Cora, 5 and Dawson, and  8-month old baby Callan, before injuring herself and jumping out second-story window in a suicide attempt while her husband went to pick up dinner. Rumors have swirled around about postpartum depression and/or postpartum psychosis, which unfortunately are incorrectly being used interchangeably by some media outlets and stories.  This tragedy is also a reminder that we only know what someone shares, and we don’t know what we don’t know. I read that Lindsay shared she was suffering from postpartum anxiety, it has also been reported that she was in treatment for ‘postpartum.’

It’s scary to know some but not all of the details, and a side effect of the broad snippets of information accessible to the media is that Lindsay’s story quickly becomes relatable, it can be scary to empathize with her suffering, and I do firmly believe that she was suffering, this was a tragedy for all.  People who have been in a dark place before, or had fleeting thoughts of harm, or those with intrusive thoughts can all be triggered and activated. It’s easy to relate and say, “that could have been me,” or “that was me.”  Some of the details that have been released around this tragedy also share similarities to unwanted intrusive thoughts that can occur in postpartum anxiety or postpartum OCD, and while terrifying, present little risk, it’s very common for these unwanted images or thoughts to escalate when learning about someone who did exactly what that person is afraid of doing. Fortunately (but uncomfortably) unwanted intrusive thoughts are much more common than postpartum psychosis and harming self or one’s children.

I don’t want to assume or speculate about Lindsay Clancy, her mental health history, what real life was like for her at work, at home, in treatment. I do feel that as information becomes public we will learn more about how inadequacies in maternal health and specifically maternal mental health impact someone’s access, frequency, and at times quality of care. Could there have been a different outcome for this family if things were different? I can’t help but wonder. I cannot change what happened to this family that many of us can relate to in a time of grief, shock and sadness. What I can do is continue to make noise- to fight for reproductive freedom, to fight to reduce inequities in maternal healthcare, to fight the siloing of psychiatric wellness from physical wellness because surprise- the two are highly connected. I will fight insurance companies to make sure clients can get therapy and other supports when they need them, I will fight to educate professionals and the community about perinatal mood and anxiety disorders. I don’t want to fight or come in ready for resistance, but I am aware not everyone is ready or willing to help birthing people navigate the postpartum… and then there are many who want to but aren’t sure how- I can educate and support those people, so little by little, more people can help more families, so fewer families are without supports or someone who knows how to help. 

In my time as a perinatal mental health professional, therapist, and advocate, I have seen great strides in raising awareness about postpartum depression (and other PMADs), and now we need more action. We must all work together to make things better for birthing people, we cannot wait for the systems and powers that be to create change- they have had their chance and in many ways, and some [not all, trying to avoid villainizing and absolutes here!] display low motivation to change things because the systems that are in place benefit certain groups of people- Some will say the system is not broken- those are the very people for whom the existing system is working and serving. If you are not for healthier birthing families, you are against them, you are the problem. Who might you say is against birthing families? Who wants moms and other new parents to suffer!? When we frame it that way you might as well be starving puppies, right!? There are many intentional and some unintentional ways that we are failing birthing families and those struggling with postpartum emotional complications. But how?! We’ve raised awareness, Catharine! 

Well….

Insurance companies charge premiums and make money when you utilize less services. When they pay unsustainable unfair rates, demand arbitrary clawbacks of claims paid, and question medical necessity of postpartum mental health care… they are working against us. They are failing birthing families.

When doctors do not screen for mental health in pregnancy and postpartum, whether it is because they don’t have time (thanks again, managed care!) or because they don’t know where to turn (Learn! Ask me!) then people suffering don’t bring it up… I’d argue they aren’t treating the whole person, and this should be in informed consent, “I’ll treat this part and this part, but not that one.” 

When providers consider postpartum people “discharged” or “done” with their care if at the six-week postpartum visit they aren’t displaying signs of an infection and their uterus is involuted as expected- or when a primary care physician is reluctant to treat someone because the identified problem is “associated with pregnancy,” They fall through the cracks and we fail them.

When psychiatrists are reluctant to treat pregnant or lactating people, and OBGYNs are reluctant to medicate those same people, accessing necessary treatment becomes near impossible, and financial obstacles in a crumbling capitalist economy make it even more difficult to find care and afford medication and treatment.

And as for Capitalism… Capitalism fuels high medical costs, abysmal family leave policies, pressure from employers to get back to work, inflexibility around medical appointments once clients return to work, we fail birthing families- but don’t worry, we will also sell you a mortgage payment’s worth of products to try to make up for the fact that people are forced back to work too early postpartum- consumerism is the answer to… nothing. Fail again.

Lindsay Clancy is a white-appearing mom from the photos shared in the media thus far, I do not want to let that fact deter from the critical truth that this country is drowning in a black, BIPOC really, maternal health crisis- birthing people of color are dying and suffering at exponentially higher rates than their white counterparts, even when we account for socioeconomic, educational, and insurance differences. We have known this for many years, and articles detailing the nuanced ways in which non-white patients are more likely to suffer complications, including mental health complications, is not new, and little has changed since these publications.. again is the system broken or is it working how it was designed? 

A friend and colleague and I spoke this week, brainstorming and supporting each other, reflecting on what we have heard about the Clancy family. One of the many ways in which we struggle to process this tragedy is that things should have changed after Andrea Yates’ tragedy in 2001. How are we twenty two years later and not every mom is screened everywhere they go postpartum, the hospital, the pediatrician, the OB or midwife? How is it that twenty two years later we don’t have mother-baby hospital programs inpatient and outpatient, in every major metropolitan area?

Wow, Catharine- long list of things to change on a local and national level there! I know… but this is my life’s work, it is what I was meant to do and I’ll keep doing it, helping clients, educating others, and fighting these strategically-designed systems, until every birthing person is cared for and no one suffers without resources and support and treatment…. Not a little bit of treatment for each person, either, I will not rest until everyone gets the care they need to grow the healthy families they want, and until each client can reasonably expect to be treated fairly, with respect, dignity and equality. 

In the mean time… here are some things you can do to feel slightly less helpless as you process this tragedy…

1. Focus on taking really good care of you. You need to recharge to keep making an impact, rest and take those vitamins.

2. Hydrate… you are not a house plant- you need water daily

3. Join or work toward building a moms club in your town- bring postpartum families new meals, sit, listen, check on them

4. Attend postpartum support groups, keep them full and keep them running, be kind and welcoming to new attendees, let them know they are not alone.

5. Ask your healthcare providers if they screen for postpartum mental health, and what they do about positive screens - if their answer is lacking, demand better! They can contact me or other local specialists for training and resources… no excuses!

6. Get your own therapy, with a perinatal therapist… break stigma and keep yourself in a good headspace, everyone wins there!

7. Ask for help when you need it and offer help when you can… Let other love you and return the love when you have extra to give 

Resources for Parents & Professionals

Postpartum Support International  www.postpartum.net  

Call the PSI HelpLine:  1-800-944-4773    #1 En Español or #2 English

Text “Help” to 800-944-4773 (EN) Text en Español: 971-203-7773

Support Group Listings:   [National] Postpartum Support International  https://www.postpartum.net/get-help/psi-online-support-meetings/ 

Postpartum Progress https://postpartumprogress.com/ 

National Maternal Mental Health Hotline 1-833-943-5746 (1-833-9-HELP4MOMS)

Learn More about Postpartum Psychosis - 
PPP Awareness Day https://pppawarenessday.org/  

NHS Postpartum Psychosis Info  https://www.nhs.uk/mental-health/conditions/post-partum-psychosis/
MGH Center for Womens Health https://womensmentalhealth.org/specialty-clinics-2/postpartum-psychiatric-disorders-2/ 

Royal College of Psychiatrists, UK https://www.rcpsych.ac.uk/mental-health/problems-disorders/postpartum-psychosis 

Suicide and Crisis Helplines

988 Suicide and Crisis Lifeline  [Formerly National Suicide Prevention Lifeline]

https://988lifeline.org/ 

Maternal Mental Health support- https://988lifeline.org/help-yourself/maternal-mental-health/ 

Crisis Text Line  Text HOME to 741741

In Connecticut

2-1-1 for Mobile Crisis and/or Emergency Mobile Psychiatric Services

Support Group Listings  www.psictchapter.com 

Find a therapist with perinatal training: www.psidirectory.com 

Pregnancy, Postpartum & Pills: Considering Medication.

To medicate or not?

That is the question and there is no one right answer. I cannot begin to count the number of times I heard the response, “Well, it depends.” in graduate school. As an aspiring counselor little did I know how much the uncertainty of counseling life would mirror motherhood. While I sighed countless times back then just wishing there were a definite answer to my question, I now have to pass along that vague unknown to clients at times. Many mothers ask me,

“Should I take medication?”

“Is it safe?”

“Will it hurt my baby?”

And sometimes the opposite occurs, a woman knows she needs medication and because she is pregnant or breastfeeding she is given fear rather than facts, misinformation rather than medical care. Clients tell me their medical providers refuse to prescribe, will only prescribe in a certain trimester of pregnancy or bargain with clients requiring they promise not to breastfeed. Some prescribers mistakenly offer a woman a sub-optimal dose thinking that less is better however then we are faced with exposure without relief of symptoms. Women are forced into a dark, lonely corner with nowhere to turn and no clear information. I must ask, how does this help anyone? Mom, baby, or the family unit?

Let me be clear, there are risks and benefits to any medical intervention. I am not going to blindly say that there is no risk in consuming medication while pregnant or breastfeeding. I consider my practice orientation to be holistically minded and am a crunchy mom myself, however we must ask ourselves

What are the risks to mom and baby [and the family as a whole] if mom is unwell?

What are the risks to baby if mom cannot get out of bed to respond to cries, or cannot eat enough to make milk?

What if mom isn’t sleeping, or is paralyzed in her anxiety and can’t get the baby to pediatrician visits? Or get herself medical care? What if she cannot work because her symptoms are so severe?

 

Women, their doctors, their therapists and their supports all need evidence-based research and an honest conversation about risks AND benefits to make an informed decision. No one deserves to suffer in silence, and no one deserves to be backed into a corner to make a tough decision alone.  

Some questions I ask my clients include

-Have you had anxiety or depression severe enough to warrant medication in the past? Is it likely that is necessary at this time in your life, too?

-Have you had recent comprehensive blood work? At minimum, a full thyroid panel, iron, vitamins B & D? Even if you’ve had previous diagnoses related to your thyroid, pregnancy and postpartum can shift what you need to keep your thyroid supported and individuals with no history may be surprised to learn they have a new imbalance.

*Keep in mind that if you’re still nursing, your body prioritizes your baby, high quality multi-vitamins are a great start, and consulting with a naturopathic doctor or your trusted medical professional can offer additional recommendations for your unique needs

-Have you talked to a holistic provider?

-Are you staying hydrated and getting as much rest as you can? Do you have supports to give you breaks ?

-What are the risks to you AND your baby of NOT-treating your mood symptoms?

Ideally a pregnant or postpartum mom will have the expertise and support of a team of informed providers including a psychiatrist or psychiatric nurse practitioner with training in perinatal mood issues, who understands risk/benefit assessment of medications and has experience prescribing to expectant and nursing women. This prescriber can collaborate with a client’s therapist to monitor weekly progress and the prenatal provider (OBGYN or midwife) to monitor pregnancy progress.

Whatever mom decides should be what helps her and her baby achieve wellness sooner rather than later- stable mood, restful restorative sleep, reasonable appetite, and ability to not only complete daily tasks but find enjoyment as well are my goals for women experiencing perinatal emotional distress. Studies show that cognitive-behavioral therapy in conjunction with medication is most effective against depression, so don’t quit counseling as soon as you have prescription, utilize all resources [medical doctor or midwife, prescriber and therapist] to help you get well. You are worth it. It does get better.

Disclaimer: This post is informational and nature and not a substitute for psychotherapy. 

Work-Life Balance is Malarkey

When you google the topic, it yields 95 MILLION results. You and I are not the only ones seeking this mystical unicorn of a concept.

As a society we often speak of work-life balance as a destination, an end point that you can arrive at if you work long enough, hard enough, and pin enough homemaking ideas on Pinterest while flying under the radar from internet monitoring at work. It’s not uncommon to hear of this search in my counseling office- moms are tired, stressed, overwhelmed and frustrated. Their romantic relationship and own self-care are neglected, and they still feel as though they’re drowning.

Many women come into my practice with similar frustrations, they’re tired and feeling inadequate, discouraged, and angry with themselves. Social media creates a facade of accomplishment to mask insecurity and self-doubt as some share their highlights almost obsessively, further skewing expectations of what ‘should be.’ My clients motivate and inspire me- I reflect on each session and my understanding about motherhood and all it brings are constantly evolving- in this moment, here is what I have concluded regarding work-life balance:

1. There is no one definition or magic formula. Work-life balance looks different for everyone and therefore there is a different path for each woman/family.

2. Career, relationships, and children can and will each dramatically shift what work-life balance looks like and how you travel [not arrive] there, often at unexpected times.

3. A reasonable expectation for a family is that most of the time everyone gets what they need, and you have time to connect and enjoy each other as well as nourish yourselves.

4. Sometimes it just isn’t the season for balance- there are life circumstances and brief stages [hello, newborn stage!] that it isn’t realistic to expect to feel balanced and mitigation of chaos is an achievement.

5. Just like the laundry, work-life balance is never done.

How do we move forward on this endless path? What can make it more manageable [notice I didn’t say easy!] ?

Let go of comparison.

You do not need to meal plan like the pinterest lady sponsored by a frozen food conglomerate with has a colorful vibrant blog covered in professional photos. More often than not, that’s how she makes her living and it’s not realistic for most of us. Take the one recipe of the eight she has to offer today and run.

Likewise, you do not need to give your child a Pinterest party each birthday- we all grew up with plastic store-bought favor bags with tchotchkes and likely-GMO candy and we were ok- toss some all-natural animal-shaped grahams in there and let children be children.

Say No [Thank You].

A free hour in your day is likely a rare occasion-don’t rush to give it away. If you find yourself wuith , enjoy it yourself while it lasts. Read this month’s issue of a magazine- this month! Drink coffee or tea while it’s still hot. Scroll facebook mindlessly and ignore Mount Laundry-est. I’m guessing you don’t have to look far

Accept Help when offered

Just as we often turn to the default response, “Good!” when someone asks how we are, when a helping hand is offered we may be inclined to say, “Thanks, I’m ok!”-- Stop. Let a friend pick up your kid at school, let your mom do your dishes even though she doesn’t maximize the dishwasher real estate. It’s more clean dishes than you had this morning!

Ask for Help- Be Specific

Whether it’s from your partner or a friend, when you ask for help, be as specific as possible. A well-meaning partner may struggle to fix, “I am just too overwhelmed!” or “I’ve had it! I can’t do this!” --- Reflect on what you think would be useful or restorative and ask for specific things people can deliver. Can your spouse fold two loads of laundry? Can they take the baby next Monday after work for a few hours so you can get your hair done? Can a grandparent bring your oldest to an activity on Saturday morning so you can meet a friend for tea? Who can help you help yourself in little (and big) ways?

Keep a calendar.

The Erin Condren Vertical Life Planner is my favorite,

The act of physically writing things down commits them more efficiently to your mind, and unlike a phone, the battery never dies and the system doesn’t crash. You can color-code, use pretty stickers, integrate hand-lettering or other art, whatever works best for you. Write it all down- unpack as much of the mental load as you can and commit to looking at your calendar daily. Personally I use mine not only for my office hours and client appointments but my kids’ school calendar and events, my husband’s work schedule, our family commitments, extracurriculars, holiday planning, birthdays, meal planning, budgeting, and my own self-care. Divvy up chores and tasks on your never ending to-do list by week rather than day so you grant yourself some [needed] flexibility, try out different meal and cleaning schedules to see what works for your family.  

Schedule yourself into your calendar

If you went out and got a calendar or planner, Bravo! Now book yourself in as you would any other appointment. Schedule time for self-care appointments such as hair, a massage, etc, as well as down-time, with and without kids. If you have three busy weekends next month, block off the fourth as a Family Weekend, In and Around as opposed to Out and About. Don’t forget date nights, connect with your partner in and out of the home. Consider day dates and meeting for lunch as your schedules allow. Sneak in quality time where you can and write it down, commit to it.

Be True to Your Priorities.

Leave work at work- most employers reward productivity and will not encourage you from stepping back at the end of your work day- they benefit when you send that one extra email, stay late to finish a report, or sign on from home after dinner. Resist if you can, or strive to limit crossover between work and home. If you are self-employed, give yourself permission to honor boundaries and set work hours. If possible, unplug from work, leaving work emails and phone calls for work hours.  Give each role your best when you are there and let them be separate.

Be kind to yourself.

This endless ever-changing balancing act, like every aspect of motherhood is TOUGH! You are enough, you do enough, you are awesome. No one is perfect and no one will mother the way they want to 100% of the time just like no one will be able to give their job they effort they want to “all the time”.

You are doing what you can with what you have in this moment,

and that’s all anyone can ask.

You were mistreated in birth? #metoo #hertoo #toomanyofus

It’s hard to avoid the recent media blitz of #metoo posts, copied and pasted all over the internet, some women sharing details and others simply re-posting not because they don’t have the time or drive but for many because the attention Harvey Weinstein’s allegations and the resulting courageous speaking out from his and many others’ victims is triggering and too much to reveal on social media. Some don’t re-post because they don’t want attention on their trauma, they do not want to tell their story- and I don’t blame them. Many women have sat in my office through the years reflecting on how they tried to tell someone of their abuse, maltreatment or harassment, and no one listened- they were silenced, ignored, and at times accused of fabricating their experience.

This public acknowledgment of the prevalence of mistreatment of women elicits many emotions for me- I’m sad but not surprised, and more sad that I am not surprised, I feel angry that so many friends and acquaintances have been victims and can nod my own head and also say, “ #metoo .” I feel troubled raising a daughter whom I never want to be able to say #metoo and I have two sons whom I strive to raise in such a way that no one would ever feel pressured, harassed or victimized in their presence. No pressure!

As a therapist many of us have heard the stories behind these posts on social media- we listen, we comfort and hold space for these stories. Some stories hit closer to home than others, some show running themes, and all of them sadden us.

Working with perinatal women, I often hear of a lesser known form of trauma and harassment- mistreatment of expectant and laboring women. During what is supposed to be a special and memorable life-changing experience, many women are victims of abusive and/or disrespectful behavior and language.

Over one-third of women describe their birth as traumatic.

I can tell you many more describe experiences during their pregnancy and postpartum period to be traumatic as well, we just haven’t surveyed comprehensively enough to offer a statistic.

What goes on in prenatal care or birth that’s traumatic? Unfortunately many women experience care that fits the EEOC definition of sexual harassment,

““Harassment can include “sexual harassment” or unwelcome sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature.

Harassment does not have to be of a sexual nature, however, and can include offensive remarks about a person’s sex. For example, it is illegal to harass a woman by making offensive comments about women in general.

Both victim and the harasser can be either a woman or a man, and the victim and harasser can be the same sex.””

— EEOC

 

I have seen this play out in too many ways to offer a comprehensive list however a few examples include,

-a good friend once shared with me that her doctor [a female] reached her entire hand up into her uterus to manually scrape away retained placenta with no anesthesia, despite her bucking her hips off the bed and screaming, “STOP!”- the doctor did not.

-a woman being told, “be a good girl and push harder,” in labor

-a client reflected that a male healthcare provider came into her hospital room while she was in labor, did not introduce himself or say a word and spread her legs and had his hand inside her to examine her cervical dilation- she had no idea who he was and he certainly did not ask permission. She described the exam as painful and embarrassing.

-a woman was told by her midwife “this shouldn’t hurt you’ve had kids.” during a painful pelvic exam.

When I was pregnant with my firstborn I started bleeding around 24 weeks- it was a weekend and my midwife advised me to go to a local hospital to be examined. When I arrived I was told I needed “an exam” and, “it would hurt but was necessary.” A male in scrubs who never bothered to introduce himself and I believe was a resident came in and proceeded to conduct a fetal fibronectin test (a swab test like a pap with a dry-speculum) despite my screaming and raising my hips telling him to stop- the nurse who was assisting him pushed my hips down and told me to calm down for my baby. This experience of being pinned down brought up memories of another #metoo moment, a forceful person I once dated as a teen attempted to force himself on me when I was supposed to be helping him study for a science test. I vividly recalled the color of his walls and the detailed trim on the dresser he pushed me into when I declined his advances.

Back to the hospital, it turned out I was not in labor and at the moment I was relieved that our baby was okay. It wasn’t until years after her birth I reflected on this and thought about how incredibly messed up and inappropriate the situation was.

What on earth gives anyone, particularly one with an oath to do no harm, the right to conduct procedures on women without their consent or with their explicit decline?

 

Too often healthcare providers treat women as submissive objects with no presumed rights- Is consent implied by presenting for care? In many settings there seems to be an unspoken free for all with women’s bodies and the amount of say you have in your care depends on who is in the room at the moment.

All patients deserve respect. No means no regardless of location or setting. There’s a phrase for this, it’s called OBSTETRIC VIOLENCE. In some countries it’s a punishable crime. In our culture it’s another day in modern obstetrical care.

What do we do to as a society? As women?

We speak up.  

File complaints with office managers and hospital administration when appropriate. If you think someone violated the law or their provider license, speak with an attorney and the Department of Public Health. 

We take our business elsewhere.

Many women I meet avoid OBGYN care which doesn’t help you in the long run- take your business [literally, take your lady business] elsewhere. Find a respectful provider who will treat your body appropriately.

We share our stories.

I try not to get personal on my blog, but I hope my story elicits a “me too.” from someone and they feel validated that their negative hospital experience was a violation of their body and should not have happened. Could your story empower someone?

We get self-care.

Don’t let your trauma weigh you down or steal your joy. Find a flipping fantastic counselor who gets it and work through your painful experiences- heal and take that joy back. No one has a right to disrespect you, your body, or your birth experience.

Ponderings from the Cave

Those of you who know me personally know that I love analogies. My creative mind loves to wander and I was born a story-teller. I often use analogy in my practice and weave these abstract examples into my work with expectant and postpartum families. One of my favorites is the cave family. Neurobiologists know that during pregnancy and postpartum both mom and dad undergo hormonal and neurological changes that influence their relationship with each other, feelings about their growing family, and their interaction with their newest addition whom I’ll refer to as Cave Baby. Many of our shifts in our experience and perception remind me of those distant cave-dwelling relatives who had to navigate dangerous predators, harsh weather conditions and hunt for their next meal. 

Many of the unexpected changes in the cave [now known as your modern American home] can be explained by looking to our primal ancestors.

Nesting- a cave woman would want to prepare her cave to ensure the cave baby didn’t slip and fall off any sharp rocks or other hazards, she also doesn’t want to be wandering around in the dark cave at night after the fire is out and trip while tending to her baby. I’m sure caves weren’t the most hygienic of our ancestors’ housing options so if you feel the urge to bust out the Mr. Clean or Clorox, that makes sense, too.

Worry about baby’s arrival- Cave mama needs to plan ahead! She needs a dry, warm, secure spot to keep primal-minded cave baby happy, fed and quiet. She needs a place to feed baby easily so she can fatten him up to survive the first winter. She needs to have a plan where she will deliver so she doesn’t leave a trail of her scent that would lead predators to the cave.  

Feeling frustrated that it seems you are constantly holding or feeding baby to keep him quiet- Well, in those early weeks you often are! Baby has spent his entire being inside 98* of warm dark fluid, forever nourished by the placenta and surrounded by cave mom’s scent.  Now all at once he is adjusting to shifting light, temperature, and gravity,  the tactile sensation of clothing, the sensation of gravity, being lifted and put down, lying down, being held upright, and the two worst offenders- hunger and absence of mom’s pheromones! Either of these is likely to feel like a crisis to newborn cave baby who knows to be safe he must have an escape vehicle from predators [you got it, YOU!] because he can’t walk or run himself, and in order to survive the first long winter he must fatten up.

Any hunger pang can feel like the end of the world because in that primitive hind-brain, it sort of is. I often remind my clients that babies are not born with watches, they cannot tell time and they don’t understand how long it has been since they last ate.

Panic or urgency when baby cries-Do you want the loud cave baby to lure the saber-toothed tiger to your dwelling? Nope! Moms often describe their own infant’s cry as ear-piercing and highly disturbing, while seemingly able to tune out the cries of other babies. We are programmed to react to our own offspring’s needs in a fast and furious fashion because it serves us to protect our own young, and in more primitive times the entire family.

An increase in anxiety around possible dangers, more worry than you’re used to- well there’s more at stake now! If Cave Mom was nonchalant about random berries, small woodland creatures and fire, she might not be as likely to raise a good number of strong hunters- our caution in pregnancy and postpartum serves a purpose to keep our children safe from real or perceived threats. This urge to protect and be vigilant is not a weakness but your instincts showing through. When anxiety strikes we may experience more anxiety than is needed, but the anxiety itself serves a purpose, and in counseling we can work to tame the anxiety so it’s tolerable and serves you rather than takes from enjoying day to day life.

You may also feel fiercely protective and easily aggressive when a possible perceived threat comes about- your cave woman instincts come out to protect your offspring and you may find yourself more ferocious than ever before- of course you are, there’s more at risk now! Others may perceive you as overreacting, your partner may wonder what you are up to, but your fight-or-flight response is in overdrive to ensure you don’t snooze on the job protecting your little one from potential predators and other threats.

Feeling incredibly disorganized -It’s very common for moms [with each pregnancy and subsequent postpartum period] to feel disorganized because for your mama brain IT IS a massive time of reorganization, your neuronal pathways need to clear room for  all your revised priorities, night-time waking, feeding, nourishing yourself and baby to perpetuate the cave family. The Cave doesn’t operate smoothly without a strong cave woman- we may not feel strong when our mind bounces from task to task or we suddenly misplace a word, however this isn’t a short-coming but evidence that we’re preparing for new priorities and tasks. Things will fall into place with rest and nourishment and we will again feel in control.

Dad feeling isolated or not-bonded- I often hear from moms or partners that the second parent feels detached or distant, sometimes inadequate. Cave dad may feel  disconnected from cave mom and baby, however this is to some degree beneficial. If Cave Dad is all distracted feeling feelings about his growing family, he may not be as vigilant to predators, or he may be daydreaming about his growing pack of cave babies as the wild antelope herd passes by on a hunting trip. Dad needs to be focused on hunting and gathering efficiently so he can get back to the cave and feed and protect the cave family, all in preparation for surviving cave baby’s first winter.

Sometimes dads struggle to bond early on, they may feel it’s not their place, perhaps they didn’t get much paid leave and have to return to work days after baby arrives. For others they had no role model showing them how men nurture babies and aren’t sure where their place is. I remind families all the time that cave baby is much more useful to cave daddy later on when they are more interactive, when dad can teach cave baby to run, jump, and hide [or ride a trike!] to build hunting towers [or lego towers] and track animals [or pets in the home]. Cave Dad may find bonding comes later on, and that is completely normal.

As you can see, there are so many instances in which the cave family mirrors modern American families, in our isolated society it’s easy to feel and to a degree be disconnected from other families, we all drive past our coordinating mailboxes up our concrete paths into our brick and mortar caves without community interaction. If we want community we must venture out into the wild and seek it out whether it’s a 30-minute library story time or a paid baby gymnastics activity, both of which still offer an unspoken distance to overcome between bonding with other moms and families. Finding your village is no easy task, but an important one.

Where do you see parallels in your life and the cave family? I’d love to hear from you!

How to be a fabulous mom in 500 words or less

Ah, I see I piqued your interest! I must confess this post has a misleading title- the real answer is only three short words… You already are.

Not a day goes by when at least one [usually all] of the clients I see come in and take a brief reprieve on my couch, sometimes with tea, other times with one instead of three or more babies in tow, and share their most personal, guilt-ridden notions of shame and guilt over not being ‘good enough,’ or not giving enough. The running theme I see with these amazing moms is that all of them are giving more than they have to offer, they strive to pour from that empty vessel in hopes of giving one last drop to others, and because of their selfless love, they feel it is not enough.

in my fairly-expert clinical opinion, Each mom I meet IN MY PRACTICE is giving more than enough.

 

She lies awake at night wondering if she met each little one’s developmental needs. Did she read enough? Were those snacks healthy enough?

Each chicken nugget served comes to represent a Pinterest 32-step recipe shortcoming all while minimizing the inquisitive conversation shared over dinner or the veggies on the side.

The dirty laundry left overshadows the many drawers in the house that she has transformed into a home full of clean clothes.

The moms that I meet in my professional and personal life are constantly swimming against the current of self-judgment, wanting to give more, do more, plan more, tidy more, organize more, bake more, read more, play more, and all the while, the hustle and bustle of daily life is swept under the proverbial rug instead of giving credit where it is due.

Modern American Moms are constantly pulled in many directions, they work outside the home, they work inside the home [without union-negotiated breaks or paid time off!], they plan how children get to and from school and daycare, how they will get home, and sometimes where they will be safe and cared for in between. They are the keepers of massive amounts of mental post-it notes, address books, phone numbers, birthdays, doctor’s appointments, the never-ending grocery list and meal plan, extra-curricular calendars, family calendars, work calendars, the mental list goes on and could fill all of Google Drive in one day.

You are a great mom. How do you do that? You are doing it. Everyday. I have no doubt you are giving what you can with what you have and then some. I urge you to shy away from social media shaming of moms and one-sided articles that can induce mom guilt, there’s enough of that in this world.

Disclaimer: This post is informational in nature and not a substitute for psychotherapy.

ABC's of Intrusive Thoughts

During the perinatal period, intrusive thoughts are extremely common. Approximately one in ten women disclose having intrusive thoughts and my clinical guess is another four in ten are sitting back thinking to themselves, “Like heck I’ll tell you about these dark thoughts, you’ll think I’ve lost my mind and take my children away!”  

You may be wondering yourself if you have lost your mind. Having the insight to ask this question tells me, probably not.

You may be terrified that if you share your scary thoughts with someone that the thought will come true. Again, not likely so.

Perhaps you were brave enough to tell someone and they judged you. Likely because they do not understand.

What the heck is an intrusive thought, anyway?

An intrusive thought is unwelcome in your mind. It was uninvited and showed up anyway as if you don’t have enough to worry about right now! You’re expanding your family and your whole life is turning upside-down in enough ways. These thoughts cause distress, panic, disgust, and often fear and worry.  Here come the promised ABC’s…

✔ If you find the thought APPALLING and AWFUL  

✔ If you think the image or act your thought is about is BAD, negative or wrong

✔ If you find yourself CONSCIOUSLY avoiding or being CAREFUL about the thought

…then you are NOT experiencing something out of the ordinary, you are experiencing an unwanted intrusive thought.

Safety Check: If you DO experience a disturbing, violent or harmful image or thought and do not think it’s a negative or unwanted thing, now is a good time to check in with a trusted healthcare provider, therapist, psychiatrist, OBGYN, midwife or primary care, or call 911- these are very different and you want to consult a medical expert as soon as possible.

Very much like a colander, our unconscious mind filters through thousands upon thousands of thoughts per day, many pass through with ease…  

Oh what a lovely flowering tree. Wow, traffic is heavy today. Do I want romaine or iceberg lettuce today? I hope steaks are on sale this week at the grocer. While I’m at the store I’ll pick up more laundry detergent. Why do socks always separate in the wash never to be matched again?  

These thoughts do not elicit a strong reaction and we may give them little attention- when a thought is dark, violent, disgusting or scary it sounds off all sorts of alarms and panic- WHY did I think that? HOW could I imagine something so terrible?! And the narrative of self-criticism and panic starts.

Giving time and attention to these questions occurs when that thought gets stuck in the colander, it sits there creating resistance and perhaps worry or panic, which leads us to focus on it more in turn allowing this unwanted thought to grow bigger, louder, brighter. What once was a tiny abstract thought is now a giant LED billboard in Times Square.

In reality the thought is no more likely to pose a risk to you or your baby than the lovely flowering tree, but it certainly doesn’t feel that way.  You may find yourself full of dread and agony, over-thinking each step you take to protect yourself or your baby [or both of you]. Perhaps you avoid possible perceived risks or dangers to protect yourself or your baby, this is your maternal instinct protecting you both. It speaks to what an amazing parent you are.

Working through these thoughts in counseling with a trusted therapist may seem scary, it requires courage to disclose that your mind goes to such a dark place, but you are not alone. You are not the first nor are you the last mom to think and see upsetting images or thoughts. The potential benefits include less anxiety and worry, a more peaceful mind, feeling safer and more confident in your parenting and more enjoyment in your day to day life.

One more A-B-C for today:

ANXIETY about an intrusive thought is a strength, it’s a positive sign that you are having a symptom, a thought, not an ACTION.

BAD thoughts do not equate bad mothers. You are not bad, you are not terrible, you are living with unwanted thoughts or images.

COUNSELING can help. Speaking to a therapist who understands perinatal obsessive-compulsive and intrusive symptoms can help you CALM and quiet those unwanted thoughts so you can get back to enjoying your life and your family.

Disclaimer: This post is informational and nature and not a substitute for psychotherapy.