Mental Health

Where is the instruction manual?

Melissa Medjuck, MSW, RSW

Reprinted from the Supporting Parents issue of Visions Journal, 2021, 17 (1), pp. 14-16

Before I gave birth to twins three years ago, my partner and I discussed a lot of topics: strollers, baby names, birth plan. We felt prepared...and we were. Just not in the areas that counted the most. As a new mom¹ I struggled. Despite my privilege and being well supported, I felt anxious and overwhelmed. I had an acute sense of loss of self. I wondered why no one had told me how hard it would be: did I miss out on some magical instruction manual others had read?

Parenthood can be a tough transition for many reasons. We have unrealistic expectations about what our experience will be like, and this can lead to feelings of shame and self-judgement. We internalize society's beliefs about motherhood as effortless and intuitive, while taboos against expressing negative feelings about motherhood lead to isolation. Mental health stigma reduces disclosure. Ultimately, our system does a poor job of supporting new parents.

In hindsight, I wish my partner and I had discussed issues related to parental mental health, like how to:

• assess and talk about my mental health as a mother

• budget for mental health and postpartum doula support

• define and support one another's ideas of self-care

• support me when my perfectionist tendencies might not best serve me

• identify words of affirmation for times of struggle

• list parental duties and determine how to share them

It's never too late to start these discussions—whether it's just before another baby arrives or months and years in.

In my case, early motherhood left me feeling like a failure. I know I am not alone. As a maternal mental health therapist, I speak to moms every day who feel like they are failing. All new parents worry. Sometimes this worry can escalate into anxiety, including scary and intrusive thoughts, which over half of new moms report having.² Many are experiencing what is called "perinatal" anxiety and depression, which often starts in pregnancy or begins any time during the first year postpartum and can last for years if untreated. Perinatal anxiety and mood disorders are influenced by a mix of genetics, biology, stress, environment, systemic inequalities and social determinants of health—not personality flaws.

Parents are not regularly screened for perinatal mental illness, a concerning reality given that a recent Canadian study revealed that levels of postpartum depression have almost doubled during the pandemic, with 35% of mothers reporting symptoms of depression compared to 19% pre-pandemic.³ Postpartum anxiety rates are even higher: over 72% of moms experience postpartum anxiety, and this number has almost tripled since the pandemic started.⁴ Fathers, nonbirthing partners and adoptive parents are also at risk for perinatal anxiety and depression. One of the greatest predictors of fathers' and non-birthing partners' perinatal mental health is having a partner with perinatal depression and anxiety.⁵

Postpartum care should be an ongoing process, with holistic, affordable and accessible support tailored to each new parent's needs, rather than a single encounter at a six-week checkup. This support should include programs for specific groups, such as Indigenous, immigrant and non-Indigenous Canadian-born people. Perinatal mental health counselling should be free and offered to all parents and parents-to-be.

And while we advocate for systemic change, here are some strategies to help you navigate motherhood:

• acknowledge and validate your feelings: "This is hard. It makes sense that I feel this way"

• engage in self-compassion; talk to yourself like you would to a friend

• examine perfectionist tendencies and consider where you can lower your expectations

• value your work as a mom, give yourself praise and notice what you're doing well

• try relaxation and mindfulness practices to reduce anxiety (and limit your time on social media and Google if they're not serving you!)

• develop realistic self-care goals, including activities you can do with your child present

• move your body, eat nutritious food and give yourself permission to rest

• connect with family, friends and moms who "get you"

• if you have a partner, discuss the invisible load that the default caregiver carries and try a weekly partner check-in

• explore supports groups and self-help programs

• talk to a maternal mental health therapist or your health care provider about how you're feeling

How we support new parents needs to shift, as do the cultural narratives of parenthood being joyful and easy; our avoidance of sharing parenting challenges; and the stigma surrounding and devaluation of perinatal mental health. Venturing down this unchartered emotional road requires a village to march along with you. Isolation and lack of support are leading causes of perinatal mood disorders, which is why I believe that receiving support is essential. It certainly was for me—my decision to see a maternal mental health therapist was a turning point in my motherhood journey.

I hope if you are a new parent reading this, you know you are not alone in your struggles, you are not to blame and it's okay to ask for help.

Guides and resources

Current toxic cultural narratives around motherhood cause us to internalize unrealistic expectations about what our experience "should" be like. I wish I had examined my assumptions about motherhood because, in many cases, I discovered very different realities.

Related resources

Organizations

• Pacific Post Partum Support Society (postpartum.org) provides free or low-cost programs for mothers in BC experiencing a difficult pregnancy or postpartum adjustment, including telephone support, weekly support groups and support for partners

• Postpartum Support International (postpartum.net) provides a helpline and free online support groups. Visit postpartum.net/get-help/provider-directory for their Online Provider Directory

Tools

• For help with intense emotions, see the guide Coping with Depression in Pregnancy and Following Birth, at: heretohelp.bc.ca/workbook/coping-with-depression-in-pregnancy-and-following-birth

• For information on self-compassion, visit: self-compassion.org

• For a social network connecting women across fertility and motherhood, consider Peanut, available at: peanut-app.io

• For more on assertive communication, visit: psychologytools.com/resource/assertive-communication and gottman.com/blog/weekend-homework- assignment-tips-for-asserting-yourself

• For more on partner check-ins, visit: gottman.com/blog/how-to-have-a-state-of-the-union-meeting