The Self-Critical Thought Loops That Accompany Postpartum Depression, Or Show Up Unannounced, Can Be Helped
In the year after my eldest daughter was born, these were just some of the self-critical thought loops of postpartum depression (PPD) and anxiety (PPA) that I found myself in:
I'm not doing enough for my career. I'm stagnating. I'll never work in the industry again.
I'm not doing enough for my baby. I'm spending too much time on my phone. I'm not present. I need to stop thinking about work and social media and my child-free friends. It's OK to just enjoy being a mom!
I want to go out more. God, I miss partying. I just want to drink. I'm letting myself become boring.
I can't believe I stayed out so late. I shouldn't have left my kid. I'm so f*cking selfish.
I wish I could be more selfish. I don't spend any time on myself. I need to be taken care of, too. Why can't I find the time? Other moms find the time. Kylie Jenner finds the time.
When I look back on those months, which dragged on for what felt more like a decade, the continuous game of back-and-forth I played with myself is what I remember most. In every moment, I either felt I was doing "too much" or "not enough" for my daughter, my job, my husband, my friends, my home, and myself. If ever I started to feel like I was doing things right in just one of those categories, the sense of comfort would quickly dissipate as it dawned on me that I was neglecting everything else.
These psychological loops are not uncommon of postpartum depression and anxiety. In fact, they're one of the "most toxic" habits new mothers engage in, says Dr. Alexandra Sacks, M.D., Reproductive Psychiatrist, co-author of What No One Tells You: A Guide To Your Emotions From Pregnancy To Motherhood (Simon & Schuster, 2019), and a leading expert on matrescence, in an interview with Romper. She describes the looping as an "interior monologue that is unforgiving."
"When you have a new baby, your identity, daily routine, relationships, sleep, exercise, eating, and body are all in flux," Dr. Sacks says. "It’s normal to feel overwhelmed by money, in-laws, sex, date nights, socializing, and work. With all of these changes and challenges, it’s easy to doubt yourself... even if the changes are happy ones, for most people, major life changes are also stressful."
Despite recent gains in awareness around perinatal mood disorders, it can still feel as though a cultural veil remains drawn over PPA and PPD. After all, most of us still grow up hearing that the aftermath of birth is meant to be the happiest time of our lives — so when we don't feel like this, we assume we are failures. To reframe our experiences, we must begin by seeking support. Cutting ties with self-critical thought loops is possible, no matter how very impossible it may seem.
[New mothers] think they must cope with all the demands of a baby and must know what to do without any help.
It's important to first understand why so many mothers — one in nine — begin to feel depressed and anxious after their babies are born, according to CDC data. Even coming across that number was edifying — proof that I was not alone.
According to Marisa Peer, one of the UK's leading therapists and motivational speakers, there are often three tiers to this rather ordinary phenomenon. The first is physical. "The body is reacting to the tremendous hormonal changes that come about immediately after giving birth," she tells Romper. "Any fluctuation in hormones can make women feel teary, emotional, and unable to cope, and at an extreme level depressed."
"The second level is that many women feel overwhelmed after the birth of a baby as we no longer live in a tribal society," she adds. "They think they must cope with all the demands of a baby and must know what to do without any help and this can leave women overwhelmed and feeling very stressed."
Finally, Peer acknowledges that we, particularly as women, "are under so much pressure to be perfect." The impossible expectation follows us from childhood and onwards: We must have the perfect body, the perfect demeanor, the perfect wardrobe, the perfect job in order to be accepted — and, unsurprisingly, the perfect pregnancy, birth, and entry into motherhood.
"We see celebrities get into perfect shape a week after their babies are born, their lives and their homes are perfect, and so many women feel so inadequate by comparison," Peer says. "Having a newborn baby should be about enjoying that but when we see Kim Kardashian or Kate Middleton with blow-dried hair and immaculate clothes an hour after giving birth, we feel we are not capable at any level. We forget that these women have armies of staff."
Figure out how to connect with some of the experiences and relationships that have always made you feel like you.
Luckily, there are foundations that mothers-to-be can set in place during pregnancy that may help avoid the self-criticism of PPD down the road, according to Dr. Sacks.
"I recommend that women make a list of their most essential and pleasurable weekly activities before the baby arrives," she says. "Keep it on [the] fridge as a reminder for after the baby arrives that these are the regular things that make you happy. Even if you don’t have time to do all of them once the baby comes, it’s important to figure out how to connect with some of the experiences and relationships that have always made you feel like you."
The beauty of this is that it's a small action that won't take a lot of time or energy (two resources that are limited during pregnancy and arguably even more limited after labor), but that can potentially have a big impact nonetheless. If one of the main self-critical postpartum thought loops we enter is that which tells us we are losing our identities outside of motherhood, having a tangible reminder of the things that fulfill those identities could be immensely helpful.
Some preemptive planning for the initial postpartum weeks should also come in handy, says Peer. "During the pregnancy, plan to do nothing at all for the first few days, even weeks [after labor]," she says. "Be at home with your baby and don't have too many visitors. When people do come, encourage them to stay just for a little while. You need to put as little pressure on yourself as possible, so plan this in advance."
Although she notes that it's important to take full advantage of any help that comes your way, be it in the form of in-laws who offer to watch the baby while you catch up on sleep, or siblings who bring over some food, it's perhaps equally important to limit your time with the relatives or acquaintances who are known to offer unsolicited advice. "Be very aware that this is your baby and other people's opinion on co-sleeping or feeding on demand are not your opinions," she adds. "You must be free to raise your baby your way."
Pretending nothing is wrong and hiding your feelings can cause your despair to deepen.
Considering how very personal and psychological our negative thought loops can be, it is not especially surprising that some of the work we must do to escape them is also personal and psychological. This type of work — the abstract, emotional variety — is often the hardest, and the most important.
Dr. Sacks tells Romper that "social isolation is a classic symptom of PPD, but even women without PPD tend to stay hush-hush about the negative stuff for fear of being judged." Unfortunately, "pretending nothing is wrong and hiding your feelings can cause your despair to deepen, and it can isolate you from other new moms who feel the same way you do."
This is where talking to other people, and particularly to other mothers, comes in. It is only then that we learn "no one is judging you as harshly as you’re judging yourself, the people who love you will want to help, [and] many, many other moms will be able to relate to your ups and downs.”
'Try to just be with your baby and enjoy that time' without hyper-focusing on all the other things you 'could' or 'should' be doing.
Peer agrees, advising that new mothers "try to just be with your baby and enjoy that time" without hyper-focusing on all the other things you "could" or "should" be doing.
To make things easier on yourself, she says, "Don't buy baby clothes that have to be ironed, forget about having a perfectly tidy house, make the simplest of meals, and remember this time goes so quickly and you have all your life to have a tidy house and make exquisite dinners."
While it may be a tip we hear often, and get frustrated by just as often, Peer adds, "When your baby sleeps in the afternoon, you should sleep as well. So many women are up at night with the baby when they could nap in the afternoon. Instead, they are cooking, cleaning, emailing — go to sleep with your baby and enjoy this magical time."
The scales may never be even. There will always be sacrifices.
I have felt that guilt that comes with immersing myself into motherhood fully, instead of seeking professional advancement or youthful fulfillment on the dance floor. It is a form of guilt that compels me to hop on Gmail when I could be napping with my kid; a voice that tells me I should clean the kitchen instead of sitting down to play a game with her; a voice that sometimes wants me to go on a night out, but that chastises me all the times that I don't want to. The guilt is wholly unnecessary, though.
Dr. Sacks says the most crucial element of all of this is perhaps to "give ourselves permission to be good enough." Achieving the elusive "balance" between your career, your parenting, your relationship, and your own self-care may not be possible. The scales may never be even. There will always be sacrifices, and we won't always feel like we've sacrificed the "right" things. But doing what we can, when we can, is enough. It is more than enough.
If you or someone you know is experiencing postpartum depression or anxiety, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.