I looked at my doctor, and my eyes welled up because I was so tired of being in pain. Of sleeping on the couch. Of waking up throughout the night. Of throwing up. Of taking things out on the wrong people. Of not enjoying life. Of not seeing my friends. Of not having the energy to take my baby for a stroll … I still don’t really like to say, “I have postpartum depression,” because the word depression scares a lot of people. I often just call it “postpartum.” Maybe I should say it, though. Maybe it will lessen the stigma a bit.
— Chrissy Teigen
Though life with a baby is generally known for being overwhelming, it can be difficult to understand what is happening specifically with the mood and mental health of a new parent. I created the Perinatal Mood Framework to help parents deconstruct the confusing landscape of information that they’re bombarded with. I wish I knew why so many new parents struggle with their mood, but what I have concluded is that trying to understand perinatal mental health through the lens of thoughts versus biology is far too limiting. My position is that perinatal mood disorders emerge from a complex set of biological, psychological, and social factors.1 Becoming a parent is a messy, confusing, identity-altering process, accompanied by a shocking amount of adjustments to both gestational and non-gestational parents, including financial, hormonal, neurological, and identity changes, as well as completely new day-to-day routines. And it requires a curious, compassionate response.
There are many biological influences on perinatal mood, most of which affect parents who carry a pregnancy and give birth. Some of us are probably more susceptible to postpartum depression and anxiety because of our genetic makeup. In fact, a gene study at Johns Hopkins University suggested that there’s a link between two genes and PPD, which prompted an international research project (which is still ongoing) to fully understand the role genes play in perinatal mental health. This could lead to the option of prenatal testing for pregnant people who want to know if they’re at heightened risk for PMADs.2
Hormones also play a role in perinatal mood. According to Dr. Laura Kent-Davidson (ND), estrogen and progesterone levels initially plummet after parents give birth to the placenta, which can contribute to low mood and is likely a factor in “the baby blues.” Nursing parents experience additional hormonal changes that can affect mood, as prolactin and oxytocin (a hormone and neurotransmitter that helps you feel loving, calm, and connected) increase and act as a mood protector for parents that enjoy nursing. But you don’t need to be a nursing parent to reap the benefits of increased oxytocin, because snuggling your baby/babies, particularly skin to skin, can also cause levels to increase. Thyroid imbalances are also a common problem in the first year after childbirth, and can also increase feelings of depression and anxiety.3 However, while it’s important to have a sense of how birth affects our hormones, I’m wary of chalking up mood changes to hormone variations exclusively. After all, in both depressed and non-depressed birthers, hormone levels readjust in the weeks after birth (although the readjustment is generally not complete until the birther resumes menstruating), nursing parents can get PMADs, and birth hormones don’t explain why non-birth parents also struggle with their perinatal mental health. It’s important to remember that the hormonal experience of each parent is unique.
Brain chemicals affect postpartum mood. When neurotransmitters such as serotonin, dopamine, norepinephrine, oxytocin, GABA, or melatonin are out of balance, deficient, or not firing effectively, it has a massive impact on our mood — postpartum or otherwise.4 As I mentioned, snuggling babies can increase oxytocin levels and increase feelings of love and connection, but there are unfortunately many aspects of postpartum life that make it hard for our neurotransmitters to fire effectively. These aspects can affect all parents, regardless of whether you gave birth, and include sleep deprivation, malnutrition, or high stress combined with minimal time for the stress-management habits you used to rely on.5 To restore the efficacy of some neurotransmitters, doctors can prescribe antidepressants, most commonly serotonin reuptake inhibitors (SSRIs), or potentially mood stabilizers. Research also suggests that gut health and inflammation affects our mental health, making many microbiome researchers excited about the potential of probiotic treatments for depression and anxiety in the future.6
Pregnancy, birth, and the postpartum period are hard on our bodies. We need to support our bodies through these many transitions and intentionally address parts that need healing, whether from emotional or physical pain. But biology isn’t everything. It’s just as important to address our thinking styles and thought patterns.
Parents who are prone to negative thinking, worrying, perfectionism, rumination, or heightened critical analysis are, unfortunately, prone to postpartum depression and anxiety.7 And many of us do struggle with these types of thinking patterns because they have a protective function. Negativity bias, anxiety from trying to minimize our exposure to threats, and existential fear of death have always been critical to human survival because they contribute to keeping us safe! It makes sense that these thinking styles and thought patterns increase when we have children, because suddenly we’re not only responsible for keeping ourselves safe but also for keeping them safe. What makes this even more challenging is that most of us tend to overestimate how much control we have over our ability to protect ourselves and our loved ones, which creates an incredibly stressful and confusing thinking process.
For example, many new parents struggle with intrusive thoughts, which are sudden thoughts or images of frightening, tragic, or violent circumstances happening to their baby/babies (or to them or their loved ones). The first time I had an intrusive thought, I was six months pregnant and I tripped near a wide-open 450-degree oven door. I was able to steady myself, but I was flooded with images of falling stomach-first into the hot oven and somehow burning my growing baby. Other common intrusive thoughts include dropping the baby, wounding someone with a knife, drowning, having a car accident, or falling down the stairs. One theory suggests that parents have intrusive thoughts because the part of our brain that is constantly engaged in risk assessment needs to be retrained to understand what is safe to do with a baby. It is risky to walk downstairs or use sharp knives. You could fall or cut yourself! And when we were first learning to go downstairs or use knives, we were really careful to minimize the risk, but over time as we gained confidence in our ability to do these activities safely, we stopped paying much attention to how risky they are — we began to do them automatically. When we have a baby, it’s suddenly not obvious how safe it is to walk down the stairs holding a baby or how risky it could be to chop vegetables while eight months pregnant, so our internal risk assessor sends us a warning, through terrifying images that get us to pause, slow down, and be careful. When I have clients with intrusive thoughts about falling down the stairs with their baby, I often suggest that they lovingly remind their internal risk assessor that they are capable of walking down the stairs safely and that they will be extra cautious by holding on to the rail and the baby tightly. With repetition and intentionally noticing how many times they walk down the stairs safely, the intrusive thoughts often disappear (or at least become manageable).
Thankfully, there’s a lot you can do to challenge thoughts and influence thinking patterns. This is why various forms of talk therapy can help with depression and anxiety (as well as lots of other things). Therapists and counsellors use a variety of strategies to help clients process and cope with thoughts that are negatively impacting their mood. This is not the same as making the ridiculous and insensitive statement “Just think more positively and you’ll feel better.” If parents could feel better, they would feel better. Challenging negative and anxious thoughts is difficult, and finding the right practitioner with the right therapeutic focus is often the most important part of doing this intense work. Good therapy also supports the healthy functioning of brain circuits in a way that is different from medication, which is why therapy and medication are such a powerful combination for treating PMADs.8
All new parents need to navigate a complex set of individual circumstances, while completely exhausted and very limited on time. Research has also shown that there are a number of particular risk factors or life circumstances connected to PMADs. The list is very long:
relationship dissatisfaction
limited support
stressful life events
unwanted/unplanned pregnancy
young/advanced maternal age
history of intimate partner violence
difficult infant temperament
history of thyroid issues
trouble nursing
weaning
birth and reproductive trauma
challenging pregnancy
premenstrual dysphoric disorder (PMDD)
challenges with fertility
history of addiction
history of eating disorders
unhappiness with baby’s assigned sex at birth
financial concerns or unemployment
solo parenting
experiences with discrimination
Broadly speaking, anything that a parent considers an added stress, trauma, or barrier to coping belongs on this list, which continues to grow with more research. Knowing the risk factors for PMAD is simultaneously helpful and unhelpful, because there are so many ways in which a parent could be at risk. I have concluded that every parent is at risk. Rather than think of risk factors as a warning list, I suggest that parents use it as a guidepost for problem solving and deepening their understanding of their experience. It makes total sense that you would feel anxious if your family was feeling financially strained, or if you are pregnant during a pandemic! Or if you identify that part of what’s contributing to your depression/anxiety is a lack of support, you can start creating individual solutions for you and your family.
All parents go through a process of developing their parenting identity, which can have a dramatic impact on their perinatal mood. You’re exploring both your individual parenting identity, meaning how you feel about yourself as a parent, as well as your community parenting identity, meaning how successfully you publicly meet the ever-evolving cultural norms and expectations of parenting. These two aspects are intertwined, yet there is often a discrepancy between our individual parenting identity and our community parenting identity. I’ve known people who felt like “bad” parents, yet whose community members were constantly trying to convince them that they were “good” parents. I’ve also known parents who felt like they’d been identified as “bad” parents but who personally felt like they were actually doing a pretty good job!
The interconnection of our individual and community parenting identities is significant. There seems to be a collective agreement that babies and children are innocent blank slates that require a certain style of parenting in order to become successful adults. Many parents measure themselves against the social obligation to raise happy and healthy children, using that to self-assess whether they think of themselves as a “good” or “bad” parent. Propping up this belief are all kinds of systems of social surveillance designed to ensure that parents meet these standards, such as unsolicited parenting advice from friends and family, well-baby checkups, and investigations by child protective services, with marginalized groups of parents encountering unequal levels of surveillance and intervention due to systemic discrimination. Ideally, we would all intentionally develop a positive parenting identity through individual reflection and supportive conversation with our peers and older, more seasoned parents. But unfortunately, through criticism and judgment from ourselves or our community, or through public policing, some of us develop a negative parenting identity.
In the early 2000s, nurse and researcher Linda Clark Amankwaa conducted a study about the experiences of Black mothers in America diagnosed with PPD.9 She started to notice a pattern in the experiences of the women she was interviewing. These moms weren’t delivering their baby one moment and then suddenly depressed the next. They were having children, feeling the weight of mothering, and then slipping into depression at varying speeds. As Amankwaa explored this pattern, a theory about the impact of community mothering identity on an individual mother’s mood began to emerge. Amankwaa’s theory outlines the process of maternal identity development that mothers navigate as they are figuring out what it means for them to take on the social role of mother, and how this process contributes to the onset of PPD. First mothers with PPD experience maternal role strain, then maternal role stress, and finally maternal role collapse.10 Before we explore these three concepts, I want to clarify that although Amankwaa was specially researching cisgender women with postpartum depression, I apply her theory to primary parents of all genders and I extend it to include postpartum anxiety as well.
Role Stress: “This is harder than I thought.”
Take a moment to reflect on where you learned what it means to be a successful parent. Can you even remember the origin of those messages? If you were lucky enough to be raised by people with a parenting style that is generally admired, you would likely start by listing the qualities or behaviours your caregivers demonstrated or the values that they passed on to you. Perhaps your grandma played a significant role in modelling good parenting to you. Or maybe you learned about good parenting by critiquing the negative experiences of your own childhood and having vowed to do the opposite. We also learn how to parent by observing our friends, extended family, and community members, and we almost always include ideas that we’ve learned from television, books, professional parenting experts, or any other cultural narrative about what makes someone “good” at it.
Because we spend many years learning about what it means to perform the role of “good parent,” when we eventually have children, we already have a sense of what we’re supposed to do. For example, if we understand that a good parent is someone who looks after children, teaches them right from wrong, and keeps them alive, then that’s what we aim to do!
Amankwaa suggests that mothers who find meeting their internalized expectations of this newfound social role unclear, difficult, or conflicting, or those who encounter emotional and physical resource deficits while attempting to fulfill this role, experience maternal role stress.11 In other words, parents become stressed when the vision they had for themselves doesn’t match the reality of their experiences. The challenge is that until we become a parent, we only have hypothetical ideas about what it’s going to be like, and our visions don’t always align with our lived experiences, which generally leaves us feeling confused and overwhelmed. The good news is that maternal role stress is normal! All parents experience a discrepancy between what they thought parenting was going to feel and look like and what it’s actually like.
Role Strain: “I don’t think I’m doing a very good job.”
This emotional reaction — the growing fear that we’re not going to be able to do this or that we may have made a mistake by becoming a parent — is what Amankwaa calls maternal role strain.12 Essentially, parents’ feelings of failure or guilt for not being able to fulfill their parenting role in the way they had envisioned starts to accumulate, and it can cause them to feel down, overburdened, or withdrawn. Some parents don’t fall too far down the role-strain tunnel. They just readjust their expectations and accept their limitations through a lens of self-love or pragmatism or some combination of the two. They may not like every moment of postpartum life and may still feel like they don’t know what they’re doing, but they’re able to focus on the bright and joyful spots and take care of themselves along the way.
Others don’t cope with role stress as easily. Not having our parenting expectations met makes us feel like failures or that something is wrong with us. When we internalize this experience, we personalize it and blame ourselves and all our perceived flaws. When we externalize it, we become angry and blame our difficult babies or difficult partners or lack of adequate support (and, as you will read later, these aren’t necessarily wrong places to lay the blame). This doesn’t mean these parents aren’t doing a good job, it just means they don’t believe they are, and it’s causing them distress. If you’re having a tough time adjusting emotionally, it’s important to get support at this stage, because without it you can find yourself in a full role collapse.
Role Collapse: “I’m a failure.”
Maternal role collapse occurs when parents start to feel like they aren’t capable of fulfilling the role of parent anymore.13 Parents experiencing Amankwaa’s proposed maternal role collapse will show clinical symptoms of PMADs, and they often feel like they can’t cope effectively with the day-to-day demands of life or regulate their emotions.14 At this stage, parents may no longer be able to care for themselves or their infant(s). Negative thoughts and feelings take over. Anxiety gets trapped in the body and destroys the ability to go to sleep and let go of intrusive thoughts. Some parents feel like they can’t control their behaviour, as the negative thoughts, insomnia, and chronic stress escalate the biological and neurological responses in the body.
This is what many parents who have been diagnosed with PPD/A will refer to as a living hell. The speed at which parents arrive here varies. Sometimes it takes just a few days, but often it happens slowly over the course of weeks or months, and even with the onset of returning to paid work or weaning. The severity of the symptoms and the ability to get through the day-to-day also varies widely. But what remains consistent is that parents experiencing role collapse deserve support, and sadly we know that not everyone gets it.
While Amankwaa’s theory that our inability to enact our envisioned maternal role (which I will refer to as parental role from here on) negatively affects our mental health certainly resonates with many of the parents I work with, Amankwaa’s work doesn’t spend a lot of time describing exactly what the social role of parent looks like or discussing what about it feels so burdensome to so many. But it is critical to analyze the relationship between the culture of parenting and parental mental health, because our socio-economic family systems (meaning how families are shaped by structures such as employment, education, child care, community belonging, or health care) affect every aspect of the Perinatal Mood Framework. The biological aspects of perinatal health are influenced by the social determinants of health, such as food and housing security. Our thought patterns and thinking styles are influenced by our parenting role models and our access to information, such as being able to afford therapy or post-secondary education. The individual risks and circumstances of parents are influenced by our experiences with relational and intergenerational trauma, discrimination, and barriers to resources. And a positive parental identity is influenced by how successful we think we are, and our community thinks we are, at meeting the markers of “good parenting.”
Because socio-economic family systems shift cross-culturally and over time, what it means to be a “good parent” is continuously changing, and there have been two social changes that have profoundly affected the Western culture of parenting over the last seventy years. The first was the sharp increase of women into the paid workforce, resulting in the normalization of dual-income families and, at the same time, the cultivation of intensive-mothering culture (more on that below). The second was how the emerging fields of psychiatry and psychology produced a new set of knowledge about parenting practices and child development, leading to the creation of self-proclaimed parenting “experts” and increased parental surveillance to ensure children develop as optimally as possible.
In the 1990s, researcher Sharon Hays coined the term intensive mothering to describe the cultural demands of parenting that required mothers’ full-time investment and preoccupation. Intensive mothering insists that mothers be continuously available for their children’s physical and emotional needs, ideally anticipating these needs before the children even communicate them, and that they invest heavily in their children’s intellectual, educational, and social development.15 It encourages mothers to make parenthood the most important aspect of their identity and assign themselves responsibility for their children’s academic, peer, and personal success — with little to no consideration of their own parental mental health, needs, or desires. According to intensive-mothering ideology, there are three core beliefs that underpin what it takes to be a “good mom”: (1) parenting requires that time, energy, and financial resources be centred around the needs of the children; (2) parenting decisions need to be informed by research and led by experts; and (3) children require constant attention and nurturing by a biological mother.16 Although Hays’s research is thirty years old, the belief that intensive mothering is best for children remains the prevailing parenting ideology in Western cultures.17
Many scholars on motherhood argue that the way intensive mothering has been enacted and performed in family life was through the development of attachment parenting practices, commonly referred to as attachment parenting (AP).18 There seems to be a lot of confusion about the difference between attachment theory, attachment parenting philosophy, and attachment parenting practices. I want to make those distinctions clear, because while they all inform each other, they can have a significantly different impact on parenting identity and confidence.
Attachment Theory: Popularized by psychoanalyst John Bowlby, attachment theory emerged out of the body of psychological research on the impact of children’s early experiences. Bowlby argued that in order to be emotionally healthy, infants needed to attach (or bond) to a primary caregiver, who would become the secure basis for children to understand the world and become the model that forms their child’s future relationships.19 Poor attachment, according to Bowlby, would result in future mental health concerns and behavioural problems for those children. While he agreed that children could form multiple attachments, he also felt that a child’s primary attachment should be to their biological mother, and he valued mother-child relationships above all others.20 So much so that he developed a theory of maternal deprivation, meaning that that if babies’ cries or bids for attention are not continuously and quickly responded to by their mothers, they risk losing their connection or failing to secure attachment.21 According to Bowlby, if mothers are unable to provide this for the first two, and ideally five, years of their child’s life, their children could suffer irreversible health and development consequences, ranging from poor behaviour to psychopathy.22
Attachment Parenting Philosophy: Attachment theory led to the development of attachment parenting philosophy, which created a framework for parents to raise children. It’s made up of eight principles that are said to create secure attachment between infants/young children and their parents:
Prepare for pregnancy, birth, and parenting: Although AP refers to the language of being “informed,” this principle maintains the intensive-mothering belief that parenting must be expert-led and well-researched.
Feed with love and respect: While nursing is often associated with AP, it is not required. However, non-nursing parents are encouraged to bottle-feed in ways that maximize connection.
Respond with sensitivity: AP parents are instructed to respond quickly and gently to their children’s needs and provide a lot of positive attention, with the argument that this will benefit children neurologically.
Use a nurturing touch: AP parents are encouraged to touch their children lovingly and with a lot of frequency, especially if kids are sick, injured, or emotionally upset.
Ensure safe sleep, physically and emotionally: AP refers to responding to infant and child waking in the night as nighttime parenting, and encourages parents to respond to their children at night in the same way they would in the day.
Provide consistent and loving care: AP believes that children have the best outcomes when given consistent nurturing, empathy, and age-appropriate boundaries.
Practise positive discipline: Parents are encouraged to discipline through non-punitive, teaching strategies and to avoid physical or harsh punishments.
Strive for balance in personal and family life: Parents are encouraged to do their best to take care of themselves, so that they can be the best parent they can be. Interestingly, AP started out with only the first seven principles, but this eighth principle was added by Dr. William Sears (a popular American pediatrician and one of the most well-known advocates for attachment parenting) after years of hearing stories of maternal burnout and mental distress, likely because the way in which these principles are often turned into parenting practices is incredibly demanding, both physically and emotionally.23
Attachment Parenting Practices: Developmental psychologist Alan Sroufe is wary of these principles, and argues that “attachment is not a set of tricks … These [attachment parenting principles] are all fine things, but they’re not the essential things. There is no evidence that they are predictive of a secure attachment.”24 So while there isn’t an exact prescription for how to live the principles of attachment parenting, often parents will use the “tools” of baby-wearing/child-carrying, on-demand nursing (often extending beyond the first year), co-sleeping, and no-cry sleep strategies. Other lifestyle trends associated with attachment parenting may include committing to full-time parenting, home-schooling, or trying to create a “natural home” (e.g., eating organic, not using plastic), but these are aren’t necessary for meeting the eight principles of AP.25 While it can be tempting to follow a set of clear rules for early parenting because it helps us feel like we are doing it “right,” parenting according to this narrow (and exhausting!) script comes at cost. A study of mothers actively engaged in attachment parenting practices finds that while they are adamant that their parenting style is the most natural and biologically informed approach, they also agree that it is intensely physically, financially, and emotionally demanding.26
There is an interesting contradiction that emerges from the mothers in this study, because they argue that they parent instinctually, yet they rely on scholarly research and expert knowledge to inform and defend their parenting practices. And while many of the mothers in the study describe mothering as very enjoyable and rewarding, they also describe feeling “utterly shattered” in areas of their life, particularly their sleep and energy.27 Although many attachment parents describe themselves as operating outside of mainstream parenting, attachment parenting practices are so closely connected to the popular intensive-mothering belief system that it can be hard to distinguish between them.28 Given that so many mothers with young children engage in paid work, AP creates quite a conflict for parents as they try to figure out how to be fully present for their work and be fully present for their children at the same time. As Hays says, parents are expected to build a career like they don’t have children and parent like they don’t have a career.29 Part of how parents sometimes rectify this inner strife is to compensate by spending money on their children (throwing elaborate birthday parties or booking expensive lessons) or by engaging in emotionally absorbing parenting in the evenings and on weekends as a way to “make up” for having to take time away from parenting to go to work.30
While I agree that attachment to a loving caregiver is important for children, I have some major concerns with the way information about attachment is provided to parents, as well as the prescriptive, labour-intensive way parents, and especially mothers, are instructed to attach to their kids. One concern is with the idea that the eight principles and the tools of attachment parenting are the best way to secure attachment. When we look historically and cross-culturally we find that there’s a wide variety of parenting styles and practices that create secure attachment.31 Some of the earliest research in this area compared the attachment experiences of neglected children with those of well-cared for children whose parents followed 1950s cultural parenting norms, such as bottle-feeding, cry-it-out methods of sleep training, and limiting physical touch with babies out of a fear of “spoiling” them. As expected, there were long-term mental health and developmental concerns with chronically neglected children, but children raised in loving families were deemed to have healthy attachment, even though the behaviour associated with loving parenting was very different from the behaviours we associate with it today.
It also concerns me that attachment is often discussed as though it can be empirically measured, yet much of the early attachment research involved the personal observations of male doctors who had presumably never been the primary caregiver to a child. Attachment theory is, well, a theory, and it relies on a lot of assumptions about infant, child, and parent intentions and consequences. Unless the early researchers were using feminist research methods to identify their personal biases and how those might impact their results, it’s likely that each doctor’s interpretation of secure attachment was heavily influenced by whatever childhood outcomes they personally valued. If so, it means that attachment theory was built on white, gendered, able-bodied, middle-or upper-class, heteronormative nuclear family values that idealize the fantasy of capitalist success. This doesn’t leave a lot of room for parents whose ultimate goal for their children isn’t how much they can align with dominant cultural norms.
I want to be clear that I don’t think attachment theory is useless, but I do think that, like all theories, it needs to be understood within the context in which it was created, so that we can take what we need from it and leave the rest. I’m concerned that the way we talk to parents about attachment makes it feel outcomes-focused, rather than focused on how we anchor ourselves in relationship to our children. I don’t think attachment research was ever meant to have parents fearfully questioning whether they are attached to their children or not, and I encourage you to let go of this fear and to instead play with the idea that there is an ebb and flow to closeness in all relationships, involving children or not. You generally can’t destroy a social bond with one misstep or by going through times of disconnection, nor do you have to enact someone else’s idea about how you should bond to your children. For many parents, it’s actually quite interesting to identify the unique and nuanced ways in which they build relationships in all aspects of their life.
I find the assumption that developing emotionally healthy and socially successful children requires continuous maternal caregiving deeply problematic, not only because it excludes parental sex and gender diversity, but also because it limits the expectations of other care-givers in the child’s life, such as co-parents, friends, family, and hired professionals. It’s critical to remember that parental and caregiving relationships are not the only ones that impact children’s development. It’s common for children to abandon the values and behaviours held dear by their parents (much to our frustration) and instead pick up on social cues from their peers.32 Each new generation of children also internalizes their particular generation’s cultural norms, and rejects any of the norms that feel outdated from their parents’ generation. Think about how intensely family values and communication have changed across Baby Boomers, Generation X, and Millennials, and how the iGeneration is being shaped. When I accidently threw something out that should have been recycled, my eleven-year-old called me out by rolling his eyes and sarcastically quipping, “Okay, Boomer. It’s not like we’re trying to save the planet or anything.” And I’m not even a Boomer!
The narrative that “good parents” raise “good children” who turn into “good adults” is too flat and overly simplistic. That’s partially because I’m not totally sure what it means to be “good,” but also because there are a lot of children who grow up in secure households, with parents that are committed to their development, who still struggle emotionally and socially as an older child, adolescent, or adult — either chronically or for short periods of time.33 It’s normal to have times of personal and relational strife, and, while it is true that early family relationships are important for development, there are many other serious environmental factors that contribute to the children’s outcomes, such as poverty, discrimination, or trauma.34
Similarly, there are babies/children who are raised in chaotic households with confusing attachment relationships who find strategies to become secure and functional adults.35 I suspect that this is because personal grit, resilience, and stress management stems from both internal resources, such as autonomy, problem solving, and a sense of purpose, as well as external resources, such as caring adults who model emotional regulation and set high expectations.36 These need to be analyzed together in order to theorize about children’s outcomes, as most parents of multiple children would acknowledge that every child is born with their own unique attributes that shape their experiences in the world. And as neuroscientists continue to learn more about just how plastic and flexible the brain is, it becomes more difficult to assume that the first few years of life solidify a child’s destiny, because humans’ ability to learn, grown, and heal is pretty spectacular!
My final critique of attachment parenting and intensive mothering is that there is such a hyperfocus on creating positive experiences for infants and children that the experiences of parents, particularly mothers, is an afterthought. Much of attachment theory prioritizes the mother role above all else and seems to imply that mothers should willingly forfeit their own autonomy in the quest for attachment. Although attachment theory does suggest that attachment requires a bidirectional relationship between mother and baby, I find it often ignores the idea that individual mothers are — and should be — whole people, and pays insufficient attention to how the temperament of babies/children contributes to the parent-child relationship.37 Sometimes high-needs babies wreak havoc on their parents’ nervous systems. Sometimes an infant’s night waking creates debilitating sleep debt for its parents. Sometimes parent and child temperaments clash. There are many reasons that parents need distance from their children to tend to their non-parent parts!
Does this mean that it doesn’t matter how parents interact with their children? Of course not! Parents and children deserve a parenting relationship that is anchored in love and support.38 Unfortunately, what it means to feel loved and supported varies widely from person to person, and for some relationships it can feel exceptionally difficult to decode each other’s love languages. It’s also normal and okay to not be consistent, loving, and supportive of your children 100 percent of the time. We cannot continue to hold one parent, usually a mother, responsible for the outcomes of their children when partners, family, friends, and community share in the responsibility. Additionally, the target of raising “happy, healthy, and successful” children is problematic and needs to change (I explore this in detail in chapter nine).
Clearly, there is a lot to consider as we try to wrap our heads around perinatal mood. Biology, thoughts, identity, and parenting culture influence each other, creating an intricate web that spins parents in deeply personal ways that affect their mood. What the Perinatal Mood Framework gives parents is a starting point for unpacking their individual experiences. Parenting is complex. Mood is complex. But working to understand the complexity of perinatal mood matters, because it dramatically affects the support that parents get when they reach out for help.