We are all recovering from something.
— Dawn Nickel
It’s easy to feel lost and overwhelmed when you’ve been struggling with your mood, and the demands of having a baby/babies can make it extra challenging to know what to do about it. It can be very helpful to create a Perinatal Mood Recovery Plan, which is a tool for parents to identify detailed action items that have the potential to help them feel better. This chapter offers a broad overview of topics and strategies to consider when building your personalized plan, which ideally you would create or share with your mental health team. In the chapters that follow I provide very specific exercises to support you through the day-to-day challenges of parenting when you’re struggling with your emotional health.
There is a lot to be hopeful for when creating a Perinatal Mood Recovery Plan, because as we continue to learn more about the individual, collective, and biological experience of perinatal mood, we are also learning more about what can protect parents from developing PMADs, or at least minimize their impact. When we acknowledge that many aspects of the postpartum period feel tough as hell, it creates the space for a culture of postpartum resiliency to emerge. I define postpartum resiliency as the ability to cope with and endure any obstacles or challenges that emerge during the postpartum experience, while simultaneously embracing and integrating the joyful and positive moments into one’s parenting experience. One of my favourite papers on this topic was written by Stephanie Knaak, who conducted a qualitative research study to explore what factors contribute to a positive postpartum experience.1 I’ve used her work to identify six pillars that parents can focus on to help develop postpartum resiliency. Together, these pillars form a powerful framework to anchor yourself in, helping parents break through the good-parent/bad-parent dichotomy.
Pillar One — Adequate Self-Care: Parents who purposefully protect guilt-free and unapologetic self-care time have an easier time with postpartum adjustment. How each parent does this is unique, rooted in the activities and boundaries that are important to them, rather than in the culture of impossible parenting’s prescriptive style of self-care. While there’s more on the switch from self-care to what I call self-parenting in chapter eleven, I want to highlight the importance of feeling entitled to self-care. You, and all parents, deserve to have your care needs met, even though it is often hard to know what care we need to give ourselves, what we need from others, and what we have to give. Parenting is only one aspect of your identity. In order to be fully human, parents have to support multiple aspects of their identities.
Pillar Two — Having Enough Help: Help with parenting means different things to different people, but generally it refers to having support with: the day-to-day tasks of caring for a baby/babies, such as comforting and feeding; keeping a household running, such as making meals and completing chores; and emotional help, such as providing stimulating conversation and the space to complain. These needs change day to day and often require a team of friends, family, and paid workers (if it’s an option) to be met with relative ease. While it’s not surprising that new parents need help, there are two important things to consider, in order for help to feel supportive and not simply another burden. The first is that just like self-care, parents who don’t feel guilty about asking for help but instead see it as a healthy part of parenting have smoother postpartum experiences.2 The second is that parents must feel a sense of control over what kind of help they ask for and who they receive it from.
Postpartum practices such as “doing-the-month” or a “lay-in” are non-Western systems of support designed to maximize rest and recovery in the first month of parenting. How they are practised varies from region to region, but generally these practices include live-in and hands-on help, as well as a nourishing diet, for birthers in the first thirty to forty days postpartum. This practice has been romanticized and appropriated by some Western parenting experts and suggested as well-meaning advice in an effort to increase the amount of support for postpartum parents. However, there are many challenges that Western families face when trying to organize live-in care because most of us don’t have the socio-economic systems in place to facilitate it easily. It puts the burden of organizing care onto new parents, and it assumes they have family members who are available for an entire month or that they have enough financial resources to hire a full-time doula or live-in nanny. The global research on the experience of “doing-the month” suggests that parents only find these practices helpful if they have positive relationships with their live-in caregivers and have a personal desire for this kind of support.3 If parents feel forced to participate in this process or have tense relationships with in-laws or family members, this kind of help is, understandably, a hindrance to their postpartum mood.4
I think what’s important to remember about the concept of having enough help is that the early postpartum period is a vulnerable time for parents and they need to be accommodated by their community. The sleep deprivation, stress of newborn care, and physical recovery for those who gave birth requires more resources than can be provided by one or two people. Often that support needs to be explicitly negotiated, and community members should never assume that they know what you need (or don’t need). I’m also aware that the pandemic has halted brilliantly negotiated support plans because of limitations in people coming to your home.
Pillar Three — Feeling Understood: Having a collection of people who validate our feelings, offer solidarity, and can provide feedback to the many parenting questions — such as “Is this normal!?” — is critical to breaking through the feelings of loneliness and isolation that come with being a new parent. Interestingly, I’ve found that close friends with kids may or may not be the people who help us feel understood. The people we like to work or party with may not share our parenting philosophies, and this isn’t necessarily unusual or problematic, but it is sometimes surprising. Our parenting ideology and practices often shape our parenting identity, which has led to an increase of parenting subcultures, such as attachment parents, tiger parents, dolphin parents, free-range parents, or unicorn parents. Seeking inclusion in a defined parenting group such as these isn’t necessary and sometimes leads to feelings of inferiority or superiority, but generally parents who find a parenting group or groups that are a good fit, either online or in person, see them as invaluable for their mental health. I know parenting subcultures can be a loaded topic and I promise to return to this in chapter twelve, but the reason I keep coming back to this concept of community/collective care is that when parents are able to find a supportive community, it is incredibly protective to their mental health.
Pillar Four — Stress Management: While we can’t control external sources of stress in our lives, parents who use stress-management techniques and practice surrendering to circumstances and events that are out of their control find the adjustment to parenting easier. Life can throw some very difficult situations our way during the postpartum period, including preterm babies, traumatic births, job loss, or death of loved ones, and we need to feel as though we have enough internal resources and coping skills to navigate the storm. This doesn’t mean we don’t feel stress or anxiety when things go awry. It just means we are able to self-soothe, ground ourselves, and feel hopeful that we will survive each difficult circumstance. Even without additional life stressors, handling the competing demands and responsibilities of parenthood is stressful enough and we deserve support in managing our personal set of stressors. Building up your internal resources and bolstering stress-management strategies is something that a skilled therapist can really help with.
Pillar Five — Feeling Ready for the Baby: Getting enough rest before the baby/babies arrive and feeling confident that you know enough to successfully care for them can make a big difference to your mood in the early postpartum days. Parents of preterm babies often struggle with not feeling ready, as do parents with older children who feel like time has passed too quickly and they aren’t adequately prepared — they might have unassembled baby furniture or piles of baby laundry to wash and put away. While parents can’t control when they meet their baby/babies for the first time, I think it’s ideal when pregnant parents feel so prepared and sick of being pregnant that they get bored and wake up every morning hoping that today is the day they go into labour. These parents get a protective mood benefit from this frustrating experience.
Pillar Six — Having Realistic Expectations: As I’ve suggested, every new parent experiences a discrepancy between what they think life with a newborn(s) will be like and the reality. The smaller the gap, the easier the transition to the new reality, so I often encourage soon-to-be parents to identify and become familiar with the vision they have for their birth and postpartum life. Once they have a sense of what they’re expecting, I encourage them to find a variety of birth and postpartum stories that both reflect and don’t reflect their vision. The goal is not to induce anxiety or burst their idealized vision, nor is it to reinforce naive optimism, but instead it’s to foster a non-outcomes-focused vision where they can both feel hopeful and know that they can cope, regardless of how birth and postpartum unfold. It’s also important to acknowledge that we are all trying to figure out how to parent in the culture of impossible parenting, and it’s worth questioning and evaluating where our idealized visions of parenting come from.
Developing a sense of resiliency is helpful for all parents, but this is not a foolproof prevention strategy for bypassing a PMAD, because perinatal mood is complex and influenced by a variety of factors outside of our control. The six pillars of postpartum resiliency offer an interesting starting place to think about what goals we have for ourselves and how we might build a bridge toward those goals.
To build a template for your Perinatal Mood Recovery Plan, it’s helpful to revisit the Perinatal Mood Framework from chapter two. You can create a personalized plan at any time, whether you have been diagnosed with a PMAD or you suspect you might have a PMAD. You can even create one if you are feeling emotionally healthy but are concerned about what becoming a parent will do to your mood, in which case you can simply change the name to Perinatal Mood Protection Plan.
Any plan that you create will need to be adaptable as you learn more about what works and what doesn’t. I encourage you to imagine that you’re conducting a mood experiment wherein you are both the test subject and the scientist. Scientists never expect to get any experiment right the first time. They understand that each failed attempt provides them new information and brings them closer to understanding what will lead to success. The same is also true when we are trying to determine which strategies will help us manage our mood. As you read through these sections, take note of which tools resonate with you and get you excited, and which ones feel annoying or silly. Try out lots of tools and exercises and don’t be afraid to adapt them as you build your Mood-Managing Tool Box, which is an intentional list of actions you can take when you’re feeling emotionally charged or ungrounded. Once you have what you need, you can simply leave the rest, knowing you can return to the unused tools at any time if things shift. This is not dissimilar to experimenting with parenting strategies, such as figuring out how to soothe a crying baby or manage a tantrum. Often our parenting tricks work for a time, but soon our kids develop and outgrow them. We are constantly sent back to the drawing board to tweak old strategies and gather new ones.
Please note that the self-support strategies listed here are for those who have the emotional bandwidth to engage in experimenting. Psychosis, mania, or suicidal planning are medical emergencies that require immediate intervention.
Biological support is a big, broad category that will mean different things to different people. I always suggest that perinatal clients who are having a tough time with their mood start by talking to their family doctor (if they haven’t already), and my favourite doctors are the ones that order lab tests to rule out factors that can contribute to low or anxious mood, such as thyroid malfunction. I believe that medicinal support can be an important part of PMAD recovery, but I also respect that the term medicine is often associated with allopathic medicine (conventional medicine, provided by someone with an MD), and I know that it’s not the only type of medicine that parents use. It’s important that we interpret concepts such as health and wellness using an anti-oppressive, intersectional, and cross-cultural perspective, remembering that there are many different approaches to healing the human body. Whatever medicinal system(s) you use, such as allopathic, Chinese, naturopathic, Ayurvedic, or Indigenous, I encourage you to find a qualified doctor that you trust, and ideally someone who specializes in perinatal health.
If there is one thing I wish I could give every new parent, it’s a therapist that they trust and feel connected to. If it’s possible for you to work with a therapist one on one, start by looking for someone who has a deep understanding of perinatal mood. You don’t need to have a clinical diagnosis of a PMAD to benefit from talking to a therapist; there is value in processing the experience of becoming a parent and all the identity changes that come with it. I wouldn’t get too worried about what approach to therapy your therapist uses; the most significant predictor of therapeutic success is arguably the alliance you feel to your therapist.5 Being respected and deeply listened to, and having your feelings validated by someone with whom you have a solid rapport, is critical to doing work that by nature requires you to be vulnerable.
When starting with new clients with PPD/A, I often limit a deep exploration of their own childhood and instead concentrate on understanding their current experience, with a forward-looking approach that focuses on developing coping tools, processing emotions, and setting up a family system that maximizes support for their needs while respecting their access to resources. I start here because some parents find that fixating on the ways in which their own parent(s) failed them increases their anxious worries that they will permanently damage their children/babies. Analysis of our past is important work, but it’s a big request to make of someone who might only be sleeping for three hours at a time and can’t even pee alone.
If you’re looking to work through birth or reproductive trauma, you will want to ensure that your therapist has been trained in a trauma-specific modality such as eye movement desensitization and reprocessing (EMDR), brain spotting, or sensory motor therapy. If you are able, shop around for a therapist until you find the right fit. If finances are a concern, don’t be afraid to ask if they offer any sliding-scale spots, meaning the session fee is reduced to make it more affordable. They may not, but some therapists do and may not advertise it.
Group therapy can also be very supportive for PPD/A and is usually more affordable or even free. Ask your family doctor for a referral to any hospital programs that are offered, and check out community organizations that run postpartum groups. The not-for-profit I run, Postpartum Support Toronto (PPSTO), offers free online skill-building courses for new parents, run by local counsellors, on topics such as dialectical behaviour therapy (DBT) for postpartum, cultivating self-compassion, expressive arts tools, and overcoming parenting guilt.
Regardless of where you find therapeutic support, it’s worthwhile to find a place where you can dump out all the things that have been rattling in your head, have someone help you process your feelings, and figure out what to do with the dark thoughts.
Ideally, we would reduce our exposure to some of the risk factors that are associated with PMADs, such as opting not to move or renovate our homes during pregnancy or early postpartum, but many of the risk factors are not within our control. Often I ask clients to make a list of all of the problems they are currently facing, and together we identify which aspects of these problems are solvable or time-limited, such as “My partner is going away for work for a week and I don’t know how I’ll cope,” and which ones needs to be endured for an undetermined amount of time, such as “My partner works evenings, the baby cries non-stop from 4:00 p.m. to 7:00 p.m., and I feel like I can’t cope.” For the unsolvables, I suggest adopting an endurance-based mindset, meaning that you recognize the limits of your control and prepare to endure what feels difficult. Accepting the challenging parts of postpartum life doesn’t mean you like them or that you don’t get to feel sad or angry about your circumstances, it just frees up emotional space by laying down your resistance to what you can’t control. I know that this is easier said than done, which is why many of the tools outlined in the chapters to come are designed to help you cultivate an endurance-based mindset.
Parenting culture continuously shifts and adapts, and it’s time for the culture of impossible parenting to come to an end because of the negative impact it has on families, whether or not a parent develops a PMAD. I encourage you to find ways to resist it as we clumsily move toward a new culture of parenting. While I am not totally sure I know what that will look like yet, nor do I suggest that I have the solution, I dream of a culture of postpartum resiliency that is rooted in compassion, curiosity, inclusion, and anti-oppressive cultural humility. I hope that the concepts in this book inspire increased public discussion about how to deconstruct the culture of impossible parenting and build a culture of support-focused parenting.
There are many ways to resist the culture of impossible parenting on an individual level. It may be as simple as talking openly about it and challenging its messages when you see them come up in the media, in your personal relationships, or with other parents. Often it involves challenging the problematic messages you have internalized and finding new ways to talk to ourselves. I suggest four strategies to cultivate internal resistance:
Soften into the energy of self-permission and allow your feelings, honour your desires, and accept the difficult circumstances outside of your control, which can help guard against the values of danger is all around us and keep it natural.
Adopt a family-centred parenting approach to organizing family systems and decision-making, as opposed to a child-centred approach, as a way to reconceptualize the values of invest up front and make every moment magical.
Shift from the value of prescriptive self-care to self-parenting to bring more awareness and responsiveness to your needs and wants in creative ways.
Think through how to be less alone, by communicating your needs and gently seeking new community members, to help you resist the value of the more you sacrifice, the more you love.
Recovering from a PMAD is an amazing feat, but I also want to gently note that when you come out the other side, you may be filled with grief about what it robbed from you. I didn’t even realize how much I had missed out on until my friends started having their own babies, and I realized what joy some postpartum families experience. It made me sad and jealous to watch other parents seem to navigate it all so gracefully — so much so that I desperately wanted another baby with my partner, Janna. I had sworn I would never have another baby, but all of a sudden, I felt the strong need for a do-over. As I painfully came to the realization that it wasn’t going to happen for us, I realized that grief from experiences that we long for but will never have is a particularly tricky type of grief to process, because there is no anchor or name for it. The challenge with grief is that there isn’t much to do about it other than learn how to hold it. I can tell you that it helps to find meaning in the experience. For me, that meaning came from supporting others through perinatal mood hell, which I think is common for many of us who survived a PMAD, but it doesn’t have to be that. You might focus on how much you learned about yourself or how you and your partner are now really clear about what it looks like to effectively support each other. You don’t need to be grateful and you certainly don’t need to try to make it positive — because it wasn’t — but it can help to integrate the experience in a reflective way.