Today I knelt on the floor, changing my son’s diaper. I placed my index finger along the ridges of indentation on his skin, just below his hip, as I loosened the tape. My brain, cued to comfort him, had clocked this moment. It was one of the many essential daily tasks heaped upon my new mental load. Motherhood, I’ve discovered through trial and error, and through my work as a clinical psychologist, is a series of a million ‘clocks.’ As a new mother, I had stepped into a new time zone, one where a million little ‘clocks’ happen each day. As any mom will tell you, becoming a mother represents a whole new way of thinking about time. It is fast and it is forever.
Motherhood represents a dramatic and ‘traumatic’ change, albeit a normative one. I have dedicated my career to helping patients—particularly new mothers—navigate this developmental stage with evidence-based therapy. They may not know that the maternal brain undergoes a comprehensive rewiring. It’s pruning what it doesn’t need and amassing massive new neural networks—millions of neural pathways that make mom brilliant at caring for a child, even when changing a diaper. Especially when changing a diaper.
But I know all too well how the postpartum period can be studded with landmines. Even though this was my area of expertise as a psychologist, postpartum depression and anxiety took me by surprise. Curled up on my closet floor in tears, I diagnosed myself in real-time. Thanks to medication and therapy, I made it through to the other side. Through therapy, I understood that I was in a nascent stage in my brain’s adaptation to motherhood. I learned the power of my own brain’s neuroplasticity. My brain was changing because of the normative trauma of giving birth and caring for an infant. Once I began to understand what was happening; both physiologically and psychologically, I began to thrive.
Not all new mothers are so lucky. For some new mothers, without access to a postpartum mental health support network, these collective traumas pile on to a back that is already breaking. The numbers indicate that we have a maternal mental health crisis in the United States. One in five women will experience a postpartum anxiety or mood disorder and postpartum mental health conditions are the number one complication from childbirth.
As a society, we are completely unprepared for mothers, and the most unprepared of all are actual mothers. With only four percent of research funds dedicated to women’s health, it makes sense that after decades of research, we have a scant understanding of the maternal brain. In spite of the paucity of studies, we have learned some profound information. We now know that when women become mothers, the brain undergoes prolific biopsychosocial changes. The stage, termed matrescence, marks a profound neurocognitive developmental phase. The brain develops these changes with a clear focus on keeping a baby alive. Along with that focus comes intense emotions such as guilt (for example) when you get a sitter and step out or deep-seated shame when you don’t know how to swaddle.
Those emotions are in great contrast to everything women are taught to expect about the mothering experience, which we now know maternal instinct is a myth. We somehow think we’ll automatically know how to do it, we’ll do it well, and we’ll do it all. When people say, “My mom did everything for me and gave me everything,” they broadcast that moms can “do it all.” But being supermom flies in the face of an unfair division of labor, increased mental load, and lack of affordable childcare. Mothers are simply forced to rise to every relentless challenge that new motherhood brings.
Imagine if we prepared women, families, partners, and society to understand this developmental phase that changes her brain, body, psyche, relationships, identity, and hormones, instead of making sure they stock their baby registries with cashmere lined swaddles and booger sucking devices. Imagine we told mothers that they will feel like their brain is foggy, forgetful, and interrupted, all due more to sleep deprivation and increased mental load.
It’s imperative that we educate mothers during pregnancy to anticipate the vast functional and structural neuroplastic changes that reorganize and rewire her brain to improve her abilities to care for her baby. These same incredible changes make mothers more vulnerable to postpartum mental health conditions because of the extensive and rapid brain development. For example, only two percent of the population has obsessive compulsive disorder, but the base rate in mothers is nine percent because the brain changes in ways to adaptively make mothers more hypervigilant and scan the environment for dangers to protect their babies—also hallmark symptoms of OCD.
Normalizing and validating the need for proactive mental health care postpartum might alleviate or even prevent suffering, given that the rates of postpartum depression are underestimated because mothers are still afraid of reporting their symptoms for fear they will be viewed as unfit. Unfortunately, the onus still falls on mothers to prepare their postpartum mental health care.
I instruct all women to prepare for the postpartum period while pregnant by scheduling an appointment with a postpartum therapist to line up care. I can’t tell you how many high functioning women come to my office suffering more than they need to—and of note, high functioning women are more vulnerable to postpartum because it’s especially disorienting to go from CEO in their personal and professional lives to a beginner in motherhood overnight. The ones that seemingly have it all together may well be suffering the most.
The mental health of caregivers is rarely discussed, even though they bear the weight of their loved ones’ illness and its attendant emotional toll. I developed programs focused on helping them prioritize their mental well-being and now translate those evidence-based skills to mothers after realizing that support for mothers was lacking during my postpartum. As I emerged from this dark chapter thriving—engaged with my family, creatively inspired, and filled with renewed purpose. This transformation led me to explore why I flourished when so many mothers struggled.
Society is not prepared for mothers, and new mothers are the most ill-equipped of what is to come—both the brilliance, bliss, and risks. Through my research, I identified three pivotal factors that can help mothers not only survive but thrive:
- Early and Robust Postpartum Mental Health Support
- Immediate access to mental health care is essential. Having a psychiatrist on standby meant I could avoid the all-too-common scramble for help when postpartum limits our abilities to problem solve in the moment. No mother expects to get postpartum, but if the safety net is in place, we can catch more women.
- Understanding Matrescence
- Matrescence, the developmental phase of becoming a mother, is a crucial yet often overlooked aspect of maternal mental health. These neurological adaptations equip mothers with improved skills for caregiving and bonding, yet the narrative often reduces their experience to a stereotype of forgetfulness and deficits in cognitive functioning.
- The Power of Posttraumatic Growth
- The concept of posttraumatic growth suggests that trauma can lead to profound personal development. By understanding that at baseline, becoming a mother is a normative trauma, and then taking into account the rest of the mental health statistics, we can better guide mothers through their trauma.
To prepare the world for mothers, especially themselves, will pave the way to a healthier and more resilient society.
