TGIF: Managing Perinatal or Postpartum Depressive Mood and Anxiety
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Dear Community,
Welcome to our weekly well-being column TGIF - Your Weekly Reset. Each week I will answer questions from you (or topics of interest!), bringing in themes of mental wellness-related tools, reminders of gratitude, innovative solutions, and a summary of my own feelings related to the topic.
Submit your questions as often as you’d like and I’ll be sure to address them in our upcoming columns.
As always, thanks for being here.
This week’s question comes from a new mom experiencing perinatal anxiety. Even if you yourself are not pregnant or in the newborn stage, I believe her question and my response can relate to anyone. All of us know a new mom and many of us have been there or hope to be. Her question spawns an even greater conflict in how we take care of each other in our most vulnerable times.
How to decrease intrusive thoughts during pregnancy of fears related to my health/baby’s health even though things are going well? I’m struggling with fears of the unknown and worrying more than I thought I would!
Dear Reader,
Thank you for asking this question and sharing your worries. I have been there and I can assure you, many other women have too. The preciousness of what you’re doing - building a human inside of you - is just that, precious and heightens our vulnerabilities to both internal and external threats. You have someone who needs you in ways you’ve never experienced before, which is both magical and intimidating.
I’ve said this before, but love is inherently vulnerable and I really do not know love as intense as the love you have for your child, especially when they are closely nestled inside you and you are keeping them safe within.
And so when it comes to anxiety, I always ask myself - how is this [anxiety/anxious thought/intrusive thought] for me? The fear thoughts, the worry thoughts, the grief over failed or traumatic births previously… they want to be acknowledged and appreciated.
In our work we do a lot of integration with the parts of us - the “voices” in our heads that intrude on our quiet spaces, that keep us up at night, that cause us to react and behave in certain ways. These parts are, as one of my intensive clients called them, little warriors. Why warriors? Because each thought, action, and belief is in a way trying to protect you.
TOOLS
Let’s think about anxiety and the intrusive thoughts, in this reader’s case, about her and her unborn baby’s health. First, we acknowledge the part - that anxious part. We say, “Hi anxiety, I see you.” Rather than shove them away, get angry with the thoughts, or be annoyed we’re even thinking them (aka, the “I should know better!” narrative), we welcome them in. Like a worried friend, you bring that part in closer. You wouldn’t abandon or dismiss a worrying friend, you would create space for them.
Creating space looks like taking some deep breaths and physically feeling expanded. It looks like pausing with a journal and pen to allow that part a voice. It looks like talking about it with a friend, loved one, or therapist.
We need to give attention to the anxiety, instead of banishing it away, for it has something important to share. Once you’ve found a grounded avenue to approach this part of you, you can inquire further. With a curious, more compassionate, and spacious attention on that anxious part, we get into dialogue.
GRATITUDE
I understand it may feel counterintuitive or even unproductive to look at those pesky anxious thoughts with gratitude and curiosity, but these are the tenants of a mindful approach to observing the thoughts in our head (and the actions of ourselves and others!). When we approach with less judgment, we create space to not be so consumed and debilitated by our internal stories.
Here’s a little script you can use with that intrusive voice in your head:
Offer appreciation:
“Thank you for showing up for me, [anxiety]. There’s something here you want me to acknowledge”.
Validate the concern:
“I understand you’re worried about [the health of me and the baby]. That makes sense because this is a time of big uncertainty. I believe your worries and understand.”
Get curious:
“What is it that you’re most afraid of? What are your trying to protect me from? Is this part reminded of a previous event?”
Listen:
Let the part tell its story.
As you uncover the fear, we can generally appreciate the root of the part’s concern. In this case, obviously, it’s the most feared outcome that feels so intensely overwhelming. The feared outcome is generally one of imaginable pain, suffering, and in many other situations, feelings of shame, disappointment, abandonment, and guilt.
Allow Yourself to Feel:
Feel into your body where you most feel the part’s story. Perhaps it’s pressure on your chest, heart racing, itchy skin, or shaky limbs.
Regulate (breathe, expand) as you hold space to feel the feelings.
Give it Over:
Here, this is where we at Reset use our Objective Consciousness Meditation or other trauma-informed practices. Using imagery, creative expression, music, EMDR, breathwork, bodywork, or journaling, you can approach the fear story and give it over to something else.
For example, if the physical sensations are most powerful, turn them over as you move your body, shake, breathe, and release. If it’s powerful imagery we can make it more palatable through visualization or art. We can take the feelings and turn them into a poem, song lyrics, or journal entries.
The importance here is that you are not abandoning or dismissing the part’s story, you are integrating it in a way that honors it but it doesn’t debilitate you in the same way because you’re processing through the feelings.
Return to the Part:
To complete the exercise, you’ll want to return to the activation that needed your attention to begin with. Now that you are no longer in reaction to the [anxiety], you can gently ask it to take up less space, because it isn’t as needed right now.
“Thank you for your story and I’ve now acknowledged, appreciated it, and given it tender attention. I feel I do not need to carry your worry any longer. [Anxious part], are you ready to move aside?”
If you’ve done the above steps with intention, the part will usually feel satisfied and allow your more confident, joyful, present self to return.
INNOVATION
Now, I understand that the above steps may feel lengthy, which is why it’s important to set aside time to be with these thoughts and feelings. The more we ignore them, the louder they get. Taking the time to do this exercise by yourself or with a therapist is vital to quieting the parts.
With practice and frequency, you can move through this exercise in minutes. You will find you get much more familiar with naming and labeling those thoughts, observing without judgment, releasing them, and returning back to a present self.
For me, I return to mantras, quotes, images, and songs to bring me quickly back to my center. I’ve found the “quick release” methods that get me there now that I’ve become intimately familiar with my anxious parts (as well as my “screw up”, “people pleasing” and “highly sensitive” parts).
Reader, as a soon-to-be new mama, I encourage you to prepare these rituals for yourself now, before the baby arrives. Whenever we’re in anticipation of a big change and wading in the uncertainty pool, the best thing we can do is prepare for the big feelings.
Set up a space in your home that can be your “retreat” or “reset” space. Have candles, incense, pictures, inspiring quotes, a music player, journals, and your favorite books. Make it cozy and give it soft lighting. This can be a closet, an entire room, or if you’re like me, a quiet corner in the basement ;)
Make a playlist of the songs that bring you back to your center. You may even make a few that have uplifting themes, “cry it out” themes, rage themes, and calming vibes. Give yourself the gift of choice when you’ll most need it.
Ask for help, now. Especially when entering the newborn stage, you’re going to need help. Develop a word that your partner or support network knows is the SOS signal of, “I need a break, come help now.” When you give that signal, you drop all guilt and go take care of yourself. Go to your reset space or get in your car and go somewhere. Your partner or support person needs to know they cannot ask questions and they just need to show up. This cannot be understated how vital it is as a new parent to have support, readily available. If you find yourself struggling to implement these SOS supports, think outside the box and hire a sitter, night nurse, postpartum doula, or consider a membership service to something like our friend’s center, Fourth Tri Sanctuary. And of course, it does not hurt to have a therapist now who can be available with flexibility once you deliver. This is where telehealth is dreamy these days :)
FEELS
I am a mom of two kiddos and both of my labor experiences were dramatic. My second son was born 6 weeks into the Covid pandemic. I labored with a flimsy fabric mask on, in an eerily quiet maternity ward where “Celebration” was played more often than nursery tunes, signaling the release of another Covid patient. I couldn’t go anywhere postpartum but thankfully neither could my spouse so he helped a lot.
My first son’s labor was a traumatic birth. It wasn’t until a few weeks after I got home with him did I realize my own PTSD. I was having flashbacks to pivotal, scary moments of birth, feeling uncontrollable anxiety, loneliness, grief, guilt, shame, and desperation. My husband was home for 7 days postpartum (American parental leave is the pits) and I did not understand what was happening to me. I constantly had the narrative of, “I should know better,” being a therapist, but I was losing my grip on reality.
Here’s what I can tell you: I wish I had a therapist sooner. I am 100% convinced the therapist I did find, finally, at 4 months postpartum saved me. I still refer anyone in Chicago to her and miss her dearly. I wish that my midwives and doctors would have warned me that traumatic births (anytime a delivery does not go as planned) despite a healthy baby, increases the risk of postpartum mood disorders.
As many as 25% of women experience childbirth PTSD, and 90% of women with childbirth PTSD have elevated postpartum depression symptoms. That means one in four new moms is suffering from the co-morbidity of PTSD and mood disturbance. During Covid, one in three moms screened positive for postpartum depression. The implications of so many moms suffering are gigantic as we consider the impacts on attachment, regulation, self-esteem, connection, and self-compassion. Taking care of parents is a missing piece of our culture and it is our hope that Reset, we can be part of the solution.
So much of being a parent is about learning how to navigate the unknown. No one is taught how to be a parent and no matter how many books, articles, or mother’s advice you get, your experience is uniquely yours because no one else is you or your baby.
Embracing this uncertainty, doubt and unsettling nerves is part of parenting. Learning how to balance the suffocating love and responsibility is paramount to functioning daily with our increased vulnerability. And tending to our own needs to keep ourselves regulated, connected, and present is vital for the health and success of our children.
And so, dear reader - I hope today’s content helps as you prepare to step into this magical, expansive new chapter. And for anyone feeling the weight of change and related big feelings, I hope you have found the resources helpful for you, too.
It’s never too early to ask for help.
Big hugs,
Kerry
