The bulk of my practice centers on helping moms and their families move through challenges during the pregnancy and postpartum periods. Many people experience depression and anxiety during pregnancy and after the delivery of their babies. Some have endured a perinatal loss (stillbirth or miscarriage), while others are facing fertility obstacles. Some moms are entering perimenopause as they are delivering their children.
The reproductive years for a woman can definitely set up a window of vulnerability for perinatal mood and anxiety issues (clinical term: PMADs). More than 20% of child-bearing women will experience a PMAD. In addition, I am seeing a return to psychotherapy for some people who had experienced PMADs, as their children enter elementary school and beyond.
Often, all that is needed is a booster, so to speak, and a revisiting of self-care, a psychotherapy buzzword for incorporating good sleep practices and nutrition, a strong support network, exercise, and other stress-reduction interventions. The journey of motherhood is a rewarding one, but there is no question that each developmental stage brings different challenges to moms, children, and the family system as a whole.
When children enter elementary school, often moms are simultaneously relieved and heartbroken. The intensity of the baby/toddler/preschool years is now over with, and one’s children are no longer babies. In a very real sense, there is an experience of mourning the loss of that stage as a past chapter in one’s life, one that can now be revisited only through photographs and videos.
Certainly, the entrance of children to formal education is also a celebration of perhaps embracing a new stage in children’s development where the opportunity for verbal interaction increases and more family-centered activities that were formerly very difficult or impossible are now manageable (traveling, hiking, camping, bicycling, etc.). No longer are dirty diapers or packing the baby paraphernalia daily realities. Children can feed themselves and actually verbalize where their boo-boo is. In many ways, parents report a return to positive memories of their own childhoods as they share with their children special camping spots, favorite sports or pastimes, or perhaps a conversation about philosophy or politics. Children are becoming their own small people with a very clear emergence of personalities, preferences, and styles of interacting. German child development theorist Erik Erikson postulated that children during the 6-12-year age range generally develop a sense of confidence in their abilities and an emerging thrust toward industry. For many, this school-age stage is truly a rewarding chapter in parenthood.
That said, many moms of school-aged children can revisit symptoms of depression and anxiety, particularly if they have had prior episodes. Women who have experienced PMADs often need to practice shoring up coping skills and social supports in the event that symptoms of depression or anxiety resurface. For many mothers 35 and older, perimenopause (the 10 years preceding menopause) has begun. During this time, women’s hormones undergo a transformation and upheaval, not unlike the expanse of time preceding menarche (the first menstruation of a woman). Women are more vulnerable to depression and anxiety during perimenopause if they have experienced a PMAD (Sichel and Driscoll, 2000). It is with this evidence-based knowledge that women focus on revisiting self-care simultaneously as their children enter the school-age stage.
As mentioned previously, self-care can include: good sleep and nutrition, exercise, social support networks, psychotherapy (if indicated), stress management (yoga, meditation, spirituality), journaling, creative expression (through art, dance, writing, music, etc.), and good time-management practice and boundary setting. Some moms may have unresolved losses or trauma healing which would be beneficial to explore in therapy. Speaking with a psychotherapist trained in women’s reproductive mental health can be particularly helpful during this chapter in a woman’s life, to shore up her resources (both internal and external) and prevent/be proactive about any emerging depression/anxiety surfacing as a result of perimenopause and/or life stressors.
Excellent self-care/women’s mental health books and websites include:
- Sichel and Driscoll (2000), Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Women’s Health
- Barnes, Diana Lynn and Balber, Leigh (2007), The Journey to Parenthood: Myths, Reality and What Really Matters
- Dunnewold, Ann (2007), Even June Cleaver Would Forget the Juicebox: Cut Yourself Some Slack (And Still Raise Great Kids) in the Age of Extreme Parenting
- Kleinman, Karen (2005), What Am I Thinking? Having A Baby After Postpartum Depression
- Brizendine, LouAnn (2007), The Female Brain
- Brizendine, LouAnn (2011), The Male Brain
- Northrup, Christiane (2012), The Wisdom of Menopause: Creating Physical and Emotional Health During the Change
- Northrup, Christiane (2010), Women’s Bodies, Women’s Wisdom: Creating Physical and Emotional Health and Healing
- Domar, Alice and Dreher, Henry (2001), Self-Nurture: Learning to Care for Yourself as Effectively as You Care for Everyone Else
- Louden, Jennifer (2005), The Woman’s Comfort Book: A Self-Nurturing Guide for Restoring Balance in Your Life
- Patton Thoele, Sue (2001), The Courage to Be Yourself: A Woman’s Guide to Emotional Strength and Self-Esteem
- Patton Thoele, Sue (2008), The Mindful Woman: Gentle Practices for Restoring Calm, Finding Balance, and Opening Your Heart
- Hayhouse.com: positive affirmations, self care, meditations
- Postpartum Support International: postpartum.net (resources for pregnant and postpartum women and their families)
- Postpartumprogress.com (blog by Katherine Stone)
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