Research has demonstrated that mothers actually have a higher likelihood of depressive symptoms four years after the birth of a child than they do in the first year after birth.5 Given how much publicity postpartum depression gets, most people are surprised to learn this. In my mind, it makes very good sense. Life is “supposed” to be easier four years after becoming a mother than it was at first, and remember: expectations and shoulds and supposed-tos lead to suffering. Babies are hard, toddlers are notoriously difficult (the “terrible twos”), but people talk less about what we might call the “fucking fours.” Perhaps women are more depressed several years out because the marriage has not yet recovered from the blow it suffered when the baby first arrived. Maybe there is a second baby now. The cumulative exhaustion has likely taken a heavy toll. Perhaps a mother’s sense of herself as still so very off-kilter, years later, is harder to bear. My friend’s friend with the three-year-old sleeping on top of her and hijacking her spa day is a prime candidate for this kind of maternal depression. It’s not about the hormones or the upheaval of brand-new motherhood. It’s about the long, hard assault on a woman’s autonomy and vibrancy.
The Longest Shortest Time
As mothers, we sometimes want to freeze time; we are aware that our children grow so fast, and even without our elders reminding us, we want so much to savor the precious moments of caring for little ones before they’re no longer little. On the other hand, as mothers, we sometimes want to fast-forward into a future we envision as more comfortable and more productive. We long for escape from the truly grueling work of caring for infants and toddlers. We count the hours or even minutes until we get some relief—until our spouse comes home, until bedtime, until we go to work—only to miss our babies immediately upon parting ways and to feel guilty for letting our minds wander so much when we were with them. We cannot wait to press play on the parts of our lives we’ve had to pause: creativity, sexuality, careers, travel, adventure. Like with our mixed emotions, we wonder, Which is it? Do I want time to slow down or speed up? And like with our mixed emotions, relief comes when we embrace the paradox. It’s both.
What if we could both try harder to remain in the present moment when we are mothering, and accept that we will fail at this task some, or even most, of the time? Better yet, what if we did not use the word “fail” at all, but rather we simply noted that sometimes we are mindful and sometimes our minds are elsewhere, and carry on with our efforts to tip the balance in favor of trying to be more present with our children?
Time elapses, and we are not always as awake to the current moment as we would like to be, because we are only managing to keep our heads above water. Time elapses, and we are not always able to participate in other realms of life and attend to vital dimensions of ourselves and our relationships.
Parts of our lives are on hold, and also, life is moving so fast we can barely hold on.
5
It Takes a Village to Raise a Mother
We need to ask the question: What do mothers deserve if they are to mother well? We need to answer: Everything. Everything that is due them.
—Naomi Wolf, Misconceptions
During my first pregnancy, I had the most extraordinary dream life. I have vivid dreams in general, and though they are sometimes a nonsensical mishmash of superficial material, often I find great meaning in them. What was so different about my dreams when I was pregnant was that just about every person I’ve ever known appeared in them. Each night, against the dark backdrop of my closed eyelids, I would watch scenes play out with hordes of characters from every phase of my life. I noticed that certain characters made repeat appearances—usually people with whom I’d fallen out of touch but who remained quite important to me. I would wake up with strange pregnancy cravings not for pickles and ice cream but for phone conversations and email exchanges. It seemed to me that my unconscious mind was rounding up my village, saying, “Don’t forget about all the people you have in your life. You’ll soon be needing them.”
Given that it was cranking out these dreams night after night, my unconscious mind evidently also knew I’d need some serious persuading. An introvert by nature, I have always preferred depth over breadth in my social relationships. And I really hate talking on the phone. And I’m exceptionally reluctant to ask for favors. And at the time, we hadn’t been living in Vermont long enough for me to feel all that well connected, and our families were on the West Coast, and all our good friends from graduate school had scattered to different pockets of the country to establish their careers just like we had. It was going to take some real work for me to find the village that would help me raise my child.
When I first began to conceptualize the contents of this chapter, I envisioned focusing on one phenomenon. I thought I would write about how young couples are raising their children in increasingly insular environments—geographically separated from their families of origin and their best friends from childhood and their college or graduate school mates—and the detrimental role this plays in our adjustment to parenthood. I soon realized that the situation is even bleaker than that. The “village” is lacking in so many ways, from the failure to support women well enough during and immediately after giving birth, to the laughable policies surrounding maternity and paternity leave, to the general decline in meaningful face-to-face social connection and the increasing reliance on one and only one person—our spouse or partner—to support us through hard times. It’s not enough to say that the culture of postpartum care and support in the United States is subpar. It’s more accurate to say that new mothers are thrown to the wolves.
Aloneness, Loss, and Shame in Childbirth
Sometimes when I am struggling to catch my breath while hiking or bicycling up a big hill, cursing my choice to take that particular route and thinking maybe I’ll just turn around and head back, I remind myself that I birthed two babies. And I think, If I can do that, I can do anything.
I had the good fortune of being able to give birth naturally, with no medications or medical interventions, twice. I say that I am fortunate because I recognize the likelihood that something will go awry during labor is largely a matter of luck and random chance, but I also give myself some credit. I’m proud of my natural childbirths. I was determined to give birth the way women have given birth for thousands of years, until really quite recently, when childbirth became medicalized in the Western world. When it came time for me to think about how I wanted to give birth to my sons, I did an enormous amount of reading and research. Having as natural a birth as possible was important to me, and I wanted to trust my body to do what it is designed to do. Luckily, I had two mostly uncomplicated labors and deliveries, and I know that I will always look back on the births of my children as the most amazing, meaningful experiences of my life. I drew on internal resources I did not know I had, and now, many years later, I tap into those resources in times of challenge, knowing they exist.
It often feels risky to tell this story of fulfillment and good luck in giving birth, because I know this is a sore subject for so many. My hesitation seems to be a form of survivor guilt, similar to what people feel when they emerge alive from an accident or battle zone that killed others. Many women intend to give birth without medical interventions—and they deserve that experience every bit as much as I deserved it—but for various reasons, they end up with epidurals, Pitocin, episiotomies, and/or caesareans. Often, the hope for a specific scenario of childbirth is a mighty one, cultivated over the nine months of pregnancy and held very dear. When that hope is dashed, the sadness and anger women feel can run very deep. Those feelings are obviously valid, but because they stand in such contrast to how women are “supposed” to feel when they have a healthy, brand-new baby, they very often become a source of confusion and shame.
When Natalie began therapy with me after a very difficult birth, we spent most of our first several sessions processing her feelings about her unplanned, unwanted C-section. She needed to tell me her birth story many times, often pu
tting its details under a microscope, identifying all the places where a different decision might have meant a vaginal birth. She cried as she told and retold the story. Natalie was actively mourning the birth experience she had imagined and did not get. This made sense to me, and I was glad that coming to therapy to talk about it was helpful for her. Natalie’s caesarean was six months prior to her first therapy session, but for her, it still felt fresh. It was an open wound, despite the time—and all the practical challenges of her baby’s first six months of life—that had elapsed. I came to understand that Natalie had kept the wound under wraps, hidden from view, until she came to see me. It was as if, once inside my office, she unraveled the bandages and said, “See, here it is, and it has not healed at all since I wrapped it up.”
Everyone heals on a different timetable, of course, but I believe one reason Natalie’s pain was still so raw was because she had never been able to express it fully. Natalie’s mother, mother-in-law, sister, and friends—all with good intentions, I’m certain—hushed her anytime she tried to talk about her horrible experience of childbirth. They all directed her attention to the thriving baby in her arms and told her to focus on that instead. But Natalie had a whole host of very strong, understandably negative feelings about how that thriving baby made his entrance into the world. She was angry at the medical professionals involved in her birth, and she was angry at her husband for not having been a better advocate for the birth they’d both envisioned. She was disappointed in herself for not having more resolve and not asserting her wishes more adamantly when the medical team began to suggest a C-section. She felt bitterly envious of a close friend whose birth experience a few months later was so much smoother. She continued to relive the intense fear she had felt when it seemed the baby was in danger, and she worried that she’d never be able to forget the scary scenes that played in her mind again and again. She hated that her memory of giving birth was so contaminated with fear. And she was also just plain sad about the childbirth experience she did not get to have.
None of those feelings had found a voice, or perhaps more accurately, the voice couldn’t find a compassionate listener other than her husband. And Natalie sensed that even he was growing weary of the topic. He, too, sometimes implied that she should just be happy about having a healthy baby. She’d been very busy in the last six months trying to do just that, like everyone was telling her to do.
Studies show that when babies are born vaginally and without medical intervention, they get the healthiest possible start. Their little bodies, squeezed by contractions, are bathed in oxytocin as they travel through the birth canal, facilitating their ability to bond with those who care for them. When babies are born vaginally and without medical intervention, their mothers also get the healthiest possible start at mothering, and at physically recovering. There are no surgical wounds, no medications to clear from the bloodstream, and an abundance of oxytocin and natural endorphins to shrink the uterus, help with pain tolerance, and promote a sense of emotional well-being and connection to the new baby.1
These are all very good reasons for a great many women to set their sights on a birth experience with as few interventions as possible. Of course, an unmedicated birth is not for everyone, and women can and should be able to choose epidurals or C-sections or other medical procedures to increase comfort and decrease risk. But it is the concept of choice that matters so much, and it is there that things often go awry. After hearing from so many clients and friends about upsetting and traumatic birth experiences, I watched the documentary The Business of Being Born. For those who have not seen this film, it reveals how the practice of defensive medicine negatively impacts the childbirth experience for millions of women in the US. Because I was one of the lucky ones in terms of my own experiences giving birth, my intensely angry response to this film caught me by surprise. I think it came at least in part from knowing, firsthand, how birth could be, how the process can go when there is trust in it for all parties involved (especially the mother) and an absence of bad luck. I know I am not alone in being quite troubled about the culture that has taken shape around childbirth, undermining that crucial sense of trust in the process for so many women.
Despite recent home-birthing and birthing-center trends, the great majority of American children are born in hospitals. Among the many consequences of this is that from a liability standpoint, practitioners who deliver babies practice from a “risk management” position. Childbirth is seen solely as a medical issue during which many things could go wrong, rather than an organic, miraculous act of one human being emerging from another. Within this medical climate, not only are various preventive measures taken that end up directly affecting the course of the birth (for example, the standard practice of continuous fetal monitoring can lead to false indications that the fetus is in distress, which can then lead to an unnecessary decision to perform a caesarean), but also the air of defensive medicine is breathed by the laboring woman. She senses the concern that something may go, or has already gone, wrong. She doubts her body’s capacity to deliver a baby safely into the world. She leaves the hospital feeling robbed of the birth scenario she wanted for herself and for her baby, and if that were not a difficult enough feeling to endure, she may well be blaming herself for it. The sense of perceived failure and inadequacy is very strong for many women whose births do not go as planned, and it can permeate their experience of the early weeks and months of motherhood. Preoccupied by a birth story so counter to what they had hoped and imagined, struggling to accept it and somehow integrate it into their larger life story, they often feel very alone.
Well-intentioned others, like Natalie’s loved ones, tend to say things on the order of, “You have a healthy baby, and that’s all that matters.” Embedded in those words—“that’s all that matters”—is the notion that neither the mother nor her feelings matter. Though no loving spouse or family member would actually make that claim, they often don’t realize what their words imply, and it is within that implication that the pain arises. Caught in a bind between what they actually feel (a complicated mix of happiness about having a healthy baby and unhappiness about how that baby entered the world) and what they believe they should feel (just the happiness part), these women often get derailed in their attempts to validate their own experience. What they need is permission to feel the full range of their emotions. What they get is an implicit message that the value of their emotional and physical well-being pales in comparison to the value of a healthy baby.
A particular kind of damage can be done when one’s partner is the person sending that implicit message. Natalie’s husband had his own traumatic experience in the birthing room as a witness, and so she was fortunate that he could join her at least sometimes in her distress about the memory of their baby’s birth. His empathy for what she had gone through and their shared sense of being shaken by what happened that day in the hospital created a safe haven in which Natalie felt mostly free to speak to her feelings with him, even if elsewhere she did not feel that freedom. Sadly, this was not the case for my client Daniela. Her husband couldn’t understand why Daniela was still upset, two months later, about having a C-section. From his standpoint, the doctor’s declaration that a caesarean was necessary ushered in relief—relief from watching his wife labor for a solid day with little progress, and relief from his worry about their baby’s well-being. Over and over, as he listened to Daniela’s frustration and disappointment about how the birth had gone, he responded with the same refrain. With tenderness in his voice, he said, “Honey, I wish you could let this go. So many people have C-sections. It’s not a big deal.” For Daniela, it absolutely was a big deal, and her husband’s response—though not at all unkind, and spoken with earnest hope that it would help her feel better—left her feeling unsupported.
In a study I conducted, levels of marital distress among new moms were found to be higher in women who had undergone a caesarean than in women who had given birth vaginally.2 This was one of those accidental
research findings; I hadn’t been looking for any such connection, but there it was. The study was correlational, which means that we can only speculate about whether a causal relationship exists, and if so, in which direction. Did the C-section birth contribute to marital problems? Are women with less-fulfilling marriages somehow more likely to end up having a caesarean? Or is there some separate third factor that accounts for the link? We need more research in order to know the answer, but the anecdotal evidence seems to favor the idea that C-section is cause and marital distress is effect. This is not to say that marital distress after birth is caused primarily by a less-than-optimal birth, nor is it true that C-section births automatically and always create tension in a marriage. Rather, my sense is that unplanned and unwanted caesarean births plant seeds of marital tension in a ground already fertile for this kind of tension (and we will look at that fertile ground quite closely in the next couple of chapters). Unexpected birth experiences leave an emotional mark on women, and create an opportunity for (usually) well-meaning husbands to invalidate their wives.
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