Postpartum Mental Health: A Therapist's Perspective
I am here today with Lily Rossman, LMFT. She works mostly with women, specializes in perinatal mental health and fertility issues. She also focuses on healing trauma, using EMDR, EFT (tapping), somatic psychotherapy, mindfulness, meditation, energy healing and other modalities. She has a practice based in Sonoma, CA. Lily believes in using a holistic approach; healing the body, mind and spirit.
Colette: Welcome Lily. Good to see you and glad we are making time to talk about maternal mental health, postpartum depression and anxiety today.
Lily: Good to be there with you Colette.
Colette: How did working with postpartum and pregnancy become your focus as a therapist?
Lily: I’m glad you asked. After I had my kids in Taos, New Mexico, I did training to become a birth doula. With the experience of having my own children, I was really inspired by birth and the life of motherhood. I became a birth doula and after doing that work for a while, I realized there was a much bigger need. In that moment of time, of the birth, support was essential of course. And I could see how these women needed more support in the postpartum period... even many months after the birth...but for most, this area was unknown and unsupported, in this country, at least as far as I have seen.
It really motivated me to go back to school, get my masters degree, and become a therapist. I was very clear from the beginning of that program that this is the work I wanted to be doing...that postpartum was the main focus for me and working with new moms.
Colette: Wow, you were really called to this… and you listened to this calling to serve.
Lily: Yes, really called to it.
Colette: Wonderful. It was so clear to you.
Lily: Yes, it was a deep knowing in my soul… like I was on a mission.
I could really feel the pull and it felt exciting to know what was next and what I needed to do.
Colette: Are there other things from your postpartum period that you draw on when working with mothers or that you have in the back of your mind?
Lily: It was interesting to have my kids at the time of life when I had a big community of friends. We were all having babies at the same time. It was such a blessing to have a community like that. What I noticed with other moms is that they don’t have community-- no potluck dinners, events, or fun... and noticing how many women were struggling alone, in isolation without close friendships with other moms or families.
Colette: I know, it’s sad how isolated we are as a society, culture, in nuclear families, etc.
Lily: Yes and I have a history of depression. I have battled with it on and off in my life .. knowing what I know now, I am really surprised I didn’t have postpartum depression. I can tell now that it is because I had community, and that was everything. My parents lived in the same town too, so they helped every week, not a lot, but it was extra support if needed. It was huge.
Colette: Yeah, and I can relate to that, not as a birthing mother but as someone who lives in community, As you know, I live on land with 8 households It is invaluable the support that has provided me over the years. The human contact… just walking to the mailbox or my car and having a casual conversation. It breaks up the isolation of modern life.
Lily: I’m always looking back in history-- how did we used to live as humans… or in other countries… in some places, postpartum depression isn’t a condition like it is here. We used to live more communally and I think we are unconsciously longing for that...especially with the pandemic. Moms are more isolated than ever before. Even before the pandemic, moms were so eager to see each other in the mom’s group I ran because they are alone every day, all day long with their babies.. And we are meant to be around people much more than this.
Colette: What you are sharing brings up for me how moms that are home all day with their babies feel guilty that they are hungry for that contact and moms who aren’t feel guilty that they aren’t able to be with their babies all day… there’s so much guilt about either being isolated or not accessible enough to their babies. Mom can be so self-critical and hard on themselves. Expecting perfection at a time when that is impossible to achieve.
Lily: Yes, and now there’s guilt about moms and whether they are or are not making money.
In the American isolated life, everything is separate… compartmentalized and moms feel like they can’t do anything with the baby.
When I had my first baby, I was single at the time and baby just came with me everywhere I needed to go… there was no separation between time for the baby and time for me… we did everything together. We went to see music, friends and it felt good to have her building her community too.
Colette: Yes, and it can be a wonderful thing to have the room and privilege to just focus on the baby all day but when you're alone as a parent or a young parent, it’s more integrated because you have to do everything together. It’s less one-sided and the baby is experiencing life with you.
Lily: That’s right. We are just being in life versus separate from or outside it.
Colette: What do you love about working with this population?
Lily: Becoming a mother, you are becoming something new. It’s the biggest transition of your entire life. Dads have a different experience, that is unique to them. Moms are already giving up things as soon as you become pregnant… your body's changing... it tugs on your life force. You have to walk through fire to become a mom, you have scars, it changes you, you are different. Instead of being alone in the suffering of that, because there is suffering -- where is the celebration of it and grief over letting go of the single, maiden self. How do we celebrate the warrior nature of becoming a mother? I love working with mothers because when they give birth, everything changes and then there’s the 4th trimester (whoever coined that phrase was brilliant). It can take up to a year because of who you are and how you saw yourself is now totally transformed. And I love helping women find empowerment and joy in that.
Colette: Beautiful, I love that. What was in my mind here is where is the accompaniment and witness to this transformation? Who midwives the mother into her new self, not just the birth? That’s what you are speaking to and that’s what’s exciting to me too about this work and population. I love the process of becoming a new self.
It also reminds me of this training I did last year where in research looking at brain scans of prenatal and postnatal mothers there is drastic change in the brain. Lots of old neuropathways close up and new ones open. Different areas of the brain become more and less active. It was essentially the neurobiology of ‘mommy brain.’ Mothers are literally transforming, it is not only spiritual and archetypical, maiden to mother, it is physical. It’s all levels.
Lily: It’s very true. I also found for myself as a mother, when you are pregnant, you have that glow, there's magic inside you. Then the magic is outside you. You feel flat, grey, recovering. The focus is on the baby and if you lost a lot of blood in birth, you are grey literally. And all your energy goes outside of yourself to someone else.
It’s such a journey to remember how to tend to and care for yourself. For the moms I work with I say you must take care of yourself first. Put your oxygen mask on first. The importance of well care can’t be underestimated. What I see, so severely, is how depleted moms are after they give birth and it’s not addressed. Other cultures have 40 days of other people feeding you nourishing foods and tending you. And I see in my practice, postpartum mood disorders can be connected to nutritional deficiencies. My new favorite book is called the The Postnatal Depletion Cure. By Dr. Oscar Serrallach.
He acknowledges what I have seen in my experience. I have seen women’s postpartum depression shift by seeing other practitioners who help them address their depletion. A lot of moms I see get a prescription of Zoloft (an antidepressant, that can also help with anxiety) and I’m not judging that because it’s not good to be so anxious or depressed that you can’t take care of yourself or your baby, that causes other issues and needs to be addressed, but Zoloft does not address the root cause, the depletion.
Colette: What you are saying is speaking to something I have been thinking about as I work as a therapist with postpartum anxiety and depression. As you know, I delivered babies for 15 + years and had very few clients who had postpartum depression and anxiety. Very little. I have been wondering, why that is. Some talk about a link between birth trauma and postpartum mental health. There were certainly plenty of women in my practice with hard, traumatic births. Still little postpartum mood disorders. I have wondered if the emotional support offered with home birth midwifery care deceased some of the struggles postpartum. However what you're saying is a different angle on that, as women in my midwifery practice were potentially less depleted afterwards, because I was educating them about protein intake, nutrition, and ensuring they went into their birth as resources as possible, with good iron levels… not to mention making sure they were in bed for at least 2 weeks postpartum and had adequate support, in addition to home visits to check on mom and baby.
Lily: Yes, so important to take care of yourself and have accountability to do so going into birth. Also I have seen people who have a history of eating disorders and addiction, they experience more depletion because their body is depleted from the mom’s past history. Also there’s a lack of care after 6 weeks pp and women are on their own. You might see a pediatrician… but nobody is screening you.
Colette: You are so right that there is such a lack of care postpartum.
Lily: People who do a home birth, like your past clients, part of the agreement is to do radical self-care and take self responsibility. And so these moms are getting set up for success and taking responsibility for their own health and wellness.
Colette: What do you feel that you want your moms to know going into their births and postpartum? How do you like to prepare moms for these transitions?
Lily: Radical self-care and support, across the board. What to eat and where’s your tribe. How do you set that up for after? So many people don’t have that support from their community … it’s sad that people don’t have it. I tell my daughters, that when you have a baby, no matter what, where I live, what I do for work, I am going to take care of you for at least a month after the birth… no matter what. These are the building blocks for your life and your baby’s life. And if you have challenges with depression and anxiety how to build your tool box before the baby comes … and remember you matter. You have to take care of yourself. You must sleep. After a few days with no sleep, things get really hard. Body goes into distress. Things feel critical, like do or die.
Lily: I also like to talk to partners about how urgent the situation can be . I tell them ‘the ship is sinking and you have to do more.’ Even though you are working, you have to come home and work more. Partners have to step it up.
Colette: It’s a full time job but you don’t ever get to clock out. There is that traditional idea of what it is supported to look like— with one partner working and the other tending to the baby and household. It leaves the moms feeling abandoned. Once women go back to work, if they do, it’s the second shift. But partners need to be part of the second shift too. It not only helps the mom but enhances the partner’s bond with the baby. It’s good for the family. And it’s hard to do because everyone’s in survival mode to some degree in those first few months.
Lily: And postpartum moms please quit cleaning the house… take care of yourself, let go of the household tasks.
Colette: I notice moms struggling to let go of their idea of how things should be done. If you want your partner to change more diapers, you have to let them do it… and learn from blow-outs, empty diaper bags, cold baby wipes, crying over-stimulated babies. Partners need room to find their way of taking care of the baby free of critiques. Let others be beginners at learning to care for the baby. This dynamic can stand in the way of getting the support that is so needs.
Lily: That’s right, they need to figure it out and let them bond with the baby while they do it. They will figure it out.
Colette: And how do you see relationships changing after a baby is born?
Lily: I actually think this can be one of the hardest things. Back to this is a 24-7 job… we are all tired and how do we stop arguing over who is more tired and team up. We are the team now and how do we support each other on this team…let go of the struggle. Now the baby gets all the attention, Things change in the relationship. Really, as mom holds the baby, the partner needs to hold the mom. And the partner needs to take care of themselves too. And of course, nurture the relationship. The simple gestures can be what makes it work-- a little hand holding, a smile, saying I’m on the team with you, what can I do to help? Saying I love you or thank you for what you are doing.
It comes down to how people deal with stress in their relationship and in the postpartum period it can become heightened. How to address it before the baby comes. Make a plan and get help. Ask family, friends. If people can’t help ask for contributions to hire help. If this (the pandemic) is how the world is looking right now, we need to find new ways to make support happen for these moms, couples and families.
Colette: Thank you so much for this. I feel like we could talk about this all day long.
Lily: It’s definitely something we are both passionate about. When we think about global maternal health care, we need to think about how caring for women’s mental health postpartum needs to be prioritized. The well-being of families and our futures depend on it.
For more on Lily Rossman and her therapy practice click here.