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Postpartum Depression: Diagnosis and Treatment
Postpartum Depression: Diagnosis and Treatment

Section 2
Transition to Motherhood

CEU Question 2 | CEU Test | Table of Contents | Depression
Psychology CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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In the last section, we discussed symptoms and factors related to postpartum or postnatal depression.  These included characteristics, predispositions, emotional causes, external factors and consequences for the family.

In this section, we will discuss when a woman becomes a mother.  This will include a feeling of suffocation, everything revolving around the baby, making motherhood the only source of fulfillment and the "icing on the cake" technique.

As you may know, the arrival of a baby, especially the first, can transform the relationship between a couple.  Now there are three people that must share love, time, and energy.  The exclusive nature of the couple’s relationship comes to an end.  This realization can be overwhelming

In addition, if the parents are tired, they may be more irritable and find themselves arguing more frequently.  New conflicts can arise regarding matters that both partners thought resolved, especially regarding values and important decisions such as education and religion.  It is therefore not surprising to find that many women claim to be less satisfied with their relationship after the birth of a child.

A new mother’s feelings toward her partner can be as varied as her feelings toward her baby, and they are not always positive.  Frustration is quite common, usually due to unrealistic expectations.  A number of negative reactions are normal.

3 Effects of Becoming a Mother

♦ #1 A Feeling of Suffocation
First, let’s discuss a feeling of suffocation.  Suddenly a childless couple who were seemingly wonderfully free and spontaneous now feel the constraints and responsibilities of parenthood.  Even stable partner relationships, now reinforced by the baby’s arrival, may seem suffocating. 

Because the new mother is now feeling vulnerable, she may become uncommonly demanding, testing her partner’s ability to be a "good father."  Alone at home all day with the baby, far from the professional activities that may have given her a sense of individual identity, the mother may find herself dependent on the father for a breath of fresh, stimulating air from the outside world.  But if the father feels detached from what is going on at home, while the mother is centered solely on her infant, the disparity between these two lives can cause tension within the couple.

Many women who had a stimulating professional life before becoming mothers are afraid of losing touch with the outside world, or of becoming "boring" by staying cooped up at home with a baby.  Some 90% of couples surveyed go out less after the birth of a child.  Have you found, as I have, that this lack of outside recreational activity can quickly become constraining and frustrating for both the mother and the father?

♦ #2 Everything Revolving Around the Baby
Second, let’s discuss the feeling that everything revolves around the baby.  Having children satisfies a basic need for many women.  But all women also need adult relationships.  A child will never replace the man, the partner, and the husband.  However, in situations where the woman feels misunderstood and undervalued, having a baby can be a way of asserting herself, of claiming an identity.  The reasons for this are complex and often result from the mother’s own childhood experiences.

Many women experience a decrease in sexual appetite after giving birth.  This diminished urge can sometimes last for as long as two years.  I have found that there is a pervasive myth that a child will fulfill a woman completely.  In reality, however, many women are not entirely satisfied with their new "relationship."  Indeed, one aspect of a woman’s femininity may be the fact that she is sexually desired by a man.

♦ #3 Making Motherhood the Only Source of Fulfillment
Third, in addition to a feeling of suffocation and the feeling that everything revolves around the baby, let’s discuss making motherhood the only source of fulfillment.  Some mothers go out of their way to point out their partner’s faults and clumsiness in handling the baby so as to reinforce their role as primary caregiver.   

Likewise, some men prefer to delegate all tasks concerning children to the mother, possibly as their father did with their own mother.  New mothers often have the impression that their husband or partner idealizes their maternal capabilities, a way of justifying their noninvolvement with the child.  Thus, a woman’s fears, fatigue, and uncertainties may go unnoticed.  The woman may become resentful. 

Bethany and Guy, both 26, were new parents who started coming to me after Bethany experienced postpartum depression.  In an individual session, Guy stated to me, "I don’t know what Bethany expects of me!  She has become completely mysterious.  She’s always telling me how I’ve changed the baby’s diaper wrong or criticizing me for not recognizing which cry means what!"  Guy thought that his wife instinctively knew what to do, while in reality, she was feeling as lost as he was.

In an individual session with Bethany I stated, "You may want to keep in mind that Guy will not always guess your needs, especially if you are ashamed of your own doubts." 

♦ Technique: Icing on the Cake
Since Bethany had expressed to me a desire for Guy to apologize more often, I suggested that she try the "Icing on the Cake" Technique.  I stated to Bethany, "Try asking for what you want, and be specific.  You might start out by saying, ‘I’d like you to apologize.  It’s important to me.’  Of course, knowing what kind of an outcome you want, what’s most important to you, and what’s realistic is not always easy." 

I explained that the wishful thinking part, the "It would be nice if he’d say…" part gets in the way.  I call this "the principle of cake and icing."  I stated, "The cake is the solid part, the act of clearly stating how Guy may have wronged you.  Eliciting an apology is like the icing, and it may not always be realistic to expect.  You may never get an apology from Guy for certain things." 

Bethany stated, "Maybe I can do without the icing…but I would at least like some ‘glaze.’"  I asked, "What about when you’re on the other side, when you may have hurt Guy’s feelings and it becomes your turn to make the apology?"  Bethany asked, "Well, what if I feel so strongly about something that I don’t want to apologize to Guy?"  I stated, "You might consider saying that you’re sorry that the situation occurred, or sorry that you hurt his feelings, even if you’re not sorry for what you actually said."

In this section, we have discussed when a woman becomes a mother.  This has included a feeling of suffocation, everything revolving around the baby, making motherhood the only source of fulfillment and misunderstanding the new father’s experience.  Would playing this section be beneficial during you next session with a client you are currently treating?

In the next section, we will discuss when a man becomes a father.  This will include mixed feelings, misunderstood reactions, the "easing the father’s fears" technique and a father’s two roles.

Peer-Reviewed Journal Article References:
Davis, J. L., & Manago, B. (2016). Motherhood and associative moral stigma: The moral double bind. Stigma and Health, 1(2), 72–86. 

Kudinova, A. Y., Woody, M. L., James, K. M., Burkhouse, K. L., Feurer, C., Foster, C. E., & Gibb, B. E. (2019). Maternal major depression and synchrony of facial affect during mother-child interactions. Journal of Abnormal Psychology, 128(4), 284–294. 

Lafarge, C., Usher, L., Mitchell, K., & Fox, P. (2020). The role of rumination in adjusting to termination of pregnancy for fetal abnormality: Rumination as a predictor and mediator of posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), 101–109.

van Scheppingen, M. A., Denissen, J. J. A., Chung, J. M., Tambs, K., & Bleidorn, W. (2018). Self-esteem and relationship satisfaction during the transition to motherhood. Journal of Personality and Social Psychology, 114(6), 973–991. 

Online Continuing Education QUESTION 2
What are five feelings and attitudes that are often experienced when a woman becomes a mother? To select and enter your answer go to CEU Test.

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