Newsletter for Providers | April 2018
The Dark Side of Motherhood
When Moms Feel Ambivalent or Regretful About Motherhood

It's not an easy thing to say out loud, even to a therapist. Some moms feel an intense ambivalence, or even outright regret, about becoming a mother. They still love their child immensely, but they can't shake the feeling that they've made a huge mistake in having a baby. The shame these feelings bring up can be monumental. And on rare occasions, the mom may become suicidal.

This month, we delve into what maternal ambivalence or regret looks like, how we as providers can hold space for those intense feelings about the dark side of motherhood, and how we can prevent suicide in the perinatal period. Check out our resource list for more readings on this topic, too.

We always appreciate getting your feedback about our newsletters.
In This Issue

Holding Space for Moms Experiencing Ambivalence or Regret

Preventing Suicide in the Perinatal Period

Resources for Maternal Ambivalence and Regret

Upcoming Events and Trainings
Holding Space for Moms Experiencing Ambivalence or Regret
“I wanted a baby so badly, but now I don’t feel connected to her. This is so hard.”
“My partner and I were in such a great place. Now I’m just angry all the time. What if we ruined our relationship?”
“I love my baby but I feel trapped.”
“Maybe having a baby was a mistake.”
“Every part of my life has changed. I miss my old life.”

These are just some of many stories we hear from new mothers marked by ambivalence and regret. They often say, “I can’t talk about this in the new moms group.” But in our offices, if we can demonstrate that we can hold their experiences without judgment, these women tentatively share the thoughts that have been swirling around in fear, guilt, and hopelessness. In therapy, we decrease shame through normalizing their experience; we highlight the broader sociocultural contexts in which they’re parenting; and we explore the meaning attributed to these feelings and make room for grief and loss. And in this work, women can reflect on and begin to bear these experiences of motherhood.

“How has motherhood been, compared to what you thought it would be like?”

By inviting discussion of the divergence of expectations and reality, we demonstrate that we can tolerate a range of feelings and experiences of motherhood. Messages from partners, grandparents, Instagram, even strangers at the grocery store can morph into one loud proclamation: “You’re supposed to love this baby and this experience of parenting unconditionally.” In contrast, we say, “I know that’s not always the case. What’s it been like for you?”

We can share that we have supported other women struggling with these dark thoughts about motherhood. Acknowledging that having hope feels unattainable in this moment, we hold the hope for them: “Not everyone feels that overwhelming burst of love for their baby at the birth. Some do, but for others, it comes a few weeks or even months later. Not feeling it now doesn’t mean you won’t ever feel it.” Education about early infant development can further normalize a wide range of experiences in the postpartum. The “fourth” trimester framework with a rough timeline for social smiles, increased visual interaction, and reaching and grabbing can illustrate some the reasons why connecting with early newborns can be challenging, as there’s minimal interaction or day-to-day feedback. For women with low maternal self-efficacy, this stage can be especially overwhelming.

When we have the opportunity to work with women with their babies in the therapy office, we can also validate all that they are doing with and for their babies. For the women with difficulty bonding, we can support them in learning how to “be with” their babies and identify how those actions form the foundation of a secure attachment; this communicates that they can meet their babies’ needs enough of the time even while they are wrestling with the connection.

“Our society does not have enough policies that support new families.”

Ambivalence can arise no matter how challenging or how easy the tasks of parenting are for a mother; however, sociocultural stressors magnify the negative thoughts. When childcare is a scarce and expensive resource, social support is limited, or there is work pressure around length of leave, schedule, or role, looking back at life pre-baby longingly is understandable. We must also address experiences of discrimination within or barriers to health care; the challenges military families face; and the effects of racism, homophobia, or other oppressions. If systemic forces are working against a new mom, acknowledging that challenges are not “all in her head” is vital. We can encourage the new mother to connect with others who may have also experienced these challenges or injustices. Perinatal Support of Washington support groups are a good place to start.

“What’s the narrative you’re creating?”

Identifying the interpretations a woman is making about her feelings of ambivalence or regret can be helpful. With the woman who states, “I love my baby, but if I could go back, I wouldn’t have a baby again. What kind of mother says that?” we can use interventions from cognitive behavioral therapy. We can explore her beliefs about “good” mothers and her self-evaluation. We can support her in the process of identifying cognitive distortions, evaluating the beliefs with nonjudgmental curiosity and developing a reframe like “Even if I feel suffocated by the responsibilities of motherhood right now, I know that I love my baby, am doing a good enough job, and will be able to find a piece of myself again.”

Introducing dialectical behavioral therapy’s wise mind – the integration of reasonable and emotional mind – can also help illustrate that it’s possible to hold the juxtaposition of “I love my baby” and “I miss my old life.” By creating the space for those experiences in the therapy room, women can practice holding the both/and. We invite reflection about what she has lost in the experiences of pregnancy, birth, and parenting and what she has gained. We then support women in crafting and integrating a narrative of motherhood that allows for grief.

Finding maternal resilience

New mothers with ambivalence or regret often come to therapy with feelings of shame and despair. In therapy we make space for these “difficult” feelings, create context for some of the challenges of parenting, normalize the experience, and cultivate hope. We demonstrate a nonjudgmental acceptance of a range of maternal experiences and help her tolerate her own responses to motherhood. We also work on change by restructuring beliefs about motherhood, encouraging connection with others, or considering taking action for better policies that support women and families.

In their research from a two-year psychoanalytic group with mothers, psychotherapists Lisa Baraitser and Amélie Noack concluded that “maternal resilience can have a chance to develop not only when a space is made available for the exploration of ambivalent feelings towards our children, but when we focus on the strain mothers endure in managing the experience and meaning of ambivalence on a daily basis” (Baraitser and Noack, 2007)

As all of us – in any role we have working with pregnant and postpartum women – make space for a range of experiences of motherhood, including ambivalence and regret, we can support women in enduring those feelings, we can help them develop resilience, and we can work against the stigma that women face.

Baraitser, L., & Noack, A. (2007). Mother courage: Reflections on maternal resilience.  British journal of psychotherapy 23 (2), 171-188.

Laurie Ganberg, LICSW, CLC, is a clinical social worker who specializes in supporting women in pregnancy and early parenthood. She currently provides outpatient therapy and works in the Day Program, a perinatal mental health partial hospitalization program, at the Center for Perinatal Bonding and Support at Swedish. 
Preventing Suicide in the Perinatal Period
“Any thread of sanity I was still holding onto disappeared. I snatched the block, and without thinking, threw it back at my son. I watched in horror as it hit him in the head. . . . He erupted into sobs and the tension broke. I pulled my little boy to my chest and apologized over and over again while internally berating myself for being a horrible mother. I didn’t deserve this child. I didn’t deserve any children. I was the worst mom ever born. No other mother would ever have behaved as badly as I had—rinse and repeat.”*

These are the moments that can bring deep shame and despair to new mothers. Unless mothers are extremely brave (like Christine Walker, who wrote the words above), they rarely share these toughest moments, feeling too embarrassed to let others know who they “really are.” And yet these scenes, some a little more intense than others, happen not infrequently, when new moms are under extreme stress and struggling with depression and anxiety.

At their most extreme, these incidents, followed by harsh self-talk and judgment, can lead to thoughts (or even acts) of suicide. Other times, a deep malaise sets in, the mother convinced that she’s made a huge mistake or that she isn’t fit for motherhood. Complicating the picture, even the mom doing fairly well, with normal insecurities and apprehensions, can at times question her ability and worthiness to mother her child.

All mothers are vulnerable to feeling like bad mothers. The reality of motherhood rarely matches the fairy tale images we see on greeting cards or in story books. Mothers rarely realize beforehand that they will miss their freedom. They think only of the bliss and pure mother love that never fatigues, never resents, and always knows instinctively what to do. Then reality hits.

How can a provider distinguish new mom insecurity from something more serious? How do we know when we should worry about perinatal suicide? The mother who is in trouble does not feel relieved by ordinary reassurances. Complicating the picture, many mothers do not share with their provider (or will even deny when directly asked) that they are having these dark thoughts and feelings. A good question to ask is, “How bad do you really feel?”** This question presupposes that the mother is struggling, with the task then becoming to figure out the degree of struggle. Another technique is to take the time to really talk to the mother, normalizing that many mothers have these thoughts, giving the mother the space and safety to share what often feels like the “unshareable”. Of course, any positive affirmation for suicide (even a mild one) on a depression screening including the Edinburgh should be taken seriously and discussed thoroughly.

Paying attention to the client’s presentation also matters. Sometimes, the mother will present as disheveled. This could be depression but it could also be sleep deprivation and lack of self-care. Sometimes an impeccable presentation is actually more cause for concern as the mother may be hiding behind her perfect appearance. A flat, lifeless presentation or one with confusion and strange thoughts should be taken very seriously and queried for suicidality. A history of mental illness and being pregnant, versus in the postpartum period, also puts a mother more at risk for suicide.***

Any admission of thoughts of wanting to escape and/or having made a mistake in becoming a mother should be thoroughly investigated. Questions to a mother about her dark thoughts will never put suicidal thoughts in her head, and just may save her life.


*Walker, C. When You’re a Mother Contemplating Suicide. Retrieved from http://www.scarymommy.com/mother-contemplating-suicide/.
** Wenzel, A and K. Kleiman . (2011) Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood. New York, NY: Routledge.
***Orsolini, L. et al, (July 2016) Suicide during Perinatal Period: Epidemiology, Risk Factor and Clinical Correlates. Front Psychiatry.


Terri Buysse is a clinical psychologist with a private psychotherapy practice in Edmonds and Everett, Washington. She specializes in perinatal, parenting, and trauma work. She is one of the facilitators for Little Sprouts, a new mothers' support group in Mountlake Terrace, and is a member of Perinatal Support Washington.
Resources for Maternal Ambivalence and Regret
For Providers

By Barbara Almond

Mixed feelings about motherhood—uncertainty over having a child, fears of pregnancy and childbirth, or negative thoughts about one’s own children—are not just hard to discuss, they are a powerful social taboo. Barbara Almond brings this troubling issue to light. She uncovers the roots of ambivalence, tells how it manifests in lives of women and their children, and describes a spectrum of maternal behavior—from normal feelings to highly disturbed mothering. In a society where perfection in parenting is the unattainable ideal, this compassionate book also shows how women can affect positive change in their lives.

By Rozsika Parker

Many a loving mother has had fleeting feelings of hatred toward her children--the desire to hurl a howling baby out the window or to lock a teenager out of the house. Rozsika Parker argues that these ambivalent feelings not only are common but can actually have a creative impact on mothering.

Mother Love/Mother Hate illustrates how a mother's desire for devotion coexists with the impulse to hurt and desert. Parents will find Parker's insight into the conflicts that beset them illuminating and deeply reassuring. Reversing the conventional psychoanalytic approach, in which maternal ambivalence has been understood chiefly from the point of view of the child, this book gives precedence to the mother's perspective. Drawing on interviews with mothers, clinical material from her practice as a psychoanalytic psychotherapist, and a wide range of psychoanalytic and literary sources (including Virginia Woolf, Anne Tyler, Simone de Beauvoir, D. W. Winnicott, Melanie Klein, and John Bowlby), Parker explores experiences of maternal ambivalence in a culture painfully and profoundly uneasy about its very existence.

by Rozsika Parker

More and more women confess uneasily to finding motherhood as much a source of pain as pleasure. Rozsika Parker presents a new understanding of maternal ambivalence, suggesting that the coexistence of love and hate can stimulate and sharpen a mother's awareness of what is going on between her and her child. Drawing on interviews, clinical material from her practice as a psychoanalytic psychotherapist and a range of literary sources, Torn in Two is original and accessible. With new readings of the work of Klein, Winnicott, Bowlby and others, this book offers invaluable--and often reassuring--insight into the conflicts confronting women at every stage of motherhood.


For Providers to Recommend to Clients

By Harriet Lerner

Written from her dual perspective as a psychologist and a mother, Lerner brings us deeply personal tales that run the gamut from the hilarious to the heart-wrenching. From birth or adoption to the empty nest, The Mother Dance teaches the basic lessons of motherhood: that we are not in control of what happens to our children, that most of what we worry about doesn't happen, and that our children will love us with all our imperfections if we can do the same for them. Here is a gloriously witty and moving book about what it means to dance the mother dance.
Upcoming Events and Trainings
Climb Out of the Darkness is Saturday, June 23, 10am-1pm, Maple Leaf Park, Seattle. Join us as we walk the loop around the park's paved trail to celebrate and raise awareness about perinatal mood and anxiety disorders. This is a great event for your families to celebrate their recovery, and for current clients to see other "survivors" and get more information about local resources. It's also one of the ways PS-WA fundraises. Click HERE for more info, and click HERE to sign up and sign a waiver (no fundraising necessary!).


Birth Trauma training, Monday, May 7. There are a few spots left for our one-day Seattle training. Register today!

SAVE THE DATE for PS-WA's 2019 conference on trauma during the perinatal period. "Trauma and Birth: Multidisciplinary Approaches to Prevention and Healing," March 28-30, 2019, at the Seattle Marriott Waterfront. This regional conference will bring together professionals from all professions in the perinatal health field to learn about the impact of trauma before birth, during birth, and after. Stay in touch for our request for proposals to present your work. We welcome researchers, providers, and community organizations that are doing innovative work in this field.
Seeking Newsletter Contributors!
Would you like to write for our newsletter? We're always looking for new voices to highlight. You can write once or regularly. We publish both provider-focused and family-focused newsletters. Some of our upcoming topics include: Sex and relationships after baby; birth trauma; PTSD; infertility. Contact us today to join us!
Call Our Warm Line for Support!
1-888-404-7763
Perinatal Support Washington has a toll[-free support line for new parents. Leave a message, and a trained volunteer will return your call within 24 hours. The line is staffed by a parent who has experienced a perinatal mood and/or anxiety disorder and has recovered fully, or a licensed therapist with specialized training in perinatal mental health.

We provide warm, understanding, effective, and private support, as well as professional referrals to providers who can help. We also provide details about community support groups and resources and information in the community and online.

FOR DADS- Would it feel more comfortable to talk with a dad who has been through his own perinatal mood or anxiety disorder, or has supported a partner who has? Call our warm line and ask to talk with a dad.
Giving To Perinatal Support Washington
EMPLOYEE GIVING
Are you a Microsoft or King County employee or spouse of one? Please consider supporting us through your respective workplace giving programs. For King County employees, our code is 9187. Our tax ID is 91-1448669. If you are looking for us, be sure to check our old and new name (old name: Perinatal Support International of Washington).
WARMLINE: 1-888-404-7763 (PPMD)

Support, Education, Referral
Perinatal Support Washington | perinatalsupport.org
(formerly Postpartum Support International of Washington)