Karen Kleiman

When I knocked on their doors in the late 80s, some medical providers listened to me, but most thought they knew everything they needed to know about postpartum depression and anxiety. They believed symptoms of perinatal distress landed on two ends of the spectrum. Either women had severe symptoms, were unable to care for their children, and were possibly at risk of harming themselves or their babies, or every new mother who presented with symptoms of overwhelming anxiety and tearfulness pretty much characterized our culture’s antiquated expectation that “all new mothers feel this way.” Very few health care providers took the time to learn that there was something deeper going on with new moms’ mental health. Women who risked expressing their fears and vulnerabilities were often met with patronizing hyperboles, or in rare instances, they were shocked to discover that Child Services was called to protect their baby from the perils of misinterpreted maternal emotions. Afraid they would be misunderstood, overreacted to, or underreacted to, many new moms learned to stop telling their providers how they were really feeling. Continuing my pursuit for information and answers, I directed my attention to the moms themselves. I encouraged them to talk to me. I said, “Tell me what you are feeling, what you need, what might help you feel better.” They told me they were scared. They told me they never expected being a mother would feel this way. They told me they were terrified no one would understand some of the thoughts and emotions they were having and they would be judged to be a bad mother, or worse, their baby would be taken away. They told me they loved their babies more than anything in the world and they did not believe they were good moms. They told me they never felt this bad in their entire life. They told me no one was listening. So I listened. And I went back to knocking on doors. Today, more people are listening — but not enough. While there is momentum in the right direction, distress cries still go unnoticed and are often dismissed as par for the course for new motherhood. Perinatal distress pierces the hearts of new mothers, and until our culture takes this seriously, women and babies will continue to die. At least 1 out of every 7 women walking into OBGYN offices experiences clinical depression. This is not the blues, an adjustment disorder, or the transition to motherhood. We are talking about serious symptoms t hat meet diagnostic criteria for a mood or anxiety disorder. You cannot tell a mother has a postpartum disorder by looking at her. You cannot assume if she looks “good” or says what you expect to hear that she is fine. If you do not ask the right questions, you have no idea if she is thinking of killing herself or not. We cannot afford not to listen to new moms. And now more than ever, many new moms are incomprehensibly overworked, overtired, and near their breaking points. In today’s uncertain climate with unprecedented stressors and expectations, our mission to protect the mental health of new moms and dads is more imperative than ever. We must ask the hard questions. We must not judge. We must create a safe environment that enables new parents to trust us. We must listen. We must respond with concrete resources and support. After all, these parents are raising the children who are our future. They should not be doing that alone. Karen Kleiman is an author, an advocate, and the Founding Director of The Postpartum Stress Center, LLC.

You’ve recently had a baby. You are more than three weeks postpartum . You do not like the way you are feeling. You wonder if you are too anxious or too depressed. Your family, friends and health care provider have tried to reassure you, but you wonder if they really understand how bad you feel. You worry that this is what being a mother feels like and you might never feel better. Here’s what you should do. 1. Ask for help. Any feelings of depression and anxiety that interfere with your ability to function are not OK right now. Tell those closest to you that you are worried about the way you are feeling. If you know what they can do to help, ask them. If you are not sure, tell them you are not sure, but you need their help regardless. Then, let them help you. No one is asking that you diagnose yourself. If you are not sure what is going on, you should err on the side of “be cautious and healthy” by letting someone you trust know how you feel. 2. Contact your doctor or health care provider. Be specific and clear about how you are feeling so you can discuss options. If you feel dismissed or misunderstood, make the effort to clarify and reiterate. 3. Do your best to locate a therapist. This should be a therapist who specializes in the treatment of postpartum depression and anxiety . You can find one  here . Or,  here. Call one or two or three therapists and talk to them directly. See how that feels. Do not let feelings of guilt or anxiety get in the way of reaching out for the support that you need right now. Therapists who are trained to treat postpartum depression and anxiety understand how difficult this first phone contact can be. Take the risk and let someone help you. You do not have to go through this alone. If you cannot find a specialist in your area, call one of the perinatal specialists listed and talk to them about finding someone closer to you. They will help you do this. 4. Take your partner with you. When you make your first appointment, ask your partner to accompany if that feels better for you. Most therapists will welcome that and it is highly probable that you can bring your baby to that session, also. Your family is an vital part of your healing process. 5. Stay off of the internet until you get some relief from your symptoms. While there may be numerous outlets for support available online, you will inadvertently be exposing yourself to random and unpredictable anxiety -provoking, shame-inducing triggers. Social media, in particular, can be both incredibly supportive and unexpectedly provocative. It is best for you to protect yourself from all possible triggers for a while. 6. Practice acceptance. Accept the fact that you are not feeling good right now and that it will not always feel this way. Self-compassion will help you feel better faster and better than blaming yourself or beating yourself up. Do the best you can and be kind to yourself. 7. Take care of your physical self. Rest when you can. Eat nutritiously. Avoid substances that you may rely on for self-soothing that can make you feel worse, such as alcohol. Try to get out in the sunshine and walk. Breathe. 8. Avoid all triggers that make you feel worse. That includes people who are unsupportive, and events or obligations that increase your anxiety . Self-compassion is essential. Pay attention to what you need and do your best to express this to your partner and helping professionals. Surround yourself with people and things that make you feel safe and supported. 9. Do not stop until you find the right help. This means you should feel comfortable with the support you are getting. This means your health care provider, your therapist, your support group, your medication and your adjunctive recovery team must all be appropriately responsive to your needs and it is important that you continue to communicate with those caring for you. If the level of caring you receive feels insufficient or inauthentic, you can decide to either let someone know how this feels, or find an alternative professional or additional treatment. 10. You do not need to suffer. Not even a little bit. There are more and more health care professionals who understand that new mothers are at risk for serious postpartum disorders. Help is out there. Do what you need to do to help yourself get the help you need and deserve. You will feel like yourself again.

I was stunned and embarrassingly heartbroken when I posed the ridiculous question to my well-informed virtual group of over-worked psychotherapists: “As long as we are discussing self-care strategies during these unprecedented times, just curious… how many of you are watching Outlander?” Silence. I was shocked. ( Perhaps their computer audio was not working. Was I muted?) I double-checked, then repeated my question: “Anyone watching Outlander?” Nothing. I’m pretty sure my eyes popped open as I froze on the spot, equally dumbfounded and mortified. In an instant I had shifted from my role as a well-respected and accomplished mentor to a shallow-minded, Netflix groupie hooked on a romantic drama and soft-porn. The echoes of joy and giggles I predicted were replaced by blank stares. Why would I ask such a ludicrous question in an academic setting? I promptly did what I always remind the group to do when caught off-guard in session — I breathed through my nose. Slowly. In and out. And I smiled. I realized I wouldn’t convince any of them to watch it, and why should I? Surely they have each discovered self-care routines that can help ease the distress imposed upon them by the pandemic, universal unrest and the growing list of external stressors. Together, this awesome group of clinicians and I spend one hour a week, sitting in the muck of this challenging territory, fueled by our collective quest for meaning. The recent months have inflicted extraordinary pressure on this group, as psychotherapists, as women and as mothers. But back to Outlander. Jamie Fraser is not my type. This feels awkward to write at the ripe age of 66, but honestly, he’s not. By objective standards, he is extremely attractive with God-like proportions. Still, as an old hippie with an affinity for the more earthy, unpretentious type, I frankly didn’t expect to get sucked into this world of time travel, rousing rebellions and 18th century melodrama. Until Jamie looked me in the eyes. OK, so it wasn’t me. But it felt like me. I wanted it to be me. I remember one scene, when Claire was telling him the truth of who she was — a story so far-fetched that even the most trusting soul surely would respond with a healthy dose of skepticism — after which she returned his attentive gaze by asking something like, “do you believe me?” “Aye.” He softly replied with conviction and gorgeous Scottish simplicity. His piercing gaze was loving and steadfast. I turned to my precious husband of almost 40 years and asked with a smirk, “Is that so hard?” One of the tenets we emphasize in the world of psychotherapy, particularly in the new world of virtual psychotherapy, is the importance of eye contact. Of staying connected. Of conveying the message that we are staying present and listening. Really listening. Notably, there are many levels of eye-contact, ranging from “I-am-pretending-to-listen-and-I’m-really-thinking-about-something-else” eye contact, to “There-is-no-place-I’d-rather-be-right-now-than-listening-to-you” kind of eye contact. The closer two people get to that second end of the spectrum, the closer they get to magic. In our current state of rampant uncertainty, pervasive anxiety and widespread grief, many of us crave constancy and the affirmation of our self. As psychotherapists, who by definition must restrain from expressing our personal needs when we work to stay focused and available during any current crisis, it’s easy to feel unheard in our own relationships. Even the best of partnerships cannot tolerate constant, unremitting demands for unwavering attention and concentration. ( Believe me, I have tried.) And eye contact? Well, life gets in the way and we are all way too busy. Dogs, cell phones, work, priorities, pandemics and so forth. It’s absurd to even ask for it given the state of worldwide suffering. And yes, I get it. On balance, we are talking about real-life here, not historical fantasies streaming in the background. Even so, the desire to feel heard and acknowledged is a universal human need and perhaps one of our deepest longings. When we manage to lock in that sacred moment of connection, as fleeting as it may be, it feels gloriously indulgent. I matter. What I am feeling matters. Not to be confused with seeking confirmation from others to secure one’s own self-esteem, the hope that one will be heard is a legitimate expectation of healthy, intimate relationships. The end result is less important than the process itself. In other words, when efforts are made, when phones are put down, when eye contact takes place, when interest and attention is offered, partners move from listening, toward empathy. Within the context of meaningful relationships, that is magic. We are all trying to do our best. Those of us who feel fortunate in the midst of so much global chaos, most certainly can, and must, settle for unexpected relational disconnects. Still, we must remember not to take our relationships for granted while we are busy worrying about everything else. We must learn how to ask for what we need and do our best to listen. Let’s remember to take care of each other while we take care of the world around us. Let’s remember how good it feels to stay present if we are lucky enough to be in a relationship that feels safe and cozy to us. And during those off times when we might want or need a little bit more, because we are exhausted, or scared, or weary … There is Jamie.

What if I get sick and can’t take care of my baby? What if my baby gets sick? What if my partner gets sick? How do I do this all alone? Being a new mother is hard. Being a new mother during a pandemic is almost unimaginable. One of the things we have learned — thanks to increased awareness and the circulation of good, accurate information about maternal mental health — is scary, negative intrusive thoughts about harm coming to the baby are a stressful but common expression of normal anxiety. Almost every single new mother and most new fathers experience the presence of scary thoughts that can range from mildly annoying to excruciatingly painful and debilitating. It may be hard to distinguish between “normal scary thoughts” and those triggered by the current extraordinary stressors associated with sheltering in, isolation, quarantining, social distancing and all the other mandates that are imposing gut-wrenching restrictions. It stands to reason new mothers today are bombarded on a moment-to-moment basis with negative thoughts that may feel out of control, never-ending and often shame-inducing. After all, we often hear, “How can a good mother think these thoughts?” But good mothers do have these scary thoughts. Awful thoughts. Terrifying thoughts. Indescribable and unfathomable thoughts. And if these moms do not find the support and validation they need, the thoughts can swirl around in their heads, gaining momentum from the fear. Anxiety is at an all-time high right now, for good reason. It’s scary outside and some new moms understandably feel out of control with anxiety. When the anxiety emerges within the context of having a new baby, it often manifests as specific thoughts about something horrible happening to the baby. By accident, or by intent. The guilt and worry can be excruciating. Information and knowledge about the nature of these scary thoughts can empower women and help them feel more in control. New moms need to know: 1. Scary thoughts are a very common symptom of postpartum depression and anxiety, but can also be present in the absence of a clinical depression and anxiety. 2. Scary thoughts are negative, repetitive, unwanted, intrusive thoughts that can bombard you at any time. They can come out of nowhere. 3. Scary thoughts can range from mild to unbearable. 4. Scary thoughts can come in the form of thoughts (“What if I burn the baby in the bathtub?”) or images (picturing the baby falling off the changing table). 5. Scary thoughts can be indirect or passive (something might happen to the baby) or they can imply intention (thoughts or images of you throwing the baby against the wall). 6. Scary thoughts are not indication of psychosis. 7. Scary thoughts can be part of a postpartum obsessive-compulsive disorder (OCD) diagnosis or they may occur in the absence of a full-blown diagnosis. 8. If you have a history of OCD or tend to be a worrier or describe yourself as overly analytical or a perfectionist, you may be at increased risk to experience this symptom. Then again, you may have no history of any anxiety symptoms. 9. Scary thoughts will often make you feel like you’re a “bad mother.” They can make you feel guilty and ashamed. Try not to beat yourself up about this. You are not your thoughts. Remind yourself it is a symptom. It is not who you are. Helpful Resources New moms tell us they feel enormous relief when they hear other moms experience these thoughts, too. This is why The Postpartum Stress Center (PPSC) launched the #speakthesecret campaign a few years ago and created a forum in which moms can anonymously submit their scary thoughts. Women report they feel extremely supported by this and their anxiety reduces when they begin to understand this is a common and normal response to anxiety and overwhelming distress. On the PPSC Instagram account (@postpartumstress), these #speakthesecret submissions are posted with comic faces depicted by artist Molly McIntyre who illustrated Karen Kleiman’s newest book GOOD MOMS Have Scary Thoughts. This book is helpful resource for moms to find support for their scary thoughts as portrayed through relatable characters, speaking those very thoughts. During this time of constant uncertainty, new moms need this support to help manage the pervasive anxiety that is invading their precious space. Knowledge is indeed empowering. Additional tips for managing anxiety 1. Understand that the anxiety will not hurt you and the discomfort is temporary. 2. Accept there will be extraordinary levels of anxiety right now. 3. These thoughts are not associated with any action being taken. Having a scary thought, no matter how scary, does not increase the risk of harm coming to your baby. 4. Try to rely on strategies that have helped you in the past. 5. Let someone you trust know how you feel and what you are thinking. It will help diminish the power the thoughts hold over you. 6. Remember you are not your thoughts. These are symptoms. They are not about who you are. 7. Distract your brain. It really works! Books Coloring books Music Dance Art Walk Drink water / eat something Shower/bath Phone call Sit in the sunshine Breathe deeply/slowly TV/movies Phone games Pets Puzzles 8. If you feel your distress is too high and you are unable to get through the day, let your health care provider know how you are feeling. 9. Therapists who specialize in perinatal mental health can provide amazing support through teletherapy during this uncertain time. If you need help finding someone who is trained, contact Postpartum Support International or The Postpartum Stress Center. Struggling with your mental health due to COVID-19? You’re not alone. Check out the following articles from our community: 6 Tips If You’re Anxious About Being Unable to Go to Therapy Because of COVID-19 7 Things to Do If Social Distancing Is Triggering Your Depression What to Do If the Coronavirus Health Guidelines Are Triggering Your Anxiety or OCD How Can You Tell the Difference Between Anxiety and COVID-19 Symptoms? Feeling Calm in the Midst of the Coronavirus Pandemic Might Be a Trauma Response

The awesome responsibility of caring for a newborn naturally warrants a heightened sense of vigilance. Sometimes this necessary state of watchfulness can be confusing. At every turn, a new mother believes a crisis is looming. Afraid of slipping and dropping the baby, she holds him extra tightly while she goes down the stairs. Afraid of a disaster in the night, she keeps herself awake to hear the silent sounds of breathing. If she falls asleep from sheer fatigue, she dreams of causing the baby harm through her own negligence. — “Dropping the Baby and Other Scary Thoughts” by Karen Kleiman and Amy Wenzel No one talks about the negative thoughts new mothers have after they have a baby. Not healthcare providers. Not mothers. Not family members. It is making postpartum women sick. Even though there is increased attention to pregnancy and postpartum mental health, we remain stunned to hear that sometimes, a mother doesn’t feel so great about being a mother. There are times when it is just plain hard and exhausting. Sometimes, it’s terrifying. If a postpartum woman experiences  anxiety after the birth of her baby, it can manifest in many ways. It can make her doubt the choices she makes. It can damage her self-esteem. It can cause her to ruminate and worry more than she ever has before. Or, it can give rise to negative thoughts that swirl around in her head and make her feel as if she is losing her mind. But she is not. Despite advanced public awareness and increased attention to the experience of motherhood on the whole, expectations that new mothers feel good about themselves, and particularly about their babies, remain extremely high. Thus, postpartum women do not talk about how they are really feeling. The unspoken words often reflect a strong negative inner critic. Women fear being judged, misunderstood, dismissed or deemed unfit to be a mother. They fear having their baby taken away from a mother who surely, must be “crazy.” The taboo against mothers expressing negative feelings about their experiences or about their babies, operates as reinforcer of their silence. Some women try not to think about how bad they feel, hoping it will all go away by itself. Others worry this is a permanent state of being. Still others are not sure if seeking help will make things better or worse. This prevailing notion that mothers should endlessly radiate joy paradoxically keeps them feeling sick longer. Postpartum women are not sure what to expect. So they often choose not to disclose the extent to which they are struggling. They pretend to be fine. They go to great lengths to look good and create the illusion that everything is in control. They often find it difficult to ask for help and spend a ton of energy making sure everything appears perfect. It needs to be public knowledge that anxiety is an expected part of motherhood. Even negative thoughts about being a mother and scary thoughts about harm coming to the baby are common during the postpartum period. They are common in all new parents, not just those with symptoms of  depression and anxiety. Furthermore, women discover when they talk about what they are feeling and thinking in a safe environment with someone who understands that this is a universal phenomenon, they feel better. Their anxiety decreases. Those of us in a position to understand the nature of these thoughts want postpartum women to know: It’s OK to talk about your negative thoughts and feelings. The isolation and shame associated with the reluctance to disclose will make the anxiety worse. Find a safe person and let them know how you are feeling and what you are thinking. If your feelings of distress interfere with your ability to get through the day, let a healthcare professional know so find support and feel better.

You’ve recently had a baby. You are more than three weeks postpartum. You do not like the way you are feeling. You wonder if you are too anxious or too depressed. Your family and friends have tried to reassure you, but you think to yourself that they couldn’t possibly understand how bad you really feel. You worry that this is what being a mother feels like and you might never feel better, but you’re not sure. Maybe if you just wait, it will get better on its own? Maybe if you pretend everything’s OK, you will feel better? But you continue to worry about the way you are feeling. Here’s what you should do. 1. Ask for help. Any feelings of depression and anxiety that interfere with your ability to get through the day are not OK right now. Find a safe person you can trust. Tell that person you are worried about the way you are feeling. If you know what they can do to help you, be specific and ask them. If you are not sure, tell them you are not sure, but you need their help, regardless. Then, let them help you. No one is asking you to diagnose yourself. If you are not sure what is going on, you should err on the side of caution and let someone you trust know how you feel. 2. Contact your doctor/healthcare provider. Be specific and clear about how you are feeling so you can discuss options. If you feel dismissed or misunderstood, make the effort to clarify and reiterate. If you continue to feel that your provider does not understand or is not responding in a way that feels supportive and collaborative, seek help from another provider. 3. Do your best to locate a therapist. Find one who specializes in the treatment of postpartum depression and anxiety. You can find one here . Or, here . Or,  here. Call one or two or three therapists and talk to them directly. See how that feels. Do not let feelings of guilt or anxiety get in the way of reaching out for the support you need right now. Therapists who have received specialized training to treat postpartum depression and anxiety understand how difficult this first phone contact can be. Take the risk and let someone help you. You do not have to go through this alone. If you cannot find a specialist in your area, call one of the perinatal specialists listed and talk to them about finding someone closer to you. They will help you do this. 4. When you make your first appointment, ask your partner to accompany if that feels better for you. Most therapists will welcome that and it is highly probable that you can bring your baby to that session, also. Your family is a vital part of your healing process. 5. Stay off of the internet until you get some relief from your symptoms. While there may be numerous outlets for support available online, you will inadvertently be exposing yourself to random and unpredictable anxiety-provoking, shame-inducing triggers. It is best for you to protect yourself from that for a while. 6. A ccept the fact that you are not feeling good right now. It will not always feel this way. 7. Avoid all triggers that make you feel worse. That includes people who are unsupportive, and events or obligations that increase your anxiety. Self-compassion is essential. Pay attention to what you need and do your best to express this to your partner and helping professionals. 8. Do not stop until you find the right help. This means you should feel comfortable with the support you are getting. This means your health care provider, your therapist, your support group, your medication and your adjunctive recovery team must all be appropriately responsive to your needs and it is important that you continue to communicate with those caring for you. If the level of caring you receive feels insufficient or inauthentic, you can decide to either let someone know how this feels, or find another/additional professional/treatment alternative. 9. You do not need to struggle. Not even a little bit. There are more and more healthcare professionals who understand that new mothers are at risk for serious depression and anxiety disorders. Help is out there. Do what you need to do to help yourself get the help you need and deserve. You will feel like yourself again. #beyourownbestadvocate. If you or a loved one is affected by postpartum depression or other postpartum disorders and need help, you can call Postpartum Support International ‘s hotline at 1-800-944-4773. We want to hear your story. Become a Mighty contributor here . Getty Images photo via monkeybusinessimages

No one talks about the negative thoughts new mothers have after they have a baby. Not healthcare providers. Not mothers. Not family members. Even though there is increased attention to pregnancy and postpartum mental health, we remain stunned to hear that sometimes, a mother doesn’t feel so great about being a mother. There are times when it is just plain hard, exhausting and wearisome. Sometimes, it’s terrifying. If a postpartum woman experiences anxiety after the birth of her baby, it can manifest in many ways. It can make her doubt the choices she makes. It can damage her self-esteem. It can cause her to ruminate and worry more than she has ever done before. Or, it can give rise to negative thoughts that swirl around in her head and make her feel as if she is losing her mind. But she is not. Despite advanced public awareness and increased attention to the experience of motherhood on the whole, expectations that new mothers feel good about themselves, and particularly about their babies, remain extremely high. Thus postpartum women do not talk about how they are really feeling. The unspoken words often reflect a strong negative inner critic. They fear being judged, or misunderstood, or dismissed, or deemed unfit to be a mother. They fear having their baby taken away from a mother who surely must be “crazy.” The taboo against mothers expressing negative feelings about their experiences or about their babies operates as reinforcement for their silence. Some women try not to think about how bad they feel, hoping it will all go away by itself. Others worry this is a permanent state of being. Still, others are not sure if seeking help will make things better or worse. Therefore, postpartum women pretend to be fine. They go to great lengths to look good and tell others they are “fine.” They often find it difficult to ask for help and spend a ton of energy making sure everything appears perfect. Negative thoughts about being a mother, even scary thoughts about harm coming to the baby, are common during the postpartum period. They are common with all new parents, not just those with symptoms of depression and anxiety. Furthermore, women discover that when they talk about what they are feeling and thinking in a safe environment with someone who understands this is a universal phenomenon, they feel better. Their anxiety decreases. Those of us in a position to understand the nature of these thoughts want postpartum women to know: It’s OK to talk about your negative thoughts and feelings. Find a safe person and let them know how you are feeling and what you are thinking. If your feelings of distress interfere with your ability to get through the day, let a healthcare professional know. For more on the #SpeakTheSecret campaign, click here. If you or a loved one is affected by postpartum depression or other postpartum disorders and need help, you can call Postpartum Support International ‘s hotline at 1-800-944-4773. We want to hear your story. Become a Mighty contributor here . Images via Karen Kleiman and Molly McIntyre for The Postpartum Stress Center.