When Being A Maternal Mental Health Expert Doesn’t Help Much

I thought I knew what postpartum anxiety was. Until my daughter with a history of OCD gave birth to a premature baby the day the pandemic was broadcast.

I have been studying, researching, practicing, writing, and interviewing about maternal mental health for over 30 years. For some time now, my work has been acknowledged as “groundbreaking” as it has been instrumental in getting the conversation about prenatal and postpartum depression/anxiety started. I have been honored to be recognized as a trailblazer in this amazing field of study and clinical practice.

Suddenly, none of that mattered. Not one little bit.

Without hesitation, my expertise took a backseat when my daughter called the night before my two-day professional training and said, “Mom, my water just broke.”

“What?! Are you kidding?” (Not the best mom-response, nor the best maternal expert response, but it was the best I could come up with since she was four weeks early and labor was not yet on our list of things to worry about or plan for). My hope of getting a good night’s sleep before the long weekend of teaching rapidly vanished.

Drop everything. Recalibrate. Make sure she is safe and prepared for the next step.

My head was unexpectedly flooded by the convergence of professional and maternal responsibilities splitting my brain into conflicting obligations. Somehow, I managed to do both, doing neither as well as I would have liked.

Fast forward to the NICU. Everyone was well. Baby needed some extra time catching up. My daughter went home a few days before her son was ready to join her. In the meantime, we did our best to protect her from being inundated by the developing news of the coronavirus outbreak. Although there were some changes already in place at the hospital, such as visitor restriction and intense hand-washing guidelines, all of these expectations seemed in line with having a preemie, and in fact, helped us all feel well-protected.

Pandemic announced. Immediately, nothing was the same. For anyone. Throughout the entire world.

For us, in our small circle of elated grandparents, and brand new parents of a preemie, the uncertainty hung over our heads like someone had their finger on the nuclear bomb and was waiting to push it. Stay safe. In our baby bubble. Take precautions. Stay home. Wash your hands. Wipe down the house. Wash hands again. And then again.

My daughter was good at that. Over the years, she had established routines and daily practices that worked well to protect her from her irrational beliefs that certain foods would make her sick or germs would invade her space. She was good at taking care of herself and able to laugh at some of her compulsive habits that were ingrained in her moment-to-moment thought process. She had always functioned perfectly well despite extraordinary internal distress and interminable self-monitoring.

So when she brought her baby home, the timing was staggering. The air permeated with endless breaking news messages while all irrational fears quickly became rational. Soon, the world was feeling what my daughter had always felt. Nothing was safe.

My anxiety did not help. But it did contribute to some pretty absurd exchanges that I swore I would never reveal to those who look to me for personal or professional guidance. Such as my daughter asking, “Mom, why is he sleeping so much? I can’t wake him up,” while I stood there beside the two of them watching him sleep peacefully.

“He’s fine. He’s a preemie. He’s okay, honey.” What? Why can’t you wake him up? What does that mean? Why is he sleeping so much? I have no idea if he’s okay or not.

“Mom, what is this? Is this okay?” (Referring to a mark or a look or a sound.) “Why is he squeaking like this? Why is he breathing like this?”

I don’t know!?!

“He’s okay.” I would try to reassure, with little conviction behind my words. “He’s still catching up. But you can call the doctor if you are worried. That’s what they are there for.”

“My breasts are so engorged. Should I start with this one, instead? Should I feed him again since he keeps falling asleep? Is he getting enough? How do I know? I found a lump in this breast, do you think I have cancer?”

How do I know? I have no idea. About breastfeeding? About cancer? OMG.

“Let’s call someone from my team. It’s been 34 years since I’ve breastfed! They can help, I’m sure!” I hope she doesn’t get mastitis. What is that lump in her breast? Am I exposing her to the virus?

Anxiety is a funny thing, the way it convinces us to believe the irrational thoughts that come and go. Our best defense is to try not to pay attention to those thoughts. To not empower them. To distract our mind and stay focused on things that feel good as best we can.

My daughter is a wonderful mother. I am so impressed with her ability to transcend her pervasive anxiety and begin make sense out of the shock of being unprepared for the birth, the dreadfully long and scary delivery and ultimately, her early connection with her precious little one. While I knew how important it was, and continues to be, for us to feel especially grateful during such dark and uncertain times, that juxtaposition between gratitude and the unknown was a source of incredible anxiety. For both of us.

Postpartum anxiety has never exposed itself with such magnitude and personal investment. The world has been shaken by a force outside of ourselves. Distress is at an all-time high. Panic is lurking at every corner. My daughter’s anxiety was expected and understandably large-scale at this point. Mine, well, that’s just a bonus for her. She gets to see her mom’s anxiety in full bloom. Not because I’m showing it all that much. But because we know each other so well and cannot hide anything, as hard as we both may try.

What has surprised me the most is how regulated she feels and how little her OCD is interfering with her day to day routine, alone with her baby. Normal outlets for support are not always comforting to new moms with anxiety, she reminds me. Sometimes, group support — now online — or social media can be enormously triggering. Still, I am only too aware that if we ask moms to shelter-in without outside support, and align themselves with the mandate to practice social distancing, they put themselves at risk for significant isolation, which we have known for some time can increase perinatal distress. So we do the best we can, and encourage connectedness.

I remind my daughter what I have always told my clients and my students, that new moms can be symptomatic and competent at the same time.

You can be scared and still take care of your baby.

You can be uncertain and still do things that help you feel more in control. You can have scary thoughts and be a wonderful mother. You can be anxious beyond belief and still experience joy.

My daughter has been outstanding. My grandson is outstanding. Our combined anxiety is outstanding. But for the first time in a long time, the anxiety feels justified from a global perspective. In a strange way, that feels validating. It also feels terrifying. One thing I am certain of is that my daughter will have good days, or moments, when she feels distracted and enjoying her baby … and she will have bad days, or moments when she feels overwhelmed and utterly distressed. I am oddly comforted, however, by her lifelong practice of OCD rituals which appear to help her feel more in control, during a time when few people are feeling that way.