Instagram Pregnancy and Postpartum Mental Health

They call it “The Goddess Myth.” In its October cover story, TIME highlighted the growing cultural pressure to mother well — to mother to Instagram-worthy perfection— and the resulting emotional detriment of not living up to those standards. Failing to meet society’s expectations during pregnancy, birth, and delivery can lead to debilitating shame and disappointment, undermining the accomplishment of having a baby and exacerbating the emotional whirlwind postpartum.

Establishing that motherhood is hard seems like a no-brainer. So why, instead of celebrating what we do right as moms (like, keeping our kids alive, for example), do we compromise our emotions by building our expectations on a rickety framework that can’t support the pains and surprises of real-life motherhood? Maybe it’s not our fault.

This pressure on moms begins to build at conception and continues to balloon through birth and postpartum. “I think first-time moms put a lot of pressure on themselves to do everything perfectly — we obsess over these little details because the world is a scary place. Birth is the first big step in the whole parenting world and we put all kinds of expectations on it,” Minneapolis mom Stina Kielsmeier-Cook tells Brit + Co.

Determined to give birth “nature’s way” (sans epidural, with a midwife) after watching a natural birth documentary and reading Ina May Gaskin’s Guide to Childbirth, Kielsmeier-Cook ended up with an unexpected prolonged labor, an epidural, and vacuum extraction — and ultimately, a healthy baby. But somehow, sadness about her birth experience overshadowed what she had accomplished: successfully delivering her child.

“I felt like my body had failed me. If I couldn’t have a ‘natural’ birth, there must be something ‘unnatural’ or bad about me,” she said.“I would compare myself to others who did have these unmedicated births and think, why couldn’t I do that?”

Not surprisingly, Kielsmeier-Cook is not alone: TIMEcommissioned a survey of 913 mothers, which found that half of all new moms experienced regret, shame, guilt, or anger because of unexpected complications or lack of support. This undue stress and emotional load can, in many instances, be traced back to the frequently toxic cultural pressures surrounding motherhood. But experts are careful to differentiate between traumatic birth (where a baby dies or gets taken away, or where a mother nearly loses her own life) and a birth that includes traumatic elements (including unmet expectations like Kielsmeier-Cook’s), which are often more isolated. While a traumatic birth experience can contribute to the likelihood of a postpartum mood disorder like postpartum depression or anxiety, evidence does not link traumatic elements of a birth to PPD.

“If you look at, for example, an unexpected c-section or a really prolonged labor, those are what we think of as a delivery that has some traumatic elements in it,” Dr. Patricia Widra, MD, Assistant Professor of Psychiatry at the University of Maryland School of Medicine tells Brit + Co.

But traumatic elements like unplanned interventions or difficult labors do not always add up to trauma, which Widra explains more often stems from significant stressors that take place during the entire first year postpartum. For example, a seriously ill baby in the NICU or ongoing lack of support from a partner can be major risk factors for postpartum depression and anxiety. In other words, unmet expectations during pregnancy, birth, or postpartum may be part of the equation — correlating with PPD — but by themselves, they aren’t likely to cause PPD.

On the other hand, Dr. Widra says, trauma can be subjective. Traumatic elements during birth affect everyone differently, and what a woman brings with her emotionally to her pregnancy and birth play a large role in her mental state during and after pregnancy. For instance, a woman who has experienced other trauma in her life, like serious personal losses, interpersonal violence, or any kind of abuse as a child is more likely to deal with perinatal anxiety or depression, which can be exacerbated by motherhood-related disappointments.

“These women might have a stronger emotional response to a difficult delivery, particularly if trauma they have experienced in the past is unresolved or untreated,” Dr. Widra says. “That can be a setup for someone to have an experience of a delivery they feel was traumatic.”

Whether a woman’s anxiety and depression can be traced back to the pressure surrounding motherhood or stem from her family of origin, Dr. Widra says it is important to identify mental health symptoms and create a foundation of support during pregnancy instead of after, when the stakes are higher.

Practitioners checking in with women during pregnancy to both discuss birth and postpartum expectations, and identify red flags for mental health concerns, could prevent a range of emotional struggles after delivery. This is partially because, more often than not, women with unresolved emotional trauma actually have mental health needs during pregnancy that go unmet, which continue after the baby is born. Anxiety and depression that begin during pregnancy are so common that the array of symptoms once grouped under “postpartum depression” are now being more commonly identified as “Perinatal Mood and Anxiety Disorders” by medical professionals.

In fact, Dr. Widra says, somewhere around 30 percent of women who are identified as having postpartum mood or anxiety disorders actually had symptoms during pregnancy, which many times go unnoticed by busy or oblivious healthcare providers. “I encourage OB-GYNS to do active screening throughout pregnancy for any mood disorders, which can be exacerbated by pregnancy and made worse after delivery because no one thought to ask about a woman’s history,” Dr. Widra said.

Though managing mental health before or during pregnancy is the ideal, preventative approach, it’s never too late to seek help for mental health concerns. “The bottom line is, if a woman has symptoms, she should ask for help,” Dr. Widra says.

If you’re not feeling supported by your provider, there are a number of resources available online, such as Postpartum Support International, which can help you identify a new provider in your area.

How did you deal with surprises in your birth? Tell us about your experience @BritandCo.

(Photos via Getty and Brit + Co)