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What No One Tells You About Becoming a Mother: A Q&A With Alexandra Sacks, MD

The reproductive psychiatrist who is popularizing the term “matrescence” shares how we can have a more honest conversation about the emotional challenges of motherhood.

A headshot of Alexandra Sacks along with a cover image of her book

When a woman becomes a mother, huge shifts happen not only in lifestyle, but also identity, notes Alexandra Sacks, MD. As a reproductive psychiatrist, Sacks helps women with depression and anxiety in planning for and during pregnancy, and after birth. But she has also noticed that some patients who didn’t meet the criteria of postpartum depression still felt better after talk therapy to acknowledge the challenges, stresses, and ambivalence involved in becoming a mother. Sacks is popularizing the term for this transition — “matrescence” — through her upcoming book, What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood and podcast Motherhood Sessions in hopes of creating a larger, more honest conversation around motherhood.

We caught up with Sacks to learn how new moms can create a supportive environment and care team when a new baby arrives.

Experience Life | What is reproductive psychiatry, and how did you get into it?

Alexandra Sacks, MD | Reproductive psychiatry became a focus when doctors were seeking ways to help manage medication for women with a history of depression and anxiety who become pregnant. We also help those who have their first experience with anxiety and depression when they’re pregnant or in the postpartum period. We’ll see patients struggling with premenstrual dysphoric disorder, infertility, pregnancy loss, or issues surrounding menopause. I’m trained as a psychiatrist and have an interest in women’s issues, so it really just felt like a calling.

EL | Your popular TED Talk and New York Times essay focused on “matrescence,” the transition women experience when they become mothers. Where did this concept originate?

AS | I was seeing patients who didn’t quite meet the clinical criteria for diagnosis of depression, but they felt better after one or two conversations with me about the transition a woman goes through during pregnancy and new motherhood.

We’d talk about how breastfeeding is stressful, and about how some people are not able to do it. Or about how miscarriage is common; about how parenting is often a strain and a stress on your romantic partnership; about how people often find early caretaking of children to be boring and not only hard but not that inspiring. How it’s absolutely normal to question if you are cut out for motherhood or even if it’s the right decision — that that’s a normal question that most people ask themselves around this transition.

So I was trying to find a word to capture what’s not postpartum depression but also not easy about new motherhood, and I discovered the term that [the late medical anthropologist] Dana Raphael coined in 1973, “matrescence,” to describe the transition into motherhood.

I think mothers should be further defining and figuring out what matrescence is and how to support each other around it. I don’t think it needs to be a doctor leading the conversation because I think it’s a lived experience that women are going through.

I really want to create a vocabulary and put this information out into the world to normalize the experience — to give women permission to talk about it and to encourage them to keep sharing their stories to further define what matrescence has meant to them, and really reduce the stigma and shame of ambivalence in parenting.

EL | Why do you think this hasn’t been discussed more broadly?

AS | We’ve been much better about educating the public about postpartum depression. While many women do suffer from that treatable, but serious, condition, the vast majority of the pregnant and postpartum women I speak to have discomfort, but not this disease. I think there’s been a sort of turning away from that conversation for those people.

EL | How can new parents get comfortable with sometimes feeling ambivalent about having a child?

AS | Every relationship in your life has both good and bad feelings attached to it. With your best friends, with your own parents, with your partner — every day is not perfect. That’s not what human relationships are like, and it’s just not going to be any different for you and your baby. It’s a human relationship like any other and there are good days and bad days; there are good feelings and bad feelings, and sometimes they’re mixed together. Human relationships are complex and that’s part of what makes them so rich and beautiful, but they don’t come in little boxes. It’s not a bad thing when you start encountering those moments of complexity with your child. It simply means that you’re deeply engaging as a human being with another human being.

EL | Social media has played an important role in connecting people, but studies have shown that it can negatively affect our mental health. What advice do you have for new moms, who are particularly vulnerable, when they are using these sites?

AS | Social media allows people to often share a filtered version of many of life’s experiences. Life is hard, and sometimes imagining a prettier version of it is a nice vacation for the 10 minutes you’re looking at your phone.

But it can be harmful to focus exclusively on the good times, because oftentimes when we are engaging with social media, we’re alone and we look to it for connection. And oftentimes, when you look at an example that doesn’t feel consistent with yours, it can make you feel more isolated.

Consider using social media to connect to others in a way that might make you feel more supported and might make others feel more supported. I share my work on social media (@alexandrasacksmd) using #MotherhoodUnfiltered, and encourage others to share a moment of vulnerability. It may open up a whole door of friendship. It may help you when you’re alone at home with the baby or awake in the middle of the night.

EL | What advice or resources do you suggest to pregnant or new moms looking to avoid postpartum mood disorders?

AS | Evidence shows that social isolation is a risk factor for depression. When new mothers are isolated and not talking about their real experiences honestly, it can raise their risk for postpartum depression. My hope is also that, by encouraging more honest conversation about these kind of vulnerable and complex emotional experiences, we may even be able to reduce rates of postpartum depression because we’ll be encouraging social support around new mothers for each other, and essentially encouraging community-based talk therapy. Putting your feelings into words is therapeutic.

EL | What strategies can people use to set themselves up for success before baby arrives?

AS | It’s important to figure out how and who is going to support you once the baby arrives. Talk to your partner about the different roles you’ll have, and who is going to help you in those early months of child care.

  • Who is going to help you during the day so that you can leave the house, so that you can get fresh air? And at night so that you can get some sleep?
  • Who will help so that you can go get healthy food?
  • How will you see your friends?
  • How are you going to balance that with parenting? Is it going to be with your partner to share daytime care or is it going to be with other family members? Is it going to be with your friends?
  • If you can afford it, will you get help from someone you hire?
  • If you’re single, who is going to be the supportive team that you create?

Make a list during pregnancy of your favorite forms of recreation and self-care, essentially the things that bring you pleasure — even the things that seem most obvious to you because those things fall away so quickly once a baby arrives — and post it on the refrigerator. When you stop doing the things that help you relax and that help you take care of yourself, that’s when you start cutting pleasure out of your life, and when we lose access to pleasure, it’s very, very easy to start feeling depressed.

Also, think about how you’re going to see the people in your life in a way that makes you feel connected.

EL | Sleep is so crucial to well-being, and parents of a new baby often don’t get much of it. What suggestions do you have for parents to get more sleep?

AS | Before baby arrives, talk about who is going to help you at night so you can get longer stretches of sleep and how you’re going to handle sleeping shifts. Newborn babies often need to be fed every two hours, but the human brain gets extremely depleted and irritable if you are up every two hours or if you’re not sleeping at all at night.

So can you and your partner split the night into two halves where each of you gets an uninterrupted four-hour block of sleep? Can one of you do one of the feeds? If you’re breastfeeding, can the nonbreastfeeding partner give a pumped bottle or formula bottle so that the breastfeeding mother can have a longer stretch of sleep?

EL | What advice do you have for friends and family of a new mom?

AS | Ask them how they’re doing and how you can be of help, and work hard to quietly listen. Ask genuinely and earnestly, and with curiosity and humility. In order to do that, you have to really reflect on where you’re coming from emotionally.

For example, if you’re a grandma and you’re asking your daughter how you can help, you need to sort of put aside your own way of doing things that worked for you when you were a mom. No two humans are the same, so no two pregnant women have the exact story. Try not to assume that you know what they need. Try to ask them what they need.

When a new baby arrives, people want to congregate and celebrate, but if you go to visit someone with a newborn, remember that you are visiting someone who just went through a major medical event. Your hosts are not throwing you a party; they’re in a moment of tremendous vulnerability. Ask if you can bring food, how long they want you to stay, and don’t take it personally if they need to reschedule. Be respectful, supportive, and potentially even limit your visit.

Go to www.alexandrasacksmd.com to find Sacks’s TED Talk, essays, and learn more about her work and upcoming book, What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood.

is Experience Life’s managing editor.

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