Joanna Strait, prenatal mental health specialist
Child Therapy, Parent Coaching, Videos

Live Instagram: Prenatal (and Postnatal) Mental Health

And The Impact on Parenting, with Joanna Strait 

At MCCC we work with so many adolescents and their parents at the later stages of parenting. But since we know that ALL aspects of mental health are connected and related, we wanted to bring attention to the earlier life stage of parenting. Emotional experiences for parents in the early stages of parenthood have impacts on the couple and the family unit throughout the entire life span. So back in October we hosted an amazing conversation with prenatal and postnatal mental health specialist Joanna Strait, LISCW/LCSW-C. Watch it here or read all of the highlights below!

There is a lot of room for improvement without fear of ruining your child. 

5:00 – Emotions before having a child. 

When deciding you want to be a parent, we often think it will be easy. From a young age we are taught that if we have unprotected sex, we are going to get pregnant right away. This can be true for some but it is considered normal for most to take up to a year to get pregnant. The timing of pregnancy can create pressure for some, especially in DC Metro area. In the metro area, people often start trying to get pregnant later in life because of careers. So, there is an urgency to get pregnant and quickly when they decide they are ready. This urgency can impact mental health, especially if there has been any previous loss, such as miscarriages or late losses during pregnancy. One of the hardest things that happen is cumulative grief that gets compacted. One loss can compound with other losses and this can limit your ability to cope with any of the losses. Some who might otherwise reach out and get therapeutic support might not because there is a myth in our society that loss is a part of motherhood. 

Not having the ability to process through grief will come out in some way. The grief will present itself sooner or later. The business and distraction of life can get in the way of processing the grief. This distraction can be adaptive for survival. It can also distract from processing the feelings.

11:00 – Every negative pregnancy test is a pregnancy loss that comes with big feelings and disappointment. 

The longer it takes to get pregnant the more people struggle with the loss of not getting pregnant. The anxiety builds up and you begin living cycle to cycle the longer it takes to get pregnant. “The two-week wait” is the window between ovulation and when you get pregnant or you get your period. This time can feel so hard because you are sitting in a place of uncertainty. It is complicated and so are the feelings connected to this process of trying to get pregnant. Men also struggle with this too when there is difficulty getting pregnant. 

There is a distrust that can build between partners. You begin to think something is wrong with you or something is wrong with your partner. “Is my body broken?” There is often so much unexplained. It is so hard to sit within such a big unknown. 

15:45 – “I just want to fast forward to the next opportunity to try again can take away from the joy and experience of getting pregnant.”

If you have experienced a loss during pregnancy once you may go through an entire healthy pregnancy with the anxiety of another loss. This takes away from the joy that can come with pregnancy and preparation for having a child. The anxiety can become the norm and be a chronic unhelpful distortion that begins to feel normal. The distortion can take away from other experiences with a healthy pregnancy experience. Not checking in on reality and relying only on your emotional experience, can make it hard to experience the moments. 

18:00 There is a trauma piece to all of this. 

Having been through a loss or losses in getting pregnant can be traumatic and then lead to birth trauma. Many women have complications at delivery and we don’t often hear about this. The trauma then debilitates your ability to be present in your prenatal and postpartum experience. As a result of birth trauma, a parent can carry shame and guilt. These emotions keep him/her from connecting to her child during the first year. This can dominate her feelings about being a mom. 

20:00 – Shame and guilt. 

Shame and guilt are such powerful emotions and can feel like a fog. It is so difficult to make effective parenting decisions when you are in the fog of shame and guilt. Traumatic birth experiences can escalate and create fear within the parent. They want to protect your child after birth. The early months and years can set the stage and create early scripts of not being good enough. This can create a dynamic that lasts for years and sometimes a lifetime. Working to let go of that narrative is helpful in processing the current experience. It also can impact your future parenting experiences. 

Every parent and every stage can question “am I doing a good job as a parent?”. There can be a lot of shame and guilt that comes up over the years that are points of vulnerability. This comes up when difficult things are going on with our kids. This can be scary and felt deeply and it is hard not to take it personally. These feelings can lead you to question yourself and your parenting. 

23:30 Postpartum depression and Postpartum blues – what is the difference between normal and not normal. 

There is a hormonal adjustment that happens to everyone after giving birth. This is a hormonal shift in the body during the 2-3-weeks period after birth. Typical symptoms, baby blues, resolve after 2-3 weeks. When the symptoms go beyond this time frame, we start to look at clinical postpartum depression, bipolar, anxiety, OCD, psychosis, and other diagnoses. If the symptoms you are having are impacting your functioning, your ability to care for your child, or your ability to enjoy being a mom/parent you should consider seeking help. People are often told their symptoms are normal or part of being a parent. Consider how you have been functioning and what’s normal. Some anxiety is normal and beneficial and helps you react to the things you need to as a parent. It is when the anxiety makes you react beyond normal when we start to consider if it is not helpful. We always look at three things: duration, severity, and intensity. So often people wish they had started with counseling during pregnancy. Getting support earlier than later makes it easier to navigate the postpartum piece. 

29:20 How does this idea of postpartum mental health affect men? 

It is rare that men seek counseling for postpartum and during pregnancy. The rarity of male clients is a reflection of how socially unacceptable it is for men to seek supports for mental health during pregnancy and postpartum. There is a shame around this idea that postpartum is something women deal with not men. A lot of dad’s present with symptoms of depression and anxiety and don’t seek help. These feelings unaddressed can impact their attachment with their child. Dad’s feel they don’t have the skill set needed to soothe the baby. Often with dad’s, it is about psychoeducation and normalizing their feelings. Giving men space talk about their own needs is really helpful. They can also explore and understand their partner’s needs better. Communication work can be really helpful for both partners. Resentment can easily creep in if you are not supporting your partner the way they need to be supported. The only way you know what they need or they know what you need is if you communicate those needs. The only way to do this is by making invisible needs visible so that resentments do not continue to build. Resentment can build between the partners and towards the child. It is so important to communicate. This is true when parenting in the early years and also during other stages of your child’s development. 

36:20 How do you know if the struggles during adolescents are developmentally appropriate versus challenges needing more attention?

There is not a simple time frame or symptom to follow and look for. There is a developmentally appropriate expectation that your teen will reject you. This is often difficult for parents. If the rejection is taken personally, the response for some parents is to hold on tighter. This response can get in the way of the adolescents’ development. Forcing a child into independence rather than fostering dependence often occurs when parents don’t want to let go. This is hard to navigate especially if there are mental health issues in the parent(s) or child. It is so hard to launch your child/teen when there are life-threatening issues at play. These life-threatening challenges make the process of fostering dependence more challenging. 

42:00 In therapy we often focus on the here and now, especially when using a behavioral approach. Sometimes it is helpful to process past experiences to better understand the present. A lot of stuff comes up for people when becoming a parent. Becoming a parent can “kick up the dust” from your own childhood. It can also bring up challenges in your own relationship with your parents. This dust can be both good and bad. Sometimes this can be connected to sexual trauma or other traumas from childhood. These traumas can resurface when you think about having your own child. Fear and anxiety can come up around your ability to protect your child from the same pain and trauma you experienced yourself. 

45:00 Dad’ trauma is trauma too

It is not uncommon for dads, or partners not delivering the baby, to experience trauma around a traumatic birth. This can be because they face the possibility of losing both mom and baby. Where the one delivering the baby and going through the medical procedure can have an emotional blackout, the other partner is sitting with the trauma as it happens. 

46:00 Love Languages

How you communicate love and how you receive love can change over time. When you have a child, physical touch may not be what you need or want during that phase of parenting. As a mom, especially if you are breastfeeding, can feel like they are always being touched. Even when the doctor clears you for physical intimacy, you may not feel like being physical. This can be hard for you and your partner. It can feel lonely and isolating. No matter how much you try to connect with your partner there is an adjustment. Each partner is experiencing the adjustment in a different way. This time of adjustment and transition that needs to be talked about. 

49:15 Therapists who are not specialists in this area can still be on the lookout for these things. A client may not present with birth or transition to parenting concerns yet they are dealing with the feelings connected to this life transition. Physical Intimacy piece often causes feelings of disconnectedness. Working on communication can help build intimacy. This also involves processing how things have changed. 

51:00 How do you know if the changes in your relationship are “normal” or not during this transition to parenthood?

Notice if the complaints or frustrations are pertaining to the situation or who your partner is. If it’s the later, it is beneficial to get help. When you begin to notice the Four Horsemen of the Apocalypse (criticism, defensiveness, contempt, stonewalling) showing up in your marriage you need to address those head-on.

53:20 When should you reach out for help and what does that look like? 

This is common and you are not alone in this. The number one thing to know is that even if you have clinical anxiety or postpartum depression, it is treatable. The experience can be very isolating and lonely, especially now with COVID. Know that you do not have to do this alone, you do not have to feel like this heavy weight or burden is not yours alone. Perinatal therapy is there to help and can help the whole family. The goal is to help people feel better, function better, and improve relationships. So often people feel relief when they have supports and know they do not have to do this alone and it is very treatable. Help can be through individual work or couples’ work. It is not doom and gloom forever, just because it’s difficult at the beginning does not mean it will be difficult forever. 

58:00 taking care of your health is beneficial for you and your family. By getting help for yourself you are investing in you and your child’s future. In fact, it is often better to take early steps that can make lasting changes in the whole family. It is worth the investment. 

Self-care is part of being a good parent!

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