Pregnancy and Postpartum

Shame and the postpartum experience

shame and postpartum. perinatal mental health. shame and pregnancy.

One of the biggest aversions to attending postpartum therapy is shame. You feel ashamed that your emotions are messy. This isn’t like you. Normally, you’re calm and cool. But, suddenly your hormones are all over the place, your hair is a mess and you can’t remember the last time you showered. There hasn’t been a single day where you haven’t burst into tears or rage.

You feel ashamed about your relationships. It feels like a huge risk to acknowledge how you truly act around your family. What would the other person say if you admit you don’t really like your baby? What if you told them you sometimes screamed at your children? Are they going to judge you if you tell them you’ve stopped breastfeeding? Would you get mocked for admitting you haven’t had sex in months? What if you revealed that you suddenly can’t stand your spouse? How will the other person react?

It’s incredibly vulnerable to open up to a stranger, especially if you worry how he or she will respond. So rather than talk, you stay silent. Shame feels awful, but it protects you. It keeps you safe from being judged. But it also means you are stuck with all these difficult thoughts and feelings bubbling inside.

The shame of mental health

Despite all of the social media posts, campaigns, and recognition about mental health today, there is still a stigma in admitting we are struggling with mental illness. You may worry about what it means to be attending therapy or starting medication. Does it make you incompetent? Are you still able to say you are a good parent if you also admit you are mentally unwell? How do you cope with your family members telling you to “suck it up” or “get it together?” All of these shameful questions and thoughts prevent you from admitting that you need help.

shame and postpartum. perinatal mental health. shame and pregnancy.

Perinatal mood and anxiety disorders are genuine illnesses. During pregnancy and postpartum months, an individual could live with anxiety, depression, OCD, bipolar disorder, or PTSD. The chance of experiencing any one of these illnesses is not uncommon (e.g. approximately 1 in 4 Canadian mothers reported experiencing symptoms of postpartum depression or anxiety).

As with any illness, you deserve appropriate treatment and care. It is not a matter of will power. We cannot wish it away. My favourite recommendation is to consider how you’d talk to a friend in a similar position. Chances are you would be more compassionate and open-hearted. For example, following a surgery, you would encourage said friend to attend medical appointments, take prescribed medications, and follow their health team’s recommendations. In the same way, would you be able to give yourself the permission to seek the treatment and attention that your mental health needs?

What if the therapist judges me?

Every therapist claims they are nice and nonjudgmental. That doesn’t mean you truly believe it. For those cautious and skeptical parts of you, I want you to know, that’s okay. It’s absolutely okay to have your guard up. Starting therapy feels awkward. As with every relationship, it takes time to build trust.

Take the time to share slowly, if that is what your system needs. Watch how your therapist responds to your words and concerns. You will notice that you either feel more settled and at peace, or if your shame increases. Trust this internal feedback. If you are comfortable, let your therapists know you feel this way, and see how they respond to your words.

Will I get in trouble?

shame and postpartum. perinatal mental health. shame and pregnancy.

One of the biggest fears that pushes clients away from voicing their experiences is the fear of how others will react. In prenatal and postpartum therapy, I see many clients hesitate to talk about how they truly are with their children and relationships. Not only are they managing their internal shame, but they are weary of judgement and negative consequences. Clients are often fearful because they fear the truth will lead to the therapist ending the relationship, calling the Children’s Aid Society or disliking the person. So let’s address these fears:

1) If I am truthful, my therapist will end the relationship:

In most cases, therapists will only end the relationship if they are outside of their clinical scope or the treatment goals have been met. If you have met your treatment goals, that’s wonderful! Celebrate all of your hard work. You don’t necessarily have to end your relationship with your therapist, but you can talk about tapering off sessions or increasing the time in between appointments. If it’s loneliness that drives you to stay, your therapist will support you in exploring how to improve outside relationships. It is not okay that the therapy room is the only space where you are heard, validated and supported.

If your counselling goals are beyond your therapist’s knowledge and skills, they will admit this to you. It isn’t personal. Consider your experiences with other specialists. You may really love your hairdresser, but this is not the person who can necessarily answer your medical concerns. You connect with the clinician who is best able to meet each of your needs. If you keep asking your hairdresser for advice on all things medical, neither of you will leave satisfied or confident that your goals can be achieved.

2) What if they call the Children’s Aid Society (CAS)?

shame and postpartum. perinatal mental health. shame and pregnancy.

This is a common myth that prevents parents from reaching out for postpartum therapy. Postpartum depression often shows up as rage, anger, outbursts and distress. I see many parents who are frustrated with themselves and with others, but are too scared to ask for help in fear of being reported. Postpartum depression deserves respect, compassion and appropriate support. The only reason to reach out to CAS is if there is a genuine concern about a child’s physical or emotional safety. If there is a worry about abuse or neglect, your therapist will ask you directly. However, yelling at your child does not mean an automatic phone call for outside authorities. Having negative or intrusive thoughts does not mean we are automatically contacting outside authorities.

3) What if my therapist dislikes me?

shame and postpartum. perinatal mental health. shame and pregnancy.

I can’t speak for other therapists, but I can speak for myself about this worry. The beauty of Internal Family Systems (IFS) therapy is that IFS therapists are always looking for positive intentions. This means, irrespective of the behaviour, words, or emotion (anger, infidelity, jealousy, disgust, etc), your IFS therapist is always trying to understand how there are parts of you trying to get you through a difficult moment. It’s not about assessing whether the outcome is successful or whether the efforts are worth it. It’s about understanding the actual intention.

IFS therapists go to their own therapy. It’s how we do the work we do. If I feel triggered in a session, that’s an indicator that there is some part inside of me needing support and attention. It has nothing to do with you; it has to do with my own history and experiences. That part, similar to yours, will need support and processing. I take it to my own session or my supervisor. IFS therapists’ intentions are always to keep our parts out of the session, because in therapy, it really is about the client. It’s not about my agenda or my needs; it’s about yours.

The shame of not meeting our own expectations:

You had lots of hopes and dreams of how your pregnancy or postpartum months would turn out. Chances are you did not wish for mental illness.

Many of us struggle when our expectations are not met. We feel a sense of shame and inadequacy in falling short. You may have hoped to be a Pinterest-parent, and realized you have zero interest in arts and crafts. Perhaps you thought you’d enjoy spending days with the baby, and found you were bored out of your mind by week 4. Maybe you thought you’d ace the whole sleep training thing, only to be struggling 15 months later with a toddler who refuses to go to bed. Somehow these results create a sense of failure that we equate into our self worth.

For any parent who struggles with this sense of “inadequacy”, please know that you are not alone. We all have moments where we worry about being good enough parents. Remember that you have so many years ahead of you to figure this out. We often label ourselves as success or failures, but we fail to pay attention to all the efforts and practice we need to improve our skills. We will screw up many times, and we will learn constantly. In this way, there is always space for us to grow.

goals, high expectations. shame and parenting

It isn’t fair to assume we’ll be great at parenting from day one. Think about how it was like when you first learned to drive. In the start, you were in the “conscious incompetent” stage where are very aware that you have no idea what you are doing. However, with time, you get to a place where you can automatically drive your car. Unfortunately, when we are at this place of “unconscious competence” (a.k.a. “I don’t have to think about it, I can do it in my sleep”), we forget how much we initially struggled. We forget the intensity and shame of not doing well.

Make it safe

We can all play a role in reducing the shame of mental illness and perinatal mental health. Talk about your experiences openly with safe others. Offer validation and compassion to those who are in this phase of life. Reach out to a therapist that you can trust. We can work to shift away from judgment, and instead, appreciate that we are all doing our very best.

Warmly,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.