Molly Nourmand, LMFT
Exploring the Emotional Impact of Motherhood
EPISODE: 46 | DATE: June 10, 2021
“Culturally there is this myth that motherhood is all joyful and having a new baby is so joyful. And it is. There are a lot of joy and joyful moments. And there is a lot of grief. Your old life is over!”
Can you tell us a little bit about what you do and where your passion for this facet of your career came from?
- My company is called Life After Birth and I created it after my daughter was born in 2016.
- Prior to having my daughter, I was working in drug and alcohol rehabilitation. I loved doing that work.
- But after I had my daughter, I had a really challenging transition into motherhood. I felt called to hold space for the initiation into motherhood.
- Since 2017 I’ve been running my group which is a postpartum support circle for new moms.
- I see it as the counterpart to mommy and me groups. I find that mommy and me groups focus a lot on the baby and their development. My group focuses more on the mother and her transformation.
- I work both one on one and in groups, and though my focus is on postpartum, I see a lot of pregnant women as well.
Can you share more about your postpartum experience?
- When I was pregnant, I knew that I had risk factors that could contribute to postpartum depression.
- Some of the risk factors include if you have a history of depression or anxiety, or even a family history of it; if you are sensitive to hormonal shifts around your menstrual cycle, etc. I have both of those risk factors.
- I thought that because I’m a psychotherapist, I’m aware of these factors and I can do things to prevent them. So I wasn’t too worried about it.
- I am a yogini and very into the holistic world, so I had this idea that I wanted to have an unmedicated birth.
- I did a lot of prenatal yoga and I did all the things to set myself up for success in my birth and thereafter.
- The irony was even though I did all these things and I thought I could control the outcome, I was in for a big tidal wave.
- I did end up having an unmedicated birth and it was fast. And everything went more or less fine until after I delivered my baby. There were some challenges delivering the placenta.
- I ended up losing double the amount of blood you’re supposed to lose and hemorrhaging. I have a history of some anemia. I ended up needing a blood transfusion.
- My recovery physically was tough and I didn’t get that euphoric high they talk about after you’ve had an unmedicated birth because of the interventions I had after my baby came out.
- So there was that disillusionment and disappointment, but the first 3 weeks after birth I had set myself up with a postpartum doula, my mom was in town, and I had a lot of support so I felt ok.
A word about the baby blues:
- The first 2 weeks after birth there is what is called the baby blues.
- 80% of birthing people have baby blues in those first 2 weeks after birth.
- It’s actually very normal. You just had a baby and then this drastic hormone shift and this dractist shift to adjust to, so it makes sense that most women experience this.
- However, it resolves itself after 2 weeks without any intervention or treatment.
- Itcan be similar to postpartum depression in that there is a lot of tearfulness and ups and downs of moods and things like that.
- But when the onset of a depressed mood happens after that 2 week period or it continues, that’s when it could be in the perinatal mood or anxiety category, AKA PMADS (Perinatal Mood and Anxiety Disorders)
How did things play out for you after your mom left?
- My mom left 2 weeks after birth and the doula left 3 weeks after birth.
- And I remember both moments. When my mom left, I just felt so sad and begged her not to leave.
- And then when my doula left I remember having a strong emotional reaction. I was crying and just feeling this sense of abandonment.
- I think having my mom and doula there really bolstered my first few weeks postpartum. Other than recovering physically, mentally I felt pretty good.
- I felt really alone after my mom and doula left. And it was – this was pre covid so my husband went to an office. It wasn’t like he was home.
- One of the biggest silver linings for the women I’ve worked with this past year is that they have their partner home, in general, during this transition.
- So essentially I was alone and the details are a little foggy now but just remembering starting to feel not ok. But not knowing that it wasn’t ok not to feel ok.
It’s Ok not to feel ok.
- I know that it’s ok not to be ok. I’m a therapist!
- But I must have drunk the kool aid of new motherhood. I thought that it was supposed to be this blissful cool easy time and it wasn’t for me. It was really hard.
- And I just felt like I had to fake it in front of other people. I felt like I couldn’t say oh my God, I’m not ok. And I think there was this dissonance inside me.
- And then I think another part of me maybe downplayed what I was feeling. Of course new moms feel this way! It’s such a big transition! Of course they’re going to cry every day and feel overwhelmed and feel panicky and all the stuff.
A key moment right before the 6 week checkup:
- Between weeks 3 and 6 is when I think the onset of my depression hit. But I didn’t fully know it.
- Right before my 6 week check up, I had a resurgence of symptoms from my hemorrhaging.
- And it was really – a really scary thing. I was alone with my baby when it happened.
- We went to UCLA to see the midwife.
- While in the waiting room, one of the nurses handed me a clipboard, and at the top of the clipboard it said Edinburgh postnatal depression scale.
- The therapist in me was like that’s so great that they are screaming for this! So progressive.
- I filled it out and I didn’t hold back. I was honest with answering the questions, whereas I think with that scale, some of the critique with it is some women aren’t honest with it because they think someone is going to take my baby away or think they are crazy or whatever.
- When my midwife took us into her room, the first thing she said before addressing the bleeding was, “I’m concerned about your mood.”
- From there that opened up the first honest dialogue about how I was really doing and feeling. And my husband reflected back to her and me that what he’d been seeing over the past few weeks was similar to when I had been on a birth control pill that didn’t jive with me.
- So from there I began to stop lying to myself and start to climb out of the shame of what I was feeling and begin to get support and help.
What did that support and help look like for you?
- One of the biggest things that actually got me out of the funk and fog was a friend of mine who was a trimester ahead of me was also experiencing some postpartum depression.
- She told me about a naturopath that had helped her.
- Aalso let me just say – even though I’m into holistic health, I have no qualms about western medicine. I am a fan of both.
- But my first line of defense is holistic. So I went to the naturopath.
- She was so wonderful and really helped me restore myself and helped to counter the depletion and sleep deprivation.
- We worked together to create a plan for me to really prioritize my sleep and really kind of fill my cup.
- So that started – prioritizing sleep and really filling myself with all these things I was depleted from – really started to slowly turn things around.
- And around that time I found a nanny who was a godsend and she started working with me when my daughter was 2 months and continued until 2 ½ years when my daughter went to preschool.
- And my mom came back to town.
- Then I reached out to some of my good friends and disclosed what I was feeling.
- All of those factors started to help me feel better.
- Interestingly enough I didn’t end up seeing a therapist at that time. I had tried to reach out to therapists that specializes in PMADS but it wasn’t working.
- So that’s one of the things that I encourage my pregnant clients to do especially if they have any precursors for getting PMADS. I will encourage them to find a therapist before they have their baby that they connect with.
- A lot of my work is based on what I didn’t have or what I wish I would have had. The wounded healer archetype.
- Life After Birth is the group I wish I had had. Just giving moms more time and space to process all the issues around identity and relationship with partner and body changes and just this whole drastic transformation.
Did you end up going on medication for your depression?
- I initially didn’t in the first wave.
- With my naturopath’s guidance and support of friends and family and my nanny – around 9 months after birth, I started to feel much better and I didn’t feel like I was in need of taking any medication.
- However, from 2 to 2 ½ was a tough transition for me and my daughter.
- I started to feel a resurgence of my depression, which kind of came more in the form of irritability.
- And that’s when I got to a point where after my daughter started preschool – I was seeing a therapist.
- I found my therapist a year after I had my baby. And I said to her, “You know, I’m thinking about trying antidepressants. What do you think?”
- She said I fully support that. So I went on them and it really helped.
- And I think similar to having some shame around postpartum depression, I had to release some shame or some stories around taking medication.
- It’s a perfectionist thing. I think to myself, “I’m a therapist, I shouldn’t have these problems. I shouldn’t need to take medications. I shouldn’t have these mental health issues.”
- So for once I pushed that aside and went on lexapro – it’s an SSRI and helps boost serotonin, which I was lacking.
- I felt much more stable since then. So I’m glad you asked.
- I like to embrace Eastern and Western wisdom and there should be no shame in going on it. That’s why I’m happy to share that truth: even therapists have to go to therapy and go on medication!
- And also I’m friends with a lot of therapists and ther moms and we are sensitive creatures!
- We’re drawn to the work because we’ve had a history of some challenges or have gone through life feeling really sensitive. And we want to give back and hold space for people.
A word about highly sensitive people
- There is a high correlation with those of us who are highly sensitive people (HSP) and developing a PMAD.
- And one of the big factors with HSPs is that we need a lot of sleep.
- And as we know, mothers’ sleep gets really compromised unless there are other factors in place to help support that.
- So I would say sleep deprivation was if not the number one factor, one of the main factors of my depressive mood.
How much does having community and support around you play a role in easing the burden of your PMAD?
- Since my daughter was born, I am continually trying as best I can to create and build community within my life. And support as well.
- And I find that when I’m around another mom and her child or children, it’s just so much easier. Things are normalized.
- Like the other kid has a meltdown and then you’re like ugh, I don’t feel so bad! My kid has meltdowns too!
- Or the kids can run around and play together and you get to swap stories with the mom and feel heard and hold space for them. It’s the best.
- So I think it is just such good medicine.
- It’s one of the reasons I’m so passionate about my group, Life After Birth. It has been a little virtual village. Moms who come to the group get the opportunity to be witnessed. We need to be witnessed.
- And with covid – some people who’ve been pregnant haven’t even been able to be witnessed. And now you don’t get to show off your cute baby!
- So this past year has been extra isolating for moms and extra hard for those of us with small kids and extra hard with those of us working in addition to momming.
- I think this time has shown us even more how important community and support is.
Can you walk us through some of the PMADs and tell us what to look for?
- For some women, PMADs start in the pregnancy.
- Pre-covid, 50% of PMADs started in pregnancy.
- So even though my work is technically more focused on postpartum, preventing PMADs or treating them really starts in pregnancy.
- I find myself now working with a lot of pregnant people too because people will reach out and say they’re anxious or disillusioned or feel like maybe they made a mistake, like maybe they don’t know if I want to be a mom.
- Ambivalence is a big topic to normalize. People feel shame saying this isn’t that great!
- So for pregnancy anxiety and postpartum anxiety, it can be a generalized anxiety where there is constant worry.
- And just to distinguish between being a new mom and being hyper vigilant about things and having postpartum anxiety: it’s when it interferes with your level of functioning and it’s when it feels almost constant or a lot throughout the day.
- That’s when it can be more of a PMAD.
- And the same for postpartum depression. Of course as a new mom you’ll have times when you’re in a bad mood or crying or feeling overwhelmed but it’s when it interferes with your level of functioning and is more bad than good.
- Another form that postpartum anxiety can take is obsessive compulsive disorder.
- In the media and the culture we sometimes use the term, “I’m so OCD!” and I think that terms gets confused with obsessive compulsive personality disorder, which most people don’t have that extreme version. But people joke about it when they like things to be neat and tidy and color coded. That’s more of a personality trait.
- OCD is when you have an obsessive thought and it’s sometimes coupled with a compensatory behavior.
- So a lot of times with postpartum obsessive compulsive disorder, it takes the form of having really dark thoughts about your baby – something bad happening to them.
- Just to clarify, these dark thoughts happen to all parents because you’re been entrusted with this precious jewel and you’re responsible for keeping them alive! So we all have those thoughts. But again, when it’s interfering with your level of functioning or just constant and you’re being bombarded with these disturbing thoughts, that’s when you want to seek help.
- With postpartum OCD, they are called ego dystonic, meaning when you have these thoughts, it’s disturbing to you. You think, I can’t believe I had this thought! That’s so dark and awful! It bothers you. That’s why there can sometimes be a compensatory behavior.
- It could be – let me just preface that this is potentially triggering content – for example, if someone could be having a thought that they are going to stab their baby, they will hide the knives. Things like that. And again the thought that they are going to stab their baby disturbs them. They wouldn’t actually do it. It’s really scary for the mother.
- And then I always like to counter this with talking about postpartum psychosis, which is very rare.
- When they have postpartum psychosis, which pre covid was 0.1 to 0.2 of the population, that’s when someone has a break with reality – a psychotic break. And what can happen with the disturbing thoughts is they can be ego syntonic, which is in alignment with how they’re feeling. So you’ve probably heard a story on the news of a mother who kills her child or children. It’s usually because they are overcome with a disillusion that killing their baby is for their highest good.
- I’m going to this because it exists but it’s very rare and very different from postpartum OCD.
- And the last thing I’ll talk about within PMADS is to talk about birth trauma.
- With birth trauma, sometimes the birthing person can develop post traumatic stress disorder (PTSD) because of the birth if there is trauma around it.
- Some examples could be having a baby in the NICU, or having an emergency C section, having preeclampsia, hemorghing or having other medical interventions that feel invasive.
- If you have one of those things it’s not a guarantee you’ll get PTSD. You have to meet certain criteria to be diagnosed.
- So for myself, even though my birth had a traumatic aspect to it, I didn’t get PTSD.
When working with pregnant people, do you pull their partners into the conversation and give them a checklist of things to look out for in terms of PMADs?
- Yes – I’ll do some psychoeducation around what to look out for.
- And depending on their history, I will kind of tailor it to that.
- For example I worked with a woman before she conceived her baby and had some ambivalence about becoming a mother.
- She got pregnant and was worried she was going to have postpartum depression because she had a severe depressive episode earlier in her life.
- So we worked on heavily creating a google doc with resources for her.
- Her husband was included in those resources and some of those preferences.
- And I even had her contact her psychiatrist and say ok, if this does happen, what are the meds, what number do I call, how do we take action if stuff hits the fan.
- And her husband was in on it.
- So we worked together to make her feel as relaxed as possible around it and feeling like she had all these bolsters around it.
- She didn’t get postpartum depression, in the end. I don’t know why. It could have been that we created these great resources for her and set her up for success.
A word about normalizing our feelings in motherhood:
- One of my pet peeves after I had my baby is when people would ask me,“Isn’t it just so great?”
- It’s not even a question because there is no space for the truth there! Or at least I didn’t feel much space for truth. I just felt so alienated.
- So that’s why my mission is to facilitate honest convos about motherhood and part of it begins with me modeling that I’m going to be honest about my journey and I’m not perfect.
Do you think it’s important for women to process their birth and if so, what does that look like? How might someone process their birth?
- I do think it’s important to process your birth.
- The caveat is you have to make sure the people helping you process it earn that privilege to hear your birth story. Especially if there is any trauma around it.
- I’m sure there are many ways to process your birth, but I will sometimes facilitate a birth story exploration within my groups, and sometimes I will do it one on one.
- I have found that the feedback I get is that it’s a healing experience and enjoyable for the participants to hear.
- What I like to do is ask certain questions about the birth instead of having them tell the whole story from start to finish. Especially in a group setting, I’ll just ask certain questions about it.
- And I make sure to start off by saying that this story might have some traumatic elements, so it might be triggering for the person telling it or for the people listening.
- I use my training in somatic experiencing, which is a technique to help process trauma.
- I use that to help with birth stories and I will sometimes pause or have the person pause and just slow down a little and ask them – what are you feeling in your body? Let’s slow this down – especially if they’re talking fast or something seems intense.
- I’ll slow them down. And then at the end of the story I’ll ask how that was for you and what came up for you and just to check in with them.
- And then I’ll also check in with the people listening – how was that to hear? Was anything triggering? Anything you need to share? And just to handle it in a safe tender way.
- Because giving birth is such a vulnerable tender experience. Every aspect of it – physically, emotionally and spiritually.
- It can be very healing and I think telling it and processing it at different stages after birth or with different pieces of the puzzle will come together about the birth.
- I think writing about it can be helpful too. Because sometimes you think you’ll remember things about the birth but you may not if you don’t capture it.
I was so surprised to feel grief in motherhood. Grief over the loss of my old life, my body, and so many things. How would you coach a mom around integrating the aspects of grief in motherhood into her life?
- Culturally there is this myth that motherhood is all joyful and having a new baby is so joyful and it is. There are a lot of joy and joyful moments.
- And there is a lot of grief. Your old life is over!
- It’s often talked about as the journey from maiden to mother. In my head, what I think about is the death of the maiden. And with death comes grief and rebirth.
- It takes a while to let go of your maiden self and to not cling to that.
- And then once you’re kind of able to let go of that maiden and come into your own as a mother, then I think you become more integrated.
- I’ve found one of the gifts of motherhood and letting go of the maiden has been feeling more authentic as a person.
- I think it takes a while to get there but it’s normal and it’s understandable and even though you elect to have this child and you want it, you don’t really know what you’re getting yourself into. And you don’t really know who’s going to come out of you!
- You don’t know this person and you don’t get to pick who they are.
- And I think that’s something that we don’t talk about a lot either.
- Sometimes you get a child that’s really challenging and really a teacher for you and pushes all your buttons and makes you grow. And it’s not always fun and easy.
- I know for myself, I have a very spirited strong willed child and she was a very fussy newborn.
- And statistically there is a correlation between colic and fussiness and PMADS.
- I think that could be a whole other episode talking about spirited children!
- One of my challenges has been to not compare my daughter to other kids and not wish she were more chill.
- But like I said, that can be part of the grief too. You pick you mate – the person you have children with – but you don’t get to pick your child.
- And one other thing I want to normalize is when a baby comes earthside, you might not fall instantly in love with them. That’s kind of a myth.
- Yes it does happen to some people and God bless them if it does – it’s awesome.
- But for others it doesn’t’. It’s kind of a slower build of the love. And that’s ok.
Thank you, Molly. Do you have any parting words for everyone?
- Just to reiterate how important it is to cultivate a community. Getting support is really the best medicine.
- You may need medication too and that’s ok.
- Also, finding other moms to be around can help normalize your experience. And to have your experience reflected back to you is important.
- Just being around other people and feeling that sense of community really can go a long way.
Psychotherapist + Founder & Director Life After Birth®
Molly is a licensed psychotherapist, yogini, and mother. Her multilayered lens brings healing, integration, and transformation to the lives of women through both 1:1 and group therapy. Molly’s approach is grounded in Psychodynamic Theory, and informed by over a decade of teaching yoga and meditation, as well as an ongoing exploration of Somatic Experiencing and Conscious Parenting.
Molly received a Master of Arts degree in Counseling Psychology with an emphasis in Depth Psychology from Pacifica Graduate Institute. Due to her own experience with depression after becoming a mother, Molly felt called to create Life After Birth® in 2017: a postpartum support circle to hold women through their initiation into motherhood. Molly completed the Advanced Perinatal Mental Health Psychotherapy training with Postpartum Support International, and has translated her passion into a specialty in her practice.
Resources mentioned in this episode
Episode #21 with Britta Bushnell, PhD