Maternal Mental Health and the Infant-Parent Relationship
Blog submitted by Claudia Rios-Gastelum, LMFT
Motherhood and childhood remain interconnected long before and after the umbilical cord is cut. As both baby and mother transition into each of their roles, they will create this dance by reading each other’s cues to build on their relationship. However, in a partnership where the mother is experiencing a perinatal mood and anxiety disorder (PMAD), this dance might cause distress to both partners. Coincidentally, the first week of May is the Maternal Mental Health Awareness Week and Children’s Mental Health Awareness Week. When discussing the importance of addressing maternal mental health, the focus for many parents and treatment providers remains on the impact untreated PMADs have on the child’s wellbeing. Research has demonstrated that there are correlations between an undiagnosed and untreated PMAD and negative implications on a child’s social and emotional development and the parent-child relationship.
Research has found significant correlations for a mother experiencing perinatal mood and anxiety disorders in both her and her child’s physical and psychological wellbeing. The children of mothers who were depressed while pregnant show developmental delays at 18 months compared to the children of mothers who did not experience perinatal depression. Perinatal mood disorders have been found to have “a negative effect on caregiving, which in turn affected language” development in infants. One potential symptom of PMADs identified by mothers is not feeling bonded to their child which brings feelings of shame and guilt. Popular belief is that a woman should be bonded to her baby during pregnancy or at birth; however, it takes time to build this relationship. These feelings of shame and guilt may further reinforce a mother’s bonding difficulties with her child and decrease the instances of mutual enjoyment. Research has also found that infants whose mothers experience PMADs are more likely to present with more irritability, less activity, less attentiveness and demonstrate fewer facial expressions leading to a mother’s difficulty in reading her infant’s cues and less ability to respond to his/her needs. Research has found strong correlations between infant behaviors (poor soothability and sleep behaviors) and maternal distress which can negatively impact a mother’s mood. An infant’s poor sleep behaviors may build on the typical sleep challenges that a new mom has and continue to further disturb her sleep and cause additional distress.
As treatment providers, allies, family members, or even mothers, what do we do with these possible negative outcomes? I would like to offer an aspect of the parent-infant relationship as a tool to address PMADs and build confidence in mothers (in order to address some of the symptoms of PMADs such as the cognitive distortions brought on by depression and/or anxiety). T. Berry Brazelton, M.D. created the Touchpoints Model of Development that focuses on building on the parent-child relationship through awareness of touchpoint periods and what an infant’s behavior communicates to others. “Touchpoints [are] periods, during the first years of life during which children’s spurts in development result in disruption in the family system… Sharing these touchpoints preventively helps parents feel more confident in themselves and in their child.” For example, supporting a parent in anticipating their infant’s developmental progress (i.e. a burst in motor development will result in regression in sleep) will allow them to feel more connected to their child and reduce the belief that they might be responsible for their child’s change in sleeping habits. A child’s behavior becomes the language that their parent uses to understand their need- therefore, an infant holds a part of the key in the serve and return nature of their interaction. Dr. Brazelton states that treatment providers can be allies with parents in assuming the following of the parent: 1) The parent is the expert on his/her child. 2) All parents have strengths. 3) All parents want to do well by their child. 4) All parents have something critical to share at each developmental stage. 5) All parents have ambivalent feelings. 6) Parenting is a process built on trial and error.
As treatment providers, how can we support this developing dance? One step is to hold space that welcomes baby into the session as an active participant in mom’s treatment when clinically appropriate. If the baby is in session, a simple intervention is to use Selma Fraiberg’s technique of “speaking for the baby” were the therapist highlight some of the ways that a mother is receptive to her baby’s needs and responds to them. For example, a therapist can say out loud (as speaking for the baby) “Mom, you know me so well that you could tell that I am getting hungry.” Imagine the potential benefits of this simple intervention to a mother who does not feel attuned or bonded to her baby. Additionally, linking families to resources such as sleep coaches, feeding specialists, and programs such as First 5- Healthy Developmental Services can help mother’s address the challenges around their child’s feeding, sleeping and developmental needs; therefore, increasing her support system.
So how can something that appears to be so simple help a mother who is experiencing a PMAD? For a mother who is struggling to meet her own needs while adjusting to the needs of her child, the knowledge that she shares responsibility with her infant (and other family members) in understanding and meeting the needs of her infant might reduce the stress that the whole responsibility falls on her. Additionally, highlighting a mother’s ability to automatically respond to some of her infant’s cues can reduce the thoughts that she and her baby are not bonded. Building on the dyadic nature of the parent-infant relationship while creating anticipatory guidance allows mothers to feel like experts of her child. Additionally, she is learning how to relate to her child as much as her child is learning how to relate to her. This parent-infant dance, while just beginning, can create a beautiful rhythm.
Claudia Rios-Gastelum, M.A. is a Licensed Marriage and Family Therapist (LMFT #97284) in San Diego, CA. She is the current training chair on the board of directors for Postpartum Health Alliance. Claudia opened up her private practice, Little Way Therapy, last year and also co-founded, Well-Mamas Tribe, a therapeutic + education based support groups for postpartum families. Claudia recently graduated from the U.C. Davis Extension’s Infant-Parent Mental Health Fellowship Program and she is developing a working model to provide treatment for mothers who are experiencing PMADs that integrate dyadic interventions based on the parent-child relationship. Claudia hopes to bring the infant-parent mental health lens to the Maternal Mental Health Community