When ladies lose their temper : understanding postnatal rage

When ladies lose their temper : understanding postnatal rage

Hi everyone,

This topic has been on my mind to talk about for weeks (months at the time of publishing publicly) , and everytime I have tried to sit down at the laptop something else comes up (usually baby sick, actually) and the idea gets shelved in the corridors of my cortex. So here I am at 3am (yes – 3am) writing to you all about a hot topic, RAGE… and warning, it might make you feel a bit, well… angry!

Postnatal depression is by far the most common and well known of all the perinatal mental health conditions, and the symptoms of which are very similar to that of a “standard” non pregnant/postnatal depression – however – one symptom that comes up time and time again that is unique to the experience of postnatal depression for many women is that of increasing anger and irritability. In fact, it can often be the first presentation of postnatal depression, but many will ignore it as just “hormones” or “lack of sleep” or “expected”. Should you experience irritability or mood swings, particularly with the other core features of depression (will not list them all but examples such as loss of enjoyment in things, persistent tearfulness, feelings of guilt and worthlessness, or things are getting worse feeling that it is no longer worth living   then i would certainly recommend seeking immediate help as treatment IS available and DOES work.

In this post, however, I want to take a closer look at unilateral postnatal rage – when anger is the prevailing and only symptom, in the absence of any other mood symptoms. This may be controversial, but I would say that in this instance – rage is not an illness,

The more I have been thinking and reading about rage (as well as examining my own feeings of postnatal rage) I have come to understand that the topic is complex and fascinating in its own right. Women have been conditioned for centuries to hold their temper, to reveal such emotions was considered extremely “un-lady like” and the subtext of this remains strong in our society today. In fact, in the Victorian Era, melancholy was seen to be more “attractive” in a woman, as it evoked a sense of being a victim (thus needing a strong man to save her). You only have to refer to the media frenzy that occured when Serena Williams famously lost her temper in the 2018 US Open Tennis final against Naomi Osaka, which sparked a debate how men are allowed, even celebrated, when showing aggression whereas women are demonised and punished for daring to express themselves. Many asian cultures place greater importance on this, where women are often taught to be passive and subservient in nature.

There is also understandable rage in relation to the despair of not being able to meet the high expectations placed on women to “have it all” – to work in their careers like they dont have children, and to look after children like they do not have to work to pay the bills. Trying to have a decent work life balance can at times feel like shoving a square peg through a round hole and is enough to make anyone full of rage. Again, the stark contrast of fathers returning to work (with their body and life largely “back to normal”) can also be difficult to comprehend. The Feminist and sociological literature surrounding this topic is an actual delight and deserves a blog post all to itself, but in a nutshell within the patriarchal system within society reigns supreme and one must place the experience of rage (or rather, the perception of anothers rage) within this context.

There is also the concept of “vertical transmission” of female rage – whether that be because there is a lineage of strong, defiant women – or – rage “against the machine” so to speak of being at odds with the women that have come before you (something very pertinent to mothers learning to mother in the shadow of their own mothers, with the weighty expectations of the mothers before her) leading to friction within families about differences in parenting styles and practices. Although I am yet to find a paper discussing this, there is plenty on the topic of the vertical transmission of trauma, which, I believe is for many the core of their unexplained expressed rage.

How about the biological argument ? The concept of Maternal aggression has been studied for many years in animals. I recently learned that the agapornis (commonly known as love birds) are widely misunderstood as “needing” to be in pairs, where in fact they are better suited to being alone – the female can become extremely aggressive particularly when hormonal and is at risk of killing the male species (!)As we know in the postnatal period the mother is a flurry of oscillating hormones re-calibrating themselves to their pre-pregnancy state, whilst, at the same time, with the understanding that they never be the same again. Having a baby releases a rush of hormones including oxytocin, vasopressin as well as seretonin and CRH (cortisol releasing hormone) which most recently has been linked to levels of maternal aggression – that protective “mama bear” instinct where a mother would do anything to protect her child from harm. So yes, it could be your hormones playing up – but that is only one piece of the puzzle, and I am always wary of the minimisation of symptoms “just because of a hormonal imbalance”.

So we appreciate that rage can have social, familial and biological roots, but how can this help us in our modern day, rage inducing circumstances ?

R = Reflect on your narrative

How was rage expressed (or not) whilst growing up? Do you come from a family used to having shouting matches across the dinner table, or a home where expressing ones disagreements were frowned upon. How about your partner, your colleague or your parents? how were they brought up? Much of the conflicts we find ourselves in can be found in the spaces between us – the differences of opinion as well as the differences in managing moods. You will soon learn this if you are the type to want open dialogue about every issue and the other is someone that prefers to bury their head in the sand!

A = allow yourself to feel angry

The expression of anger is such a taboo in our society, especially in the virtuous, ever-sacrificing mother. As long as you are not putting yourself, or others in harms way – it is acceptable and even at times advisable to let go of some steam. Sublimation is a mature defense mechanism of transferring an unwelcome socially unacceptable impulse into a positive and accepted behaviour. A good example is taking out that frustration in a kickboxing class! channelling all that energy into something that  will make you feel good but at the same time will expel that nervous energy, which if left inside may implode. If all that sounds too strenuous (especially whilst caring for a teething baby…) there are plenty of other positive ways to channel your emotions – and even just acknowledging them out loud ” I Feel angry because….. (Fill the blank)” can often be enough to address the moment to allow it to pass unscathed.

G = Go to sleep 

Sleep deprivation is real, and is the number one reason why you probably have a shorter fuse than usual. I remember before having a baby, I would naively advise in clinics to “sleep when the baby sleeps” – but now being on the other side I understand that this is not always possible. The “downtime” of naps are often when mothers try to accomplish everything on their never-ending to do list (try being the operative word – many of us just revel in mindless scrolling …)  I would however urge you to put the list (and phone) down. If you are at the end of your tether, the vacuuming can wait one extra day. For me personally I make sure to take at least 2 nights a week where I go to sleep early the same time as the baby. This guarantees me a few solid extra hours (which would probably be sat in front of the TV mindlessly) to recharge, and I am a better parent the next day for it.

E = eat well and exercise

Eating for wellness and exercise sounds boring but is absolutely essential, and trust me I have heard (and personally used) every excuse in the book, but it does not make it any less true. The reason why I’m including this in the management of rage is because part of the reason rage is surfacing is because there is a significant loss of that internal locus of control and power, and if left to linger will result in deep resentment. The rage presents itself as a response to the panic within us when there is a threat. The arrival of a newborn is not a threat per say, but it is a perceived threat to the life you once had – your brain is now in overdrive on constant HIGH ALERT caring 24/7 for a helpless individual that is your responsibility – but what about you? who is looking after you? We as women often lose ourselves in the “Caring” role (whether that be for our own children, our parents or our clients) but are the first to neglect ourselves. To eat well and to exercise, in whatever form that takes, is the acknowledgement to yourself that YOU MATTER. It is a form of selflove a respect, and brings back a sense of routine when feeling overwhelmed.

 

I hope this is helpful for whatever stage of life you find yourself in to take from it what you need.

Much love

-x-

 

An ode to breastfeeding

An ode to breastfeeding

Hi everyone

Well, hello from the “otherside” – apologies for the radio (blog?) silence but for good reason – I am officially a mother now to our beautiful baby girl born six weeks ago – she is absolutely precious and what a month it has been. I have so much to say and so much to tell you – but have to grab the few peaceful minutes here and there whilst my newborn naps (as I am sure many of you will understand).

Whilst on maternity leave one of my resolutions is to write more on the blog, I want to continue to embrace the dialogue surrounding maternal health, with the added bonus of sharing my own “lived experience” which will no doubt accent my academic understandings.

The go to first topic to discuss would be around my pregnancy and labour experience – but I will intentionally leave this for another time, as I feel a pressing need to give attention to something very rarely talked about in clinical settings – and that is the topic of breastfeeding. It is something I know quite a lot about from a medical perspective, and was kindly invited to speak at the Great Britain Lactation Consultants conference last year on the use of medication whilst breastfeeding, however only recently have had first hand (breast?) experience of.

There is often so much emphasis placed by staff and patients alike on the birth experience (and yes, I have seen laminated birth plan 5000 word essays) but by doing so its almost like focussing all your energy on planning the wedding without giving a second thought to the aftermath of having a happy and healthy marriage.

The topic of feeding your child is complex – specifically the intention to breastfeed and the emotions evoked when this is not as easy as one hopes/assumed it would be. Nursing your child carries a heavy psychological weight. It is associated with being a bountiful women able to nourish and provide for her baby from her breast, with any deviance from thus idealism deemed as defeat with feelings of failure, guilt and shame… emotions I have often seen women in clinic struggle with, and many have told me the stress  of which triggered their postnatal depression. There is also an additional dichotomy women face of being divided in their position between the maternal and the sexual – with the depiction of breasts throughout modern history as erotic rather than a practicality perpetuates this (often collective societal subconscious) conflict. I remain in awe how a woman can be half naked exposed on a massive billboard on a train platform, marketing, well, anything (don’t you know sex sells, darling) yet a woman trying to breastfeed her child on same platform with a fraction less exposed skin will face all sorts of spoken and unspoken commentary. This manifests itself in those same feelings of guilt and shame, except this time when needing to nurse.with a third of women feeling embarassed to breastfeed in public .

 

Although it is well known that breast feeding has a range of benefits for the child, The UK interestingly has one the lowest rates in the World, with only estimated 1% of mothers exclusively breastfeeding at 6 months postnatal. I would recommend everyone to check out the great baby friendly initiative from UNICEF if this is something of interest to you – as they are championing change in attitudes towards breastfeeding on a societal and political level. The Lancet also published a fantastic comprehensive series on breastfeeding with an interesting economic analysis, with a noted difference through rich and poor, in sickness and in health – with rising popularity (and prices) of substitute milk formula, preferred by many lower socio-economic communities as breastfeeding is becoming to be seen as “primitive”. Since becoming a mother of course I have naturally become interested in the activity that takes up most of my day, but there is so many opinions and conflicting information on the subject – and then theres the pumping and expressing..

 

                    ... dont even get me started on expressing and the world of breast pumps!

 

All of that is fascinating in theory – but what about in practice? I put myself to the test and just had my first experience of trying to breastfeed alone in public – in a busy Starbucks no doubt (insert despair emoji here).

It was all going so well, until the little one started screaming and there was no where to hide. I suddenly felt all eyes on me, and a sense of “why can’t you control your baby  – you are ruining our afternoon coffee”. I then realised this was my moment to fly the #normlisebreastfeeding flag – so i sat down, got my big muslin shawl and tried to console my newborn, but i couldn’t get comfortable as she continued to scream and i got so frazzled trying to not expose myself i ended up getting tangled with my head under my scarf ! when i managed to detach myself I realised my “quiet corner” was in fact in front of a full glass wall, with plenty of onlookers witness to my meltdown. Just before I tipped into full panic mode I decided to try make a gracious exit – but the pram got stuck in the doors as the entrance wasn’t wide enough – i pressed the disability button (for wheelchair access assistance) but the baristas paid no attention to me or my screaming newborn. Eventually a man helped by unlocking the double door and I RAN as fast as my buggy would allow.

Although on the surface it wasn’t the best experience and the young women next to me gave me and my screaming daughter a disapproving stare – I am glowing with pride for leaving the house alone with my newborn for the first time (after an emergency caesarian section) and for managing to overcome my fear to feed her in public.  I still have a lot to learn, but I feel proud I did my tiny part in challenging societal assumptions and normalising the highs and lows of breastfeeding! I am a huge advocate of the movement “fed is best” , rather than the “breast is best” mantra many women have grown up with. Breastfeeding of course has a wealth of benefits, but none of these matter if you are either unable to physically breastfeed or the perfectionist pursuit is causing nothing but stress and anxiety (both of which will rapidly cease your milk supply anyway!)

However a women chooses to feed her child through breastmilk, formula or a combination of both – it is our duty (as health professionals and members of society) to empower them and eachother to create a space (physically and emotionally) that is safe for families to nuture their children. I have learned so much in these short 6 weeks, and will continue to advocate this issue with a passion as I believe it is a womens basic human right. I think we also need to do a better job of preparing women in pregnancy for the reality of life in the immediate newborn period, because it is not all cute baby clothes and cuddles (although there is a lot of that!).

What are your thoughts on breastfeeding ? have you had any experiences of nursing in public? do let me know in the comments below or on twitter

Much love

Cx