Perinatal loss impacts 1 in 4 childbearing families. It is estimated that about 10-15% of known pregnancies end in miscarriage. A stillbirth occurs after 28 weeks of pregnancy and before birth, and neonatal death occurs within the first month of birth. About 1 in every 50 pregnancies in the US is ectopic, meaning the egg is fertilized outside of the womb and therefore not viable. Despite these significant statistics of events often experienced as traumatic, unexpected, and life-changing, they are still considered taboo. With the recent overturning of Roe vs. Wade, ALL pregnancies–whether unwanted, ectopic, or medically complicated–are now scrutinized, jeopardizing maternal physical and mental health. Individuals and families experiencing perinatal loss often experience disenfranchised grief since societal expectations for mourning associated with this kind of loss are noticeably absent. Bereaved mothers in particular are more at risk for perinatal mood and anxiety disorders– 4 times more likely to develop depressive symptoms and 7 times more likely to develop PTSD.
TV personality and model Chrissy Teigen has become a recent spokesperson for miscarriage after publicly sharing details of her and husband John Legend’s loss at 20 weeks in utero in 2020. She explained to “People” magazine, “I think that it's important that more people keep talking about it and more people talk about their losses, so people know that they're not alone in all that. Because I think one of the hardest parts about it is you just feel like, 'Am I the only person? Why is it not working for me?' We see these perfect lives and these pregnant bellies and people covered in children. And it could be really frustrating to compare yourself to people that seem to have everything all the time."
Health and healing are possible in the face of perinatal loss, especially with social support and sensitive presence, which can buffer the effects of the trauma and reduce isolation. Creating meaning through the sharing of the story of parental loss, engagement in sociocultural rituals associated with loss, creation of tangible mementos, and validation of the loss with peers and trained mental health professionals also promote resilience and post-traumatic growth. If you or someone you love has been impacted by perinatal loss and seeking support, please reach out.
Post by Sharon Itkoff Nacache ATR-BC LCAT PMH-C
Original Image by Mustafa Omar via Unsplash
With school almost back in session and the autumnal equinox around the corner, it's a perfect time to practice self care. Join CBT expert Dr. Terri Bacow, Ph.D and myself virtually on Thursday September 22 from 12-1pm for a free, experiential workshop to learn several concrete coping strategies to reduce daily anxiety and practice mindful art-making for stress management in real-time. All that is needed is basic drawing materials and an open mind! Spaces are limited so register today here.
The process of becoming a parent involves a massive bio-psycho-social-shift that can shatter one’s previously formed sense of self. This can feel overwhelming and even traumatic without a compassionate space to process, repair and authentically integrate the birth of this “new” parent identity. Reva Rubin, one of the 1st specialists in maternity nursing, wrote, ”childbearing requires an exchange of a known self in a known world for an unknown self in an unknown world.”This, on top of the fact that 25-34% of birthing persons report a traumatic birth experience, can leave a new parent feeling disconnected from themselves, others, and their new baby.
Jungian analyst and art therapist Nora Swan Foster advocates for a systemic shift of naming and normalizing the often traumatic adjustment period of “matrescence,” or process of becoming a parent. She explains, “Birth is a normative experience of rupture and repair. What if we viewed pregnancy and birth through a lens of cultural humility and feminism that honors a woman’s desire to have control of herself throughout pregnancy and birth while holding the knowledge that these experiences may be out of control and traumatic?” She continues, “trauma is a natural part of life; the very genesis of life is a rupture. It is a part of how we live and grow…recognizing birth as a normative traumatic experience would…support the mother in moving forward, while honoring the loss of her previous identity and providing support to manage ongoing change.”
Traumatic memories are stored as images or within the body, so personal exploration within the safety of a therapeutic relationship in art therapy helps externalize negative emotions, trigger positive associations through pleasurable art-making moments, and decrease hyperarousal responses around difficult content. Swan Foster elaborates, through “mixed media, wet and dry, watercolors, and the process of tearing rather than cutting…” the birthing person is encouraged to familiarize themselves with an imperfect creative process that symbolically “repairs whatever mutations or traumas her body endured and finds wholeness within her changed body through telling her story and perhaps finding a personal symbol.”
Post by Sharon Itkoff Nacache ATR-BC LCAT PMH-C
Excerpts from “Art Therapy & Childbearing Issues” by Nora Swan-Foster
Original photograph by Greg Rakozy
Artwork "From Womb to Tomb" by Sharon Itkoff Nacache
When it comes to an infant's diet, there is no one "right" way. The primary caregiver’s mental health overrides any formula vs. breast milk debate. But in honor of World Breastfeeding Week, let’s review some nursing pros and cons:
The mother-infant bonding that happens during breastfeeding helps to build a secure attachment relationship while the physical touch, eye contact, and mirroring of facial expressions during a feed helps release the “feel-good” hormone of oxytocin. This can also help to reduce symptoms of anxiety and depression. And breast milk itself is amazing! Skin irritations can miraculously be healed by a drop of breastmilk. A mother’s breast milk contains essential nutrients and antibodies to promote growth and cure illness in her infant, while the infant’s saliva contains microbes that are passed through the nipple during breastfeeding that target specific ailments in the lactating body. It is a process that is beautifully symbiotic.
On the other hand, breastfeeding can come with a cost, and is hardly a positive or easy experience for all lactating people. The unpaid labor of pumping and nursing an infant every 2-3 hours can be literally draining, demanding, and at times isolating and restrictive. In addition to an array of physical complications including supply issues, nipple pain, or mastitis, some women also experience overwhelmingly negative feelings while breastfeeding called D-MER, or dysphoric milk ejection reflex, which includes strong feelings of sadness, disgust, anxiety, or rage during the first 10 minutes of each feed. This syndrome was first coined in 2007, so research around the scientific etiology is still emerging around the hormonally-induced stress response to breastfeeding that involves fluctuating levels of oxytocin, prolactin, and dopamine. Weaning and decreasing the number of feeds throughout the day can also trigger an increase in anxiety, and lead to feelings of shame around the length of time breastfeeding a baby.
Sustaining a fully dependent human is hard work, regardless of how it’s done. Cheers to all those feeding littles world-wide.
Original photo by Lucas Mendes via Unsplash
Sharon Itkoff Nacache ATR-BC LCAT PMH-C
Just back from a month of travel throughout France visiting family, I'm reacquainting myself with the streets of my beloved city. I pass a compelling mural by collage artist Brittney DiMauro depicting actors of “The Handmaid’s Tale” on currency wearing their signature red uniforms with “Blessed Be My Basic Human Rights” written above in ransom-style lettering. Although the television series is dystopian and fictional, the street art response to the timeless fight for female bodily autonomy is striking.
Here in NY state, abortions remain legal up to 24 weeks of gestation, but the recent reversal of Roe vs. Wade Supreme Court case in the US essentially criminalizes unwanted pregnancy nationally, promoting forced birthing as the norm. France, on the other hand, has historically offered more comprehensive reproductive healthcare for women. This June, French legislation ensured that a women’s right to abortion until 14-16 weeks gestation was protected in their Constitution. They also offer supportive postpartum care that includes at least 10 visits of free pelvic floor “re-education or physiotherapy” for all birthing people. (Although I originally assumed this was due to progressive and feminist thinking, I recently learned it was a political move to address concerns around a dwindling population. Regardless, this is preferable to the American pressure to “bounce back” postpartum, with 1 in 4 new mothers returning to work within 2 weeks of birth according to a 2012 study.) Like most members of the EU, every expectant mother is eligible for paid maternity leave in France, though the exact length of leave depends on her current and expected number of children.
French feminist and philosopher Simone de Beauvoir is quoted as saying, “Never forget that all it takes is a political, economic or religious crisis for women’s rights to be called into question. These rights are never fully acquired. You must remain vigilant your whole life.” These NYC streets, too, serve as gritty visual reminders of what has and perhaps always will be at stake for birthing people.
Post by Sharon Itkoff Nacache ATR-BC LCAT PMH-C
Mural by Brittney DiMauro @eternalpossessions
Just established as a federal holiday last year, Juneteenth is a loaded reminder for Black Americans that although we celebrate the 1865 date when news of emancipation finally reached enslaved Black communities in Texas, true liberation includes reproductive justice now. Feminist activist and educator Loretta Ross defines reproductive justice as “the human right to maintain personal bodily autonomy, the right to have children or not have children, and the right to parent those children in safe and sustainable communities.” And yet, in this country, sexual health has always been inextricably linked to systemic oppression for Black women in particular as their enslaved bodies were used without consent or pain management to develop practices that still inform the field of modern gynecology and obstetrics today.
Disparities in quality healthcare with compassionate providers, lack of paid medical leave from work to allow for sufficient recovery time, and limited education and employment opportunities are all contributing factors to the chronic exposure to racism that affects both mental and physical health, known as “biological weathering.” This is especially impactful during the child-rearing years, as the maternal mortality rate for Black women is almost triple than that of white women in the US. Less hands-on postpartum support also contributes to lower rates of breastfeeding in communities of color. Dawn Godbolt and Alice Powell of Rewire News Group urge, “This Juneteenth, as we remember our Black Independence Day, we must continue to advocate for reproductive justice so that more Black mamas and babies can experience the fullness of liberation.” #juneteenth #blackmaternalhealth #reproductivejustice
Post by Sharon Itkoff Nacache
Original Photo by Max Leveridge via Unsplash
Today marks the 1st day of Pride month. Queer and nonbinary folks face unique challenges on their family building journeys. Popular culture, policy makers, and the medical community too often use terminology that only applies to cisgender and hetero-parent families which can be both frustrating and alienating to the over 11.3 million adults identifying as LGBTQ+, according to a 2019 survey by the Family Equality Council. But the social stigma extends far beyond gendered newborn gear and gifts pre-labeled with “mommy” and “daddy” or standardized forms that require a choice between only 2 boxes to encompass the sex assigned at birth, the nuances of the gender identity, AND sexual orientation all at once. Beyond an archaic maternity clothing industry or gender reveal parties, LGBTQ+ discrimination also looks like a deficit in care providers who are both sensitive to and educated about their specific needs, an uptick in violence and hate crimes toward these communities, and restrictive parenting and adoptive legislation across the country that neither represent nor protect queer or nonbinary families. LGBTQ+ allies can make a conscious effort to use inclusive, gender-neutral language with preferred pronouns, acknowledge the birthing person over a specific gender, and avoid assumptions around a traditional division of labor at home that has historically always been associated with “masculine” and “feminine” jobs inside and outside of the home.
In a 2019 “Xtra Magazine” parenting article Andrea Bennett explains, “When you’re a queer parent, there is no automatic delineation of roles; every family looks a little different, but somebody has to bathe the child, teach her to read, do the laundry. There’s no falling back on cultural expectations, so a negotiation follows: what’s important to you? What do you like, dislike? How will we share things in a way that seems fair and sustainable?” Bennett goes on to contextualize how limiting language and gender roles have been historically: “While feminism has tried to move the needle on parenting issues, we are still culturally stuck in 101-level conversations about mothering and fathering… “Mothering” is a field that has not expanded nearly as much as ‘woman.’” Indeed, we have a long way to go to better support and represent caregivers in general, and especially within queer and nonbinary communities. #nonbinaryfamilies #queerfamilies #LGBTQIApride #mentalhealth #cocreatearttherapy
Original photograph by Carlos DeToro via Unsplash
Post by Sharon Itkoff Nacache LCAT ATR-BC PMH-C
The term “mommy brain" is used jokingly and sometimes critically to describe the mental “mush” that results from the day to day stress of being a primary caregiver in today’s world.
To me, it’s a frequent “tip of the tongue” feeling during conversation that falls somewhere along the spectrum of postpartum sleep deprivation and COVID brain fog. The juggling act of balancing a career, the mental load of daily domestication, the unique stressors of pandemic parenting of littles, the full time job of nursing an infant in the midst of a national formula shortage, the existential angst about the future of women’s reproductive rights… all involve just enough cognitive exertion to render us speechless at times, grasping for the right words to capture just exactly how we're feeling at the end of a given day. Emojis help.
#arttherapyheals #NoParentAlone #IGotBetter #LiveintheLight #PMADs #Postpartum #Pregnancy #PostpartumDepression #PostpartumAnxiety #PostpartumPsychosis #PostpartumPTSD #PostpartumOCD #Moms #NewMoms #Motherhood #MaternalMentalHealth #MaternalMentalHealthMatters
Art by Paula Kuka of Common Wild
Post by Sharon Itkoff Nacache