Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood (Kleiman & Wenzel, 2010) is a courageous and compassionate examination of the scary thoughts that may accompany anxiety in pregnancy and postpartum. Recently, author and perinatal mental health expert Karen Kleiman, MSW shared valuable insight into the topic, and how every mother and care provider can benefit from this book.
Can you describe the term scary thoughts?
Scary thoughts is the expression we use in the book to incorporate any and all categories of faulty thinking that can interfere with feelings of well-being of a new mother. This term refers to thoughts, urges or impulses that are intrusive and bombard a new mother at any time with no notice. They can take the form of worry (anxiety), obsessive thinking (OCD), rumination (depression), catastrophic misinterpretation of bodily sensations (panic), and intrusive memories (PTSD). Whatever form the scary thoughts present in, they are always unwanted and the degree of distress can range from mildly annoying to severely disturbing.
How common are scary thoughts in motherhood? And what are helpful signs needing help?
Research by John Abramowitz has shown that 91% of all new mothers (and 88% of fathers) experience unwanted thoughts after childbirth (Abramowitz, Schwartz, & Moore, 2003.) That's a very high number! That means almost every new mother experiences some degree of obsessive thinking.
Keep in mind that it is not the thought itself or the content of the thought that is worrisome it is the level of suffering it causes. The level of suffering refers to the amount, frequency, and how time-consuming the distress is. Not surprisingly, if a mother perceives the thought as threatening, her anxiety will be greater. In this way, it is actually her interpretation, or misinterpretation, of the thought, rather than the thought itself, which makes her so anxious about them.
Women who have a history of an anxiety disorder or depression, or who tend to be a worriers, or describe themselves as perfectionist, have an increased risk of experiencing scary thoughts. (Though having no such history does not exempt a woman from experiencing them). The presence of any anxiety during pregnancy and the postpartum period is typically associated with scary thoughts.
What advice would you give to pregnant and postpartum women today who may be experiencing scary thoughts, anxiety, or symptoms of mood disorders?
Intrusive thoughts are almost always unwanted and scary. One of the best things they can do is to understand that these thoughts are extremely common and occur all the time. Almost all mothers will admit they have had distressing thoughts that bombard them out of nowhere from time to time. The important thing to remember is that having the thoughts is not, in and of itself, problematic. Rather, how the women reacts or deals with her troublesome thoughts is what determines whether she needs treatment or not. In other words, we know that the thoughts are triggered by anxiety. The more anxiety a woman has, the harder it may be for her to deal with it, and the more it may interfere with her ability to function and get through her day.
How do you think the book would be best used by pregnant women?
Pregnant women are also vulnerable to having scary thoughts. Will my baby be okay? What if I do something that hurts my baby? What if I don't want my baby? Why did I get pregnant in the first place? Pregnant women also need to know that these thoughts are common and if they persist or are particularly troublesome for a woman, she can get treatment, such as Cognitive-Behavioral Therapy, which will help her learn how to adapt her thinking in response to these thoughts and better manage the anxiety. This way, she will develop skills that will help reduce her risk for postpartum depression and anxiety after her baby is born.
How could a pregnant or newly postpartum mom use this with her care provider (OB/GYN, midwife)?
Perhaps the best way to use this book is to either let her care provider understand what she has learned or by sharing the book directly with her provider. The book is geared toward both the consumer and the provider since it has been our experience that excellent healthcare practitioners do not always have up-to-date information, and unfortunately, many still do not understand the nature of scary thoughts. Providers who are misinformed can inadvertently agitate a situation by over-reacting, thus, reinforcing a woman's greatest fear - that if she discloses what she is thinking, someone will judge her or think she is crazy.
How can new mothers help each other de-mystify mental health and deconstruct the happy mother = good mother myth you discuss?
The stigma attached to new mothers who are anxious or depressed has been around for ages. The best things women and healthcare providers can do is to help educate others and speak about the issues that surround this vulnerable time in a woman's life so accurate information can be disseminated. Though much headway has been made in the areas of research and public awareness, we still have far to go as a society who is learning to accept and embrace a mother who doesn't always feel so good.
I encourage all moms, family members, childbirth educators, doulas, and care providers to add this book to their must have' library. Further information about this book and topic are available at www.postpartumstress.com.
Karen Kleiman, MSW, licensed, clinical social worker, is founder and director of The Postpartum Stress Center of Pennsylvania and The Postpartum Stress & Family Wellness Center in New Jersey. She is author of several books on postpartum depression, including This Isn't What I Expected , and an internationally recognized postpartum depression expert. In 1988 she founded The Postpartum Stress Center, a treatment facility for prenatal and postpartum depression and a training center for therapists. Her work has been featured in local and national magazines, numerous radio shows, local and national television shows, including Inside Edition, The Oprah Winfrey Show and NBC Nightly News with Tom Brokaw. Karen lives with her family outside of Philadelphia, Pennsylvania. In addition to her clinical practice, Karen teaches a specialized post-graduate course for clinicians, provides training programs for healthcare professionals and mentoring opportunities for therapists who wish to specialize in the treatment of perinatal mood and anxiety disorders.
Amy Wenzel received her Ph.D. in clinical psychology from the University of Iowa, followed by her clinical psychology internship at the University of Wisconsin Medical School. She has served on the faculties of the University of Pennsylvania School of Medicine, the American College of Norway, and the University of North Dakota. Her research has been funded by the National Institute of Mental Health, the American Foundation for Suicide Prevention, and the National Alliance for Research on Schizophrenia and Depression. She is author of Anxiety Disorders in Childbearing Women: Diagnosis and Treatment and editor of the forthcoming: Handbook of Perinatal Psychology (Oxford University Press), as well as author or editor of books on topics such as cognitive therapy, cognitive research methods, and close relationships. She is founder of the Hope & Resiliency Clinic, a treatment, research, and training clinic focused on suicide prevention and support for survivors of suicide.