New mothers, don’t fear: You were made for times like this

Giving birth provokes profound changes in a woman’s brain. Those adaptions may be especially helpful now, as women grapple with the realities of a world in turmoil.

Giving birth provokes profound changes in a woman’s brain. That may be especially helpful in a crisis like this.Michelle Kondrich/For the Boston Globe

Alice Owolabi Mitchell watched her husband dancing with their two-week-old daughter and realized something. He was enjoying new parenthood in a way she wasn’t.

She loved little Everly Rose, born at the end of February, but those first days were all work. Work and worry.

Then and in the weeks that followed, Mitchell worried about things that are common in new motherhood, about whether Everly was latching on correctly when breastfeeding, for example, or whether baby and mother were connecting enough. And she worried in ways that are particular to this moment, to this pandemic.

Was she doing enough to keep the coronavirus out of their home? Would she be able to get help from her doctor or Everly’s if something else went wrong? What if Everly developed diaper rash or needed formula, and they couldn’t go to the store for supplies? There was, she felt, so little room for error.

Mitchell worried about her breast milk production and whether her own stress could hamper supply. She kept telling herself, “I can’t be anxious right now, otherwise she can’t eat.” But she couldn’t help it, not when “the whole world is crumbling.”

In normal circumstances, new motherhood can be overwhelming, at once full of joy and anxiety, growth and loss. The emotional rollercoaster of the postpartum period so often is dismissed as the result of sleep deprivation and hormones gone haywire, a moment of hardship in an otherwise happy phase of life that for most mothers will pass.

The truth is that distress and ambivalence are a common part of maternal development, which entails dramatic changes in the structure and function of the brain. Understanding what’s happening to the maternal brain can help women to put the intensity of those first months into perspective: All that worry has a point. And it may be especially helpful now, as women grapple with the realities of new motherhood in a world in turmoil.

Many are entering motherhood after a pregnancy and childbirth experience very different from the one they had anticipated and some are facing unexpected financial strain. They are going without visits from family and friends, bearing gifts and meals, that could dispel the loneliness that comes from tending to a cute but nonverbal creature who has not yet figured out the difference between night and day. In-person mothers groups have ceased, along with lactation support programs or walks with friends — places they might typically find answers to a question that looms large for so many new mothers in relation to her baby’s development and her own: “Is this normal?”

During pregnancy, every aspect of a woman’s body and behavior is measured and scrutinized. Once baby arrives, the attention shifts to child development, to making weight and marking milestones. Maternal development is largely ignored, the hard parts often kept hidden by the desire not to scare an expectant mother.

In 2018, I wrote in the Boston Sunday Globe Magazine about my own transition to motherhood and the comfort I found in the neuroscience of the maternal brain. Dozens of women wrote to thank me for validating what they were going through, for explaining what they had been through.

The response was heart-warming. It also made me angry. How have we gotten the story of what it means to become a mother so wrong that so many of us are left in the dark? This question grew more urgent when the pandemic arrived.

As I’ve worried about the health of my elderly relatives and fretted over caring for my family as we shelter at home, I have ached for all the women on the brink of the unmooring that comes with new motherhood. Would they find themselves alone with their baby in the quiet of the early morning asking, is this normal? And, with the coronavirus consuming so much attention, would they find the answers they need?

‘Understanding what’s happening to the maternal brain can help women to put the intensity of those first months into perspective: All that worry has a point. And it may be especially helpful now, as women grapple with the realities of new motherhood in a world in turmoil.’

LET’S START HERE. Women are not born mothers. Maternal instinct as we commonly understand it, as something innate and automatic, particular to women, is a fallacy.

The brain circuitry that supports maternal caregiving develops over time. It is propelled at first by a jolt of hormones at childbirth and then shaped by exposure, by the very act of caring for a baby. And, in fact, a similar parental circuitry develops in fathers, adoptive parents, and likely anyone who fully engages in the work of parenting, though through different mechanisms.

Becoming a mother is a process, one that builds on the nuances of our own neurological disposition and is influenced by the trauma and healing we’ve experienced, by the stresses and support we encounter as new mothers and beyond. It’s a process that our babies are a part of, as people with their own genetic makeup and agency.

There is no “fixed action pattern” for maternal behavior, said Alison Fleming, a retired professor from the University of Toronto Mississauga who has studied the psychobiology of maternal behavior for more than 40 years and is known to some as the mother of mothering research. “It's not like a mechanistic thing that happens automatically. It has its own development.”

Early on, that development can feel like obsession. Among dozens of parents interviewed by researchers at the Yale Child Study Center, nearly all reported recurrent thoughts about their child’s safety at two weeks postpartum, and many said those thoughts persisted even when they knew their child was fine. Preoccupation was so intense, especially for first-time mothers, that the researchers concluded that new parents experience an “altered mental state.”

Mia Edidin sees that to some degree in most of the parents she works with. She is a social worker and clinical director at Perinatal Support Washington, and keeps a short list of topics that come up with nearly every family. It includes the Big One, the massive earthquake due, someday, from the Cascadia subduction zone.

It’s a risk people live with daily in the Pacific Northwest. But for new parents it becomes a real and present danger. They think, “I have actually threatened the safety of this being that I am so intricately tied to that it hurts,” Edidin said. And for a new parent, that sense of having put your child in danger “is the worst feeling ever.”

Edidin tries to help parents identify anxious thoughts about their baby’s well-being that may be irrational. That’s harder to do with the coronavirus, she said, when the whole world is in a state of vigilance, but it’s not impossible.

“We can use the data that we have right in front of us,” she said. “In new motherhood, regardless of COVID, we can look at our baby to determine if our baby is OK.”

Scientists have hypothesized that parents’ worry and attention helps them to learn their baby’s cues, which stimulate further changes in the brain.

A baby’s cry is a powerful force, as any mother who has felt its pull in her body knows. That input, but also a baby’s smile, her smell, or her sweet expressions, triggers activity in brain regions involved in motivation and salience, or how we assign meaning, including to things that are potentially threatening. They compel a new mother, through worry and joy, to continue interacting with her baby.

Researchers have found activity seems to shift from the “checking and worrying” brain circuits to those that control social cognition as mothers become more confident in reading their baby’s cues and as babies themselves become more engaging.

I’ve come to think about early parenthood as a kind of boot camp for the brain. It won’t always feel as intense as it does in those first weeks, but you’ll never be the same.

‘Women are not born mothers. Maternal instinct as we commonly understand it, as something innate and automatic, particular to women, is a fallacy.’

THAT MAY BE a scary thought. The profound changes women experience in motherhood can make them vulnerable. As many as 1 in 5 women develop a postpartum mood disorder, which can include clinical levels of anxiety that interfere with a mother’s well-being or her ability to take care of her child. Plus, our cultural understanding of “mommy brain” is that it is diminished, that mothers are forgetful and frazzled, consumed by their kids. But the research on the maternal brain shows a much more complex picture.

Many women do experience real but generally small deficits in certain kinds of memory during pregnancy and afterward. But motherhood also is thought to fine tune a mother’s ability to read and interpret social cues not only from her baby but potentially from her partner and other adults. Over time, it may recalibrate her emotional regulation, so that she can control herself in the face of a screaming child (or a moody teenager) and plan a response. It may even enhance certain kinds of executive functioning related to working memory and the ability to shift attention between tasks. And one study published last year looked at the brains of more than 12,000 women and found that the more children they had, the younger their brains appeared.

Researchers have a long way to go to fully understand what motherhood means for the brain, but it is clear that the changes a woman goes through, while often grueling at first, are generally adaptive, aimed at making her better able to care for her child and herself.

MITCHELL, WHO TEACHES fifth grade at Match Community Day school, had a plan for baby Everly’s arrival. The 29-year-old had worried about childbirth, as a Black woman in a country where the rate of pregnancy-related deaths is more than three times higher for Black women than for white women. When Mitchell was 14, her own mother died of cardiac arrest two weeks after giving birth to a son. Mitchell wanted extra support.

She started seeing a therapist during pregnancy and enlisted help from the Boston Doula Circle. She planned to attend a diverse mothers group in Dorchester and another near her home in Quincy.

“Obviously, I can’t do any of that now,” she said. “What I envisioned my post-labor, early stages of motherhood to look like has been just completely altered.”

New mother Alice Owolabi Mitchell and her 10-week-old daughter Everly Owolabi Mitchell.Pat Greenhouse/Globe Staff

Support for new mothers is critical. Pregnancy and the postpartum period already place a heavy demand on the brain’s stress-response systems, and researchers are raising alarms about how the stress of the pandemic could compound a crisis in maternal mental health. A lack of social support is a significant risk factor for depression during pregnancy and afterward.

Postpartum support professionals understand this. As the pandemic began, they scrambled to move mothers groups and talk therapy sessions online. Lactation specialists tucked canisters of formula into clients’ bags, just in case. Doulas strategized about how to continue supporting women laboring in the hospital and after they returned home.

They repeated advice they give to all newly postpartum mothers: Take a shower. Put on clean clothes. Get fresh air, even if it means simply opening the window. Limit your news consumption. Stay connected to the people who support you best. Get help if you are struggling.

Sharon Dekel, assistant professor of psychology at Harvard Medical School, whose lab at Massachusetts General Hospital is focused on maternal mental health and traumatic childbirth, began thinking through how to measure the pandemic’s effects.

“The question was: How are mothers managing the transition into the postpartum period, when you have this kind of unpredictable, unpredicted stressor at a very kind of large scale?” she said.

Dekel has collected stories from hundreds of women about their childbirth experiences and their postpartum mental state. She and her colleagues took a questionnaire from that work and adapted it for the COVID-19 era, asking about how hospital policies affected birth experiences and what caring for a newborn is like while social distancing.

More than 1,700 women have enrolled in that study so far, and Dekel plans to launch versions in Spanish, Arabic, Chinese and other languages soon. One factor Dekel will look for in their responses is signs of growth.

Her prior work examined post-traumatic growth in people who experienced war, captivity, and disaster, including the Sept. 11 attacks on the World Trade Center. Post-traumatic growth unfolds over time, she said, and in many ways it is a product of distress, which can shake a person’s worldview and make them reevaluate their choices.

Someone who has just had a baby may be struggling and mourning the childbirth or postpartum experience they thought they would have. But over time, they may recognize their own strength. The story becomes, "you did it, and you were still taking care of your baby," Dekel said.

Mitchell said she and her husband, who also care for her little brother, now 14, are trying to fill their house with as much joy as possible. She’s celebrating the little changes she sees in herself and in Everly, like when Mitchell lets out her warm, bubbling laughter, and Everly seems to startle in recognition.

“We’re learning each other,” she said.

Chelsea Conaboy is a writer and editor who lives in Maine. She is writing a book about the maternal brain, forthcoming from Henry Holt & Co.

RESOURCES FOR NEW PARENTS:

The Massachusetts chapter of Postpartum Support International runs a helpline by phone [phone]) and email ([e-mail]).

Check your local hospital or parenting support center for groups that have moved online.

These organizations offer free online groups for new parents:

• Jewish Family & Children’s Services, Center for Early Relationship Support
• First Connections, a program of the Justice Resource Institute (scroll down to “First Year of Life” for online listings)
• Group Peer Support has started a group for pregnancy and parenting during the pandemic