Wednesday, December 9, 2009


This is a chunk of a large article I found here.

I'm posting it here for a number of reasons - in part, it's for my many friends who have recently become parents or who soon will. Food for thought, a defense against the "no one told me" shock. It's an interesting mental model of what happens in women's lives after children arrive, because it goes beyond just looking at individual issues as separate and unrelated. For anyone reading this blog and contemplating parenthood, read the whole article, not just the section I re-posted here. It's long but worthwhile.

But I'm also posting it as an answer. Family and friends have been asking when/if I will have another child, and usually say I don't know, but that's not quite true. I'm in the second third (see red text). I'll have another when and if my reserves of strength/health/sanity are rebuilt to the extent that I think I can handle another kid without being in the third third.


What's more, a new, small field of study is focusing on mothers on a day-to-day basis, particularly on the effect of mothering on a woman's general health and well-being. For the time being, these researchers are concerned not with major illnesses like cancer or postpartum depression, but with all the minor ailments that can add up to a life lived at a lower level of happiness and satisfaction than it could be.

They're concerned about mothers who can't or don't take good care of themselves, don't eat well, don't sleep enough, don't get out enough, who spiral down, sometimes slowly, sometimes alarmingly fast, into a state of low energy, depression, marital dissatisfaction, guilt and disappointment, unhappiness with themselves and with their lives. These factors all add up to a condition that the authors of a recent book have dubbed Maternal Depletion Syndrome (MDS), a serious bio-psycho-social condition that they say affects the well-being of many women who bear and/or raise children.

The book that outlines MDS, Mother Nurture: A Modern Mom's Guide to a Healthy Body, Mind, and Intimate Relationships (Penguin, 2002), was written by psychologist Rick Hanson, nutritionist Jan Hanson, and OB/GYN Ricki Pollycove, the former chief of gynecology at California Pacific Medical Center. Together they're on a mission to bring MDS to greater public awareness.

In a Powerpoint presentation that Hanson and Pollycove often present to med school classes, they list "common presenting problems of women"--in other words, ailments that bring women in their childbearing and child-rearing years into their doctors' offices. These range from depression to low libido to auto-immune conditions, excess weight, fatigue, and gallbladder or kidney problems. The single common factor that increases the risk of each one of these conditions is motherhood, the authors point out.

The insidious thing about it, says Hanson, is that motherhood isn't usually considered a factor in any one of these conditions. Or if it is, it's written off as "just part of the job." Take fatigue, for instance, or stress. How many times have you heard people say that it's all part of having kids?

Maternal depletion is the number one unacknowledged health care problem in the U.S., Hanson says. We should take this condition seriously not only for the sake of the individual women themselves, but also for the impact on our country and the economy when so many women are "running on empty." Children are neglected, marriages get into trouble, jobs suffer--"all of which, one way or the other, costs our economy billions," Hanson says.

But research that correlates motherhood with particular health complaints is spotty. "There are virtually no longitudinal studies that match mothers with non-mothers over, say, a three to five year period to assess their risk for certain conditions," Hanson says. He and his co-authors spent months doing a thorough review of the medical literature, in the end compiling eighty pages of references. ("I'm the guy in your seventh grade class with three pages of footnotes on his book report," he says.) All of it adds up to a big gaping hole in our knowledge of how being a mother affects us on a day-to-day level.

The authors are both adamant and anti-alarmist. They don't want to sensationalize their findings, but they firmly believe it's both pervasive and invisible. It's been so easily ignored up to now, Pollycove says, partly because our culture doesn't like to hear mothers complain. And women who are ground down are less able to muster the energy to make a big issue of their health. Hanson also points to a psycho-social reason we've overlooked MDS to date: At some level, he believes, we're aware that our own mothers may not have always had an easy or wholly enjoyable time raising us. That makes us feel guilty, which makes us more inclined to stick our heads in the sand when faced with evidence that many women are suffering through their child-rearing lives today. "And you can't underestimate the economic motive either," he says. "We don't like to acknowledge that we are always exploiting the unpaid labor of mothers."

MDS happens, they say, when three common factors collide: the high physical and mental demands of bearing and raising children; the low resources many mothers have on hand when they have kids (ranging from poor-quality food to insufficient help from a partner); and "personal vulnerabilities," such as having children at an older age, a prior health problem, a temperament that's unsuited to the chaos of living with young children, or a bout of postpartum depression.

By their calculations, one-third of all mothers will sail through the birth and caregiving years relatively easily. They're likely to have the deck stacked in their favor: a loving, helpful partner, good overall health, youth, enough money, and "plain old good luck," Hanson says. One-third are likely to find it more challenging, suffering some depletion, fatigue, depression, or difficulty with their relationships--but they're able to rise out of it by the time their youngest child is in kindergarten.

The remaining one-third of mothers are at risk for significant depletion. "They have a really difficult time, especially in the early years, with more serious health problems and deeper depletion that has longer lasting consequences," Hanson says. "Their depletion may last into their children's teenage years, and then collide with the challenges of the transition to menopause."

Those mothers often suffer for years without pinpointing the problem. "It typically takes one to two years for a woman who has underlying risk factors to drain their deepest resources," Hanson says. "They'll have a lot of subclinical problems: they're run down, they're having weird periods, they've got no patience, they have insomnia, or a loss of libido. They see their doctor for the typical six-minute appointment, and they may get one of those thing looked at.

"But if one more stressor is added to her life--a spouse's job loss, a difficult child, even less sleep than normal--she starts circling the drain of depression and depletion."

Many women are able to begin building up their resources (sleep, time apart from their baby, healthier eating habits) at about the time their child starts coming out of the toddler years. But if she hasn't fully "restocked" before the next baby comes along, the cumulative stress could drain her more quickly and more deeply.

Some of the underlying issues of MDS can be easily addressed, they say. There are simple medical tests that can pinpoint a thyroid problem (which is often a culprit in fatigue), for instance, or a nutritional overhaul. There are relaxation techniques for dealing with day-to-day stress and communication strategies to help an MDS mother talk more effectively with a spouse or partner. But the first thing that has to happen, they say, is that the mother herself has to acknowledge that her health matters. "I've been trying for twenty-seven years to sell women on the idea of taking care of themselves," Pollycove says wryly. "It's a hard sell. Women will buy ten books on pregnancy and the newborn stage. But after that, it's like they drop off the planet."

"We're not knocking the wonderful parts of motherhood. We're just trying to point out that if we can gain some recognition for the idea of Maternal Depletion Syndrome, more research can be done," Hanson adds. "Maybe we could find a way to flag those women who are higher risk earlier in their child-rearing careers which would not only help them, but help the children under their care, and even the economy.

"Motherhood is not a clinical condition," he says. "On the other hand, it's a very serious undertaking that doesn't stop when mom and baby go home from the hospital."