Rage Against the Postpartum Machine – Let’s Talk About Postnatal Rage

Published on: February 12, 2020

This month Midwife Emma McNerlin explores the often-overlooked phenomenon of “Postpartum Rage” and reminds us that help is available so we are not alone in this journey.

 

By Emma McNerlin (midwife)

The adjustment to motherhood and life with a new baby can be tough both physically and emotionally. When listing symptoms of postnatal depression (PND); anger or rage is either absent or disguised in benign language like “mood swings” or “inability to cope”. These terms lead to feelings of guilt and inadequacy and possible reluctance to seek help, which can lead to a dangerous downward spiral. 

Society has conditioned us to view pregnancy and becoming a mother as a wholly joyful experience. Media and advertising depict soft focus pictures of beautifully calm newborns cradled by perfect mothers overlooked by an adoring dad. This sets unrealistic expectations for new parents. No one shows the early days of adult diapers and topless wandering around your room to let your cracked nipples heal, the half-eaten sandwich from lunchtime still on the plate at 7pm, or the baby having an epic meltdown in the evening while your other half hides out at the office waiting for normality to return (he’s not, but that is what your brain will tell you as you slowly despair). 

When you attend your postnatal check at 1 week and 6 weeks in Bangkok, most doctors are unlikely to ask about your mood or mental health, the focus being on physical recovery and the “all clear” to go back to normal life, whatever that is! You can self-screen for mood disorders, the tool most commonly used is the Edinburgh Postnatal Depression Scale or EPDS (Cox et al 1987), a set of statements on which you reflect over the past 7 days and answer accordingly. What is striking, is that of the 10 questions listed, anger or rage does not feature.  (Link to EPDS: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Documents/Postnatal%20Depression%20Scale.pdf).

Not all women who experience postnatal rage or anger have PND, but research suggests that when anger is present, the risk of developing depression and its severity, is greater (Raynor, 2015); recognizing the symptoms and getting help early is vital to stop a negative spiral. Anger can manifest in different ways and can be directed at different people, your partner, doctor, nanny, visiting family, the weirdo who stared at you breastfeeding in a coffee shop, and in serious cases, it can affect your relationship with your baby. As a new mum these episodes of rage can be really scary because they are so out of character and lead to helplessness and shame. 

Partners are often the sustained target of the anger and often they don’t know how to react to these changes in maternal behavior or how to help. Whatever they do, they should never utter the words “Calm Down” or mutter “It’s the Hormones”. The mother of your baby is crying out for help, is scared and doesn’t recognize herself anymore, meet her anger with compassion and understanding. It’s not your job to fix her or explain how to do better, love her and help her reach out to get help. 

The anger or rage is an outward expression of an unspoken emotion, which will be different for each individual woman. The Anger Iceberg by Gottman is a useful illustration of the deeper emotions fueling postpartum rage. Psychologist Carolyn Wagner refers to postnatal rage as a red flag to unspoken or uncomfortable feelings or emotions related to circumstances, or adaptation to motherhood. This anger feels overwhelming and is often accompanied by a feeling of losing control. This can be frightening for a new mother, especially as she is caring for her newborn and feeling out of control. It can also make her feel less secure in her relationship as she finds herself screaming at her partner. Is it any wonder that women do not seek help allowing guilt, shame and negative self-talk to spiral? 

A recent review of evidence at University of British Columbia found common themes of the source of postnatal rage in the context of postnatal depression. “Feelings of powerlessness, a mismatch between reality and expectations of motherhood, and unmet expectations of support contributed to anger in the context of postpartum depression” (Ou et al 2018).

We all come to motherhood with different expectations of the type of mother we will be. For some of us, the pregnancy may not have been planned, for others the journey to motherhood may have involved much emotional pain, trauma and loss. We read all the books, go to the birth classes and buy all the gadgets and kit. In reality though, nothing can prepare you for the total change motherhood brings. The immediate responsibility of caring for a newborn can feel overwhelming, you may be second-guessing your judgment or feel judged by well-meaning friends and family.

Postpartum can also be a lonely time, believe it or not very new babies can be quite boring. Even in a room full of people, it can feel isolating as a new mother, prolonged weeks and months of broken sleep can leave you in perpetual brain fog. 

Being open and honest about how you are feeling is vital and getting help, finding someone to confide in confidentially, your partner, a counselor or even your doctor. You are not alone, that cannot be stressed enough, many women share the same feelings, BAMBI New Moon is a great resource for new mums to find friends and gain support from our team of volunteer midwives and doulas. 

Counseling can help you to confront the uncomfortable deeper emotions that are fueling the anger and can give useful strategies to address issues. Sometimes just realizing you don’t have to be perfect, recalibrating your expectations of yourself and your partner and asking for more practical help can make a massive difference. 

Postpartum mood disorders such as PND and Postnatal Rage can be devastating for new families, putting a strain on relationships and tainting a new mother’s perception of her bonding with her new baby. It’s important not to suffer in silence if you are feeling this way, speak with your doctor, come and see us at Bumps and Babies in confidence, we are here to listen and to signpost you to professionals that can help. It does get better when you access help.

 

References

The Anger Iceberg https://www.gottman.com/blog/the-anger-iceberg/

Wagner, C. [2019] Available online www.mother.ly.com

“Anger overlooked as feature of postnatal mood disorders.” ScienceDaily. ScienceDaily, 26 June 2018. www.sciencedaily.com/releases/2018/06/180626113415.htm

Christine H. Ou, Wendy A. Hall. Anger in the context of postnatal depression: An integrative reviewBirth, 2018; DOI: 10.1111/birt.12356

Raynor, C. (2015) Postpartum mood disorders in Mayes Midwifery 15th ed. 

Cox et al (1987) Edinburgh Postnatal Depression Scale

 

Photo by Priscilla Du Preez on Unsplash.

About the Author

Originally from Ireland, Emma is a UK-trained midwife who worked in the maternity unit at a busy NHS hospital just outside London. Emma moved to Bangkok with her husband in 2014; they have a 14-year-old son, Toby. Volunteering with BAMBI Bumps and Babies since August 2015, Emma regularly conducts sessions on pregnancy, birth, breastfeeding, and infant first aid. In her spare time, she enjoys baking and Muay Thai and is an active member of her son’s parent group at school.


The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects.

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