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“Are you having any thoughts that scare you?” I ask this question to every client I work with as a postpartum therapist, usually in the first session.

I know how heavy it is, yet I still ask because it is important.

As a new parent seeking mental health support, you have a split second to decide if I am someone you can trust. You may wonder if the truth will lead to child protective services becoming involved. You may worry I will think you love your child less or that I will judge you. You might fear that being honest will create even more stress.

In the quiet moment between asking and waiting for the answer I often drift back to a day when my firstborn was about two months old. I remember the light coming through the window and the ache in my ears as my baby cried. I remember the helplessness in my body, the effects of the weeks of not sleeping and how exhausted I felt after hours of trying everything I could think of to help him and me.

Then it happened, my scariest intrusive thought.

What can I do to stop the crying? Where can I go for a moment of relief? My brain began offering every possible option including one that would have been life-threatening to him.

The shame and panic arrived instantly. I could not believe I had even imagined harming him. I felt disgusted with myself, frightened by the thought, and still overwhelmed by the crying.

How could my own mind, something meant to help me, make the moment feel so much worse?

I was already a therapist and understood intrusive thoughts. I knew there was no real safety risk and that the shame I felt for having the thought was the proof I needed to know we were both safe. The thought came in quickly, and I recognized just as quickly that it was not something I would ever act on. My brain was doing what human brains do. It was trying to solve a problem by offering every possible option.

Whenever a client says “yes” to having scary thoughts, my next question is simple.

How did you feel after the thought appeared?

This is often the first clue in telling the difference between postpartum psychosis, postpartum obsessive compulsive disorder, and postpartum anxiety. The emotional response that follows the thought matters.

Postpartum Psychosis and Postpartum Obsessive Compulsive Disorder, Why the Difference Matters

There is a lot of commentary circulating this month as the Lindsay Clancy trial moves through the legal system. As a postpartum therapist, I worry about how fear based stories can overshadow what we actually know about postpartum mood disorders. It is easy for the public to misunderstand the difference between postpartum psychosis and the intrusive thoughts that show up in postpartum obsessive compulsive disorder or anxiety.

To help clarify this, I have included a table adapted from Postpartum Psychosis: A Preventable Psychiatric Emergency by Sit, Rothschild, and Wisner (2006), published in The Journal of Clinical Psychiatry. Their research offers a clear and evidence based overview of postpartum psychosis, including how early symptoms appear and why timely support matters. You can read the full article here: https://doi.org/10.4088/JCP.v67n0801

Diagnostic Table: Differential Diagnosis of Postpartum Psychosis

TABLE 1. Differential diagnosis of postpartum psychosis

If you’re still feeling unsure, please reach out for help.

Most parents who experience postpartum psychosis recover with the right support. We often hear the tragic stories and those stories can create fear and confusion about what postpartum psychosis actually is. In reality, early symptoms are recognizable and typically respond well to treatment.

If you are navigating intrusive thoughts, postpartum anxiety, or overwhelming emotions, or you are worried about someone you love, please reach out to a trusted health care provider as early as possible. Scary thoughts do not automatically mean danger. They do not mean you are a bad parent. They are a sign that your nervous system is overwhelmed and needs care.

Postpartum mental health is complex, and it is also deeply hopeful. With compassionate support, accurate information, and a safe place to speak honestly, healing is absolutely possible. You are not alone, and help is available.

Sometimes grief shows up in the most unexpected places.

Before becoming a parent, I had no idea how interwoven grief is with daily life. I used to think it was only the grief of loss – of a loved one, a pregnancy, a beloved pet, the end of a friendship.

As a new therapist, grief terrified me. I recall confidently declaring to my colleagues in those final weeks before graduation that I could not and would not ever be a bereavement therapist. It just wasn’t for me.

But then, as a parent, everything changed.

I’ve had to come face to face with my personal grief on a daily basis.

I realized it was grief that caught in my throat as I packed away the 0-3 month onsies. It was grief that flooded me as my son’s first birthday approached and I processed my birth trauma. And it was grief and fear of missing out on all those mundane but magical moments of his life that triggered my postpartum depression when my return to work date approached too quickly.

As a parent, it began to feel like grief was lurking around the corner at every new milestone.

I also realized there was the grief of missing who I once was. Part of me desperately missed my old pre-child lifestyle. I was grieving the days of endless hours with my partner and friends with no demands of tiny, sticky fingers reaching up at me. I was grieving being able to jump into my car on a whim and drive where I wanted to go instead of pausing to double check the diaper bag while being hyper aware of the next nap or feeding time.

As my children have grown, the grief has only continued. In recent months I have sat willing the tears back as I notice how those little sticky fingers have grown. Those little faces who were once the smallest at the baby groups have become the awkward, full of energy toddlers and children who I need to warn to “watch out for the little ones”. At moments I wonder if this will be our last time in the toddler section or the under 5 areas. That’s the thing with parenting, we are scared to miss the firsts but we are also never ready for the lasts.

As I’ve learned to invite the grief in as a parent and sit along side it, I have also learned to help my clients hold and share space with their grief as well.

Some of the most rewarding and magical experiences I have as a therapist are witnessing my clients learn to hold their grief with kindness and compassion. By learning to lean into our grief, we can learn to hold it and have space left for our other emotions like excitement, pride, joy, happiness and relief. Grief doesn’t have to yell so loudly when you are open to listening.

As the more modern parenting approaches have taught us, parents are learning how important it is to allow our toddlers and children to be seen and heard. We know how important it is to validate our child’s emotion before we can address the behaviour being caused by the emotion. How might you benefit from treating yourself the same way?

The next time you catch that grief welling up inside you– say hello. Don’t push it away as you always have but invite it in, just a little bit. If you can, be thankful to the grief for helping you see how important and precious this moment in time is or for showing you how deep the love runs.

Take a moment and visualize your grief. Maybe it’s a colour or shape. Maybe it has a face –the face of an animal or of a version of your own face, young or adult. What does it feel like to share space with this grief? Does it evoke anger or shame?

Now, say thank you. If you can, be thankful to the grief for helping you see how important and precious this moment in time is or for showing you how deep the love is. Notice how you can be both full of grief and gratitude. Our human brains are designed to hold more than one emotion at a time, after all.

If you find yourself struggling with the grief of parenthood – you’re not alone. If it feels like the grief is overwhelming you, this might be a sign to seek support.

Birthdays are a big deal for parents, too.

As a parent, have you been surprised at how much emotion goes into planning and celebrating your child’s birthday?

I find this time of year especially difficult as a mother. In my early motherhood years, I had been known to stay up into the wee hours of the night creating Paper-Mache piñatas and hand-crafted decorations. At my son’s first birthday, every item of food was made BY ME. The busy pace of party planning became a familiar space to avoid the emotions I was having about him getting older and moving out of the baby-phase that I had always longed for.

By the time he was three, I found his birthday one of my biggest mental health triggers. Through the years I have learned to navigate this time with more balance, more self-awareness and a focus on what is really important as a parent.

Here are 5 tips to help you get through:

1. Keep your emotions in check.

My mom was the queen of birthday planning. Some of my favourite childhood memories are helping her plan, prep and then host my birthday. I know this isn’t the case for all families. For some, the lack of birthday celebrations and feeling special in their own childhood can fuel an over-reaction. Either way, birthdays tend to be an event where emotion takes over.

If you are beginning to feel overwhelmed or pressured, stop and see if you are using your wise mind. If we make decisions with only emotion or only logic we are going to miss out. Use your wise mind – a combination of both emotion & logic, to help you set expectations about the day. You don’t need to make up for your own negative past birthday experiences via your child’s birthday. You don’t need to mend and fix those extended family relationships via you child’s birthday. Whatever it is that’s fueling your emotional mind, keep it in check with some logic.

2. Keep your goals in mind & set realistic expectations.  

What is it that you want to convey with your child’s birthday? For me, I want them to feel special and celebrated. This can look many different ways.

I also want them to know they are a member of a community and a family. This means not burning myself out and keeping in mind all the guests and family member’s experience at the party.

Birthdays can also be a time when outsiders get a glimpse into your world, your home and your skills as a parent. It can feel like a lot of pressure to perform and incredibly vulnerable. Decide in advance what your priorities will be: invest in those 1-2 priorities and drop the rest. You cannot do it all: cleaning, hosting, decorating, cooking, baking, planning games. Buy the cake. Order food. Plan the party outside your home if you need to. Ask for help from family and friends.

3. Be mindful of your time & resources.

It’s so easy to over-commit, burn out and forget that this birthday is also about you as a parent. Set aside some space for quiet reflection on what it means to you that your child is getting older. For many parents, birthdays are bittersweet. Let yourself feel both the warm, comfortable emotions of the day with any uncomfortable ones that might come up. Plan some down time to journal or just sit with a favourite drink and let yourself feel whatever emotions come up.

4. Heal any past birth trauma.

This is for BOTH birthing and non-birthing parents. What happened in the birthing room can follow you for many years. As your child gets older, they will often want to hear the story of their birth. If you find re-telling this story brings you emotions of grief, overwhelm, anger or a desire to numb or avoid – you might benefit from seeking therapy.

A scary birth can also be a good birth

5. Remember, it’s just a day.

You get 365 days to show your child how loved they are. You get 365 days to be a good enough parent. Yes, birthdays are important but we really live and connect in the mundane moments of life. It’s the day to day experiences that true attachment and love grows.

It’s pretty common knowledge now that there are more than the three trimesters of pregnancy. The fourth trimester has been referred to as the time after baby is born and is adjusting to life outside the womb. Those sleepy, overwhelming newborn months are a time of survival for many new families.

 The fourth trimester is a time of growth, transformation and a slow letting go between birth giver and baby. It is a time of difficulty for the whole family. As baby learns life in the outside world, parents are growing into themselves and siblings are learning to share time and attention with their new family member.

Learning to be a Working Parent

As a therapist specializing with postpartum families, I have come to refer to the transition back to work as the 5^th trimester. It is yet another time of major transformation for the family, the love relationship and at the individual level.

In her book The Fifth Trimester, Lauren Smith Brody describes this as the time “the working mom is born”—which can be just as intimidating of a process as the newborn phase.*

Most of the research about this phase has centered on the American experience, where the average return to work date is 8.5 weeks postpartum.

Does this mean that parent’s who are given extended parental leave from work don’t experience this 5^th trimester period of transformation? Hell yes they do!

As a therapist specializing with clients who experience postpartum mood disorders such as postpartum depression, anxiety and rage, I often assist clients move through this 5^th trimester despite being off work for 12-18+ months.

Shifting Your Mindset

In some ways, this transition can be especially difficult because the workplace you once knew has also changed and grown. Maybe you will return to a new boss, new work assignments or as we have seen this year, a return to a completely unidentifiable job due to adjustments made due to the pandemic.

 My advice: During my own return to work, a friend expressed the helpful guidance to “go in with the mindset you are starting a new job”. When we start a new job we give ourselves grace and compassion. We know it will be stressful and we adjust our expectations of what we are capable of. It doesn’t matter if you have been away from your job for 8 weeks or 18 months – this is a new job for you: the job of a working parent.

Planning Ahead for Change

At the couple level, this is a time to re-adjust your mindset about division of chores and work. It can be a time of conflict and resentment if not acknowledged properly or it can be a opportunity for connection and expressing respect to one another.

The parent who was on leave might have once been able to do the majority of the cooking, cleaning and childcare. If the working parent does not step up and do more it will grow into a major area of strife for one or both partners.

My advice: Plan ahead. If you know your return to work date, sit down a few weeks ahead and talk about what each of you is willing to do differently. Consider how you will divide the work in the following categories:**

• Cleaning, cooking, household chores: consider daily, weekly and seasonal chores.
• Kin work: giving emotional support to relatives, buying gifts, managing holidays and celebrations
• Emotion work: the constant checking in on everyone in the household
• Consumption labour: buying the things for all the people such as do the kids have winter gear, school supplies, researching car seats and big ticket items for house or car maintenance
• Chauffer duties: driving family members to appointments, pick up/drop off from daycare, grocery shopping, etc.
• Household manger aka making all the decisions: meal planning, creating the grocery list, scheduling appointments, arranging childcare, etc.

Remember the goal is not equality. You will never do the equal amount of dirty diapers in your relationship. Aim for equality and adjust, adjust, adjust. This plan is done on a white board, not in stone.

Being Kind to All The Parts of Yourself

And finally – attend to the hurting parent inside of you. He or she is likely going to be grieving that this phase of parenting is over. It is so bittersweet watching our children grow. As with every new development, every new step we are also saying goodbye to the babies we once held in our arms, the newborns who cooed with pleasure at seeing our smiles and feeling our warmth. If you feel it, let yourself be sad, cry, be anxious. It is also okay to be really, really excited that you get to have a hot drink, a warm lunch and to talk to another ADULT! And it is possible to be both sad and excited about your return to work.

My advice: Let yourself feel what you need to feel. If you are feeling overwhelmed or flooded by your grief, if you are finding it hard to hire a daycare provider because no one seems good enough to care for your baby these might be signs to reach out for support.

As an EMDR therapist, I often sit with these hurting parents and help them integrate the professional parts of themselves with the mother inside of them. Both roles and parts of yourself are important, precious and deserve respect.

References:

*The Fifth Trimester by Lauren Smith Brody

**How Not to Hate your Husband After Kids by Jancee Dunn

Big T vs Subtle T Trauma

We often think of trauma as big, overwhelming and uncontrollable events in our lives. A natural disaster. A major accident. Witnessing or experiencing a violent act. Society as a whole has become more trauma-informed and we now know and honour that these major life experiences can result in profound changes in how we think, feel and act.

When it comes to birth trauma, too often we mistakenly think of only the big things that happen to us. Those moments where the life of the birthing parent or the baby are at risk. Something unexpected occurs, a significant medical intervention is needed like an emergency c-section and decisions are made with urgency.

These are the Big T traumas of our birth experiences.

But what about the Subtle-T traumas?

It is possible for PTSD to occur after what the medical community would call an uncomplicated pregnancy or birth experience.

Subtle-T traumas in pregnancy and labour refer to the non-life threatening but still wounding experiences that birthing people and parents can experience on their journey into parenthood.  

If we shift our thinking from trauma being an event that happens to us and instead focus on the feeling we have, we can better understand why some parents continue to experience symptoms of PTSD after birth or pregnancy.

Let me ask you…

Did you feel empowered during your birth experience and pregnancy?

Did you at all times feel heard, listened to and that your voice and opinion mattered?

Were you informed and given the opportunity to fully consent before all the tests you or your baby experienced?

Were there ever hushed-tones or semi-private conversations between the nurses or medical staff that left you feeling insignificant or panicked?

Do you feel icky, uncomfortable or invalidated when someone says the only thing that matters about your pregnancy or birth experience is that you got a “healthy baby”?

Do you find yourself jealous or uneasy when another parent talks about their pregnancy, birth or labour experience?

Can you look back on your pregnancy and birth experience with a lightness in your soul or does it feel heavy?

What is PTSD? How Do I know if I have Birth Trauma?

The human brain is a wonderful, protective thing and when we experience a traumatic event the memory gets stored in such a way as to keep it present, raw and available to ensure we DO NOT repeat that experience again. It is protective.

Unfortunately, it is also difficult to heal and move forward when our brains continue to keep us activated in our trauma responses.

Imagine you are on a major high-way and witness the after-math of a significant car accident. You are able to safely stop your car and assist the victims until medical help arrives. Maybe all you can give are words of encouragement. Maybe you can give hands-on support. The key is, you are able to take action. How do you imagine you would feel after this experience?

Now, imagine you see the same accident but you are on the opposite side of the highway. You still witness the same after-math, but this time you cannot safely assist. You are stuck. You cannot help, you can only witness. How might you feel after this experience? How might it be different from the paragraph above?

This is the difference. Trauma is not something that happens to us. Trauma is the emotional residue left after our system becomes overwhelmed. PTSD, or Post Traumatic Stress Disorder, occurs when your brain, body and soul do not know how to finish the experience you had and leaves you re-living the emotions caused by the event inn the weeks, months and even years following the traumatic event.

Common symptoms that your traumatic birth has evolved into PTSD can include:

• Re-living aspects of the trauma (intrusive thoughts and images; nightmares; distress at real or symbolic reminders of the trauma)

• Feeling on edge or hyper-alert (being easily upset, angry, irritable; being easily startled; having difficulty concentrating)

• Suppressing feelings or memories (avoiding situations or people that remind you of the trauma; feeling detached/emotionally numb; keeping busy to distract yourself; being unable to remember aspects of the event; using alcohol or drugs to avoid memories)

• Physical sensations such as pain, sweating, nausea or trembling.

• Sleep difficulties.

Who can Experience PTSD after Pregnancy or Birth Trauma?

Anyone. The birthing parent is obviously at risk but so too are any partners or other persons in the room. Support persons like doulas or nurses can be impacted, family members or siblings who are left with too much or too little information about what is happening.

What Can I Do if I Have PTSD Symptoms from my Pregnancy or Birth Experience?

Stop minimizing.

Stop comparing.

What you experienced is valid, no matter how Big-T or Subtle-T it was.

Even if you weren’t the one giving birth or pregnant. Many fathers and adoptive parents continue to experience PTSD in silence.

If you find yourself re-living your birth or pregnancy experience in any way that is uncomfortable, therapy can help.

EMDR therapy specifically was created to help our brains complete the trauma experience and desensitize and reprocess what we when through, how we feel about it, and how we can move forward from it.

If you are in Ontario, Canada – please call or email for a free consultation to see how I can help.

Firefly Counselling – Helping you find light in the dark.

Stop.

Did you notice it?

That breath you just took. How did it feel inside your lungs?

Now think back to a few minutes ago. Were you aware of the air around you? Or was it just there, waiting for you?

It’s vital to our survival. Every breath means we are living. Yet, we often don’t notice the air around us until it’s missing and our lungs start burning, waiting for that next breath.

When we tell new parents to practice self-care, I fear too often it becomes one more thing added to the never-ending to-do list. One more thing to stress about fitting into an already busy day. One more reminder of the parent guilt we carry with us when we do try and take care of ourselves.

But when was the last time you felt guilty for breathing?

Do you remember life before kids?

Back when time was there for you to use however you wanted in abundance. Maybe you didn’t notice it then but it was all around you. Down time to think. To play and have fun the way you wanted to spend it. To shower without asking someone else first.

You probably weren’t even aware of all the time you had available to you. Like the air all around you, time was just there. Waiting to support your survival and helping you thrive.

But then you had kids and a spouse. A home and a job. Add in a pet or the needs and opinions of extended family members and it quickly can become too much.

The time that was once so abundant, that you were barely aware of it as a resource, became scarce.

How do you break this cycle?

You need to change your perspective.

What if the next time you have a moment and need to decide what task you are going to do next you made self-care as important as breathing?

How might that feel different?

Would it change what you chose to do?

Do the toys on the floor and the dishes in the sink seem as important in comparison?

Make Self-Care Intentional

When someone goes scuba diving, they plan for the lack of air. They become intentional of it’s use and very, very aware of the need for it and the dangers of what can happen when they run out.

Self-care is just as important for new parents as air is for a scuba diver. It will not come to you without effort. It needs to be made, created and taken. It needs to be protected.

The effects of not having a proper balance of self-care won’t become apparent overnight. It’s a slow burn. It comes up as irritability towards your family members. As a sense of heavy limbs and difficulty thinking clearly. It shows up in struggling to know yourself outside of your roles to other people. Or a sadness and tension that you can’t shake off.

New parenthood can be all consuming. There are gadgets to buy and a whole new set of skills like feeding and diapering and sleep schedules to figure out. There are major changes to our intimate relationships and a major identity change in who you are as a person.

There are times a scuba diver is running low on air. When this happens, they are careful with what little they have and use it intentionally. They take little breaths. They spread those breaths apart. They know their survival depends on it.

Your survival depends on making self-care a priority.