In March 2020, I planted my face in my son’s bedroom carpet and sobbed. How could I take care of a newborn baby with a deadly virus that is spreading across the world? The depression was recognizable given my mental health background, but the dark feelings were heightened by the terrifying and misunderstood coronavirus. Little did I know I was about to be part of an unprecedented statistic.
I was not alone. Mothers who had just given birth at the start of the pandemic began to suffer more and more from postpartum depression. Now one on three mothers are suffering from the disease, a rate that has tripled since the start of the pandemic.
Pregnancy and childbirth expose mothers to mental landmines, from increased inflammatory markers needed to protect against infection, increased sensitivity to threats, to decreased gray matter, which may increase maternal vulnerability to postpartum depression and anxiety. Pandemic mothers have even more to manage: they must weigh and consider vaccination status, disease transmission, mental health needs, financial needs, practical childcare barriers and reconfigure their mode day-to-day functioning and evolving according to the variable chronology in play. .
The craze for moms does not stop there. The lack of flexible employment options, paid maternity leave and choice for childcare have compounded the challenges. Pooja Lakshmin, a psychiatrist specializing in maternal mental health, called it “treason” and I agree. Mothers are so stressed that they are pushed to yelling in empty football pitches. Cathartic release may be pleasant in the short term, but screaming is not a long-term adaptive coping strategy. Mothers need help, and they need it now.
Postpartum depression hit me hard, but I was blessed with resources to draw on, including great mental health treatments and resources. I offer the same to my patients. But not all mothers are so lucky. We need to pave the way for all caregivers and mothers, with better mental health screening and treatment, knowledge about the potential of the mother’s brain, more financial support and flexible work options – and here’s why.
Research shows that the mother’s brain undergoes immense neural plasticity with potentially enormous benefits. A proliferation of cells and networks emerges and reorganizes to focus on the education of children, cells acting like the little Marie Kondo of the mind. This evolution, based on the mother’s experiences with the baby, is driven by experience-dependent neuroplasticity.
Kelly Lambert, professor of behavioral neuroscience at the University of Richmond, has studied maternal neuroplasticity in rodents for decades. His current work on enriched environments in animals with and without parental experience confirms how responsive brains are to changing environmental contexts, promoting neuroplasticity by altering existing neural processes or creating new neurons (neurogenesis).
When mothers have sufficient resources, Lambert sees maternal experiences as a form of enriched environment that promotes experience-based neuroplasticity. Mom’s spirit is resilient – research backs it up. Katherine Ellison, author of Mom’s Brain: How Motherhood Makes Us Smarter, talks about the many ways becoming a mother makes our brains more efficient, adapts to challenges, and engages in intensive baby-led training for optimal functioning. Ellison recently told me that “at all times a mother is being asked to nurture, protect, negotiate, decipher, resolve, fix, mitigate, bond with her baby, and manage her own emotional regulation.” In fact, in a study published in January 2022, the results confirm that motherhood improves “knowledge, skills and abilities, while strengthening women’s mindset, will and overall emotional intelligence” and makes mothers well-adjusted to management and leadership positions.
The maternal brain may become even more enhanced post-pandemic through a phenomenon known as post-traumatic growth (PTG), where positive psychological change results from struggling with highly stressful life circumstances. A recent study Examination of post-traumatic growth in more than 20,000 respondents in Italy, one of the countries hardest hit by COVID-19, found that post-traumatic growth was reported in about one-third of attendees; similar to TKA rates seen in other traumatized populations. These PTG levels occur naturally. If we intervene with strong treatment, we can get more than a third of mothers to thrive during the pandemic.
It goes without saying, but stressed moms are bad for our kids. The greatest predictor of child well-being is maternal mental health. A recent study showed that a nine-week cognitive behavioral therapy intervention that treated mothers’ postpartum depression normalized brain activity in their maladjusted infants consistent with healthy controls in the study. Another recent and potentially groundbreaking study showed that giving a $333 allowance to poor mothers was linked to increased brain activity in their babies. The investigators postulated that the extra money may have alleviated maternal stress, allowing them to engage with their babies in more nurturing ways. These studies show that supporting maternal mental health needs can have direct and positive downstream effects on children and hopefully on society as a whole.
It’s time to address the challenges that COVID-19 has posed to mothers and caregivers. They are—we are—our country’s greatest resource. Mothers need support to unlock their potential in the form of mental health care, employer flexibility, and resources. Employers must offer affordable childcare options, flexible workplace guidelines and remote working. Mothers need easy access to mental health care. Insurance companies must extend telehealth reimbursement approval indefinitely. Individual states can join PSYPAC where providers can provide mental health care across state lines. These options have helped me overcome postpartum depression and allowed me to help my patients and meet unrelenting challenges during the pandemic. All mothers deserve the same opportunities to allow their resilient minds to evolve even further by directing maternal brain plasticity to their advantage in this paradoxical time.
Dr Nicole Amoyal Pensak is a clinical psychologist and owner of Atlantic Coast Mind & Body in Little Silver, NJ. She specializes in treating adults with anxiety and depression and mothers with perinatal mental health issues. She received her doctorate in clinical psychology from the University of Rhode Island and completed her predoctoral fellowship at Yale School of Medicine. She completed her practical training in neuropsychology at Brown University. She completed postdoctoral fellowships in behavioral medicine and palliative care at Massachusetts General Hospital/Harvard Medical School and the University of Colorado Anschutz Medical Campus. She is the former director of psycho-oncology at Jersey Shore Medical Center and assistant professor of oncology at Georgetown University School of Medicine. She has also held scientific assistantships at Hackensack Meridian Hospital and the University of Colorado Anschutz Medical Campus. She has published over 26 scientific papers in peer-reviewed journals, presented at over 30 national conferences, and is the recipient of 15 grants and awards recognizing her academic research.
The opinions expressed in this article are those of the author.