Babies don’t require perfection from mothers; only other adults do

9B1C26EB-C6D6-476B-8409-C9EF8918E61A

NPR recently published a chilling piece.

She Wanted To Be The Perfect Mom, Then Landed In A Psychiatric Unit details the horrifying experience of a woman who suffered from postpartum psychosis.

Lisa wanted to be the perfect mom. She was ready to be the perfect mom. She and her husband lived in San Francisco, and Lisa had worked as a successful entrepreneur and as a marketing executive for a Silicon Valley tech company. When it came to starting her family, she was organized and ready to go. And that first week after her baby was born, everything was going according to plan. The world was nothing but love.

Then the baby started losing weight, and the pediatrician told Lisa to feed her every two hours.

Lisa started to feel like she couldn’t keep up.

“It weighed on me as, ‘I’ve failed as a mom. I can’t feed my child,’ ” she says. “I needed to feed her — that was the most important thing. And my well-being didn’t matter.”

She was barely sleeping. Even when she could get a release from what felt like breastfeeding purgatory, she couldn’t relax. As she got more and more exhausted, she started to get confused.

When she mentioned suicide her husband hospitalized her.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Where does a woman get the idea she must be a perfect mother? From the same place that some women get the idea that they must be a perfect wife and deserve to be beaten if they are not: she is socialized to it.[/pullquote]

Lisa doesn’t remember any doctors or nurses telling her why she was there or what was going on. But she does remember, about a week into her hospitalization, her husband bringing a printout from online about postpartum psychosis.

The article said elevated hormones from childbirth — plus sleep deprivation — can trigger confusion and paranoia. Lisa didn’t believe it — she thought her husband was tricking her and had spent hours using Photoshop to piece together a fake article.

Suicide claims many women in the year after a baby’s birth:

In the U.S., mental health problems are one of main contributors to maternal mortality, according to a 2018 report from a Centers for Disease Control and Prevention initiative called Building U.S. Capacity to Review and Prevent Maternal Deaths. On the report’s list of causes of death among new moms, mental health problems (which include drug overdoses) rank seventh — nearly tied with the complications of high blood pressure. For white women, mental health problems are the fourth leading cause of death.

Where did Lisa get the idea that her baby needed perfection?

It certainly wasn’t from the baby. As attachment theorist D.W. Winnicott first articulated, a baby needs only a ‘good enough’ mother by which he meant “the ordinary good mother … the devoted mother.”

As a Wikipedia article notes:

…[T]he idea of the good enough [mother] was designed on the one hand to defend the ordinary mother … against what Winnicott saw as the growing threat of intrusion into the family from professional expertise; and on the other to offset the dangers of idealisation …

But we didn’t need an attachment theorist to explain this reality. We are well aware that children can and do bond desperately to parents who abuse them.

I doubt it was from her own experience. Most people love their own mothers dearly despite recognizing (and complaining about) the fact that she is not perfect.

So where did she get the idea that she needed to be a perfect mother? From the same place that some women get the idea that they need to be a perfect wife and merit punishment from their husbands if they are not: she was socialized to it.

For most of human history women have been socialized to the idea that they must be perfect wives; meek, subservient, devoted to meeting any and every need a husband could dream up, no matter how ugly or unreasonable. Women were taught that when they “failed,” they deserved to be punished. Until very recently nearly every culture considered a wife’s body the property of her husband and he had the legal right to beat her, rape her or lock her away forever. Many cultures still do.

Even within our own culture, where we deem wife beating a crime, many women are abused and believe they deserve to be abused if they fail to meet their husbands’ expectations. “It was my fault!” is often the first thing a battered woman will say to the medical provider who discovers her injuries.

Why do women stay with abusive partners? There are a host of reasons but nearly always one of them is that the woman believes she owes her partner perfection and he is entitled to discipline her if she falls short.

Our culture, touting “attachment mothering,” socializes women to believe they owe their babies perfection. And mothers do believe it, eagerly disciplining other women — family, friends, acquaintances on social media — if they “fall short.”

Mothers (and “experts”) verbally abuse women who don’t or won’t comply. Telling a mother she must breastfeed or her baby will not bond to her is as abusive as telling a wife she must defer to her husband in every way or he will not love her. Both are ugly lies that serve no other purpose than to force women’s acquiescence.

Sadly, the journalists at NPR are every bit as socialized to such misogynistic beliefs.

Although they correctly identify the pressure to breastfeed as a trigger for postpartum psychosis, their “solution” is bizarre in the extreme.

The writer of the NPR piece approvingly describes a psychiatric facility designed for postpartum treatment:

Every room has a hospital-grade breast pump, Kimmel says, and there’s a lactation consultant who helps women with breastfeeding. The unit has a designated refrigerator for moms to store pumped milk.

What message does that send? It’s the equivalent of treating a woman who was beaten for burning her husband’s dinner by providing her with a kitchen and a cooking instructor.

It reinforces the same misguided, misogynist beliefs that brought her to this deadly impasse in the first place.

Fortunately, Lisa understood the opposite.

She had a second child but did not suffer a recurrence:

The psychosis did not come back after Vivian’s birth, in part because of all the precautions Lisa took. She made sure she got enough sleep. She gave herself permission to give up breastfeeding if it became too much.

“We’ve got so many messages of just self-sacrifice,” Lisa says. ” ‘Do anything for your kids.’ ‘Drop everything. That’s what it means to be a good mom.’ And for me, that’s not what made me a good mom. That’s what made me fall apart.

Words that other mothers struggling to meet unreasonable goals ought to take to heart. Because babies don’t require perfection from mothers; only other adults do.

  • rational thinker

    Sadly some of these women who get post partum depression and/or post partum psychosis wont get help cause they do not want to seem like a bad mom or if its inpatient she worries about missing out on bonding while breastfeeding. They get the message from friends, face book, ncb activists, lactation consultants, and sometimes even family that you must breastfeed if you want to be seen as a good mother. I forgot what site I read this on but an adoptive mother was looking for advice on how to induce lactation for a girl she was adopting from china in a couple weeks. She said she heard how important breastfeeding is for bonding so she wanted to breastfeed the child she would be adopting. I understand the desire to bond with an adoptive child and I have heard of women who successfully induced lactation to feed an adoptive infant. But I think the breast is best message got to this lady a bit too much. The baby was actually a 4 year old girl who was raised on formula was never breastfed before either and obviously weened off formula/bottles a long time ago. It was sad that she thought she had to breastfeed to bond with her, I hope for the child’s sake she didn’t go through with this. If she did do it that poor child is going to need a lot of therapy as an adult. Its scary enough to be taken to a new country with people she just met, she really didn’t need her new mom shoving her breast in her mouth too.

    • demodocus

      Oh, good heavens. A preschooler! When they can use complete sentences and are learning to recognize letters and numbers is a little late, and more than a little pointless, to begin breastfeeding.

      • rational thinker

        When I read that I was shocked. I think it shows how many women now believe that the only way your child will bond with you is if you breastfed them.

  • KeeperOfTheBooks

    “Every room has a hospital-grade breast pump, Kimmel says, and there’s a lactation consultant who helps women with breastfeeding. The unit has a designated refrigerator for moms to store pumped milk.”
    If, IF this is done sensibly, I could see it as a very good thing. Breastfeeding, as with many things, can be a big morale boost if it’s going well, and a mom for whom breastfeeding is relatively easy might do best in a situation where she has good support to keep that up.
    The problem being, of course, that I’ve met exactly one lactation consultant I’d trust around a mom like that, and she was one of a dozen or so I’ve met by now. Those aren’t very good odds at all. *shudder*

    • Jessica

      My favorite was still the hospital lactation consultant who wrote in my chart that I was uncooperative and “seemed to want to do everything on my own.” Because I had a different consultant come in every single shift (including night while I wanted to sleep) for two days and give inconsistent advice and I just wanted her to go away. Good help can be very effective, but simply having someone there isn’t enough. (For my second kid, I told them I was combo feeding and they didn’t send a single consultant – it was great. Ironically though my son was better fed than his older sister, because I had a better supply, my mental health was worse – I was exhausted and had D-MER and felt continually depleted). I stopped breastfeeding when he was 4 months old and life got much better for both of us. But I’m sure that lactation consultant, had she known, would have accused me of “giving up.” I’d shudder to have someone like her near a psychologically vulnerable patient.

      • KeeperOfTheBooks

        Ugh. I am so very sorry you went through all that. My breastfeeding story is not dissimilar, and ditto treatment from IBCLCs.
        I would like to give a shoutout to the one awesome IBCLC I know, though. She’s the nurse at the kids’ pediatrician’s office, and while I gave breastfeeding Baby Books #3 the old college try (and then some), he was just not gaining any weight. She was incredibly supportive, offered all the formula samples I could carry, and generally said Nice, Encouraging Things through the whole process. Do you know, I didn’t even realize she WAS a lactation consultant until I happened to see her name and credentials listed on the door! She also made a point of having a solid mental health talk, with good referrals for more help, with me at each appointment because I had mentioned having had PPD with the older two kids. Now, if she could be cloned and set up on a mental-health-for-new-moms psych unit, well, it would be a grand thing for all involved. Not so much every other IBCLC I’ve ever met, though…

      • demodocus

        I’ve mentioned before that one of the IBCLCs I met was and still is the most arrogant medical professional I ever met. I felt like even the nicer ones were not listening to me. In fact, the most helpful person was my son’s male pediatrician.

  • Mel

    Question: If a man has a diagnosis of active psychosis with suicidal intent immediately after their child is born, is it best practice to expect him to continue care for the infant (with support) while in an inpatient unit of a psychiatric hospital? Won’t he miss critical bonding? Won’t the absence of the infant impair his healing?

    Oddly enough, we had two guys like that in my ward. Everyone seemed to get that one hour of visiting a day with their babies was not a lot – but the men were quite sick and needed a lot of time to rest and heal.

    • PeggySue

      I have wondered about that as well. Though I do think that for many women, having to leave the baby would be a deterrent to getting help, so as long as support is adequate to allow for rest and healing, this may be a really good option for at least some.

  • Mel

    I found that article’s premise creepy. I was hospitalized twice when I was 19 because I had severe depression with suicidal impulses.

    Honestly, I hospitalized myself the first time as the last thing to check off my to-do list before I killed myself. I was so depressed that I couldn’t imagine that there was help available – but I didn’t want anyone asking why I hadn’t tried in-patient care at my funeral.

    I am all about patient rights – but the memories of people who are struggling with active psychosis and mania while trying new drugs need to be taken with a grain of salt or two.

    One young woman told the other patients about how the staff drugged and restrained her as soon as she came on the floor the night before. We were suitably sympathetic – but we had been there for the hour when the staff used every non-drug or restraint method they could think of to help her calm down as she was running, screaming and cursing between her room, the hallway and the patient lounge. It was only when she started to slam herself into walls head first that they sedated her – and used minimal restraint to keep her calm. I believe that she believed her memories of what happened – but her memories clearly didn’t match what we saw and heard.

    I’m skeptical that no one told the women what postpartum psychosis was at first – and I think the reporter was too. Again, it’s not that the women are lying – but severe mental illness, like severe physical illnesses of all kinds, can mess with the formation of memories.

    Preventing suicide trumps breastfeeding. That should be a “well-duh” statement – but there you go. Why do I bring that up? Well, I’m hardly mechanically inclined, but I suspect the power cord knotted together with the pump tubes to a breast pump are long enough to strangle yourself with. I suspect someone with a little more skill would figure out to get into the motor to electrocute themselves too.

    • PeggySue

      Yes, I’m sure that the severe illness and crisis situation can mess with memory formation. Though some folks have some amnesia about their own behavior at even the best of times. 🙂 Like the friend who was grieving over her parents’ seeming distancing of her, “They don’t even call to ask how I am. They don’t care.” Which was fine, except two weeks earlier she had sent the same parents a letter saying she wanted space from them…

    • mabelcruet

      Your final paragraph-completely agree. It sounds as though the ward has been designed from a midwife/lactation point of view and not from a psychiatrist/psychology/suicide prevention point of view. I have friends who work in psychiatry, and in-patient facilities are very carefully designed to minimise risk in all areas, whether its in the patients room, the communal areas, the visiting areas, the hallways-everywhere. Doctors aren’t even allowed to wear lanyards with their name badges and security pass (risk of strangulation from violent patients, could be used for hanging if a suicidal patient gets hold of it), they can’t even have a safety pin fastening as that could be used for self-harm if a patient gets hold of it, they have to carry it as a laminated card only.

  • fiftyfifty1

    “Every room has a hospital grade breast pump.”

    Whether this is good or bad depends on how they store it. If it’s stored away in some closet and taken out only if a mother and her mental health team decide on it, then good. If it’s sitting out in every room so as to make mothers feel obligated to use it, then it’s bad.

    I certainly wouldn’t want a situation where all the women were required to stop breastfeeding, because then they would have to choose between getting the mental health care they needed vs stopping something that was potentially going well. I mean I would guess that for most women who need hospitalization it would be better to stop, but certainly not for all.

    The journalist, perhaps, is stuck. She may have recognized that breastfeeding was one of the factors that pushed this woman to psychosis. On the other hand, she wants to educate women that if they do accept hospitalization, that they won’t be forced to wean.

    • Amy Tuteur, MD

      I’m not suggesting that mothers be encouraged to quit breastfeeding or to be denied the opportunity to pump if they want to do so, but part of the problem is an obsession around breastfeeding so the last thing they ought to be doing is promoting it.

      • fiftyfifty1

        I agree that our society’s obsession with breastfeeding is not good for mental health and I agree that the psych hospital shouldn’t be pushing moms to breastfeed (or pushing moms to keep their babies with them for that matter.) But these psych hospitals exist in the world as it is today, not in an ideal world. In our culture today, women of a certain demographic care about breastfeeding and care about “bonding” and will be more likely to forgo care if they believe it would interfere with either. So this psych ward may be “promoting” breastfeeding in only the same way that an L&D ward “promotes” natural birth when women take the ward tour. “Oh yes of course, unmedicated birth is lovely and we support it, look at our large collection of birthing balls.”

        • Mel

          The larger of the two inpatient psych hospitals in my area has an outpatient intensive day program with nursery available for moms who are stable enough to be out of in-patient care. It seems to work pretty well – but the caveats I have are that the coverage area is pretty huge (like most of Michigan excluding Detroit metro….), the hospital is located in the middle of a city, there are far more women who need extensive outpatient support than inpatient support at any one time, and people stable enough to be in out-patient care are much easier to provide pumping and nursery support to than inpatient care.

          That’s one of the points I think the article misses.

          Unless an area is densely populated enough, I can’t figure out how the perfect in-patient unit where moms can pump and see their babies a lot would work. Pumping requires pretty close to 1:1 supervision for patients at risk of suicide. Legal baby staffing in my land is 1:4. The units at the hospital I was at could hold ~15 people with 4-5 unit staff (outside of doctors, therapists etc) during the 7am-7pm shift and 3 staff at night. On a unit with 16 patients, they’d presumably need to add 2 staff members a day (one per shift) to cover a pumping room 24/7 plus 8 nursery staff (4 per shift) – and I doubt insurance is going to pay for nursery staff.

        • mabelcruet

          I think there is also a risk that if breast feeding is promoted (by having fridges and lactation consultants and pumps in the rooms), mothers may be less compliant with medication-some of the stuff used to treat severe post-partum depression and psychosis is probably contraindicated in breast feeding-if a mum is so desperate to breast feed because that’s what she has been told is best, she might not comply with medication. We don’t deal well with maternal mental illness at all, its treated like its some sort of weakness. One of my sisters suffered quite badly with it, not to the extent of needing admission, but when she tried to discuss it with the community midwife prior to her second baby being born, she was told that it didn’t exist (everyone exaggerates, was the phrase she used, claiming that women just get on with it and you’ll work through it).

  • rational thinker

    “Every room has a hospital-grade breast pump, Kimmel says, and there’s a lactation consultant who helps women with breastfeeding. The unit has a designated refrigerator for moms to store pumped milk.” – This! That is a horrible and careless thing to do to someone who is in a treatment facility for that very reason. A better option for therapy is having this woman pick up the breast pump then go to nearest window or roof, then throw the damn thing and listen to it break.

    • alongpursuit

      YES! I also ripped up the pregnancy and baby books that upset me and put them in the recycling bin. Normally I would donate used books, but I didn’t want to subject anyone else to the misogynistic muck that once polluted my book shelves.

      • rational thinker

        It must have felt great to tear that crap up. lol

    • Zuul

      I listened to the full NPR story and feel that this is partly taken out of context. Earlier in the piece, they spoke to a woman who had been hospitalized with post-partum psychosis in a facility that was NOT equipped to help new mothers. She was lactating, but as a psych patient was not allowed to have a “personal item” like a pump. Her breasts became painful and engorged, and she developed other unspecified problems (infection?) as a result.

      I think they were trying to show that making pumps available was part of making inpatient treatment friendlier to new mothers, in case the pumps were needed for a pump & dump, and not as part of a push for breastfeeding.

      • Amy Tuteur, MD

        They talked about having a lactation consultant, too. It’s hard to imagine anything more damaging than exposing a patient who is sinking trying to meet unrealistic expectations with someone whose job description involves unrealistic expectations about breastfeeding.

        • fiftyfifty1

          I agree that the lactation consultant is a potential danger. Then again, if they have a non-toxic one, it could be beneficial. She could help the ones who want to resume breastfeeding keep up a supply, and help the ones who choose to quit dry up more comfortably. And she could give a lot of permission to quit.

      • Mel

        I think the reporter missed an important point by not talking to a standard member of an inpatient psych team without referencing the patient’s case. Psych patients are allowed to have personal items as long as the personal item is not something that can be used to facilitate a suicide by that patient or another patient.

        Anything that has long cords or strings – like the power cord of the pump or the suction tubes for the pump – is a no-go. As the story showed, she was able to use a pump – but it had to be supervised or in a room where another patient couldn’t mess with it.

        The other problem is that I’m not entirely sure how well medical staff showing up with a breast pump would have worked during that first week. The woman doesn’t remember staff talking about her diagnosis at all – which is pretty unlikely. When her husband brought an article about postpartum psychosis a week into her stay, she thought he had spent hours Photoshopping a fake article. She complained of pain in her breasts – but her husband was the one who showed up with the pump.

        To me, the article prioritizes Lisa’s position as a new mom who was breastfeeding over the fact that she was actively hallucinating, paranoid, and severely ill enough to end up as an in-patient for two weeks. I feel deeply compassionate for Lisa; mental illness sucks, the postpartum period sucks and combining the two is brutal. But I don’t think the largest problem she was facing was continuing breastfeeding – and I am worried that the article under emphasizes how ill she was during her in-patient stay.

      • rational thinker

        Its possible it was exaggerated or out of context by the journalist, maybe she didn’t want to accused of bashing breastfeeding.

  • BeatriceC

    My mother was the “perfect” mother. She breastfed me, even at the expense of my growth and development. She was a SAHM. She was involved in our schools, girl scouts, and other activities. And I haven’t spoken to her in five years. My adult siblings are at various levels of low contact. My 17 year old sibling has one foot out the door, counting the days until her 18th birthday, when she can leave. She is not a good person. Love, kindness, understanding, are all more important than the “perfect” that’s touted as good mothering today. I’ve made my share of mistakes with my kids, including some colossal ones. I have a pretty good relationship with my kids these days, as they enter young adulthood. I’m not perfect, but I thank the stars every day that at some point I realized I didn’t have to be.

  • TsuDhoNimh

    “a baby needs only a ‘good enough’ mother by which he meant “the ordinary good mother … the devoted mother.””

    My mom was one of those lackadaisical “good enough” mothers when I was young. I was 100% formula-fed. She had a career, and she (gasp, clutch pearls) even LEFT US with a housekeeper and my dad for almost a full year to get her teaching degree for that career, she was active in county and state politics, she had a semi-pro hobby that sometimes took her out of state. How SELFISH of her to have a life outside us right?

    It would have killed her to be the dedicated SAHM, Pinterest-Perfect
    helicopter or bulldozer “momof4” that is currently fashionable.

    She was a damned good mother where it counted: she wanted us to grow up independent and healthy. And it worked. She let us make as many decisions as we were intellectually capable of and live with the consequences … starting when the consequences were nothing more than a missed dinner or movie I didn’t see because I came home late and they had gone already.

    The few times when I needed adult backup and was in the right (I fought and lost a few battles with schools) she or my dad were right there.

    On the other hand, if I had been caught violating curfew laws, they would have just asked when visiting hours were … my choice to stay out late as a minor was not their problem to solve. It would be between me and the judge.

  • space_upstairs

    I actually found pumping to be a great alternative to on-tap breastfeeding after being chewed up for a few days at the hospital, allowing physical healing and flexibility and enjoyment of my baby. But this was with my milk in after 2 days, the hospital supplementing my baby with gentle glucose solution in a 7-hour night nursery, my husband and mom and stepdad around and actively participating, reassurance that my baby’s weight loss stopped once my milk was in, support from the hospital to pump at home, and ultimately plentiful supply. I still prefer to mostly pump even long after healing from the cracked nipples. Insofar as pumping is offered as a heroic effort to save a primary on-tap breastfeeding relationship because bonding etc., I can see how it could make things worse.

    I think general flexibility and support regarding the care of one’s small baby is the most important thing to keep a new mother happy and healthy, not mere lactation support with the hope of minimizing technology use in baby’s feeding for an arbitrary 6 months. I had the former and would wish it for all. Support is highly touted for new mothers, but often in a narrow context that does not include the flexibility offered by technology and involvement of fathers, extended family, or professionals in a baby’s care.