In March of 2020, I planted my face in my son's bedroom carpet and sobbed. How could I possibly care for a newborn with a deadly virus spreading across the world? The depression was recognizable given my background in mental health, but the bleak feelings were exacerbated by the terrifying and poorly understood coronavirus. I did not know I was about to become part of an unprecedented statistic.
I wasn't alone. Mothers who had just given birth at the outset of the pandemic were beginning to experience postpartum depression in increasing numbers. Now one in three
mothers suffer from the condition, a rate that has tripled since the start of the pandemic.
Pregnancy and childbirth expose mothers to mental landmines, from increased inflammatory markers necessary to protect from infection, increased sensitivity to threats, to decreases in grey matter, all of which can increase maternal vulnerability to postpartum depression and anxiety. Pandemic moms have even more to grapple with: They must weigh and consider vaccination status, disease transmission, mental health needs, financial needs, practical barriers to childcare and reconfigure the way they function on a daily and evolving basis depending on the variant timeline at play.
The pile-on for moms doesn't stop there. A lack of flexible employment options, paid maternity leave and choices for childcare have upped the challenges. Pooja Lakshmin, a psychiatrist that specializes in maternal mental health, called it "betrayal," and I agree. Mothers are so stressed out they are being pushed to screaming in empty football fields. The cathartic release may feel good 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 fortunate to have resources to draw upon, including excellent mental health treatment and resources. I provide the same for my patients. But not all mothers are so lucky. We need to provide a path forward for all caregivers and moms, with better mental health screening and treatment, knowledge about the potential of the maternal brain, more financial support and flexible work options—and here's why.
Research shows that the mom brain undergoes immense neural plasticity with potentially enormous benefits. A proliferation of cells and networks emerge and reorganize themselves to orient toward child-rearing, cells acting as little Marie Kondos 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 been studying maternal neuroplasticity in rodents for decades. Her current work with enriched environments in animals with and without parental experience confirms how responsive brains are to changing environmental contexts—promoting neuroplasticity by modifying existing neural processes or creating new neurons (neurogenesis).
When moms have sufficient resources, Lambert views the maternal experiences as a form of an enriched environment promoting experience-based neuroplasticity. The mom mind is resilient—the research backs it. Katherine Ellison, author of The Mommy Brain: How Motherhood Makes Us Smarter, speaks to the many ways becoming a mother makes our brains more efficient, adapts to challenges and engages in an intense baby-led training for optimal functioning. Ellison recently told me that, "In any given moment, a mother is asked to nurture, protect, negotiate, decipher, solve, repair, mitigate, bond with her baby and manage her own emotion regulation." In fact, in a study released in January 2022, results support that motherhood enhances "knowledge, skills and capacity, while strengthening women's mindset, willpower, and overall emotional intelligence" and makes mothers well-suited for management and leadership positions.
The maternal brain can become even more enhanced after the pandemic through a phenomenon known as posttraumatic growth (PTG), where positive psychological change results from struggling with highly stressful life circumstances. A recent studyexamining posttraumatic growth in over 20,000 respondents in Italy, one of the hardest hit nations by COVID-19, found that posttraumatic growth was reported in approximately one-third of participants; similar to rates of PTG experienced in other trauma populations. These rates of PTG occur naturally. If we intervene with solid treatment, we can bring more than one-third of mothers to thriving through the pandemic.
It may go without saying, but stressed moms are bad for our children. The single greatest predictor of childhood well-being is maternal mental health. A recent studyshowed that a nine-week Cognitive Behavioral Therapy intervention that treated mothers' postpartum depression normalized their maladaptive infants' brain activity consistent to the study's healthy controls. Another recent and potentially groundbreaking study showed that providing a $333 stipend to poor mothers was related to increased brain activity in their babies. The investigators postulated that the extra money possibly alleviated maternal stress allowing them to engage with their babies in more stimulating ways. These studies show that support of maternal mental health needs can have direct and positive downstream effects on children and hopefully society as a whole.
It is time to step up to the challenges COVID-19 has brought 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 work. Mothers need easy access to mental health care. Insurance companies need to extend approval for telehealth reimbursement, indefinitely. Individual states can join PSYPACT where providers can deliver mental health care across state lines. Those options helped me through postpartum depression and allowed me to help my patients and rise to relentless challenges during the pandemic. All mothers deserve the same opportunities to facilitate 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, N.J. She specializes in treating adults with anxiety and depression and mothers with perinatal mental health conditions. She received her PhD in clinical psychology from University of Rhode Island and completed her predoctoral internship at Yale School of Medicine. She completed her practicum training in neuropsychology at Brown University. She completed postdoctoral fellowships in behavioral medicine and palliative care at Massachusetts General Hospital/Harvard Medical School and University of Colorado Anschutz Medical Campus. She is the former director of psycho-oncology at Jersey Shore Medical Center and assistant professor in oncology at Georgetown University School of Medicine. She also held positions as assistant scientist at Hackensack Meridian Hospital and University of Colorado Anschutz Medical Campus. She has published over 26 scientific articles in peer-reviewed journals, presented at over 30 national conferences and is the recipient of 15 grants and awards recognizing her scholarly research.
The views expressed in this article are the writer's own.