Postpartum brain, hormones, and motherhood
Recent events and my own journey of postpartum made me wonder is mothering natural or acquired? While sleepless nights, mom guilt, and crashing hormones can create havoc with our physical and mental health, keeping up with the changing needs of the kids, lack of a village to lean on, and doing our very best in every societal role we signed up for can make this phase of our lives quite overwhelming. In the end, we start sacrificing ourselves until there is nothing left to give. So, how can one pour care and love from an empty glass? Tragedy of a mother on trial for killing her kids needs a broader conversation on why someone who went through the pain of birthing and raising kids may have ended up taking their lives. Is this common in nature? How does the brain transform during motherhood and what derails it?
During a mouse weaning duty in grad school, I witnessed a mouse mom eating her pups and I was horrified. She was stressed by presence of older kids/litter which were about to be weaned. Another time, a genetically knocked out female mouse who rarely gave birth to couple of pups ended up eating them. No overcrowding or constant reproduction but simply stressed out because of unnatural biological changes. We tried to calm her down with sunflower seeds or extra bedding and even removing the male after she got pregnant but nothing worked. I wish at that time I would have followed up and studied mental health in these females. When I heard of the ongoing Lindsay Clancy case it took me back to those disturbing memories of female mice eating their pups. Why were they doing this? What drove this behavior? Was it a survival mechanism or was it hopelessness?
Nature coded parenting behaviors through a master switch that is galanin neurons in hypothalamus.
Destroy the galanin neurons and all the maternal instincts are abandoned. Stimulate them and maternal instincts even in males can be observed (checkout Catherine Dulac’s research). When estradiol and progesterone rise during pregnancy, they change the activity of galanin neurons forming new synapses promoting mothering behavior. While mother gets a hormonal ignition and ramp, father mostly has to drive there by being actively involved in caregiving. These architectural changes once formed are permanent in both mothers and fathers. However, the chemical activation is temporary. So when these hormones including oxytocin and prolactin plummet after pregnancy, the galanin circuit quiets down in mothers which means that the maternal empathy and memories stay while the vigilance for child’s safety goes down as the child becomes more and more independent.
Hormone crashing suddenly can feel like a withdrawal from a drug making some of us feel “less excited” and even “depressed”. What makes it hard is that these emotions don’t surface in our behavior as we continue to care and behave normal while feeling empty inside. This is because the galanin neurons involved in parenting behave like a junction box projecting to three different regions of the brain responsible for three different behaviors: the physical doing, wanting to, a separate social behavior. Basically, doing and wanting to are separate cables and factors like sleep loss, stress, loneliness, and fatigue along with high cortisol and low thyroid post childbirth can degrade one cable but leave the others intact.
The act of motherhood continues but the reward can disappear.
To make matters more chaotic, thirteen drugs Lindsay was prescribed act on the exact system the mothering circuit is built from and in the one window when the circuit is being rebuilt. In theory, some drugs like SSRIs could have improved the mother’s relationship with her infant whereas, dopamine blockade could have suppressed maternal motivation. Unfortunately, nobody has measured what these drugs do to the caregiving or the galanin circuitry in humans and in case of Lindsay, we may never be able to figure out.
What we can work towards is being self-aware and keep the glass filled for ourselves and our loved ones’ sake. You know that saying “prevention is better than cure”? It applies to postpartum moms more than anything. When you are in the weeds, it can be hard to see a way out but maybe the education, prevention, and preparation can begin before you have a child. Creating a physical support system or a village with friends and neighbors, regular checkups and integrated healthcare, partners and families being more involved like asian cultures to hold your hand through this phase. Maybe new technology can help surface some of these issues by logging mood changes and postpartum symptoms.
Sleep in the first two week is best evidenced trigger anyone has during postpartum. Absent support is the best replicated predictor. One clinician holding the whole picture is what was missing in Lindsay’s case. I have been trying to address some of these issues in the latest update of Whuman app. It will now record how broken the night was rather than how long. Once a month private checkin on whether there is anyone to take over, anyone to talk to, and whether asking for help is hard. It will take a daily mood rating and after weeks of low ones, it will surface the need to show this to someone. If you wish, you can also print all of this to share the full integrated picture of your health with your healthcare provider.
We are all born with parenting/nurturing circuitry. However, its intensity needs to be acquired by having bandwidth to connect and bonding with our babies.
