Demolishing the mother of all myths
By Erin Howe
Parenthood bore no resemblance to what Sumedha Arya (MD ’17) saw while scrolling though Instagram and feeding her three-month-old daughter at 3 a.m. this spring. “There were pictures of glamourous women nursing their babies or wearing full makeup and a pumping bra. They made motherhood look easy but here I was, with spit-up on my shoulder, leaking milk, tears and blood while watching reruns of ‘The Office,’” she recalls.
After welcoming her first child in December 2021, the fifth-year Temerty Faculty of Medicine hematology resident struggled to establish her milk supply. Arya tried medication. Then she began triple-feeding — a gruelling, round-the-clock schedule of breastfeeding, pumping and then feeding her newborn the fresh milk. None of it was easy. And no part of it felt intuitive.
Nor did her experience live up to any of the stereotypical ideals — that pregnancy, birth and new motherhood should be beautiful, natural and even ethereal. The phenomenon is sometimes called the goddess myth, an impossible standard that defies, now more than ever, the reality of this key period in people’s lives. And this mythology hurts parents and their children.
The weight of these expectations can begin even before there’s a positive pregnancy test, says Professor Tali Bogler (PGME ’13, ’15). When people are trying to conceive, there’s pressure. And if people require fertility treatments or can’t conceive immediately, there can be a sense of failure, she says. When she was pregnant, Bogler, an assistant professor in Temerty Medicine’s Department of Family and Community Medicine and the mother of four-year old twins, fielded numerous questions about whether her pregnancy was “natural.” “What does that even mean, anyway? Who gets to define what natural is?,” wonders Bogler, who is also chair of Family Medicine Obstetrics at Unity Health Toronto’s St. Michael’s Hospital.
The list of decisions parents feel they will be judged on is lengthy — from giving birth vaginally or by caesarean section, to having an epidural or not, to breastfeeding or formula feeding. And expectant parents bear these expectations during an already sensitive period when hormones and emotions are running high, and sleep is running low. Stigma can interfere with soon-to-be parents getting the help they need, says Bogler.
Despite well-established evidence that antidepressants are safe to use in pregnancy, many expectant parents still worry that taking them could harm their baby. “There can be this feeling in pregnancy that, ‘I am the vessel carrying the fetus and must do everything possible to protect it, and those concerns can mean questions about medications, vaccines, or anything else,” says Bogler. “And that eliminates the autonomy of the individual, the pregnant person, and their own health priorities.”
COVID-19 also had a bombshell effect on new parents — with wider-ranging health effects that are yet to be seen.
Like many expectant parents, public health precautions required Arya to attend her prenatal appointments alone. In the past, birth has always been a family event, says Modupe Tunde-Byass (PGME ’04), an assistant professor in Temerty Medicine’s Department of Obstetrics and Gynaecology. To bridge the gap created by COVID-related measures, Professor Tunde-Byass invited her patients to include their partners in the appointments by using video chat or speaker phone so they could be part of what was happening and ask any questions they had. “It can be lonely or sad for these parents,” says Tunde-Byass, who practises at North York General Hospital. “People who already have children know what they’re missing. And first-time parents said to me, ‘I wish my partner could see.’”
Even before the pandemic, Canadian research showed that nearly one-quarter of mothers experienced postpartum depression and anxiety. No wonder so many seemed to feel more defeated than deified.
Between March and November of 2020, research published in the Canadian Medical Association Journal showed that during the first nine months of the pandemic, the number of new mothers visiting their doctor to discuss concerns about their mental health swelled by about 30 per cent. A study in the American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine that new mothers were more than twice as likely to have postnatal depression during the pandemic than before it.
Study author and Temerty Medicine Professor Stephen Matthews points out that perinatal mood and anxiety disorders are strongly linked to adverse birth outcomes. Preterm birth, parents finding it hard to bond with their baby, and delayed infant cognitive and emotional development are among the risks of untreated depression and anxiety.
“A baby gestates in one person’s body, but the mother is part of a broader context and how they cope is related to how the whole unit is coping,” says Matthews, a professor in the Departments of Physiology, Obstetrics and Gynaecology, and Medicine. “The person who is pregnant is not responsible for the broader context.”
Much of Matthews’ research focuses on the role of stress hormones in fetal brain development and how molecular processes can impact brain development long term. More recently, he’s begun to explore the role of fathers in making a healthy baby. Though there’s little human evidence so far, Matthews says animal studies show differences in the sperm of fathers with obesity or type 2 diabetes compared to fathers without the conditions. The differences are associated with a greater risk of cardio-metabolic problems among the offspring. Scientists have also observed differences in the microRNA of sperm in mice who experienced stress. This can alter brain development and stress responses in their offspring. Matthews believes similar effects likely play out in people.
“Thinking only about the maternal environment is an issue because that implies that the mother’s behaviour is all that matters, and that’s just not the case,” says Matthews, who has a lab at Sinai Health’s Lunenfeld-Tanenbaum Research Institute.
People are often quick to blame themselves when things don’t go as expected
Adding to the complexity of the parenting process is the fact that people are often quick to blame themselves when things don’t go as expected, says Emily Ho (BSc OT ’97, PhD ’19), an assistant professor in Temerty Medicine’s Department of Occupational Science and Occupational Therapy.
“Often, when I meet parents of children with congenital limb differences for the first time, I’ll look them in the eye and tell them, ‘This isn’t because of anything you did.’ Do you know how that can relieve a parent?,” asks Professor Ho, who is also an occupational therapist working with children and youth with congenital limb differences at The Hospital for Sick Children. “Sometimes, this is the first time that parents have these feelings acknowledged. I see their eyes well up,” she says.
Parents can struggle to balance their instinct to shelter their children from all harm against knowing how much their kids are capable of, says Ho. “One mother I spoke to told me that she knows there’s this guilt inside her through every decision, whether it’s about a medical procedure or whether to allow her child to do a high-level sport,” says Ho. “The mother tells her child that she is capable of doing anything. But at the same time, this mom just wants to protect her child because, on an emotional level, she feels she couldn’t protect her child before.”
Prospective parents and new parents must also address constantly evolving social expectations around what is right for them and their child, says Milena Forte (PGME ’01), an assistant professor in Temerty Medicine’s Department of Family and Community Medicine and departmental lead for maternity care. “When people talk about natural birth, I always ask my patients, ‘What does natural mean to you?’ People have unrealistic expectations about what birth will entail. Within the medical community, we know some birth plans are completely misleading in that they give people a false sense of control. Plans can change when people enter the labour ward,” she says. Plus, standards about what community looks like after birth have changed, she says.
Professor Forte has noticed a shift in the way families spend the “golden hour” — the 60 minutes after birth finishes. “In the past, someone would go out to the waiting room and tell the loved ones sitting there about their happy news. Now, in addition to focusing on the new baby, parents also use some of that time to share with their smartphones,” says Forte, who is also a family physician at Mount Sinai Hospital. “There can be some added pressure for people to ‘get themselves together’ for that first photo.”
As well, the pregnancy advice Forte says was “heretical” 40 years ago is now much more mainstream. “Look at exercise during pregnancy — which was once discouraged. In the 1980s, we asked, ‘Is this safe?’ Now, we know it has all kinds of beneficial aspects, like decreasing the risk of hypertension, pre-eclampsia and depression,” says Forte.
“Things like skin-to-skin contact after birth, or exposure to vaginal secretions used to be seen as ‘out there.’ Now, science is catching up.” With the bleary-eyed days of early motherhood behind her, Arya says things are going more smoothly now. She’s breastfeeding her daughter, and she supplements with formula. Arya doesn’t regret her decision to use formula when necessary, which she says improved her own well-being. She also takes solace in commiserating with some of her friends, who are also new parents.
“Shared vulnerability is a powerful balm,” says Arya. “As soon as one person opens up, it dampens the isolation and helps make clear that the myths surrounding motherhood are just myths, not reality.” ●