It’s hard to go even a couple of weeks without seeing another sobering statistic on the state of maternal health in the United States. According to the National Institutes of Health, suicide is the leading cause of maternal mortality, accounting for about 20% of postpartum deaths. The Journal of the American Medical Association (JAMA) Psychiatry shows that an estimated 15-21% of mothers will experience a perinatal mood and anxiety disorder (PMAD). To assume these statistics are solely impacting mothers would fail to consider the crucial role mothers play in our society.
Just last month, in November of 2023, the National Center for Health Statistics released data showing that infant mortality in the United States rose for the first time in 20 years. A New York
Times article reporting the alarming uptick stated, “Infant and maternal mortality, inextricably
linked, are widely considered to be markers of a society’s overall health, and America’s rates are higher than those in other industrialized countries.” If these are indeed markers of our society’s overall health, we are long overdue for not only a check-up but for a fresh perspective on preventative care.
As revealed by the statistics above, the transition to motherhood has the potential to impact mothers’ physical and mental health in profound and, at times, irreparable ways. While the maternal mental health field and organizations, such as Postpartum Support International (PSI), are aware of this crisis, most mothers giving birth in the United States are uninformed of the risks they face. Mothers may not even know that any exist, and as a result, move headlong into the transition with an utter lack of preparedness.
As educators and researchers, we believe that for mothers to experience better outcomes, they must first be provided with basic reproductive health literacy around the developmental transition to parenthood. As with any other public health crisis, education is a great place to begin. Preparing mothers, in this case, would go well beyond childbirth education with its focus on labor, delivery, and the first few weeks beyond. Instead, it should take a longer view— a more holistic approach that includes informing them about the all-encompassing changes that happen during this life stage, otherwise known as matrescence.
Matrescense Like Adolescence
If you haven’t heard the word matrescence until now, it is the developmental process of becoming a mother, the transition from non-mother to mother, or the shift from being a mom of one child to more. It can be very similar to the experience of going through puberty. Thinking of “matrescence like adolescence” is useful in imagining the many normative bio-psycho-relational-social-economic-spiritual changes that occur. It also centers and empowers the mother, focusing on her resilience and self-development. In fact, in our social impact laboratory, we’ve been inspired by how widespread the positive youth model of education has become and are eager to apply similar strategies.
Just like with emerging adults, matrescence education would similarly resource emerging mothers to better understand their inevitable feelings of overwhelm while also instilling hope that their sense of confidence and capability can indeed grow with proper time, support, and patience. Holding mothers in this way would consider the severity of the risk they face, true of any major life transition, in equal measure to the thriving they have within their reach.
In my work as the director of a Montessori school, I have regular interactions with mothers of three, four, and five-year-olds. Even years out from giving birth, many of these mothers reveal pervasive feelings of overwhelm and insecurity, exacerbated by regret that they didn’t know more or do more for themselves or their children at earlier stages of development. Educating them about their matrescence “early and often,” like any good health promotion, can ease some of their regret and bring about a growing sense of self-compassion and self-awareness. Doing so before becoming a parent might even give them the same head start I am trying to give their children.
A Worthwhile Investment
Creating the infrastructure that would support widespread matrescence education is an investment not only in maternal development but child development since the two are intrinsically yoked together. Just as we know that early intervention for children can prevent challenges down the road, we should have the same clarity that support at earlier stages of maternal development will have a lasting positive impact on later stages.
Taking preventive steps to help mothers avoid falling into a diagnosable range of difficulty involves adopting measures that are put into place long before there is a crisis. For mothers, preventative care can be as simple as matrescence education being a routine part of prenatal care. In addition to learning about what foods to avoid and what supplements to take to support their baby’s development during pregnancy, mothers should also be educated about their own development.
Integrating a developmental framework in which mothers see themselves at the start of a steep learning curve, as well as at the precipice of a radical process of self-growth, can help them feel more curious and less critical as they navigate the novel demands ahead. Matrescence education can come from doctors, nurses, midwives, pediatricians, and lactation consultants. Daycares and early childhood centers can join the cause by seeing themselves as educational hubs not only for children but for new mothers with whom they have already formed a trusting relationship. Wherever mothers go, so too should education follow.
Scaling Maternal Care Cliffs
While prevention through education is a worthy goal, we must pursue preventative care alongside the realities of mothers needing a more comprehensive level of support once they have transitioned into motherhood. In speaking to mothers each day, it’s remarkable how often we hear them express a sense of shock over the sudden shift in focus to the baby upon giving birth, leaving mothers feeling not only confused about where to seek help for themselves but often too ashamed to ask.
To create a functional web of support for mothers, it’s important to look at the cohesiveness, or rather lack of cohesiveness, of care. Mothers who have just given birth regularly face incomplete hand-offs between healthcare providers, which can result in fragmented, uncoordinated care for the mother, in contrast to streamlined care for the baby. This is just one example of the “maternal care cliffs” mothers find themselves precariously balanced in their early postpartum months. As stated by Cohen & Daw,1 “This cliff in planning and guidance puts the onus on patients to navigate the health and social resources they need, while also facing the challenge of caring for a newborn.” To mitigate risks, a care plan that involves warm handoffs should be laid out so that mothers know where to turn for their care. Just as birth plans have become commonplace in a mother’s planning, so should maternal postnatal care plan.
Responding to the Call
When all the above is not enough to prevent a diagnosis of a PMAD, it is critical that we do what we can to close the gap between the time a mother is aware she needs mental health support and the time she receives that support. Organizations such as PSI have thankfully filled this growing need, which is particularly important given that barriers to accessing maternal mental healthcare are all too common. Building bridges to mental health providers, connection to peer support groups and helplines for mothers in crisis are some of the final lines of defense when it comes to protecting the health of mothers and ensuring the most positive possible outcomes.
Educating mothers and the public on the prevalence of PMADs and making resources for treatment more widely available has reduced the stigma mothers have felt in the past when faced with needing to prioritize their mental health. Continuing to reduce previously mentioned “maternal care cliffs” and ensuring coordination across not only higher tier response teams but community organizations and educational institutions will provide a supportive response network
in which mothers are less likely to fall through the cracks.
Thriving Through Transition
At Khora, the Maternal and Reproductive Psychology Lab, we know that creating a shared language which includes concepts such as matrescence enables mothers to see the nature of their transition to motherhood in a new way. Of course, it has always been a vulnerable time, inclusive of intense struggle and opportunity for unparalleled growth, but we didn’t have a name for it. Integrating matrescence as a strengths-based developmental framework when we design our maternal social and healthcare services can turn the tide for mothers and society as a whole. We are optimistic that when we give mothers the education they always deserved they can not only survive despite their transition to motherhood but perhaps even thrive because of it.
1. Cohen JL, Daw JR. Postpartum Cliffs-Missed Opportunities to Promote Maternal Health in the United States. JAMA Health Forum. 2021;2(12):e214164. Published 2021 Dec 3. doi:10.1001/jamahealthforum.2021.4164
Preparing for Better Outcomes: Matrescence Education as a Pathway
Aurélie Athan, PhD
Christine Carrig, M.S.Ed.