Reflecting on the Emotional Dimensions of Becoming a Mother

Several years ago, I sat in a conference room at St. Joseph’s Hospital in Denver discussing a new program that was uniquely focused on the experience of becoming a mother. This conversation specifically emphasized the emotional aspects of this significant life transition.

At the time, I was not familiar with the term matrescence. However, the staff began the meeting with a reflection centered around this quote: 

“No one mentioned it. In nine whole months, not one person said you’re about to meet someone entirely new, and it’s not your baby. It’s going to be you.” 

I felt chills during the meeting as we discussed that quote and how painfully true it is in pregnancy and motherhood.

What is Matrescence? Understanding the Journey of Motherhood

Origin of “Matrescence” 

In January of 2024, NPR ran a story about this very phenomenon and noted, “becoming a mother is a huge, complicated life transition that can shake every fiber of a person's being. The process even has its own name: matrescence. While this term might seem relatively new, it was actually coined in the '70s by medical anthropologist Dana Raphael.” 

According to the Cambridge Dictionary, matrescence encompasses the physical, psychological, and emotional changes you go through after the birth of your child.

Transformation of Body & Mind

According to clinical psychologist Aurelie Athan, the process of becoming a mother can mirror adolescence in terms of the rapid pace of changes. Here are some examples of changes that new parents might experience the year leading up to and after childbirth.  

Physical Changes:

• Hormonal fluctuations: The body undergoes significant hormonal changes, including a decrease in estrogen and progesterone levels, which can affect mood and energy levels.
• Postpartum recovery: The body needs time to heal after childbirth, including recovery from any tears or episiotomies, as well as changes in uterine size.
• Breast changes: For nursing parents, breasts may become engorged, tender, or cracked as they adjust to nursing.
• Fatigue: Sleep deprivation is common due to the demands of caring for a newborn, which can lead to physical exhaustion.

Psychological Changes:

• Adjustment period: New parents may experience stress, anxiety, or feelings of being overwhelmed as they adapt to their new schedules and responsibilities.
• Bonding: Many parents experience intense feelings of love and attachment to their newborn, although this bonding process can take time and may not happen immediately for everyone.
• Identity shift: Becoming a parent often leads to a reevaluation of one's identity and priorities, as individuals navigate their new role as a caregiver.
• Postpartum depression and anxiety: Some parents experience mood disorders such as postpartum depression or anxiety, which can manifest as feelings of sadness, hopelessness, or excessive worry.

Emotional Changes:

• Joy and happiness: Despite the challenges, the arrival of a new baby can bring immense joy and happiness to parents and their families.
• Vulnerability: Parenthood can make individuals feel more exposed, as they become responsible for the well-being of another human being.
• Self-doubt: It's common for parents to feel guilty about perceived inadequacies, wondering if they are good enough parents.

Just as adolescence marks the transition from childhood to adulthood, matrescence marks the transition to motherhood—a period of immense growth, challenge, and transformation. These transitions can challenge self-identity and existing relationships. 

For many, the maternal identity shift reshapes how they see themselves and how they are perceived by others. Priorities change as the needs of the child often take precedence over one's own desires and aspirations. 

Additionally, matrescence involves a renegotiation of relationships. Becoming a mother can strengthen some relationships while straining others. Partnerships may need to be redefined as couples navigate the challenges of parenthood together. Friendships may evolve as lifestyles change. In the modern world, each shift is amplified by social media’s microscope on each personal parenting milestone. 

The Postpartum Period: Navigating the Fourth Trimester

The postpartum period, often referred to as the "fourth trimester," is a particularly intense phase of matrescence. Sleep deprivation, physical recovery from childbirth, and the demands of caring for a newborn can take a toll on a person’s well-being. It's a time when self-care becomes crucial, yet according to reproductive psychologists, often neglected.

Despite the difficulties, matrescence is also a time of incredible growth and self-discovery. Birthing people discover strengths they never knew they had as they navigate the complexities of parenthood. They learn to trust their maternal instincts, advocate for themselves and their child, and forge deeper connections with their others who share their journey.

Exploring Challenges in Maternal Mental Health Quality Today

Currently, there is a limited focus on matrescence in the perinatal care approach. We tend to speak more about “having a baby” rather than “becoming a mother,” with a stronger emphasis on physical changes than the psychological and emotional transformations that birthing people experience. 

However, we know the emotional transformations experienced by birthing individuals are profound and multifaceted. Following birth, hormonal fluctuations play a significant role in shaping these emotional changes. For instance, levels of estrogen and progesterone drop dramatically after delivery, while levels of oxytocin, often referred to as the "love hormone," surge.

These hormonal shifts can contribute to feelings of euphoria and bonding with the newborn, but they can also leave individuals vulnerable to mood swings, anxiety, and depression. In fact, up to 20% of birthing individuals may develop more severe perinatal mood and anxiety disorders (PMAD’s) such as postpartum depression, postpartum anxiety, or postpartum psychosis (Postpartum Support International). 

These conditions can have a profound impact on maternal well-being, highlighting the importance of providing comprehensive maternal mental health support during the postpartum period.

Addressing Gaps in Maternal Health Care

However, significant changes are still required for safe, high quality, equitable outcomes beyond the act of giving birth. The current system in most states effectively ends perinatal care for the birthing person at six weeks postpartum, despite the fact that it may take the body much longer to feel close to normal.

Moreover, the majority of maternal deaths occur 42-365 days postpartum when clinical and social support is no longer emphasized.

Fortunately, there seems to be a growing recognition of the importance of addressing matrescence in maternal health care.

Initiatives in Colorado

Colorado, for example, recently implemented a Paid Family and Medical Leave Insurance (FAMLI) which allows new parents the time and resources to focus on their transition and well-being. 

Additionally, the state decided to expand Medicaid coverage to 12 months postpartum and the FY25 Governor’s budget supports the expansion of Family Connects, a universal, brief nurse home visiting program that offers every birthing person some knowing support in those early weeks.

As the CEO of the Colorado Perinatal Care Quality Collaborative, I can speak to Colorado best, but there are certainly other states doing their part to improve health outcomes for new mothers.

Closing The Health Gap in Matresence 

Here are some initiatives we commonly employ to improve quality outcomes in maternal mental health. We encourage hospitals and clinicians around the country to incorporate these practices.  

• Perinatal Mood and Anxiety Disorder (PMAD) Screening: In order to treat PMADs, we need to screen and identify them.
• Holistic mental health support: Treatment doesn’t start and end with the clinician. We need to build insurance and payment structures that prioritize health outcomes throughout the first year after childbirth.
• Community care: Consider non-traditional interventions such as perinatal peer support, integrated care leasing models, psychiatric consultation, anc programs that focus on cultural relevance and community engagement. 

The National Landscape of Maternal Healthcare

Still, across the nation, many states lack comprehensive programs like FAMLI or extended Medicaid coverage postpartum, leaving new parents without vital support during this transformative period. To truly prioritize maternal health quality, we must integrate matrescence into every aspect of perinatal care nationwide. 

This means providing comprehensive health care that extends well beyond the six-week postpartum checkup. It means investing in mental health resources, peer support programs, and community outreach initiatives that address the holistic needs of new mothers.

Understanding Matrescence is Vital for Holistic Perinatal Care

Recognizing the importance of matrescence is not merely a matter of semantics; it's a fundamental shift in how we approach maternal health. It requires us to broaden our perspective beyond the act of giving birth and consider the entirety of the maternal journey. It's about acknowledging the physical changes, the emotional upheaval, and the psychological growth that occur as individuals transition into motherhood.

Understanding matrescence and integrating it into high-quality perinatal care and policies is crucial to addressing severe maternal morbidity, perinatal mood and anxiety disorders, and family support and well-being.

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