Karen Kleiman MSW, LCSW

This Isn't What I Expected


Postpartum women in distress cannot always advocate for themselves

Posted Oct 28, 2016

123rf.com/Mykhaylo Palinchak
Source: 123rf.com/Mykhaylo Palinchak

"Vulnerability is not new for a postpartum woman. She has most likely opened her heart, she has opened her mind, and she has opened her legs to various levels of invasive inspection. She has learned how to bleed, discharge, defecate and lactate in front of strangers with little regard to judgment or consequences. I’m not saying that is easy to do, but she does it. It goes with the territory of giving birth. However, the vulnerability that comes with admitting you don’t feel like being a mother, or you regret having your baby, or you have thoughts of harming your baby, well, that is a state of nakedness that is simply too hard to bear." (Kleiman, The Art of Holding in Therapy: An essential intervention for postpartum depression and anxiety, Routledge, 2017)      

This state of feeling raw and exposed is precisely what propels some postpartum women into therapy and what deters others from ever seeking help.

Healthcare providers need to know this.

Therapists offering treatment need to know this.

Postpartum women need to believe that the professionals in position to help them understand this.

The juxtaposition of life’s miraculous gift of childbirth and subsequent feelings of despair is difficult for families and healthcare providers to reconcile.

It simply doesn’t make sense.

It feels counterintuitive.

It feels out of alignment with the course of nature.

Still, postpartum mood and anxiety disorders are real and impact approximately 14% of all new mothers. We are talking about serious symptoms that require serious attention.The consequences range from significant to catastrophic, which is why her concerns must be attended to immediately. While we assert that postpartum women should be their own best advocate and urge them to let someone they trust know how they feel, often, they do not feel equipped to do so, and surrender to feelings of helplessness.

That is when others must intervene.

This applies to family members, healthcare professionals and therapists who may or may not have expertise in the area of maternal mental health.

  • Ask the hard questions.
  • Do not presume she is being transparent about how severe her symptoms are.
  • Do not be misled by how good she may look or how easily she may dismiss her concerns.
  • Stay present if she trusts you enough to disclose the degree to which she is suffering.
  • Seek out and access support resources.
  • Respect her resistance and gently guide her through her options.
  • Engage and educate her partner or other family members who are in position to support her.
  • Let her know you understand and will help keep her safe, no matter how bad she feels.

The state of physical, emotional, or mental nakedness does not lend itself to help-seeking actions. At its most extreme, she cannot move and can barely breathe.

Step in. Make sure you are one of the few precious people she can reach out to and trust.  


copyright 2016   Karen Kleiman, MSW, LCSW

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