Reproductive Psychiatrist Alexandra Sacks Talks Motherhood, Guilt, And Self-Care

Photo: Courtesy of Rich Gilligan.
Motherhood is beautiful, but people are complicated. And Alexandra Sacks, MD, wants to help women remember that once they have a kid, they’re not just “a mom.” They’re still an autonomous, complex person with desires and baggage. She wants to help mothers unpack their emotions, while parsing through their new role in life.
One way Sacks, a reproductive psychiatrist, does this is through her new Gimlet Media podcast series, Motherhood Sessions, where she interviews real mothers about the “psychological big bang” that accompanies motherhood. She talks to a single mom and one who feels she can’t measure up to her own mother. She talks to an adopted woman whose children were the first people she knew who were biologically related to her. Episodes drop most Thursdays, and within them Sacks has real conversations with the women, and with real tear-eyed sniffles in the airespace. The series illuminates the idea that motherhood looks different for everyone, and that while postpartum depression is an issue that many women struggle with, there are other identity crises and dramas that mothers need to work through, too.
“People crave being heard, and need compassionate, neutral listening,” she says. “A therapist can bring a combination of empathy and neutrality.” She notes that the actual podcasts aren’t therapy — there’s no confidentiality, and real talk therapy requires building trust over time. Sacks calls the episodes “therapeutic conversation,” that she hopes moms across the nation will be able to relate to. Here are some of her thoughts on how to get through the complexities of motherhood without losing yourself.
In the podcast, the conversations you’re having with new moms cover the stuff we don’t talk about at dinner parties. Why do you think we as a society are more comfortable talking about diaper changes than the emotional impact of being a new moms?
"There are a few reasons. Number one: We as a medical community need to do a better job educating people about emotions and psychological development. We can provide a framework and language for helping mothers understand complex emotional experiences. New motherhood is one of those experiences because it’s often an intertwining of feelings that are both good and bad. Often times when we’re trying to make sense of what we’re experiencing, we want to sort things into categories of good or bad. But so often psychology is not like that. There are feelings of ambivalence. It can feel bittersweet. So many life transitions are like that, but motherhood stands out as one of the most prominent."
Why is motherhood a more prominent transition than other life changes, such as graduating from college?
"Well, a child is this thing to celebrate, right? But new beginnings also involve endings. But with motherhood specifically, people may fear being judged for talking about some of the loss that comes with new motherhood. The identity shifts that involve giving up parts of your life. I think it’s hard for people to know how to talk about these ambivalent feelings without fearing they’ll be judged for not loving their child. But you can feel conflicted about the role of motherhood, and that has nothing to do with not loving your child. They’re totally different topics."
Postpartum depression is a serious issue that impacts one in seven mothers. But how do we talk about other emotional issues that new moms might face?
"The medical community can do better to help people understand what the transition into motherhood is like outside of illnesses like postpartum depression. The transition into motherhood is a tremendous identity shift. Change is stressful. So, even if it’s a welcome change, it can still come with disruptive, confusing feelings. I think those feelings may be threatening for people to admit because they fear that they would be judged as a selfish mother. But it’s not just black and white. You’re a human being, and you’ll need to continue to take care of yourself in motherhood."
That makes sense. You said mothers might fear that society will judge them — do you think there’s also some self-judgement?
"Yes, we were just talking about how motherhood is both a beginning and an ending, right? When those feelings come up, mothers may judge themselves for it. Because it takes time to adjust, and there’s this huge cultural shaming around “the bad mother.” Whatever that means. We need to spend more time talking about the “good enough” mother. This is not about bad versus perfect. It’s really about good enough."
What is one way that the new mothers on your podcast deal with saying goodbye to what their life was before they had kids?
"One episodes features a woman who’s struggling. She has a prototype for what a mother should be like based on her mother, who is an extremely self-sacrificing person. And she’s trying to reckon with her identity. She’s holding onto parts of herself. She has a desire to enjoy a dinner alone with her husband, but she feels guilty doing it. As a mother, the woman needed to reconcile holding onto old parts of her life that made her feel like herself — the parts she wanted to retain. But it was also about trying to define motherhood for herself in contrast to the example her own mother provided."
Can you talk a little bit more about how you explore guilt on the show? I think it’s an emotion so many new mothers feel.
"Newborn babies require so much care and attention that their needs are sort of infinite. Your needs to care for yourself do not stop once you deliver a baby. That guilt comes in the push and pull of when to give yourself permission to take care of yourself. It’s essential to get sleep, exercise, and be healthy. There's a misunderstanding in our culture that stepping away from the baby to take care of yourself is a selfish thing. But self care is not selfish."
Here's a preview of next week's episode, which will be released May 9:

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