“Biologically, I became a mother overnight. But the psychological adjustment took longer, as did baby bonding and the identity development. My usually put-together, do-it-all persona struggled to navigate common early motherhood realities: new mom worries, forgetfulness and fogginess, hair-trigger temper outbursts, mom rage, mood swings, guilt and shame, challenges with breastfeeding, and ambivalence. All of it rattled me” (Introduction, x).
So writes clinical psychologist Dr. Nicole Amoyal Pensak, PhD, in Rattled: How to Calm New Mom Anxiety with the Power of the Postpartum Brain. I host a postpartum podcast and write regularly about the postpartum period, so when I found this book through my library’s website’s ‘You might also like’ feature, I was all ears, or, rather, eyes. I wondered what the average mom in the trenches could hope to gain from this book.
Would it be an academic treatise summing up the scientific literature on mom rage and other struggles? Would Rattled be a book-length regurgitation of all the tired “motherhood is the worst, try to survive it if you can” tropes we’re daily confronted with on social media? Or could it actually help new moms (whether they’ve just welcomed their first child or tenth) understand how to harness the features (not bugs!) of the maternal brain, leading to awe and respect for our beautiful design rather than frustration and fear?
Read on for my recommendation on whether to buy, borrow, or skip Rattled.
Pensak is a mom of two and a clinical psychologist certified in perinatal mental health who did her doctoral training at University of Rhode Island, a predoctoral internship at Yale, and postdoctoral fellowships at Harvard and University of Colorado. She also serves on Parents Magazine’s Expert Review Board.
Кто является целевой аудиторией?
Pensak talks straight to new moms in her book, writing “This book focuses on the primary parent or caregiver, with the premise that the majority of motherhood is really managing your own emotions and well-being. Key to this is the science of neuroplasticity and cognitive behavioral therapy. Untangling and making new pathways in your brain and increasing psychological flexibility is like getting that knot out of our fine-strand necklace” (Introduction, xviii).
“This book focuses on the primary parent or caregiver, with the premise that the majority of motherhood is really managing your own emotions and well-being. Key to this is the science of neuroplasticity and cognitive behavioral therapy. Untangling and making new pathways in your brain and increasing psychological flexibility is like getting that knot out of our fine-strand necklace.”
Introduction, Rattled
Каковы основные области содержания Rattled?
Pesnak starts off by distinguishing Rattled’s approach from that of parenting books. While parenting books emphasize the care and keeping of babies, Pensak’s work centers on the mother, because “The secret is that a significant portion of taking care of babies involves regulating your own emotions first.” Pensak believes that “educating and encouraging mothers to use their newly developed and very real changed parent brains to their advantage will be life-changing” (Intro, xviii).
Pensak summed up Rattled’s goal in this way: “Mothers need to know what they are working with under the hood: maternal brain changes, normal mom worries that are adaptive, worries that are not helpful, and how to harness it all, backed by science and therapy… By understanding both the physiological and the psychological, we can make clear-eyed decisions to nurture the process of matrescence. We can learn to accept what is typical: ambivalence, mom worries, interruptions, forgetfulness, unexpected thoughts, postpartum pressures, and new emotions. We can harness both the struggles and the gifts that motherhood provides” (Introduction, xi).
Part I: How to Really Prepare for Motherhood
Part I’s five chapters are entitled ‘The Ideal Mother,’ ‘The Real Mommy Brain,’ ‘Prepare Your Postpartum Mental Health Care Plan,’ ‘Matrescence and the Transition of Motherhood,’ and ‘Prep Your Marriage.’
Part I has two foci. The first is providing a foundational explanation of matrescence, pronounced similarly to ‘adolescence,’ and representing a similarly intense period of brain, hormonal, and identity changes. Whereas adolescence lasts more than a decade from initial signs of puberty through full development of the brain at age 26, a mother hurtles through matrescence at (relative) lightning speed. Pensak shares the physiological and psychological changes that occur during matrescence.
Also in Part I, Pensak lays out the pregnant and postpartum brain’s capacity for neuroplasticity and why she believes therapy during this time period can be particularly helpful for long-term healing and growth. As an example, in ‘The Ideal Mother,’ Pensak covers the research on the fogginess and forgetfulness we colloquially refer to as “mom brain,” noting that “Mommy brain is a very real phenomenon… In simple terms, your brain is working against you, compelling you to ignore your own needs and instead attune to your baby’s” (5). While research corroborates new moms’ reports of forgetting things, when it comes to baby-related tasks, “memory functioning was improved and actually represented a ‘boost in learning.’” (6)
I’d sum up Part I with “why all your postpartum brain changes aren’t a bad thing.”
Part II: How to Adjust to New Mom Experiences and Emotions
Part II is also five chapters, comprising ‘Baby Bonding and the First Letdown,’ ‘The Double-Down Method to Manage Mom Guilt,’ ‘Soften on Mom Shame,’ ‘Embrace Your New Mom Rage,’ and “How to Manage a Maternal Mental Health Crisis.’
These are the nuts-and-bolts, practical, “hands-on” chapters, ones I’d flip to throughout postpartum as a reference work of sorts. While some of Pensak’s advice is repetitive from one chapter to the next, that consistency reflects the blessed crossover between many challenging aspects of motherhood: learn to cope well with one, you learn to cope well with others.
Part III: How to Go from Surviving to Thriving in Early Motherhood
Part III is shorter—just three chapters—and includes a ‘How to Self-Direct Maternal Neuroplasticity,’ ‘How to Handle Transitions: Back to Work,’ and ‘Up the Ante.’ I’d sum up this section as “putting it all together.”
Каковы сильные стороны Rattled?
Where to begin? Truly, I admired Pensak’s masterful approach time and time again to common struggles such as mom brain, mom guilt (believing I did something bad), mom shame (believing I am bad), mom rage, the tendency to have a scary “what if?” thought right after having a pleasurable thought about enjoying the new baby, and more.
Much of what she pointed out helped make sense of the physiological and psychological changes the brain undergoes during pregnancy and postpartum. Case in point, she clarified that “When your brain is rewiring to increase anxiety to worry about your baby’s needs, your body does not know the difference between ‘new baby anxiety’ and general anxiety. Your body just feels anxious” (26).
A smattering of content that resonated strongly includes: her “don’t make it worse” counsel when experiencing strong anger or feelings of rage, her encouragement to new moms to take the responsibility of self-diagnosing perinatal mood and anxiety disorders off their own plates and let healthcare professionals do their jobs, and her multiple mentions of considering dads’ mental health too, since up to 10% of new dads may suffer postpartum depression также.
I loved that Pensak views postpartum as a window of возможность, from which mothers can emerge “better than ever” (8). As just one example, the “incredible and numerous challenges” of pregnancy and early motherhood have “the potential to increase cognitive reserve in the long term,” when we understand cognitive reserve as “the brain’s capacity to handle impairment due to illness, loss, and decline over time” (8).
I loved that Pensak views postpartum as a window of возможность, from which mothers can emerge “better than ever.” As just one example, the “incredible and numerous challenges” of pregnancy and early motherhood have “the potential to increase cognitive reserve in the long term,” when we understand cognitive reserve as “the brain’s capacity to handle impairment due to illness, loss, and decline over time.”
Pensak also explores the concept of post-traumatic growth, which is particularly good news for the high numbers of women who consider their labor and birth experience traumatic. Pensak helpfully spells out the conditions necessary for post-traumatic growth to occur (12).
Best of all, Pensak doesn’t limit herself to explaining the “why” behind common experiences of new motherhood. She climbs right into the fray with strategies, tactics, and tools, including proactively crafting a postpartum mental health care plan-template and all.
Limitations or blindspots of Rattled
Overreliance on self-care to handle postpartum challenges
Pensak heavily emphasizes the value of self-care and of filling one’s own cup first, because, as she repeats throughout, “you can’t fill from an empty vessel.” To her credit, she doesn’t encourage adopting a victim mentality. She instead acknowledges and advocates for increasing one’s own capacity during postpartum, capitalizing on the power of neuroplasticity.
But her lens was purely secular, with nary a mention of the role religious faith can play in helping women integrate the greater meaning and purpose behind the challenges and sufferings of new motherhood. (Christian readers may find a helpful companion book in mother of 10 Abbie Halberstadt’s M is for Mama: A Rebellion Against Mediocre Motherhood, which I read alongside Rattled. Likewise, Священное начало: Nurturing Your Body, Mind, & Soul During Baby's First Forty Days-the subject of a previous NW Review—offers an Orthodox take.).
As such, the one-note refrain of recognizing and tending to one’s own needs, rehashed in myriad ways, became a limitation and, arguably, wouldn’t translate well for a mother of three, four, or more children. While love multiplies, time to attend to one’s own needs doesn’t tend to do the same, which is where enhanced meaning and purpose from religious faith come into play for many moms. Pensak would say, and I agree, that we have to attend to the mother first. As a result, we “win” both the baby’s health and wellbeing and her own. But escalating levels of self-care can’t be the only path forward.
Lacks guidance on distinguishing mom guilt from changed priorities, new desires
Pensak addresses the worthwhile question of mothers going back to work in her chapter on mom guilt. She then devotes a whole chapter in the third part of the book to smoothing the transition period. I wish there had been guidance on discerning when one is suffering from mom guilt about returning to work—to which her response is to “double down” on the thing your fear says you shouldn’t do—versus recognizing and responding to changed priorities or desires.
No mention of progesterone support for postpartum depression
I thoroughly appreciated Pensak’s coverage of multiple evidence-based treatment options for perinatal mood and anxiety disorders beyond what research studies call “standard treatment” (aka, cognitive behavioral therapy and/or selective serotonin reuptake inhibitor antidepressants). To her credit, she mentioned, albeit briefly, the new pill specifically intended for postpartum depression, Zuranolone. I would have loved a mention of restorative reproductive medicine protocols for добавка прогестерона for postpartum depression, but in fairness, to my knowledge, there are no research trials published in peer-reviewed journals for her to cite.
No connecting the dots between hormonal birth control and postpartum struggles
I wished Pensak had addressed hormonal birth control use, for several reasons. One, developing depression from hormonal contraceptive use may be a red flag warning to look out for postpartum depression down the road. Secondly, “what birth control will you be using?” is a near-universal question at the six-week postpartum checkup, if not before a woman even leaves the hospital. Since we know hormonal contraception can exacerbate or precipitate mental health challenges for some women, why wouldn’t Pensak note that as a potential risk factor to be aware of, particularly for moms with a history of mental health struggles? Thirdly, we know that hormonal contraceptives can cause недостатки питанияи что nutrition can play a role in postpartum depression. I wish Pensak had connected these dots for her readers.
Finally, on an intellectual level, hormonal contraception ill-prepares women for the postpartum lack of control over their own bodies, time, energy, and more. As author Lucy Jones alluded to in her depressing book Matrescence: On Pregnancy, Childbirth, and Motherhood, her past use of hormonal contraception “suppressing my cycle so I wouldn’t have to bleed and could have more control of my body” (48) didn’t prepare her well for flexibility, acceptance, or surrender in motherhood. For how many other women is this also true?
The verdict
I recommend buying Rattled for pregnant or postpartum moms. While my youngest is now one and she has four older siblings, I’m considering buying it for myself to thumb through from time to time. I always want to be reminded of Pensak’s approach to early motherhood, as a time of testing and resilience, strength forged through struggle. Even with the book’s aforementioned limitations and blind spots, that central message is worth spreading far and wide.
