The Matrescent Journey

RESEARCH ESSAY

INTRODUCTION

Becoming a mother is a complex process of adaptation. During the transitional stage known as matrescence (Raphael, 1975), women face major change-inducing biopsychosocial stressors (Athan, 2011; Dooley Hussmann, 2020; Sacks, 2017; Vales-Lewis, 2020) which, in turn, impact their mental health and wellbeing, being this period one of high prevalence of psychological illnesses for women (WHO 2022; PwC 2019; Fontein-Kuipers 2016). Significant effort has been dedicated to understanding clinical distress and pathologies in new mothers. Notwithstanding, little attention is paid to the overall experiences of maternal languishing and flourishing, which seem to be at the core of the journey that is the birth of the mother. Supporting women’s optimal adjustment might hold the key to better health outcomes and a new direction to maternal care.

RESEARCH FINDINGS

A common challenge to women during their first years of motherhood is poor mental health: while 1 in 10 experience acute post-traumatic stress disorder from birth (Simpson et al., 2018), it’s estimated that 1-in-5 women struggle with depression, anxiety, or both (PwC 2019) when becoming mothers. While taking note that “mental health issues are grossly underdiagnosed”, it’s also important to contemplate that “often overlooked, subclinical symptoms of postpartum depression, anxiety, or other mental health symptoms among new mothers increase the risk of more severe problems” (Delaney, Dalmida & Gaydos, 2015). The absence of a diagnosis does not translate to mental health. Sin & Lyubomirsky stated that “the absence of mental illness does not necessarily imply the presence of (…) positive mental health” (2009). Positive mental health, meaning, not only the lack of psychological conditions, but the presence of wellbeing, well coping and well-functioning, according to Keyes (2005).

Lack of positive mental health might be linked to maternal distress. For Emmanuel and St. John, the experience of new mothers’ distress “is not related to psychiatric diagnoses, but rather “normal” feelings and adjustments to becoming a mother” (2010). Positive psychology has introduced a concept like distress: languishing. Keyes, in his landmark work regarding complete mental health, advocates that pure languishing, a state of extremely low wellbeing and distress “is as dysfunctional as an episode of pure mental illness” (2005).

As stated by McLeish and Redshaw, “many pregnant women and new mothers who do not have a diagnosed mental illness experience sub-threshold symptoms of depression and anxiety as they adapt to their maternal role or stress” (2017). It is the case for 1-in-3 women, who identify their birth as traumatic, reporting the presence of at least three trauma symptoms (Creedy, Shochet & Horsfall, 2000). According to Fontein-Kuipers’ research, “worldwide maternal distress prevalence rates are up to 41%” (2016). These numbers are in line with McConachie and colleagues’ research results, who found that almost half of their subjects suffered from psychological distress (2008). The vast number of women struggling to adapt might suggest that transitioning into motherhood imposes a condition of illbeing. When birthing the mother, languishing is normal, if not normative.

Transitioning into motherhood has been identified as a human developmental stage known as matrescence (Raphael, 1975; Athan & Reel 2015, Leahy, 2020). Beyond the difficulties that come from caring for a child, it entails major biological changes from hormonal unbalance (Athan and Reel 2015) to increased brain plasticity (Carmona et al., 2019 and Hoekzema et al., 2017). Psychological challenges from processing labour (Creedy, Shochet & Horsfall, 2000; Dooley Hussmann, 2020; Emmanuel & St. John, 2010) to learning new competencies (Mercer, 2004; Athan & Reel 2015; Dooley Hussmann, 2020). From navigating a vast novel emotional landscape to making sense of a new life and identity (Raphael, 1975; Mercer, 2004; Athan & Reel, 2015; Dooley Hussmann, 2020). Social transformations from the increased need of support (Raphael, 1975; Emmanuel & St. John, 2010; Dooley Hussmann, 2020) to acquiring a different social role and its engagements (Mercer, 2004; Athan & Reel 2015; Dooley Hussmann, 2020). Some describe the impact of becoming a mother in a ‘spiritual level’ (Athan & Reel 2015; Thomas, 2001). These change promoting factors, these stressors, create instability and can be sources of distress.

It's widely accepted that “stressors have a major influence upon mood, our sense of wellbeing, behaviour, and health” (Schneiderman, Ironson & Siegel, 2005). Nonetheless, stress isn’t necessarily a negative force. In fact, stress is indispensable for change. It entices “adaptation and are, therefore, beneficial and desirable”, but “(…) when stress is severe, prolonged, or both, it becomes an expression of “an aversive, negative state in which coping and adaptation processes fail to return an organism to (...) homeostasis”, balance, stability (NRCCRAPLA US, 2009).

Undeniably, stress is at the core of matrescence. It is the force pushing for necessary adjustments to this new life and identity phase, to the mother role. Stress brings the mother into existence. Therefore, “maternal distress should not be strictly assessed as a medical problem, but rather as a normal response to becoming a mother” (Arditti et al., 2013). While transitoning, maladaptation can occur hindering development and occasionally resulting in mental health conditions and illbeing. Nonetheless, one would expect that stress can also bring positive adaptation resulting in wellbeing and self-actualisation (Athan, 2011). Perhaps the matrescence quest is one for stability pervading distress.

DISCUSSION

Distress occurs when change is accompanied by instability, uncertainty, and vulnerability, as seen in major life transitions (Meleis 2007). Maternal distress refers to stress responses to biopsychosocial challenges which, in turn, influence the new mother’s functioning, controlling, and connecting and its consequences (Emmanuel & St. John, 2010). As described by Copeland & Harbaugh, as “new mothers actively adapt to new demands and challenges in the mothering role (…) some may find this adjustment difficult and distressing, depending on their perceptions and resources” (2019). As per Fontein-Kuipers and colleagues, “the experience of maternal distress is unique to each woman” (2017). While inherent to matrescence, due to the very nature of this phenomenon, the hardship endured by women varies depending on stress factors and responses, maternal distress is a powerful force pushing for adaptation, balance.

For Athan, the same demands that pose threats to wellbeing also “present opportunities for personal growth and self-actualization” (2011). She was the first to propose the phenomenon postpartum flourishing - the opposite concept of languishing, according to a complete mental health continuum (Keyes, 2002). If, on one hand, languishing, distress, lack of wellbeing, seem to be natural to this human complex and challenging experience, as a developmental stage, matrescence is more than a complex process of adjustment, but a call for human betterment. In this sense, regarding maternal mental health and wellbeing, the matrescence quest could be viewed as one from a languishing to a flourishing state.

IMPLEMENTATION OF FINDINGS IN CURRENT PRACTICE

Shifting from focusing on the subsequent negative mental health to preventatively fostering positive mental health might hold the key to creating optimal adjustment and maternal wellbeing. Athan suggested that maternal care should promote adaptation rather than address maladjustment (2011). The birth of a mother is a profound reformative process taking place on the everyday practices of mothering, encompassing biopsychosocial challenges meant to transform every aspect of a woman’s life and identity, thoughts, emotions, and behaviour. For Dooley Hussmann, “the postpartum period is filled with small and big reactions to new experiences (...) It is these experiences, and a mother’s reactions to them, that make up first-time mothers’ experiences of their postpartum mental health” (2020). In this sense, supporting women’s optimal adjustment during matrescence would mean helping them endure this transformative stage, better managing stress factors and respective stress responses while accepting and adapting to change.

It's believed that “maternal distress is a multi-factorial and multi-dimensional health problem that can be changed by women themselves with support of their environment” (Fontein-Kuipers et al., 2017). It aligns with Emmanuel and St. John’s belief that “personal, community and societal conditions can hamper this transition” (2010). Huppert advocated that “not only should we be aiming to enhance wellbeing (…) we should also be doing so for the majority of people rather than the few who have a disorder” (2009). In this sense, maternal care should be about the promotion of wellness, supporting the adaptation and flourishing of women navigating matrescence.

CONCLUSION

Distress is an aversive state in which a person struggles to positively process and adapt to stressors and stress responses. It can hinder healthy adaptation, which, in turn, can result in augmented illbeing, mental health conditions and other severe maladaptive behaviours. While maternal distress might be inherent to matrescence due to the very nature of this phenomenon, the hardship endured by women may vary depending on stress factors and stress responses. The notion of a normative maternal distress condition inflicting new mothers “acknowledges and normalizes feelings of distress, struggle and hardship experienced by women in response to the transition to motherhood, rather than labelling or problematizing them” (Emmanuel & St. John, 2010). It is proposed that a holistic positive approach to navigating change and promoting adaptation and flourishing should be adopted by maternal care practice. Further research could investigate if and how supporting optimal adaptation and maternal mental health and wellbeing could potentially reduce maternal distress duration, severity, and its consequences.

BIBLIOGRAPHY

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