Opinion

‘It’s not in the medical vocabulary’: Talking about matrescence


Evelyn Lewin


18/12/2019 4:20:11 PM

Matrescence, the transition to motherhood, is a period of emotional upheaval akin to adolescence, Dr Evelyn Lewin writes.

Sad young mother
The word ‘matrescence’ sounds similar to adolescence for a reason: both describe a period of expected emotional upheaval.

Before having my first baby, I had completed a diploma in obstetrics and gynaecology.
 
By the time I’d had my third, I was a GP.
 
Yet in all my years of medical training, I had never heard the word ‘matrescence’.
 
In fact, it wasn’t until earlier this year, when I was listening to a TED talk, that I first came across it.
 
The TED talk was by reproductive psychiatrist Dr Alexandra Sacks and the topic was ‘A new way to think about the transition to motherhood’.
 
Dr Sacks talked about how she learned of the term, and why she believes we need to talk about it more. She said the word matrescence sounds similar to adolescence for a reason: both describe a period of expected emotional upheaval.

But while there is a plethora of textbooks on adolescence, there is hardly any information on matrescence.
 
Dr Sacks herself only first heard the term after being contacted by ‘hundreds’ of women who all followed a similar pattern.
 
That pattern, Dr Sacks observed, was this: a woman would have a baby and then harbour concerns she was not good at being a mother, that she was not enjoying her experience.
 
These women contacted Dr Sacks because they were worried they were depressed. After exploring their symptoms, Dr Sacks would tell these women they did not have clinical depression.
 
But they were not reassured.
 
Instead, they insisted something was ‘wrong’; they were convinced that motherhood was not meant to feel like this.
 
Dr Sacks was keen to help them understand their experience.
 
‘I wanted to find a way to normalise this transition, to explain that discomfort is not always the same thing as disease,’ she said.
 
After two years of searching, she came across a 1973 essay that described matrescence.
 
Like adolescence, matrescence is not a disease, Dr Sacks noted.
 
‘But since it’s not in the medical vocabulary – since doctors aren’t educating people about it – it’s being confused with a more serious condition called postpartum depression,’ she said.
 
Dr Sacks outlines some of the expectations of matrescence, describing some of the ‘universal aspects’ of it.
 
These include a feeling of ambivalence, disappointment if the fantasy image of motherhood doesn’t match reality, guilt, shame, worries about being a ‘good enough’ mother, and feeling torn by competing interests.
 
Dr Wendy Burton, GP and Chair of the RACGP Antenatal/Postnatal Care Specific Interests network, believes GPs should play a pivotal role in educating patients about matrescence.
 
‘I don’t think we, as GPs, do it well enough,’ she told me.
 
‘And I think these are the conversations we should be having.’
 
Dr Burton said conversations between GPs and pregnant patients tend to focus on pregnancy and birth.
 
‘I think these are conversations that are absolutely worth starting before the baby’s born … planting that seed of expectation that it doesn’t always end the way that Instagram portrays it,’ she said.
 
But there is no ideal time for a GP to have such conversations.
 
‘When are we going to do it?’ Dr Burton asked. ‘Medicare doesn’t fund it.’
 
Dr Burton said the information can be gathered from other sources, such as early childhood nurses, and online resources such as Parentline, Pregnancy Birth & Baby, Raising Children Network and the Centre of Perinatal Excellence, COPE.
 
Despite there being other avenues to access similar information, Dr Burton believes GPs are perfectly positioned to educate women on matrescence.
 
By not teaching pregnant women about it, Dr Burton feels we run the risk of having our patients harbour the same concerns that Dr Sack’s patients did, regarding postpartum mental illness.
 
‘We risk medicalising what is a very normal human event,’ she said.
 
On the other hand, teaching women about matrescence gives them a word to help describe what they are going through.
 
‘Words are very powerful,’ Dr Burton said.
 
Of course, if a woman has symptoms of clinical postpartum depression or other mental illness, she should be seen and treated accordingly.
 
But Dr Sacks believes that falling to discuss talking about matrescence may increase a woman’s risk of such diseases.
 
‘If women understood the natural progression of matrescence, if they knew that most women found it hard to live in this push and pull, if they knew that under these circumstances ambivalence was normal and nothing to be ashamed of, they would feel less alone, they would feel less stigmatised, and I think it would even reduce rates of postpartum depression,’ she said.
 
I agree with Dr Sacks and Dr Burton. It’s time we help new mothers through the transition to motherhood by teaching them about matrescence.
 
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Dr Oscar Serrallach   19/12/2019 11:10:31 AM

Thank you for sharing this important topic. I believe we should also have a separate field of medicine called maybe "matriatrics" as the evidence of this new physiological landscape for months extending beyond the traditional 6 month time line is growing eg Biomarkers of Post Partum Psychiatric Disorders by Payne and Osborne