Ruth Davis Kalb, Ph. D.Ruth Davis Kalb, Ph.D.

Therapy tailored to your strengths and needs

Ruth Davis Kalb Ph.D. Licensed Psychologist

300 Tamal Plaza #140 | Corte Madera, CA 94925Ruth Davis Kalb, Ph.D.rdkphd@icloud.comRuth Davis Kalb, Ph.D.415.925.8511 x328



Just because having a baby is normal doesn't mean it's easy, doesn't mean adjusting to it happens overnight, and doesn't mean you have to like everything about it.

Babies do a few things very well. They cry. If we're lucky, they sleep. If we're really lucky, they smile. They're experts, though, from birth, at humbling us. You may know how to negotiate multinational trade agreements, litigate with the best of them, or manage a classroom full of kindergärtners -- that doesn't mean you have the foggiest idea how to strap in your baby's car seat, or how to calm your baby down.

While both parents can struggle with the arrival of a new baby, there are a number of reasons that seem to amplify postpartum challenges for mothers. For starters, hormonally, pregnancy, the postpartum period, nursing and weaning, all throw women into very dramatic mood shifts, positive and negative.

In addition, whether or not it's politically correct, for most women, how we are as mothers is a fundamental reflection of ourselves. It is a crucial part of our identities as women. If you want to go for a man's jugular, imply that he's not making enough money. If you're going for a woman's, suggest, or even hint that she's blowing it as a mom.


Throughout the world there are customs designed to help women both mark the transition to motherhood, and adjust to their new status. These customs vary greatly, but have in common a focus of time, care and energy on the mother/baby pair, often from a circle of women relatives or elders. The focus is often on the mother at least as much if not more than on the baby. By the very fact that these rituals and customs happen automatically, they provide much needed order and control during a time of great change and instability.

The idea of some circle of elders zooming in during this vulnerable time may fill you with comfort, panic, or anything in between. Think for a minute though, about the implicit and often explicit messages which cut across these customs and about how very different they are from the way childbirth is generally handled in this country, where women are usually on their own after a one day hospital stay. Instead - the message in the cross cultural customs is: " This is challenging. We've been there. We'll help you and show you. You can do it too."

Just because these customs exist elsewhere, doesn't inoculate women in those cultures from struggling with postpartum depression and other challenges. How come? Read on:


Knowing about what happens to your body postpartum is not meant to depress or agitate you. The hope is that with knowledge, you and your loved ones can be kinder and more patient, and allow you as much help as is possible as your body adjusts to the dramatic, if normal changes you are experiencing.

  • Over the course of pregnancy, hormone levels will have risen up to 30 times their non pregnant state. At birth, there is a precipitous reversal of this state. Think PMS. Now think of it sleep deprived. Try exaggerating what you've been thinking. A lot.
  • A new mother may be hungry, have chills or fever as a reaction to labor and delivery. She may have continued contractions, perineal bruises, stitches or hemorrhoids. Her gastrointestinal tract may be sluggish. Her control of urination may be compromised. Once her milk comes in her breasts will grow, larger, firmer, more tender and possibly painful. Many new mothers continue to have physical symptoms well into the first postpartum year. These can include increased sweating, hot flashes, acne and more.

Post any other kind of surgery, most people expect to feel bodily traumatized. Again, this is where thinking of childbirth as a "normal, healthy event" can get women in trouble with themselves.


Try thinking about your own experience as you read what follows. Give yourself time to really consider each question. What will be your particular challenges? How can you prepare for them?

Learning to juggle the newborn's needs while continuing your relationships with your partner.

  • How long have you been together with your partner?
  • How "couply" a couple have you been?
  • Have either of you had real life experience with babies?
  • Did you both want this child?
  • Does your partner have the option to help you with hands on childcare, time wise or financially?
  • Do they have the inclination to help?
  • Do they "get" what's going on with you emotionally?
  • Can they tolerate having you be in love with someone else?
  • Can they tolerate having you be too exhausted for, and uninterested in, having sex?       
  • Can they deal with you pushing them away while you cuddle and coo, naked and intimate with your newborn?

Coming to terms with what it means to be a mother.

Becoming a mother kicks up all sorts of dust. You may never have acknowledged certain sets of feelings about your childhood, may have thought of yourself as "done" with figuring out others, be excited at finally joining the parental ranks, or horrified that you either cannot possibly fill your mother's shoes, or perhaps worse, that you won't be able to keep from filling them.

  • Are your parents living or dead?
  • If they're alive, are they close by?
  • Will they offer help or aggravation, or some combination of the two?
  • What is your relationship with them like?
  • What do you consciously want to emulate about how they were parents?
  • What would you feel awful about repeating?

Re-calibrating friendships.

Immediately postpartum, you'll need a lot of support from friends and will have little to give back in return. You'll find that you notice shifts in your friendships.

  • Who do you suddenly relate to?
  • Who do you feel it's for the first time difficult to connect with?
  • Have you been surprised by support?
  • Have you felt side swiped by competitive feelings, either your own or a friend's?

Negotiating the "no turning back" point of adulthood.

  • How ready to be adults are you and your partner?
  • Is one of you way more ready than the other?
  • What's it like to have someone dependent upon you for absolutely everything?
  • What's it been like to have your time not be your own?
  • How have you adjusted to the lack of freedom?

Developing parental self-esteem.

  • Do you feel up to the task of being a mother?
  • Are you confident that the skills you've brought to bear in your life to date translate to your new role? Do they seem relevant?
  • How do you think you'll be able to accomplish the day-to-day tasks of motherhood?
  • How about the broader jobs - providing guidance, security, structure, direction?


You may have all the risk factors and experience no problems, or have few to none and still struggle. There are no set in stone rules here but it can be helpful to know what can contribute to problems so that you can prepare.

Biochemical vulnerability. We know that hormonal variations can effect mood, that the age that first depressions occur coincides with the childbearing years and that women suffer from depression more than men do. Your risks are increased if:

  • you suffered with biologically based postpartum difficulties with one child
  • you have a prior personal history of depression or depression runs in your family
  • you've become depressed while on oral contraceptives

Life stresses. The more life stresses, the more difficult time you may have.

  • Have you just moved?
  • Have you or your partner just lost a job or some other source of income?
  • Has someone dear to you moved or passed away?

Social support.

  • What does your support system look like, both in the immediate postpartum period, and in the longer term?
  • Do you have friends or family you can turn to for concrete help?
  • Do you have friends or family you can tell about the downside of your experience without feeing guilty or judged?

Individual expectations. The higher and more unrealistic your expectations, the more likely you are to crash postpartum. The results of unrealistic expectations tend to be guilt and feelings of failure.

  • How does the reality of having a baby deviate from your expectations?
  • Have you deluded yourself into believing you'd have time to organize your kitchen, or write a chapter for a book?
  • Are you prepared for sometimes feeling anger and resentment toward your baby?


The three most important things to remember if you're hit with any of these difficulties are:


Along with it's not your fault, it's helpful to add, you're not crazy, weak or a failure. I've heard so many women describe well meaning but completely unhelpful comments such as: "But you have everything going for you." "Think about how lucky you are" "Your dreams have all finally come true" "Think happy thoughts" "You can do it. Just do it"

Most women end up feeling, in the face of these types of comments, guilty, ungrateful and /or weak. They tell themselves that if only they were stronger, they wouldn't be struggling. The whole guilty, ungrateful set of feelings can be particularly difficult for adoptive mothers. or women who've struggled with fertility problems for years on end. It can be very tough to shift - to come to terms with your own struggles actually having a baby (or two or three as a result of fertility drugs) when the entire focus of your life has been on trying to accomplish exactly that goal.

You don't need to suffer alone. Call for a free phone consultation to see if
therapy can help: 415-925-8511 x328

© 2013, Ruth Davis Kalb, Ph. D. All rights reserved.

Ruth Davis Kalb Ph.D. is a psychologist providing counseling and therapy to older teenagers, young adults, adults, seniors, couples, and families. She has has an office in Corte Madera (Marin County) and serves Tiburon, Mill Valley, Belvedere, Sausalito, Kentfield, Ross, Greenbrae, San Rafael and Novato. She helps people with depression and anxiety, panic, social anxiety, postpartum depression, parenting problems, creative blocks, writer’s block, marital issues, and self defeating patterns.