Pittsburgh-Based Author Tackles Little-Recognized Crisis of Maternal Fear And Anxiety

Apr 8, 2020

“For me, it began with the mouse poop,” writes Sarah Menkedick. She was pregnant, living in an Ohio cabin that had mice. 

Almost overnight -- and after some Googling -- she became convinced that mouse turds could kill her unborn child. She embarked on what she calls a nine-month “cleaning frenzy,” but the birth of her healthy daughter didn’t allay her fears. Menkedick became so fixated on the risks of toxins in her environment that, once, she could barely function while staying in a guesthouse where there were traces of lead paint. (She knew because she bought a test kit.)

Finally, Menkedick realized she’d hit bottom and started seeking help. Her experience is the germ of the Pittsburgh-based writer’s new book. In “Ordinary Insanity: Fear and the Silent Crisis of Motherhood in America” (Pantheon), she explores the little-recognized phenomenon of maternal anxiety. It’s a problem partly rooted in neurobiology but exacerbated, Menkedick argues, by the medical establishment and a culture that prioritizes fear, refuses to tolerate risk, and values babies over mothers.

Though the book’s publication date falls, a bit ironically, right in the middle of a global pandemic, it’s already receiving national attention, including a review in The New York Times.

The anxiety Menkedick writes about is distinct from the better-known postpartum depression, or “baby blues,” that afflicts some new mothers. And in fact, she said, “postpartum anxiety” usually begins during pregnancy. It’s similar to other forms of anxiety, but “it’s more severe and it’s usually tied to concerns about the baby.” And more than ordinary worry, “it’s an anxiety that is bad enough to be debilitating and to interfere with everyday life.”

Menkedick lives in Squirrel Hill with her husband, Jorge, and daughter, Elena, now 5. Her publication credits include outlets like Harper's Magazine, The New York Times, The Guardian, and Buzzfeed, and her debut essay collection, "Homing Instincts" (which was also about motherhood), was long-listed for the PEN/Diamonstein-Spielvogel Award for the Art of the Essay.

In "Ordinary Insanity," she draws on her own story but also offers case studies of other women. She said postpartum anxiety, though subject to little scientific study until recently, is thought to affect “about 17 percent of women” severely enough to warrant a clinical diagnosis. A similar proportion are affected at a serious but subclinical level.

"It's an anxiety that is bad enough to be debilitating and to interfere with everyday life"

Indeed, one big issue is that the kind of irrational fear that led a pregnant Menkedick to refuse to even touch a windowsill that might have lead paint on it has been so normalized in our culture that it’s not seen as a problem. “[I]t was really hard for me to recognize … [that] this actually wasn’t normal, and it wasn’t just good mothering, that this was anxiety and it was sort of taking over my whole life,” she said.

Menkedick explores some of the neuroscience of motherhood: Evolution, she explains, has seen to it that the brains of expectant and new mothers are actually rewired to be hypersensitive to risk. That’s actually rather useful for someone suddenly in charge of caring for a helpless newborn. But our culture, she contends, promotes this kind of fear beyond rational bounds.

“We just get into this zone where during pregnancy and early motherhood, in particular, [there are] very extreme attitudes about risk and everything that you must do to absolutely ensure the complete safety of your pregnancy and your child all the time, to the point where it becomes almost a type of pathology,” she says.

"There are very extreme attitudes about risk to the point where it becomes almost a type of pathology"

She cites blanket prohibitions on pregnant women drinking, even though she says research “shows that there’s no danger from light drinking during pregnancy.” And she notes her own small defiance of conventional medical wisdom when she chose to sleep in the same bed as her baby – a practice some believe can lead to infant suffocation. She felt vindicated when, in 2018, she learned of research concluding that for mothers who took basic precautions (not going to bed drunk, removing hazards like pillows), the risk of infant death from co-sleeping is “less than [that of] being struck by lightning.”

Menkedick traces “zero-risk” thinking to the dawn of scientific parenting in the early 20th century. That, she said, is when children came to be seen as perfectible, and mothers – it’s almost always mothers – as culpable if anything about their offspring turned out otherwise. Yet for all the pressure this belief system places on them, Menkedick writes in “Ordinary Insanity,” very little infrastructure is in place to help mothers navigate the stresses of having and caring for children. She noted that while her daughter had five checkups in her first month of life, Menkedick – who was then still suffering from crippling, undiagnosed postpartum anxiety – saw her own doctor just once in that first year.

“I just muscled through, which is sort of crazy. And so many women do that,” she said. “And, you know, there’s this insane notion that we can just focus on the baby the entire time and leave the mother alone and everything will turn out fine.”

"There's this insane notion that we can just focus on the baby the entire time and leave the mother alone and everything will turn out fine"

What’s the solution? Menkedick said a good place to start would be empowering women to make more of their own mothering choices based on evidence-based medicine about the risks and benefits of things like home-birthing. “I think also women just need to have a lot more support for their mental health and care throughout this entire period [pregnancy and after],” she said. “That doesn’t mean that women are weak or pathetic, or whatnot, but that this is a time where there is a major upheaval in women’s lives, and there’s a lot of potential for traumatic experiences.”

And what about that pandemic? These are days when everyone – not just pregnant women and new mothers – is obsessed with risk and staving off a potentially deadly infection. How’s a mother to know if she’s drifting into clinical anxiety?

“It's hard to define what is normal at this time,” she acknowledged. “But when being proactive and taking measures like washing your hands or, you know, disinfecting countertops and whatnot sort of spills over into almost obsessive, life-consuming cleaning or preoccupations. So are you washing your hands before you eat, after you go to the bathroom? Are you washing your hands fifteen times every hour? … So sort of monitoring your behavior to see, ‘OK, now this has crossed over from being what is you know, quote unquote, normal and recommended by experts to being something that is sort of taken over my whole life.”