Awake at 3 a.m.: Yoga Therapy for Anxiety and Depression in Pregnancy and Early Motherhood

Suzannah (Tipermas) Neufeld has been a therapist supporting people coping with 

eating disorders, body image concerns, anxiety, and maternal mental health since 2003. 

She has worked in residential, intensive outpatient, and school settings, and has been 

in private practice since 2006. In 2015, Suzannah co-founded the Rockridge Wellness 

Center, a counseling and health collective in Oakland. She has performed speaking 

engagements widely on eating disorders, body image, media literacy, perinatal mood 

disorders, and yoga therapy for organizations such as the California Association of 

Marriage and Family Therapists (CAMFT), Postpartum Support International (PSI), 

About-Face and City College of San Francisco. 

Suzannah received her bachelor’s degree in Psychology/Drama from Stanford 

University. Her honors thesis involved writing and performing a play about women 

recovering from eating disorders. She went on to earn her MA in Counseling 

Psychology with a specialization in Expressive Arts Therapy from the California Institute 

of Integral Studies. In her master’s project, she studied the use of expressive arts in 

treating co-occurring eating disorders/addiction issues. 

Suzannah is also a certified yoga therapist, C-IAYT, having completed training at the 

Niroga Institute, and loves incorporating mindfulness and body/breath awareness into a 

creative and strength-based therapy approach. 

Suzannah published her first book, Awake at 3 a.m.: Yoga Therapy for Anxiety and 

Depression in Pregnancy and Early Motherhoodwith Parallax Press in May 2018. She 

has also contributed a chapter about yoga and body image post-baby to the anthology 

Yoga Rising: 30 Empowering Stories from Renegades for Every Body by Melanie Klein. 

Suzannah is a member of the following professional organizations: 

  • International Association of Yoga Therapists 
  • California Association of Marriage and Family Therapists 
  • International Association of Eating Disorder Professionals 
  • Postpartum Support International 

We have both suffered anxiety and Perinatal mood disorder. I was really attracted to your title awake at 3 am. It kinda sums up motherhood. So, to begin with the night time. Every mother suffers the awakeness. Why do we seem to suffer most at night? I know we are desperate for sleep but do you have any insight on what happens exactly when night falls? 

I think the struggle at nighttime can be twofold. First, this might be the time when we feel the most exhausted, and yet we have to wake up to care for our babies. For me, I would feel desperate for sleep, and would have thoughts about how I couldn’t handle staying awake for even one more minute. I would also then have intense guilt and shame for not being a “better mother” and just enjoying this time caring for my little ones, who I loved so much. I couldn’t understand why my love didn’t override my exhaustion. I think many parents struggle to have compassion for their humanity in this way–for honoring that they have a human body that does send us powerful signals that it needs sleep! 

Second, for many parents, even when their baby does sleep, they may find themselves unable to slow down and fall asleep. It can feel like the greatest torture to be so tired, yet unable to rest. They may find their minds racing about what needs to be done, what baby issues need to be researched (turning on the phone makes this so much worse), or even physically racing–cleaning the house, answering work messages, fearful of what might happen if they put all that on hold. This can be a sign of anxiety, worry, internal pressure to go-go-go. I would ask these parents, what are you worried about? What help do you need so that you can let go and rest?

I would like to discuss hormones. Do you have any thoughts on preparing women about postpartum and post-breastfeeding hormones (including the process for women who choose not to breastfeed)? Do you think women know enough now, and if not, where can they go to educate themselves. What difference do you think it would make to the postpartum mental journey for women, if they understood what hormonal reactions were going to occur in their bodies? 

I think the best reason for women to know about hormonal changes would be to help them develop self-compassion–to let go of the idea that struggles are a sign of weakness or failure. I would love for moms to be patient with themselves as their hormones shift and change, to know that nothing they are experiencing now is permanent, and that this is a time to treat themselves with great tenderness. 

The question about where to go for information is a good one–I would like to say that reaching out to your care provider for education is a good option. Some care providers are very wise, informed, and compassionate in their delivery of information. Unfortunately too many moms reach out and receive biased, unhelpful, or scary information from medical providers and holistic providers alike. My main suggestion would be to avoid getting your information from random sources on the internet–my experience is that usually only leads to more anxiety and preoccupation about what could be happening in one’s body, and also about doing things perfectly for our health. Our time would be better spent connecting with friends, getting outside, or taking a nap!

If you do feel pulled to the internet, I think of the MGH website as a really good, scientifically sound source of information: https://womensmentalhealth.org

I love in your introduction you speak about how Yoga doesn’t make us eternally calm or peaceful. It doesn’t make us good mothers. How would you explain to moms that are scared of yoga or to desperate to think about it as a coping skill? 

I do think that yoga offers us amazing coping skills–especially for helping regulate mood and anxiety. The book is full of ways to use yoga to cope. But that doesn’t mean it fixes us for good–or makes us perfect. It’s a tool, one we have to use again and again. More essentially, I think of yoga as a way to change our relationship to our suffering, instead of as a way to erase it. Yoga invites us to show up exactly as we are, with all of our messiness, struggles, and difficult emotions. It helps us feel more open to honoring all of our experiences. It may not make us good mothers, but it sure helps us uncover all the ways we may already be good enough. 

You were diagnosed with hyperemesis gravidarum. You were skeptical of taking medication and finally did. I was a breastfeeding mom who had to go on antidepressants and was so scared, for many reasons, but also because I had a very negative experience a decade ago on effexor. It was with constant speaking with the women in my out-patient group and mostly Laura who became my business partner, that I finally took them. Thank God! How can we change the negative opinions that go along with taking medication while pregnant or breastfeeding? 

I hope that me sharing my experience and you sharing yours helps! I think we need to break the silence about them in order to reduce stigma. I also think it can help for moms to feel educated

on both the pros and cons of each medication–to stop thinking in black-and-white as though all meds are good or all are bad. Mother-to-Baby is a wonderful website and app with up-to-date information about medications and safety in pregnancy: http://www.mothertobaby.org

Do you have any recommendations for how a women who is nervous about telling her partner or her support system can approach the conversation? And conversely, what should someone do if a new mom tells them that she is not coping well? 

It can be so scary to approach one’s support system about struggling with perinatal mood and anxiety issues! Many moms fear telling others because they don’t want to be thought of as a “bad mom” or as “crazy.” They might worry others will not trust them with their baby, or could even have their children taken away from them. These are legitimate fears–as these prejudices do exist. I would encourage a woman to think first about who would be the safest person to open up to–that person could then perhaps help them think through who to tell next. I encourage moms to share with as little shame as possible–you haven’t done something wrong or bad. Instead, share that you are really having a hard time with the transition to motherhood and need help figuring out how to get more support. You could hand the partner or friend a copy of my book, or of many other excellent books that have been written on the subject–sometimes hearing about it from a written source can help. 

In the book, I have a nice long list (on page 96) of things that moms can say to loved ones to ask for help–I’ve had moms tell me that they just made a copy of the page and handed it to loved ones, and found that helpful. 

For loved ones, if a woman shares with you that she is not coping well, first, thank her for her honesty. Don’t jump in to fix things–first take time to listen and understand what is going on with her. Avoid platitudes like “You just need to think more positively” “This too shall pass” or “Sleep when the baby sleeps.” Take her feelings and struggles seriously. Tell her that you will work together to figure out how to get her more support. Don’t expect her to ask for help–she may feel very ashamed and even likely to say she doesn’t need anything from you. Instead, just keep offering help–bring food, offer childcare, help her access services (calling the

Postpartum Support International Warmline is a good start). Do this all with kindness and patience.

 

 

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