It's Time to Leave the Term 'Pregnancy Brain' Behind09/01/2021
When I was preparing to give birth to my third child, I knew myself well enough to know that I would need certain postpartum coping tools. In addition to a prescription to Zoloft and therapist appointments scheduled in advance, I knew I'd need comfort reading materials (Agatha Christie), comfort TV (Schitt's Creek), and the comfort of not having to do anything which required significant mental effort. I was extremely fortunate to have the mental space to prepare for my postpartum self-care (many pregnant people aren't as lucky), and in the weeks leading up to my son's birth, I finished up any cognitively taxing work and looked forward to giving myself a hard pass for any mentally strenuous roadblocks that might appear postpartum. Because here's the thing, pregnancy and childbirth change you, but not only in the way of platitudinous Instagram infographics typed up in curlicue fonts waxing poetic about how a mother is born alongside the child (although, yeah, that's true). Pregnancy and childbirth change birthing people's brains. And we know little about it.
Anyone who's been pregnant or given birth will have experienced being told — whether by a complete stranger, friend, loved one, or healthcare provider — that their lack of focus, general malaise, inability to remember the word "grape," and bone-crushing mental fog, can be chalked up to "pregnancy brain." We're meant to accept this label as some sort of, what, exactly? Is it a scientific term for a medical phenomenon? Is it a phrase that connects us to the more collective experience of pregnancy so we might feel less alone? Or is it a meaningless linguistic rug under which we have been trained to sweep all of our ailments, struggles, frustrations, or symptoms?
In 2020, Jenni Gritters wrote a piece for the New York Times about the many ways in which birthing people's brains undergo significant physiological changes during pregnancy and the postpartum period. In an analysis of current neuroscientific research, Gritters found that "a woman's brain, it seems, may change more quickly and more drastically during pregnancy and the postpartum period than at any other point in her life — including puberty." Researchers determined that, specifically, the gray matter in the brain shrinks during pregnancy, and for roughly two years postpartum.
What does that mean exactly? "Gray matter is where most of our neuronal cell bodies are, so that's where muscle control is, sensory perception, emotions, speech, decision making," explains Somi Javaid, M.D., an ob-gyn, and CEO of HerMD. But a lot is happening in other parts of the brain as well and instead of thinking of this gray matter "volume decrease" as a deficit, Dr. Javaid said it's "actually creating a more efficient postpartum brain. So preparing for an increased amount of emotional and facial recognition and helping patients adapt to having a newborn, and being more in tune with a baby's needs . . . [these brain changes] actually makes us more intuitive, and capable to bond and care for the newborn."
Lucy Hutner, MD, a New York City-based reproductive psychiatrist and co-founder of Phoebe, a digital platform for pregnancy and the postpartum experience, echoes Dr. Javaid by pointing out that the area of the brain responsible for social intelligence, empathy, and awareness of dangerous threats, becomes very "specialized and highly efficient" during pregnancy and the postpartum experience. Which makes sense! After all, if we weren't super attuned to creating a safe environment for our baby to enter when pregnant (nesting), or hyper-focused on what our newborns' various cries indicated, basic survival rates would be in jeopardy.
Dr. Hutner thinks the current research (some of which has been conducted as recently as 2020), is important and exciting, but expressed frustration that these "really basic findings" weren't discovered "in, like 1983." When she first expressed interest in the maternal mental health field, she was told she "couldn't concentrate in this area because the field didn't exist." And after talking to several experts in maternal health, I agree with Dr. Hutner that this is both "shocking slash not shocking." Historically, the mental health field has been dominated by men whose primary fields of interest have been . . . men. Despite the fact that people with uteruses are responsible for creating new generations of humans, our bodies, which seem almost objectively capable of magic, have not been deemed worthy of serious scientific inquiry until very recently.
I asked Dr. Hutner her thoughts about the whole "shrinking gray matter" phenomenon, and she thinks the word "shrink" is somewhat misleading. She said that the brain is a "learning organ," meaning it is always adapting and changing based on experience. While hormonal changes (like rises in estrogen and progesterone) can be attributed to some of these brain changes during pregnancy, some of them are also attributed to "experience-dependent plasticity." Plasticity simply refers to periods when the brain is highly adaptive, such as in early childhood and puberty.
Several people came forward to share their stories of "pregnancy brain" with me when I tweeted about writing this piece, and their experiences vary. Widely. Taylor, a government attorney in California is currently pregnant and said, "Oh my god my brain doesn't work at all. I'm a really fast talker and now I'll trail off in the middle of sentences. I'm judged on quality and quantity standards at work and my quality has never been so bad — I'm not not trying, I'm missing absolutely easy dumb things because I just don't see them." She's unclear if her "extreme fog" is solely related to her pregnancy or if it's because she "decided to have kids 16 months apart."
Crysta, a freelance writer from Tulsa, was hospitalized after experiencing suicidal thoughts during pregnancy — an extreme example of pregnancy-related mental health changes, and certainly not the same thing as a mild case of brain fog characterized by most understandings of "pregnancy brain." "I definitely did not feel as though I had everything explained to me or that I had the proper tools. My provider's response was that it was all just pregnancy symptoms, and once I had the baby, it would go away. She prescribed antidepressants but did not increase the frequency of my visits or suggest I speak with [a mental health provider]." Crysta says her doctor weaned her off the antidepressants a month before the baby was born, and asked one (!) follow-up question about her mental health at her six-week postpartum appointment. When her daughter was nine months old, Crysta underwent doula training "in order to learn to help other women navigate . . . whatever that was." Kate, a writer based on the East Coast, also experienced a lack of respect for her mental health during pregnancy. "When I told my doctor I felt depressed he said hormonal swings are a normal part of pregnancy and to try eating more fruits and veggies."
Wendy, an investor in Taichung, Taiwan, is currently pregnant with twins and on bed rest. She tweeted that she's "lost all ability to concentrate, to the point that following a new show on Netflix feels like a lot of work." But Emily, a writer and professor in New Jersey, felt "clear as an effing bell" during her most recent pregnancy. She wrote 60,000 words of her forthcoming book, Loving Sylvia Plath. "I read a ton. I taught online. We had a pandemic pod school for eight kids at our house from Sep – Nov. I published three essays in the last three weeks of my pregnancy. I felt like Superwoman."
Perhaps the huge variety in peoples' mental health experiences during pregnancy is one reason we shouldn't focus too heavily on the "shrinking gray matter" findings alone. After all, given our culture's knee-jerk misogynistic tendencies, it's not difficult to imagine such findings being weaponized against birthing people. I think we can all envision Mr. Bad Boss chuckling villainously about not giving the important cases to pregnant Debbie because her "shrunken gray matter" will render her unable to handle the workload. Dr. Hutner thinks viewing current cognitive research in a vacuum is unhelpful. "[Birthing people] have massive sleep deprivation, they're multitasking all over the place . . . they are taxed beyond recognition." She said that yes, these "subtle structural changes" in the brain are interesting, but "we're stressing these new mothers beyond any reasonable capacity, and they need more sleep. They need more support, they need more leave, they need paid family leave. These are the things that are going to really help them feel like they're at their best, and help them be the good employees that people want them to be."
Bethany L. Johnson and Dr. Margaret M. Quinlan, faculty members in the Department of Communications at the University of North Carolina, co-wrote You're Doing it Wrong: Mothering, Media, and Medical Expertise. I interviewed them both for this piece, and Johnson cited the Victorian doctor, Silas Weir Mitchell, as an example of why historical and cultural context matters when it comes to maternal health. Mitchell made the infamous claim that "women's brains are only big enough for love," which was taught as an obstetric fact in medical schools for decades.
Johnson and Dr. Quinlan also argued that second-wave feminism allowed for women to pursue careers, but there was no large-scale consideration of how they would do so while also still being expected to maintain households and undergo the huge changes that attend pregnancy and childbirth. "So do we have 'mom brain,'" Johnson wondered, "Or do we have that [cognitive] shrinkage and redistribution as a result of generations of just having to take on the additional responsibilities?" Both Johnson and Quinlan want more questions to be asked in the context of maternal cognitive research. What happens to the brains of people whose babies die immediately after childbirth? What happens to the brains of people who adopt children? Or the brains of trans parents and nonbinary parents? Given what we know about how systemic racism impacts Black people's mental and physical health, what about the brains of Black birthing people?
There's also the matter of language. For all of human history, [men] have come up with obfuscating, sexist, and sometimes downright fanciful language to describe pregnancy and childbirth. Confinement. Twilight Sleep. Quickening. Spontaneous Miscarriage. Inhospitable Womb. Baby Blues. Dr. Quinlan pointed out that "no one ever uses the term 'pregnancy brain' or 'mom brain' as a compliment . . . it's nothing to be proud of." And in response to my question about why pregnant peoples' so-called gray matter "shrinkage" wasn't simply called an "adaptation," (which is what it is! And a very cool adaptation at that!) Johnson said, "What's the danger for a capitalist patriarchy if you acknowledge that you have these beings in your society that can adapt? It might mean that systems, workplaces, and people have to also learn to adapt. And people don't want to do that." Adaptation can be viewed as a benefit, a strength, a superpower. Shrinkage? Not so much.
Four months ago, Peanut, a social network that "connects women through all stages of womanhood," came up with the Renaming Revolution Glossary to combat the harm historically caused by words used to describe pregnancy and childbirth. The Glossary argues against, for example, labeling someone "infertile," and instead offers "reproductive struggles" as an infinitely more humane and precise linguistic alternative. I emailed Michelle Kennedy, founder and CEO of Peanut, to ask her about the power of reclaiming language. She had the idea for the Glossary after watching a "gut-wrenching video in which a Peanut user recounted her experience with a doctor who used the term 'geriatric' to describe her medical standing." Kennedy expressed disdain for the term "pregnancy brain," questioning why we "can't just give exhaustion its real name?" She went on to write, "These words hold power and can have a huge impact on mental health . . . Terms like 'mommy brain', 'geriatric pregnancy,' or 'spontaneous abortion' lead to feelings of shame during a time when mothers should feel supported. By shifting the way we discuss women and their experiences, our hope is that women will feel empowered to have more candid, honest conversations with their doctors, families, and peers in order to get the support they need."
Instead of bemoaning or fighting "pregnancy brain," let's first recognize the truth, that if we're forgetful, struggling with word recall, or feel like our heads are stuffed with cotton, it's because our brains are adapting to huge changes, both physiological and circumstantial. We need to resist the impulse to oversimplify the experiences of pregnancy and childbirth, as experiences that can be neatly contained by any one study or any one finding, but as monumental, life-altering events that should be celebrated and supported. And when we learn something new about maternal health, let's also remember how utterly little we still know/have historically cared to know, and that decontextualized research will be meaningless for the lives of birthing people unless it's considered alongside cultural and structural realities.
Amber, a writer in Washington D.C., told me she didn't write for three years after her child was born, and says it had nothing to do with "pregnancy brain" or "mommy brain." "You happen to be pretty distracted by the absolutely huge set of health things that are happening to your body at the same time you are preparing to make a home for an entirely new human being! Yeah, your priorities do tend to shift!" Maybe instead of referring to "pregnancy brain" or "mommy brain," Amber suggests, we could call it what it really is, which is "my life is completely different now."
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