Stressed as a mother

or, an interview with Dr. Molly Dickens from the Maternal Stress Project

As you may be aware, the United States Surgeon General recently issued an advisory on parental mental health and well-being. In case you haven’t heard, the report highlights the significant stressors that modern parents face—which impact both their mental health and children's development—and offers potential interventions. Given that parental stress (and, for most readers of this newsletter, maternal stress in particular) is top of mind, I wanted to dive deep into this topic.

I am excited to share my interview with Molly Dickens, PhD, a stress physiologist and women’s health advocate. Molly’s ongoing work focuses on the intersection of stress, women’s health, and the structures, systems, and cultural narratives that fail to support women and working parents. Molly currently holds a position as a visiting researcher at the University of California at Davis, serves as a research advisor to Poppy Seed Health, and founded a new initiative, the Maternal Stress Project, to explore and map the stressors related to modern American motherhood.

In American society, we throw around the word "stressed" so often that it's almost lost its meaning. Can you start off by telling us what you mean when you talk about stress? And tell us why it's important to discuss stress in the context of motherhood.

You’re right—it’s become one of those words that means everything and nothing at the same time. As a trained stress physiologist, I think of stress at the most basic level: the things that are external to us that we internalize as a potential threat to ourselves, to our offspring, and to our loved ones.

When we have a stress response, we experience both physical reactions (e.g., fight-or-flight response, increases in cortisol levels) and behavioral reactions (e.g. increased vigilance). These reactions historically helped us survive in the wild, but now as modern humans we're still internalizing “challenges” that are not actually a threat to our survival. And so we are physically and behaviorally responding in ways that are not always helpful—especially since prolonged stress responses can have negative health impacts.

I focus on motherhood because it’s both personally important to me and because, I do think it is important to discuss stress in the context of motherhood, Mothers are just swimming in stressors and so many of those stressors directly reflect the societal and systemic failures to support this stage of life. In this context, I think there are real opportunities to reduce the stress load of motherhood—we just have to see all the potential stressors and work towards eliminating them and/or reducing their impact.

With The Maternal Stress Project, you're looking to map what you call the "web of stressors" in mothers' lives. Can you highlight some key stressors that might be less obvious?

For this project I have started creating a holistic stress map that identifies stressors and their interconnections along the  parenting journey. 

I think the one stressor that I'm wrestling the most with right now is mental load. In many ways, it feels invisible and yet so connected to all the other stressors in the web. I also sense that women and mothers are starting to recognize the burden of it, and we’re starting to talk about it more. I don't think that partners know much about it, especially for those of us in different sex couples. Mental load is also key because it could be  such an easy target for solutions – if you can see our mental labor, then we can start to shift it.

The research also shows that mental load, in general, is gendered. For example, on the stressor map, it connects with the stressor of social narrative and societal expectations for mothers; it plays into an  internalized sense of guilt and shame. While dads are typically rewarded for every little thing that is done, moms are judged. When dad puts shoes on his kid and they go to the park, he’s an amazing dad! Even if that kid is in flip flops and it's 20 degrees and snowing, yay dad!! If you’re a mom and your kid is out in the snow in flip flops? You’re a failure. So we, as mothers, internalize that mental load related to something as seemingly simple as “shoes + park” differently. 

You wrote a post that really resonated with me about how child care is both a stressor and a solution. I particularly appreciated your nuanced discussion about how child care stress falls disproportionately on mothers (as opposed to fathers). Can you tell us more about your thoughts on this?

On average, mothers pick up more of the child care duty at home as compared to dads, regardless of who spends more hours doing paid work. So we have to start there.   

As a solution: Access to stable, affordable, accessible childcare essentially relieves the pressure on all these other stressors in our lives as mothers, especially as working mothers—it affects  workplace dynamics, financial stability, isolation and loneliness, sleep! So there’s no doubt that it’s an essential part of decreasing stress for mothers.

As a stressor: For the vast majority of families, managing the day-to-day childcare logistics falls disproportionately to the mother There's been some research showing that childcare precarity [having insecure and unreliable childcare arrangements while parents are working or in school] has a long tail effect on women's health, and especially their mental health—in fact, this study showed deleterious health impacts for up to six years! One evidence-based way to buffer this is having emergency backup care. And that observation alone says a lot. 

As you know, the Surgeon General just issued a report on the impact of parental stress on mental health. What do you hope this report will do for parents?

From a policy perspective I think the report was huge validation for the visibility of parenting stress as a health issue. And so I hope the report really elevates conversations around the big solutions – paid leave, affordable childcare, the child tax credit – and allow those policy conversations to include a  health application, in addition to the standard economic or gender equity arguments. 

From a workplace perspective, I hope that this report opens the door for real employer-based solutions, because, employers want their employees to be healthy.

From your perspective, where does the report fall short?

There was literally nothing in there about the disproportionate burden of this stress on moms. And that’s disappointing. It did a good job highlighting the additional stress load on different communities, for example, parents experiencing poverty, unstable housing, or food insecurity. They did discuss the impact on single parents, which is absolutely vital. But it stopped short of bringing in  the disproportionate load that is directly related to gender. Honestly, all I wanted was a mention of “... especially for mothers” in certain sections. 

This was so frustrating because it misses part of the solution. You can't talk about redistributing the mental load, for example, if you're not acknowledging that moms shoulder a disproportionate amount of stress compared to dads (again, especially when they are in different sex couples). 

Let's talk about solutions. I'd love to hear your thoughts on both micro and macro-level interventions to reduce parental stress (because we both know that while a massage is lovely, it ain't cutting it!)

I think of solutions in concentric circles. You have the individual at the center—and though there are a lot of good stress management techniques that exist on the individual-level, I think we over-rely on them when we talk about solutions. As you said, a massage is not going to cut it!

In the next circle out, there are partner-based solutions – for example, redistribution of the mental load. Outside of that you have friends and family, and beyond that is the larger community and workplace – solutions here revolve around shifting the narrative, shifting how we interact with each other, and shifting how we show up for each other in our communities and at work. The Surgeon General’s advisory also had some good ideas for community, especially as it relates to loneliness. 

And then, of course, we have the outer circle, the larger policy level, which, when done well, can positively impact the largest range of individuals —things like access to affordable (or free!) childcare, paid leave, and an expanded social safety net.

Lighting Round

We've talked a lot about stress. Tell me about a recent parenting moment that brought you joy... I really love that you asked this question, because I think joy is such an important stress buffer, and we don't talk about the joy of parenting enough. I don't have a specific example off the top of my head, but I feel like I just laugh differently with my kids. What’s more joyful than laughter?

When I think back on when the Covid lockdown started, it was such a stressful time. My kids were four and six, which was really hard, but at the same time, they were really funny ages. And so yes, the days were hard, but I laughed every day. We had a dance party every day. Something funny happened every day. We had stress but we also had so much joy. 

The most unexpected skill you've picked up as a working mom... Efficiency, absolutely efficiency. When I returned to work after having my second, I was working at a start up and we were included in this tech incubator with other companies. During that time, we had work out of this one physical location and they didn't have a pumping room so I had to say “that means that I can only be here in between pumps – three hours max”.

And in those three hours, I was heads down working – “Do not talk to me. Do not distract me. I will not be eating, I will not be leaving. I will not be doing any of this stuff that I could do in another location. I will be here busting my ass to get as much work done as possible in these three hours”. And I swear I did more in those three hours, than these 20-something goofballs I was surrounded by, did all day.

Best book you've read lately... I wish I had more time to read for fun. I did finish All Fours, which I feel like everyone is reading right now. Also, I have a fifth grader who doesn’t love reading, so we have decided to read books simultaneously. It allows me to almost “race” her along the way and be like, “oh my gosh, you will not guess what just happened! You have to catch up to me”, It keeps her going. So, we're reading the Percy Jackson series, which is super fun.

Favorite piece of advice for working mothers... Be kind to yourself. Working motherhood is a shit show and we're swimming in a sea of stressors. But you're awesome and you're doing it, so be kind to yourself. 

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