Awake at 3 a.m.

Yoga Therapy for Anxiety and Depression in

Pregnancy and Early Motherhood

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 Parallax Press
P.O. Box 7355
Berkeley, California 94707
www.parallax.org

Parallax Press is the publishing division of Plum

Village Community of Engaged Buddhism, Inc.

Copyright © 2018 by Suzannah Neufeld

All rights reserved

Medical Disclaimer: The information in this book is not intended or implied to be a

substitute for professional medical advice, diagnosis or treatment.
All content, including text, graphics, images, and information contained in this book is for
general information purposes only.

Cover and text design by Debbie Berne

Cover illustration © Alexandra Bowman
Interior illustrations © Sara Christian
Author photo © Emily Gutman

Ebook ISBN 9781941529935

Library of Congress Cataloging-in-Publication Data is available upon request.

v5.3.1
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To my husband, David, for being my 3 a.m. partner
Contents

Cover
Title Page
Copyright
Dedication

Introduction

part one
the foundations
Difficult Experiences in Pregnancy and New Motherhood
Yoga Therapy: A Compassionate Mind-Body Response

part two
the practices
Section One
Make a Plan for Practice and for Support

Where do I begin?
You don’t need a reason and it’s not your fault
No, you won’t “just be fine”
I’m not good at meditation
All you have to do is breathe
Affirmations are annoying
I never feel good anymore
I don’t have time for yoga!
 I’m having trouble bonding with my baby
Constant change is hard
I need help

Section Two
Welcome and Move with Your Thoughts and Feelings

I just want to feel better

Sadness
Anxiety, fear, and panic
I can’t stop worrying!
Preoccupations
What if I can’t stand this physical discomfort?
Rage
Sometimes I wonder if this was all a mistake
I should be grateful
Uncertainty
The darkest thoughts of depression
My baby won’t stop crying
My baby has been up for hours and I can’t sit down
Grief

Section Three
Cultivate Self-Compassion and Let Go of Comparisons

This is hard
How will I get through the rest of the day?
Compare and despair
Automatic negative thoughts
I’m not a good mom
I can’t take any more advice!
The all-natural mandate
 Body image blues
I need to make sure my baby is happy and healthy
What do they think of me?
I should…

Section Four
Develop Responsiveness and Flexibility

But I don’t have any time to take care of myself!

Why didn’t anyone tell me?
My body hurts
I’m hunched over all day
I’m so tired
I can’t relax
No rest for the weary
A moment alone
Food struggles
Breastfeeding
Exercise
I can’t handle this
Trauma
When maternal instincts don’t kick in

Conclusion
Notes
Acknowledgments
Introduction Awake at 3 a.m.

My images of myself in pregnancy and motherhood mostly take

place in the light of the moon. I’m awake at 3 a.m., throwing up. I’m
awake feeling the baby kick. I’m awake anxiously researching facts
about baby health. I’m feeding my baby. I’m waking up to feed the
baby again.
Night was always the hardest for me. In the day, with the sun
shining, my demons vanished, love for my baby blossomed, work was
meaningful, seeing friends brightened my mood. In the night, the
unbearable sense that no one was coming to save me was
overwhelming. I would think, All I want to do is sleep. I am so
desperate for sleep. I have never been this tired before. I can’t do
this. I want to be here for my baby. Why am I not a good enough
mother to just do this?
Becoming a parent is a blessing. Pregnancy is a miracle. My
children are my favorite humans, teachers, and beloveds, and, in
retrospect, they make those early nights of suffering infinitely
worthwhile. I mean it with my whole heart (and only the slightest bit
of irony) when I tell my daughters, “I love you to the moon and
back.”
But this is also true: being pregnant and having a baby are hard.
Really hard. Even for the happiest mom on earth, it’s certainly one of
the greatest physical and endurance challenges that most of us have
ever faced. It’s a marathon of constant change and new, profound
responsibility that you can’t delegate elsewhere (though my greatest
pregnant fantasy was making my husband carry the baby in his belly
for me, even for just one trip around the grocery store). You are on
the clock twenty-four hours a day. Add to that modern pressures to
do it “perfectly”—wearing your baby all day, making your own baby
food, taking adorable monthly photos and posting them online, and,
of course, “bouncing back” to your pre-pregnancy body in just a few
months.
For most moms, this combination of change in hormones and
identity and the relentlessness of the physical demands of mothering
bring difficult emotions and thoughts to the forefront. Sadness, rage,
guilt, and anxiety may come to visit. You face the unknown, filling
every day with fantasies and hopes—and worries, fears, and perhaps
even terrors. For some moms, these feelings stay mild or
manageable. Other moms, though, experience more intense
emotional challenges, and develop depression or anxiety disorders.
Perinatal mood and anxiety disorders (PMADs) are the number
one1 “complication” of birth, affecting up to one in five new mothers.
They can be serious, debilitating, and life-threatening. They affect
not just moms who suffer, but also whole families that care about
and rely on those moms. More than twice as many moms suffer from
PMADs than gestational diabetes2. Yet while every mom is tested for
diabetes, and robust support and treatment options exist for
diabetes, moms who suffer emotionally are rarely acknowledged.
Instead of receiving help, they are handed platitudes like “sleep when
the baby sleeps,” “let go of stress because it’s bad for the baby,” “just
enjoy every minute because it goes by so fast,” or “this too shall
pass.” This can be a lonely and confusing place to be—suffering
profound fear, overwhelm, or sadness at a time when your friends
and family expect you to be happy, radiant, and beatifically calm.
If this is you, you’ve picked up the right book. Above all, this book
is meant to hold with compassion the challenge and exhaustion of
this messy and transformative period in life. My intention is to help
you make space for the darkness that can be so painful or scary to
acknowledge.
These dark feelings can pose real, tangible difficulties for you and
your family, so you likely picked up this book offering yoga therapy
because you are looking for a solution. Many books or articles on
yoga for moms have words like calm or bliss in the title and feature
smiling, glowing, slim pregnant women on the cover. Yoga and
mindfulness (and pregnancy in general!) in America are usually
marketed as a path to fix all our woes, to make us happy, healthy,
beautiful, loved, eternally youthful, sexy, peaceful, more productive,
fully present. These promises sell well, because they prey on our
attachments and reinforce our insecurities—again and again. But
yoga doesn’t actually work that way.
Yoga does offer effective coping skills for depression and anxiety,
and this book will share these abundantly. Yoga doesn’t, however,
make us eternally calm or peaceful. It doesn’t make us good mothers
or turn our children into magical unicorns devoid of suffering. We
are still exhausted. We still need sleep, food, care from our
community or from professionals. Yoga doesn’t fix us, but that’s okay
—even better than okay—because we’re not broken. Yoga connects us
to our whole self: mind, body, and heart. It connects us to our
humanity and to our transcendent spaciousness. And when we hold
our arms open to our full selves, welcoming even our darkness, we
also welcome our light. We see the bigger picture of ourselves,
remembering there is so much more to us than our struggles.
Yoga, like our newborn babies, wakes us up.

MY STORY

When I found out I was pregnant, I was so happy. I had normal fears
about the possibility of miscarriage and about how my life was about
to change, as well as some realistic knowledge that having
experienced depression earlier in my life put me at risk for
postpartum depression, but in general, my mood was optimistic and
grateful. I felt like something magical was happening to me, and I
almost thought I could see the “pregnancy glow” shimmering on my
skin.
Everything changed a week later, when I started throwing up. For
me, the term “morning sickness” felt like a cruel tease. I was not just
nauseated in the morning. I was nauseated all day and all night. This
was unrelenting, soul-crushing, tide-pulling-you-into-the-depths-of-
the-ocean nausea. When I did throw up, I’d feel a few moments of
relief, try to stand up, and then slowly feel the room start to spin—
and it would start all over again. I would fall asleep in the bathroom,
leaning on the toilet. It was hard to walk, move, breathe, smile. My
regular yoga practice was out of the question.
After a few weeks of this, I began to feel helpless. In a total
turnaround from the delight I had experienced just weeks before, I
noticed that I had thoughts that my baby was like an alien parasite
taking over my body and destroying me. When those thoughts would
subside, and my love for my baby would come back, new thoughts
would arise in which I would fear that something bad was going to
happen to her because I was so sick.
In my desperate attempt to understand why this was happening to
me, I would vacillate between fear, guilt, and rage. I blamed myself. I
blamed my husband. I blamed my doctor. I blamed everyone I’d ever
met. I felt angry that “no one told me that it could be like this.” Other
times, all this analysis fell away, and I fell into feral, desperate
attacks of panic, and all I could think was, I cannot take this
anymore—I need to fix it NOW.
I also felt deeply alone. I would listen to moms I knew say, “I know
how that feels. I felt so sick when I was pregnant. Have you tried
ginger? Totally worked for me.” Yes—I had tried ginger! Here are all
the other things I tried: acupuncture, vitamins, mint, sea bands,
crackers, almonds, protein, grapes, apple cider vinegar, and any
other suggestions friends, family, a random woman at a drug store,
or Dr. Google had given me.
I went to a hypnotist who specialized in pregnancy. She told me
that “morning sickness” is always a sign of feeling ambivalent about
becoming a mother, and I could spend a few hundred bucks having
her make me custom guided meditations to reduce my ambivalence
and, thus, my nausea. At the time, I felt so ashamed and horrified by
the thought that I might be ambivalent about becoming a mother.
(Looking back, I wish I had said that any pregnant woman who
denies feeling ambivalent is lying. You should feel ambivalent about
becoming a mother—just like you would about any huge life change!)
 I finally learned that I had a condition called hyperemesis
gravidarum—extreme nausea and vomiting in pregnancy. This
diagnosis led my doctor to prescribe a medication that I first took
reluctantly and then gratefully. The medication mostly prevented me
from getting sick, but there was still a baseline of nausea that made it
impossible to enjoy life, plus occasional vomiting sprees that were
hard to stop.
A vivid memory: At about ten weeks pregnant, once I’d been on
the nausea medication for a few weeks, I was feeling okay for a few
hours. I suggested to my husband that we take a slow walk to see
some friends. We walked a few blocks and had a nice conversation.
The sun was shining, and I felt the first crack of a smile on my face
that I’d been able to muster in weeks. The smile felt foreign and
distorted on my face, but real nonetheless. I felt enough hope to say
out loud, “I think I may actually be starting to feel better. Maybe the
worst of this is over.” Five minutes later, I was throwing up in the
street. A drunk guy walked out of a nearby bar, looked over, and said
sympathetically, “Hey, sister, we’ve all been there.”
In the taxi ride on the way home, I began to sob. I felt frustrated,
hopeless, desperate, and scared. I just didn’t know if I could make it
through the rest of my pregnancy. Back at home in bed, I noticed my
mind start to wish for death. I was terrified of these intrusive
thoughts. What kind of a pregnant woman thinks about wanting to
die? What kind of a mother will I be? Why am I not more grateful?
Will I ever recover from this? What will become of my baby and my
marriage?
Because I am a therapist, I realized quickly what was happening to
me: I was experiencing acute prenatal depression and anxiety. I
reached out for help from my husband, my friends, and my own
therapist (yes, therapists go to therapy!). I began to draw on the tools
I had used to cope in other dark times in my life to help me find my
ground again.
At fifteen weeks pregnant, I talked myself into attending my first
prenatal yoga class. Yoga was already a big part of my life—I had
studied yoga for more than ten years and taught for six. The practice
of yoga had guided me through difficult times before, and it seemed
like the most familiar path for me to turn to for support. I just could
not for the life of me imagine how I would bend myself into any
physical postures without either throwing up or collapsing in fatigue.
I arrived at the studio and checked in with the teacher, Jane
Austin, who had taught the basics of teaching pregnant students in
my first yoga teacher training. “Hi,” I said. “I’m not sure if you
remember me—I was once in teacher training with you.” And then I
started to cry. I told her about how I hadn’t been able to move much
in the past three months and how awful I felt. I shared that being
present in my body used to be a source of strength and calm, but
lately it had just felt like misery and fear. I said I’d been curled up in
a ball so much that I barely knew how to stand up straight again.
Plus, my back had started to hurt, and I had a (literal) pain in my
butt that might be sciatica.
Jane welcomed me with open arms and great compassion. She
empathized with how awful I felt and didn’t try to talk me out of my
misery. She didn’t promise it would get better. “I know!” she said,
“It’s so hard! It can feel impossible to move when you feel so awful.”
She told me that I wasn’t alone, and that it was totally okay for me to
show up at class curled up in a ball. She began to teach me, right
there in the hallway, that yoga is a practice that can welcome us no
matter what—that it can hold us when we feel physically sick,
emotionally overloaded, and spiritually bereft.
Jane told me that it would be fine if I spent the entire class sitting
or in a resting pose. She said I could try to do the poses and the
movements and simply stop if it didn’t feel right. She said listening to
myself and taking care of myself was the most important part. She
suggested that I start by just focusing on my breath and soaking in
the experience of being in the room with other women going through
some of the same things I was experiencing.
Then she taught me a breathing practice, sitali pranayama, which
I could do if I felt nauseated. Sitali involves rolling your tongue up
like a burrito. You inhale the air through the little circle you make
with your tongue, and then close your mouth and breathe out
through the nose. The air felt cold on my tongue as I breathed in, like
ice cream on a hot day—sweet, delicious, and satisfying. I think it
was the first moment of pure joy I had experienced since I’d gotten
pregnant.
I went into the class, did a few downward dogs, cried a little, sat
down for all the standing poses, and sitali’d till I could sitali no more.
I practiced holding myself in my most tender, messy state. I began,
slowly, to find my strength and resilience and to forge my new
relationship with my daughter inside of me and my new identity as a
mother.
Yoga wasn’t and isn’t a panacea. I don’t remember the rest of that
class, and I continued to feel awful for many weeks after that. Yoga
didn’t fix my nausea. It didn’t even really help at all. But I felt
compelled to go back, again and again, to be in that room, greeting
and holding myself compassionately through all the discomforts,
fears, and constant changes that pregnancy brought—mothering
myself as practice for mothering my children. I began, also, to
practice again at home. I changed my idea of what it meant to “do
yoga.” Previously, yoga for me had mostly involved doing vigorous
movements and poses for exercise. Meditation, which I realized I had
subconsciously relegated in my mind as “the boring part of yoga,”
now became its most essential element for me.
It’s funny. Before I got pregnant, I assumed that being someone
who does yoga, who eats “good” food and does “good” things, should
exempt me from suffering. As if suffering were doled out according
to merit. I thought pregnancy would make me calm, peaceful, strong,
and wise, constantly connected to the sacred experience of growing a
new soul, fully able to greet pain and change as “sensations” or
primal experiences. I never would have guessed how much
pregnancy would awaken me to the true power of yoga—not to fix,
but to nourish, to hold, to accompany.
In the end, I didn’t practice yoga or meditate because I thought I
should, because I knew it was good for my baby, or even to fix myself
—though the practice did slowly bring me a lot of healing. I practiced
because yoga gave me something better.