What is up with Maternal Separation Anxiety

Maternal separation anxiety (MSA) has not been studied much and is certainly not talked about much, at least not in the terms of its normality and common occurrence. I’ve had a first hand experience of it, but I can also see from talking to my friends and observing Parenting Facebook groups that I am far from alone in this. I feel like there is no general clarity on when MSA is absolutely normal and when it becomes a threat to the mother’s mental health and her child’s well being.

Through my studies of the body and mind, as well as sifting through the available albeit limited research, I have come to a conclusion that seems to be supported by my experiences with my clients and what mothers report on social media support groups. My understanding is that MSA is a protective mechanism, it’s an alarm system that ensures we keep our baby close and therefore safe. There seem to be some links with the hormone oxytocin, which is produced during physical contact with our baby, especially through skin to skin and breastfeeding. The cycle seems to start when baby is born and placed onto the mother’s chest, the contact switches on the hormones and the bonding process begins. The more contact in the first hours, days and months mum and baby have, the more oxytocin floats around the body, the less stressed both are, the smaller is the likelihood of PND and PNA in mum and the more assured and confident mum becomes. The other side of the coin, is the discomfort that mother experiences during separation. The level of discomfort seem to ebb and flow through the first year. The first 3-4 months, a mother may experience mild discomfort when baby is being held by someone else in her presence, which would get worse, the further away she is. This seems to ease slowly, only to pick up again around 6-9 months post partum, possibly because baby becomes mobile and becomes more vulnerable to his environment, so some MSA would have a protective function. This seems to again ease as time goes on. It appears that breastfeeding mothers tend to have this discomfort at the point of separation for the duration of their breastfeeding journey, perhaps due to the hormones at play. I’d say that the feeling of mild to strong discomfort when being separated from your child younger than three years is not only normal, it is a desirable evolutionary aspect of motherhood that has the purpose of keeping baby safe.

Nature is however not the only contributor to MSA and that’s when the sensation can become intense and problematic. When MSA is caused by intrusive thoughts (about something bad happening to the baby), forced separation due to medical interventions (unnecessary and necessary) or pre-existing mental health issues, it can lead to illogical fear, anxiety and even panic attacks, if adequate support is not provided to the mother. MSA is closely linked to PND and PNA and can form part of PP psychotic episodes. It can prevent effective bonding, creating a negative cycle that often needs a professional help in breaking it.

How do you know whether your MSA is just the ‘normal’ one or it is something that you need to speak to a therapist about? I would start asking yourself what is the impact on your life? If you are almost constantly preoccupied with the safety and well being of your child, even when they are sound asleep next to you. If you feel high level of anxiety, get anxiety or panic attacks during separation or even at the thought of it. If you cannot focus on anything until you are back with your baby. These are just few examples, I would recommend speaking to a therapist if the feeling of discomfort or anxiety is so intense that it negatively impacts your life and relationships and/or stops you from allowing your child the independence appropriate for their age i.e. you feel like you are becoming a helicopter parent.

It is absolutely normal to feel MSA to quite a high level in the fist month or so, with gradual easing over time. Usually, the first people to be trusted are the father, the grandparents, godparents, close friends, health professionals or nannies. This depends on the strength of the relationships and the level of trust the mother has in these people. If you find it difficult to let a trusted person (incl the father) to hold your baby while you are present or having a shower next door, it might be a sign of MSA getting out of hand, but not wanting someone to take your one month old out without you is absolutely normal. Your baby is unlikely to be happy to be gone from you for long and that is absolutely normal too and starts easing off around the sixth month. I’ve heard of so many cases of mum being ridiculed for being a helicopter parent for not wanting her three month old to be taken out for a few hours by her in-laws or even over night. Reluctance to do so is not MSA, it is normal. We evolved to keep our babies on our bodies more or less 24/7 for the first six months or so with the baby’s independence growing on their terms over the next three years or so, with other members of community stepping in to help more and more as time goes on and where the baby would be in contact with those members of the community daily, not once a week or even a month. Unless grandma lives with you, she is a stranger to the baby. Unless dad spends a lot of hands on, skin to skin time with baby, he might need to wait few months for the bond to grow. Stressing baby for the sake of the good feeling of an adult seems irresponsible and cruel to me. And it’ll ultimately stress the mother too, combined with likely sleep deprivation, that might just send her over the edge as her hormones will be screaming at her to get her baby back in her arms. The less forced separation occurs in the first months, the more independent and sooner the baby becomes and so does the mum as they grow in confidence in each other.

Forced separation too early can bring on PND and/or PNA and if it happens in the first month, it can severely interfere with bonding between the mother and the child.

In conclusion, some MSA is completely normal and actually beneficial to the safety and relationship of the mother and baby dyad. A lot of this is likely driven by hormones so cannot be just logically explained away. 

You should seek professional help if the emotional discomfort takes on the form of high levels of anxiety, obsessive and intrusive thoughts, anxiety or panic attacks or you notice feelings of withdrawal or depression creeping in.

If you have experienced trauma as a child, lost a loved one or had a miscarriage prior to giving birth, if you have history of depressive or anxiety disorder, if you have gone through IVF, if your birthing experience is traumatic and/or you do not feel safe for whatever reason (homeless, victim of domestic abuse, lack of support, illness, poverty etc), you are at higher risk for pathological MSA and I’d recommend seeking  support as soon as possible (during your pregnancy) to enable a healthy and secure start to your motherhood.

In the UK, the NHS does provide support for MSA, PND and PNA albeit the waiting time can be very long, so if you think you are at risk, inform your midwife at the first appointment, so you can get the help you need in a timely fashion. There are also charities supporting mums that cannot afford private care and find it hard to access help through the NHS. Remember, it is never too late, so even if your little one is not so little anymore, it’s good to get the help you need to make your motherhood journey smoother. You’d be amazed how many areas of your life get better when you heal the wounds of the past.