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Motherhead

Motherhood affects our bodies and brains in profound ways that stay with us for a lifetime. Like the massive neuronal reorganization that occurs when falling in love, in the early stages of pregnancy there are countless changes in the brain. Well, one number did come up in my research: neurons multiply at a rate of 250,000 per minute, as motherhood improves learning and memory. It’s true some women feel themselves getting stupid during pregnancy; “baby brain suck” can sap your concentration and ability to multitask. Simply put, your brain is being reorganized. The increased estrogen levels put neuroplasticity into overdrive in the brain’s memory center, the hippocampus, as new behaviors are prepared for, such as feeding, protecting, and caring for offspring. Our verbal and emotional memories need to be sharp to continue to catalog potentially threatening behaviors in our mates, like abandonment or violence, but spatial learning is particularly affected, as it’s important to recall where food was located when foraging. (Again, this is likely why mothers can locate missing things better than anyone else in the house; it’s left over from our days on the savanna.) Parental-induced neuroplasticity can last for years, possibly providing protection from age-related brain changes including memory deficits seen in dementia.

The hormone responsible for this neuronal reorganization is oxytocin. Monogamy, commitment, and child care are all driven by neuroplastic changes partially facilitated by oxytocin, the hormone that makes us cleave to our partners and devote ourselves to our children. During conception, oxytocin stimulates the uterine activity that helps guide sperm to egg. During childbirth, oxytocin drives uterine contractions to expel the fetus. During nursing, oxytocin helps to bring the milk into the nipple, called the letdown reflex. Oxytocin gets credit for solidifying the mother-infant bond, making us feel warm, fuzzy, and connected. But oxytocin isn’t about bonding indiscriminately. It helps us distinguish who’s in our tribe and who’s not. In some experiments, with extra oxy on board, people are even more harsh against those they feel aren’t in their group. Motherhood brings a whole new set of behaviors from those seen in other life phases. In the research setting, aggression is seen more commonly in female mammals that are lactating and protecting their young. So it may be that part of that mama grizzly protective aggression comes from the “hormone of love.”

The hormone of mother love could also be called the amnesic hormone, because it can erase learned behavior and replace it with new patterns. Sometimes existing attachments are supplanted by new ones. This may be part of the basis for falling in love with your baby at the expense of maintaining your attachment to your mate. Couples who raise children together are bonded as family, but they also face new obstacles.

From conception and pregnancy to birth and nursing and beyond, motherhood is a time of tremendous change. It is a magical experience for many, but it’s also draining, difficult, and demanding. Understanding some of the science behind different phases of life can help you to navigate the roller coaster, and maybe even enjoy the ride a bit more.

The Ticking Clock

Women are creators. We make order out of chaos, whether we’re cooking, folding laundry, or organizing our households. As creators, we make babies, and we produce milk. Not all of us choose to perform all of these tasks, but most of us do. Though we’re starting later (age thirty today, from age twenty-three in the 1950s) and having fewer kids (two instead of three), most of us (around 80 percent) are still opting into the mommy track.

The biological clock is no joke. In my twenties, when I would see the women of the Upper East Side with their strollers and baby joggers, I would practically sneer and say to myself, Not gonna do it (à la George Bush the first). But somewhere around age thirty-one or so, I’d notice a sharp heartache happening in my pelvis when I’d see a baby, and I found myself aching for one of my own. It was as if my body were using chemical warfare to trick me into reproducing. For many of us, this sensation that our ovaries are hijacking our brains is overwhelming. Estrogen and testosterone levels conspire midcycle to make us act like cats in heat, and it becomes harder with every passing month to resist the tug to breed.

In major metropolitan cities, the age for starting a family is higher than elsewhere. I have plenty of patients in their late thirties and even early forties who are still hoping to start a family. Many of us are getting our careers in order before we choose motherhood, something that was nearly always reversed just a few generations ago. The quality of eggs produced by the ovaries drops off substantially when you get to the early forties. Because of waiting longer to get started, many of my patients go from being on oral contraceptives for a dozen years or more to taking fertility drugs to help them get pregnant, barely stopping in between these two poles.

Fertility drugs can be hard on moods. Clomifene, a medicine used to encourage the ovary to pop out a few extra eggs, can trigger massive PMS-type symptoms, as can many other hormones and follicle stimulators being used today to help women conceive. Hot flashes, emotional lability, irritability, and depression are all possible. Rare cases of psychosis or mania have also been reported.

Nesting, the particular cleaning frenzy that occurs during late pregnancy, is a very real phenomenon. What’s less clear is whether there is some biological process that happens even before pregnancy to help us get our house in order. My sister got herself into fantastic shape before she got pregnant. She quit smoking cigarettes (no easy feat), stopped drinking, and lost weight, getting her body primed as a vessel for a fetus. I’ve seen it happen in my patients repeatedly. They want to go off their meds prior to conceiving and they do. Gynecologists will sometimes recommend that their patients stop their SSRIs, as serotonin increases prolactin levels, which can impair fertility. I also recommend that my patients lay off their nightly melatonin tablets, which also increase prolactin and lower follicle-stimulating hormone, both of which interfere with fertility.

The decision to stay on meds or go off everything during pregnancy is difficult and complicated. Psychiatrists know that the high levels of stress and cortisol that accompany extreme anxiety and the poor self-care seen during depression are bad for a developing fetus, but what is less clear is how staying on psychiatric meds affects the baby. The risks are low but present. Depending on in which trimester SSRIs are taken, exposure is associated with preterm labor or miscarriage for the mother and cardiac defects, pulmonary hypertension, seizures, and withdrawal syndromes for the infant. There is some concern about a link between SSRI exposure and autistic spectrum disorders. One study reported that boys with autism were three times more likely to have been exposed to SSRIs in utero, while another said it was twice as likely. But other studies don’t bear this out.

All of my patients would prefer to be medication-free during gestation, but a few have had to stay medicated because their symptoms were completely unmanageable off meds. This is especially true for women with bipolar disorder, where the risk of severe psychiatric symptoms often outweighs the risk to the fetus. For milder depression or anxiety, pregnancy is a great time to substitute other means of treatment, like psychotherapy, acupuncture, transcranial direct-current stimulation, or light therapy.

When faced with an impending pregnancy, not only can my patients successfully taper off their SSRIs or ADHD meds, but they also can revamp their diet, exercise more, and stress less. Instinctively, we do things for our children that we wouldn’t do for ourselves, even before they exist. So, yes, our ovaries do hijack our brains, but in a way that helps us to protect and care for our offspring.

During pregnancy, hormonal levels are actually more static than they’ve ever been in your life. You don’t cycle every month, so there’s no ovulatory horniness or premenstrual bitchiness. For many women, it’s a time of stability and quiescence. I’d been taught that pregnancy was “protective” against psychiatric complaints. Rates of depression are lower during pregnancy than at other times in the reproductive age, though some women may experience an increase in their OCD symptoms. (My assumption is that this is tied into the nesting impulse and its chemistry.) However, in women who are younger, have a history of depression, have fewer social supports, or are ambivalent about their pregnancies, depression may still occur.

Certain symptoms, like fatigue or insomnia, are seen in typical pregnancies, as well as depression, which can make it hard to differentiate between the two. Many women report the worst sleep of their lives occurring during pregnancy. Insomnia comes toward the end of gestation as your mind races, worrying about everything that may go wrong with the delivery and all the years after, your bladder is being squeezed out by your uterus, and you’re trying to roll over in your bed when you’re the size of a manatee. It may be that your brain is trying to prepare you for what comes next. After delivery, life with your baby is punctuated by interrupted sleep, which may last for months or years. My advice to pregnant insomniacs: read a few books on nursing. It’s not completely intuitive, and there are things that can go wrong that are good to learn about ahead of time, not when your boobs are killing you.

Birth and Nursing

The way we give birth now is far removed from nature. It is medicalized, scheduled, and anesthetized, so that we’ve lost touch with the natural rhythm and timing of a normally progressing labor. We’re given oxytocin to bring on an unnaturally acute and painful process that then requires an epidural so we can tolerate it. Or we’re given an epidural that stalls the labor so we’re forced to use Pitocin to accelerate it. Once again, we are out of touch with our own bodies and our intuition of how a completely natural process should unravel, according to earth time, not obstetrician time. A flower’s maximal expression is in the fruiting, and fruit ripens at its own pace. This is why I, as a physician, chose midwives for both of my births. Doctors have a hard time doing nothing. It’s not in our nature.

I know that medical interventions are sometimes necessary and life-saving, and I also know this is a touchy issue for many women. There is a certain pride in how we deliver, and it’s a shame and a disappointment when it doesn’t turn out the way we planned. I delivered both my children naturally, and while it was intensely painful, things progressed quickly, thanks to my nicely wide “birthing hips,” a part of my body I fully appreciated at least two days out of my life. During my short, sharp “natural” labor, I was pretty darn altered between the endorphins, endocannabinoids, and adrenaline. My pupils were dilated, and between contractions I kept remarking to my husband, Jeremy, how high I felt. (Endocannabinoids help to maintain a pregnancy, and they peak during labor induction.) Because there was no anesthesia involved, both my children were born awake, alert, and calm. I remember not quite connecting with the warm, slimy being placed on my chest in that birthing room. For a moment, I was at a loss. What have I done and what do I do now? But I placed her on my breast; she began to suck, and the oxytocin surge helped kick everything into gear. I was a mother all of a sudden, and I was all set.

But for many women, nursing is hard, and sometimes painful until you get it right, but it’s important to remember, when you’re listening to your third lactation consultant or reading your fourth breast-feeding book, that it does have tremendous benefits. Breast milk contains everything that a baby needs and many things that formula doesn’t provide, like enzymes, antibodies, growth hormones, proteins, and bacteria. Because of this passed-down immunity, breast-fed babies have fewer infections. Also, the fatty acids in breast milk boost neural development; breast-fed babies have higher IQs than formula-fed babies. It’s also better for you. Mothers who nurse have lower incidences of breast cancer and ovarian cancer.

They also have lower incidences of stress, due to higher oxytocin levels. But remember that oxytocin can mediate maternal aggression. Never come between a mama bear and her cubs, especially if she’s still nursing. Oxytocin turns down the fear response when it comes to being aggressive, so we’re not afraid to fight.

Breast milk has tryptophan, the building block for serotonin, which stimulates endorphin production in infants. Breast milk contains a collection of endorphins called galattorphins, and both baby and mother have higher endorphin levels just after nursing. Mammalian breast milk also contains cannabinoids, naturally occurring substances similar to cannabis, regardless of whether the nursing mother is or ever was a pothead. Goat milk has the highest levels of cannabinoids, but human breast milk definitely has them, too. Now you know why babies look so happy and sleepy after they nurse. Not only are cannabinoids in maternal milk, but the activation of the cannabinoid receptors is critical in priming the oral muscles necessary for suckling in newborns. When cannabinoid receptor antagonists are given to newborn mice, it completely inhibits suckling and growth in the pups, and they die within days of its administration. Formula-fed babies may get fatter for the same reason pot smokers have smaller waistlines than nonpartakers. Even though stoners might ingest more calories, it does not result in a higher body mass index. Cannabinoids in breast milk likewise help to regulate the baby’s metabolism.

One downside of nursing? Because of our increasingly contaminated environment, our breast milk now has appreciable levels of pollutants like flame retardants and polybrominated diethyl ethers (PBDEs). These can interfere with thyroid function and cause masculinizing features in our girls and feminizing ones in our boys. I still believe that the upsides, particularly the substances found only in breast milk, outweigh this horrific fact. But one more upside: you burn about thirty calories for every ounce of milk you produce. I ate like crazy during those early motherhood years and managed to lose the “baby fat” fairly quickly. I’d be pumping breast milk into a bottle, counting the calories as the ounces accumulated. Ten ounces were as good as a three-mile run!

Bonding

Attachment is crucial for our mates and our children, hence the postcoitus bump in oxytocin as well as those sustained high levels when nursing. The bonding hormone oxytocin is the glue that keeps mother and child together, mother and father together, and even father and baby together. Babies have oxytocin just like moms. Cuddling and nurturing produce elevated levels of oxytocin, calming their stress response. And it turns out that dads have oxy too. During the early phases of parenthood, cohabiting parents share elevated oxytocin levels, which are often interrelated. Although some men may be more likely to cheat when their mates are pregnant or are new mothers, it could be that if you allow your partner more time with his baby, his bond will be stronger not just with his child but with you as well. Vasopressin is the biggest factor in paternal behavior, helping a dad to protect his child and bond with its mother. Men have prolactin as well, which elevates as they hear their baby’s cry, just as a woman’s prolactin levels do.

Like other animals, and especially primates, we thrive on attachment and perish without it. Monkeys reared without physical contact with their mothers become violent and socially impaired as adults, their brain chemicals imbalanced after only a few days of separation from them. In laboratory animals, if a mother doesn’t respond to her pup’s distress call, the pup will die even if it’s fed. The type of attachment we receive early on will affect our emotional functioning thereafter. Maternal care in infancy affects anxiety regulation in the brain of the offspring. Any disruption of attachment in infancy can lead to exaggerated stress reactions down the road in adulthood. Unmet emotional needs will trigger a stress response not just in childhood but potentially throughout adulthood as well. This is important to remember not just in mothering but also in being an attentive wife or partner. Disrupting the attachment bond causes all sorts of heartbreak and behavioral upheaval whenever it happens.

Attunement to our children’s emotional states and needs helps us to fine-tune our relationship with them. When we give our children loving attention, we not only influence their brain circuitry but also affect their future relationships. When we’re distracted, stressed out, or unavailable, our children suffer for it. Down the line, they may choose partners who treat them similarly, reenacting those early separations.

A tuned-in parent can help produce a healthy child. What our kids need most is our genuine presence. For children today, it is confusing and traumatizing to have a parent’s face on a computer or smartphone screen most of the day. We may be physically present, but we are not emotionally available. It’s hard for toddlers to wrap their heads around that paradox, called proximate separation. I’m here, but I’m not really here for you. We need to engage deeply and authentically with our kids, provide an anchoring gaze, mirror their communications, and validate and empathize with their emotions and experiences. This takes attention and focus, which can’t be divided between their faces and our glowing devices.

Postpartum Depression

The biggest disrupter of early infant-mother bonding is severe depression, which may occur after delivery. I have a colleague whose mother committed suicide when he was four months old, convinced he’d be better off without her. It has colored his entire narrative; that attachment disruption was forever wired into his stress response and temperament.

Postpartum is a vulnerable time for women both pharmacologically and psychologically, and it’s common to be down. As many as 50 to 80 percent of women report a milder form of depression, sometimes called the baby blues, which may last a week or two. But roughly 10 to 15 percent have a true postpartum depression, disrupting functioning in a number of areas for at least two weeks: energy, appetite, sleep, and libido. More rare is a syndrome called postpartum psychosis, occurring in one out of a thousand deliveries, often accompanied by dangerous thoughts. I’ve interviewed new mothers in emergency rooms at Mount Sinai and Bellevue with a similar delusion, that their baby was the root of all evil, and if they could smother the baby, they’d save the world. Scary stuff, and those women had to be hospitalized and treated with antidepressants and short-term antipsychotics and were separated from their infants temporarily. This is why I do recommend that a psychiatrist get involved to assess whether you need treatment if your mood is down more days than not after you’ve delivered.

Prolactin, the hormone responsible for milk production, reaches its highest levels when we’re nursing. Good news for a hungry baby. Not always great for the mom. Prolactin can make us sleepy and depressed. Sometimes the postpartum blues are associated with higher prolactin levels. Other times, the culprit is a quick drop-off of estrogen that occurs after delivery. Although there are massive changes in hormones that occur during pregnancy, they tend to occur gradually. Many of these changes quickly return to baseline right after delivery. Because of this, you can go from being blissed out to being an anxious mess in a matter of days. If you think about it, you can see why it would be biologically advantageous to be a bit jumpy and hypervigilant after your baby is born. Nature sets you up to be a hovering mother so you can keep your baby safe and attend to its every need. These hormonal drop-offs can be an uncomfortable and rocky time for many new mothers. Add being sleep-deprived and in constant need of a shower, and it’s understandable why you’d be irritable and weepy.

The peak time for postpartum depression isn’t right after the baby is born, but rather at ten weeks. Depending on when you wean your baby off breast milk, you may end up with a delayed postpartum depression as the oxytocin wanes. Breast-feeding reliably reduces the risk of postpartum depression, but in women who wanted to nurse but couldn’t, the rate of postpartum depression is actually higher. So these women need more emotional support. Also, if your baby is colicky or has prolonged inconsolable crying, your odds for depression increase significantly. A history of a previous depression, or bad PMS, may also increase your risk for postpartum depression. It’s challenging but important to remember good self-care after your baby is born. Sleep when you can, eat as healthfully as possible, and go outside for walks to keep your sanity.

The Terrible Twos, the F#*!ing Fours, and Moody Little Bitches

This isn’t a parenting book, and I’m not mother of the year, so I’ll be brief. Kids’ brains aren’t done cooking yet. The rational frontal lobes don’t fully inhibit the emotional limbic circuits of the brain until the midtwenties. Children, and especially adolescents, typically have poor control over their impulses and their emotional outbursts. They’re not naturally mindful. That’s your job. You need to be their holding environment, containing their emotions. The easiest way to do this is to mirror to them their concerns; don’t minimize them. “You really wish you could have a cookie right now!” works better than “You know you can’t have a cookie until after lunch.” They also want to feel in control, so offer choices that you can live with, like “Do you want your bath before or after story time?” Also, for your teenage daughter, try being a helicopter pad, not a helicopter parent. Be a loving sanctuary where she can pause to catch her breath. She still craves attachment and connection with you, though she’s not always acting that way. And keep track of her cycle. It’ll help you immensely to anticipate and make space for her moody bitchiness.

The mantras for marriage hold for mothering. Same team. Conflict is growth trying to happen. You each have the blueprints for the other’s development. Your children have valuable lessons to offer you as they push your buttons. Our demons surface when we’re reminded of their existence, and we lash out. That moody little bitch is your yoga, a trigger for self-reflection, not a reason for you to go on psych meds. First of all, Do Not Take the Bait. She knows how to get your goat, and you need to consciously decide not to engage. Ignored behavior will extinguish itself more rapidly than behavior that is met with a big response, even if it’s negative. Just stay connected to her as best as you can while maintaining your integrity. Mothering is as much about raising yourself to be an authentic, empathic woman as it is about raising your daughter to become herself.

It Does Take a Village

Since the 1970s, when I was growing up, the prevalence of nuclear families has slipped from 45 percent down to 23 percent. The rate of babies born out of wedlock has risen four-fold. Another new feature: unmarried couples living together and raising a child fathered by another man. This number has jumped 170 percent in the past twenty years or so.

My private practice is full of women in their late thirties or forties who really want a baby. They’re desperate to find the right man for the job, aware that time is running out. I’ve gotten in the habit of exploring with these women just what it would take to go ahead and have that baby, man be damned. There are plenty of ways to get sperm, whether purchased or gifted, and there’s no guarantee that the baby daddy is going to stick around or provide everything you and the kids need anyway. If you want a baby, I say gather your sisters, mothers, girlfriends, and mentors and make yourself a village. There are plenty of cultures that do it this way, and examples abound in nature, particularly among primates, that show it can be done just fine if sisters are doing it for themselves.

Three-quarters of women today are working mothers, a number that’s quadrupled since the 1950s, and even though 40 percent of us are the primary breadwinners, the bulk of the child-rearing responsibilities still falls to us. And unlike long ago, when we had plenty of help nearby in the form of extended family and clan members, now we’re going it mostly alone. We are overwhelmed by the responsibilities and the tedium that alternates with the power struggles when it comes to raising kids.

Children used to spend more time around different nurturing adults, and multigenerational homes and gatherings were the norm. Now kids are warehoused with other kids, whether in day care, school, or summer camp. They learn from their peers instead of their elders, and they are starved of the intimacy and attachment they require. Peer orientation puts them at risk for drugs and promiscuity, so my advice is to attend to your kids’ attachment needs if you don’t want them to fill those holes on the Internet or elsewhere.

Our ancestors were “cooperative breeders.” We evolved in groups where all the resources and responsibilities were shared, including food, sex, and child care. In tribal societies, everyone chips in to raise the children. In some aboriginal groups, there is partible paternity, meaning the men aren’t entirely sure which children are theirs. This not only reduces conflict in the tribe, as men are bound by the shared paternity with other men, but also benefits the children, who receive special interest from multiple male members. There are several nursing mothers, infants are shared, and each man works hard for all the members of the village. Parental exhaustion is “inappropriate for our species” and is likely a relatively new phenomenon because we’re doing it alone.

We are all exhausted. Our fatigue is a huge issue, and it affects our ability to be there for our kids, our spouses, and ourselves. Unfortunately, when the baby comes, all of our energy seems devoted to child care. But if we don’t devote time to self-care, we’re going to feel even worse than we already do from sleep deprivation. And there’s one more thing you need to fit into your schedule:

Sex During Motherhood—Having Little Kids Means Having Even Littler Interest in Sex

My life is very full, my to-do list long. Buy milk, make sure Joe’s homework is done, shop with Molly for her semiformal dress, and then one last expenditure of energy when I plop into the marital bed. Some nights, it feels like just another chore to be checked off my list. (I’m thinking of those pads of lined paper that say “Another Dumb Thing I Gotta Do . . .”) I don’t know about you, but by the time I get done in my office, having spent the day gratifying my patients, and come home to the kids, who need my loving attention, a dishwasher that needs emptying, and laundry that needs folding, there are other things that come to mind once I finally lie down. In a survey of married women, 63 percent said they’d rather watch a movie, read, or sleep than have sex with their husbands.

When my kids were younger, they were all over me—on my lap, playing with my hair, nursing. It was very hard for me to switch gears and interpret touch in a different way just because it was coming from someone I married. I remember wondering, What happened to the horny girl I was in high school when I wasn’t supposed to be having sex? Is it Mother Nature’s cruel little hoax that when I can finally appreciate and celebrate the intimacy of my relationship, I have lost interest?

Although there are exceptions, women in early pregnancy or early postpartum report significant reductions in sexuality. A major predictor of sexual satisfaction is relationship satisfaction. We know that marital satisfaction plummets during the first two years of parenting. Fatigue and depression are important throughout the perinatal period, but at six months postpartum, the biggest predictor of sexual happiness is “the quality of the mother role.” So how you’re doing as a mom matters, but let’s not forget about hormones.

After the baby, you may be nursing for an extended period of time, and your sex life will likely be minimal because of this. The first three months postpartum are the worst. There are quite a few reasons for lackluster libido. Prolactin levels are up, which suppress testosterone secretion. Also, women who are nursing have less vaginal lubrication due to lower estrogen levels. The biggest issue: you may not be ovulating yet. Nature tries to help you out while you’re nursing a little one, making sure you have plenty of time between your babies. Once the nursing ebbs, you’re more likely to ovulate, and when your period comes back, the horniness will, too, a bit, at least midcycle when you’re fertile. When you wean the baby completely, your libido comes back even more, but not necessarily to baseline. Having little kids climbing all over you can keep your oxytocin levels up, which will keep your testosterone down. Mothers of young children have lower testosterone than those with older children, who have lower testosterone than women with no children. And married women have lower testosterone than unmarried women. So that horny girl from high school? Gone, Daddy, gone.

Women’s magazines and blogs talk about being “touched out.” You have so much physical intimacy with your kids—they require a substantial amount of cuddling, holding, and physical soothing—that when you finally climb into bed with your partner, you’re sick of it. It may be that you’ve filled your quota. Your experience with your children is so sensual and emotional, and there is a euphoric melding of mother and child much like that seen between lovers. So it may not be that you have nothing left to give at the end of your day, but rather that there is nothing more you need. Your children end up being the primary source of your physical and emotional gratification.

There is also the issue of body autonomy. This means it’s yours, not anyone else’s. When you have little kids, it’s easy to feel like your boundaries are completely disrespected. With all that loss of control, it’s simple to see why you may exert some when you finally get into your own bed with a curt “Don’t touch me.” (If you were physically or sexually abused in your childhood, you can expect these issues to be even more prominent. Because your body autonomy was violated in your youth, it might be a trigger for you when your children show you the same disregard.) No matter how assertive or dominant we are out in the world, some of us turn passive and reactive once we’re finally in bed. He wants to, and it’s up to us to say yes or no. Sometimes, just like a toddler asserting autonomy over Mommy by saying no to anything she requests (even “Do you want a treat?”), we deny him his requests because we can. We have the power to refuse and we want to exercise it.

Don’t discount the loss of psychic autonomy, the “virtual annihilation of the self” that accompanies motherhood. If you have no self, you’re certainly not entitled to fight for what you desire. As our roles change from independent working woman to mommy who subordinates her desires to her toddler, it’s easy to feel lost in the shuffle. Some mothers learn to hide or deny their own needs, choosing to gratify those of their children instead, anticipating their kids’ every whim so that they want for nothing. I often joke that the word mother is based on the word martyr. We spend our evenings feeding the mouths that bite, balancing work and family with no time or space left for ourselves. Once we finally get into bed, we’re not just tired, we’re tired of giving.

Our frustration about doing more nightly housework in addition to our day jobs can be a major cause of diminished sexual desire. And until nonsexual issues get resolved, many women have minimal interest in or motivation for sex. Resentment isn’t sexy. When it comes to partner sex (not lust for a stranger, a different matter entirely), many women need to feel safe, cared for, and connected. Women are much more likely to reject their husbands if they’re feeling unsupported, underappreciated, or misunderstood. Men, however, seem to be able to put aside all sorts of issues if it means they can get it on.

Pat Love, in her book Hot Monogamy, says that more men than women complain to her that they don’t get enough touching, both sexual and nonsexual. Daddies are not touched out. For men, sex can be the only way they access emotional vulnerability and establish intimacy. The problem is, you might respond to those needs as if he were one more child to be taken care of instead of realizing that he is offering you something that both of you require.

A desire discrepancy in a marriage is normal. I have patients who routinely complain about the drudgery of attending to their husbands’ sexual needs when they’d rather do anything but. But parents seem to know sex is important and may go ahead anyway, even if they’re not in the mood. In an iVillage survey of two thousand women, those with two or more children were more likely to have sex out of obligation than those without kids.

I often talk to my patients about the difficulty of transitions. Toddlers aren’t the only ones who have trouble moving from one activity to another. Coming home from work and transforming into mother mode is hard enough. What’s even trickier is to switch gears from “mommy” to “wifey.” If you can’t turn off the mom radar, you’re not going to be able to focus on your own physical sensations.

Motherhood may be all about giving, but sex is often about taking what you need, and maybe even being a bit selfish. You have a right to receive pleasure and release after all the caretaking you’ve been doing, but that’s a pretty big mind flip. I find that transitions require rituals. You’re supposed to warn the kids two minutes before leaving the park, so at least give yourself that buffer. After the kids go down, take a shower, have a cup of tea, meditate for ten minutes, or even just take a few deep breaths and a good stretch. Any one of those may be enough to help you focus back on your body and your relationship. Even better: have him give the kids a bath and put them to bed while you prepare yourself, mentally and physically, to reconnect with your lover and yourself.

Sometimes the only way for you to focus fully on yourself and your partner is if your children are asleep or out of the house. You may need to be locked in a room far away from theirs. The book Sexy Mamas recommends that you stock a lockable guest room with sex toys and lubes, sexy outfits and props, to have an exciting quickie getaway in the “playroom.” I recommend, at the very least, that parents get a lock on their own bedroom door. The days may be focused on the kids and their emotional needs, but the nights are a time to turn to each other. This is an adults-only zone.

Children need to learn about the concept of privacy, that Mom and Dad need private time for adult conversation and adult activities. They should also learn that sex is a natural part of life and relationships. If they see you as “sex positive,” happy and sexually fulfilled, it helps them have healthier sexual relationships in adulthood.

“Date Night” Versus Spontaneity

There are two ways to go here, and you don’t have to choose. Establishing a predictable night when you promise to hook up with your spouse has its advantages. You mutually agree that it’s valuable and important, intentionally affirming your bond with each other. You have days to prepare, fantasize, and tease each other with sexy e-mails or texts. That’s a lot of foreplay. Anticipation can be a great aphrodisiac. Good sex doesn’t have to be spontaneous.

But many do complain that any sort of routine or ritual kills the excitement that comes from unpredictability. Sometimes what’s hot is a loss of control, or the risk of being caught. Enter the quickie. Your time is limited, I know. Scarcity is the watchword for young parents. There’s not enough time, not enough energy, not enough space or privacy. But a lot can be done in a short period of time if you’re game to be creative. And if you both agree that shared pleasure and connection are your goals, instead of intercourse or orgasm, you may find yourself even more in the mood. Follow your sexual intuition and do what your body tells you. What would you desire right now? Men Are from Mars, Women Are from Venus author John Gray encourages his readers to differentiate between gourmet sex and fast-food sex. Sometimes you just want small fries and that’s it. Make those wishes ultraclear to your partner, who doesn’t always know exactly what you want or when.

MILFs

Guys with babies always look hot, right? They’re nurturing, and they’ve shown they’re capable of commitment and stability. Why is it such a surprise that a mother would be sexy, too? Biologically, it makes more sense to invest your genetic material in someone who has shown she’s capable of reproducing. Of course a mom should make a man horny.

Until very recently, mothers got a pass on the “hot or not” game. They weren’t expected to be sexy, and for some women, that was just fine. It was nice to not have to worry so much about appearance and desirability. In most traditional cultures, motherhood is more saintly than sexy. It’s often taboo to fetishize mothers. My pet theory: mixing our potency as mothers and as sexual beings may be too much for men to handle, making them uneasy. It’s too much power all in one place. Or it may be a defense born of fear. Men may have difficulty eroticizing their baby mama because it tickles the boundaries of some very sensitive areas, like the Oedipal complex. And if you buy into these Freudian theories, then the MILF idea makes more sense. Lusting after someone else’s mother is a safer way for you to project all your taboo sexual energy for your mother onto another sex partner.

One thing is for sure: as we mature, so does the quality of our sex. We need to reinvent sex now that we’re mothers, building a bridge between being a mother hen and being a fox. With experience and maturity comes sexual sophistication. Optimally, we know what works for us, and we’re more confident about sharing that information with our partners. Call it “authentic eroticism.” Maybe the reason MILFs are such a turn-on is that mothers simply make better lovers. As we blossom and ripen, nurture and mentor, we are likely more capable of integrating intimacy and spirituality into our sexuality. And that is deep, and hot. So go ahead and be sexy, Mama.