Matrescence: The Developmental Transition to Motherhood孕乳期：轉(zhuǎn)變?yōu)槟赣H的過程

亞歷山德拉·薩克斯 蘇揚(yáng)

A body， mind and hormone shift that sounds like “adolescence”.

堪比“青春期”的生理、心理和荷爾蒙之變。

Though many of us have tried to block it out， we all remember puberty. First came the pimples and stretch marks. And next， feeling euphoric， awkward， and disoriented about growing from one life stage to the next.

Science and culture keep us well informed about the physical and psychological changes adolescents experience in their bodies， hormones， relationships， and identities. But women also go through a radical transformation in each of these dimensions when they are having a baby.

My work on the developmental transition to motherhood explores “matrescence，” a term coined in 1973 by Dana Raphael， a medical anthropologist who also popularized the phrase “doula1.” Over the decades， other academics and clinicians have expanded on her research， but Ive noticed that the term is not yet “out there” in popular culture and conversation. Im a reproductive psychiatrist who works with pregnant and postpartum women， and my work and this blog are motivated by the mission to change that.

Over the past decade that Ive been working in this field， Ive observed a pattern. Women regularly call me to ask if they have Postpartum Depression. Though they may not meet diagnostic criteria for this condition， Postpartum Depression seems to be the most familiar term they have on hand to frame2 their distress. Heres what many of them describe： “I love my baby but I dont have the right maternal instincts” and “Im not enjoying this， mostly I feel tired” and “I feel so guilty because I wanted a baby more than anything， but sometimes I find myself feeling bored and even resentful.”

These descriptions of discomfort are natural to matrescence， and not diagnostic of any specific disease. Its no coincidence that matrescence sounds like adolescence. Both are times when body morphing and hormone shifting lead to an upheaval in how a person feels emotionally， and how they fit into the world. And like adolescence， matrescence is not a disease， but since its not in the familiar medical vocabulary， its being confused with a serious condition （that deserves its own expanded outreach， research， and advocacy） called Postpartum Depression. （More recently， Postpartum Depression clinical terminology is expanding to the more inclusive： “Perinatal Mood and Anxiety Disorders，” PMADs.）

There is so much love in matrescence. The bonding hormone oxytocin circulates through your body， and you become attached to your baby at the most basic cellular level. But， because youre still human， your brain and body continue to send you the usual cues to take care of yourself： to sleep， to eat， to go to the bathroom. Not to mention to exercise， have sex， socialize， continue your professional， spiritual and intellectual life， and nurture your relationship. Many new moms find themselves feeling like they are in a push and pull， an emotional tug of war， as they try to figure out how to care for themselves and their babys needs at the same time.

Many people find early motherhood to be both pleasurable as well as challenging， and at times fear and anger-inducing， and this is mediated by psychological as well as physiological factors （ranging from hormonal shifts to sleep deprivation.）

Rather than feeling like something is “wrong with them，” lets encourage mothers to speak more openly with each other so that the beautifully messy challenges and joys of matrescence are as accepted in our culture as the ups and downs of adolescence. My hope is that if more women understood the natural progression of matrescence， they might feel less alone， they might feel less stigmatized， and this might even reduce rates of postpartum depression.

青春發(fā)育期盡管有許多人曾努力要從記憶中抹去，但我們誰也不會(huì)忘記：先是長(zhǎng)出痘痘和膨脹紋，然后是對(duì)生命從一個(gè)階段進(jìn)入下一個(gè)階段感到興奮、別扭和迷茫。

關(guān)于青少年在身體、荷爾蒙、兩性關(guān)系和身份認(rèn)同等方面經(jīng)歷的生理和心理變化，科學(xué)和文化給了我們足夠知識(shí)。而女性在孕育寶寶的過程中，上述諸方面也要經(jīng)歷一次巨變。

我對(duì)為人母這一過渡期的研究著力于“孕乳期”。這個(gè)詞是醫(yī)學(xué)人類學(xué)者達(dá)娜·拉斐爾1973年提出，她還普及了“導(dǎo)樂”一詞。數(shù)十年來，其他學(xué)者和臨床醫(yī)生在她所做研究的基礎(chǔ)上有所拓展，但我發(fā)現(xiàn)，大眾文化和交流中，孕乳期這個(gè)詞有待普及。我是產(chǎn)科精神病醫(yī)生，接診對(duì)象是孕期和產(chǎn)后婦女。我之所以從事這項(xiàng)研究以及寫這篇博文，初衷就是要擔(dān)負(fù)起改變這一現(xiàn)狀的使命。

入行十年，我發(fā)現(xiàn)一個(gè)規(guī)律：女性朋友們給我打電話，經(jīng)常問的是，她們是否患上了產(chǎn)后抑郁癥。她們可能沒有達(dá)到產(chǎn)后抑郁的診斷標(biāo)準(zhǔn)，但她們似乎卻能隨手拿這個(gè)詞定義自己的痛苦。許多人的描述如下：“我愛寶寶，可就是沒有做母親的天性”“喜歡不起來，經(jīng)常累得慌”“我很內(nèi)疚，之前一心一意想要寶寶，現(xiàn)在有時(shí)卻感覺無聊甚至火大。”

這些痛苦的表現(xiàn)在孕乳期很正常，不是任何病癥的反應(yīng)。孕乳期的種種聽起來與青春期相似，這不是巧合。兩者都是體形和激素變化導(dǎo)致情緒和適應(yīng)外界的方式出現(xiàn)大幅波動(dòng)的階段。與青春期一樣，孕乳期的表現(xiàn)也不是病;因不屬于常見醫(yī)學(xué)詞匯，人們把它誤作一種嚴(yán)重疾病（這又值得另外拓展探索、研究和宣傳）——“產(chǎn)后抑郁癥”。（近期，產(chǎn)后抑郁癥的臨床擴(kuò)展到一個(gè)更大的范圍，稱為“圍產(chǎn)期情緒和焦慮障礙”）。

孕乳期充滿著愛：這個(gè)階段，被稱為“連接激素”的催產(chǎn)素在體內(nèi)涌動(dòng)，母親對(duì)嬰兒的依戀達(dá)到最基本的細(xì)胞級(jí)。但是，人終究是人，大腦和身體仍如常發(fā)出“自護(hù)”信號(hào)：睡覺、吃飯、如廁，此外還有鍛煉、性愛、社交，維持職業(yè)、精神及智力生活，維護(hù)夫妻感情。許多新媽媽感到自己在拔河，在進(jìn)行一場(chǎng)情緒拔河，需要不斷琢磨怎么既照顧好自己，又照顧好寶寶。

許多人發(fā)現(xiàn)剛剛當(dāng)媽媽時(shí)苦樂參半，不時(shí)還有恐懼和惱火，這些波動(dòng)有心理因素也有生理因素（從荷爾蒙變化到睡眠不足）。

不要覺得“她們有點(diǎn)不對(duì)勁”，而要鼓勵(lì)媽媽們更坦誠(chéng)地交流，把孕乳期那些糾纏不清的苦樂，像青春期的起起伏伏一樣，變成我們文化的一部分。我的希望是，倘有更多女性了解孕乳期的這一自然過程，她們就能少一點(diǎn)孤立無援，少受一點(diǎn)指責(zé)，興許，還會(huì)降低產(chǎn)后抑郁率。

1 doula（雖未接受專業(yè)訓(xùn)練，但是在嬰兒出生過程中以及之后承擔(dān)照料產(chǎn)婦工作的女性）導(dǎo)樂，助產(chǎn)士。

2 frame（措辭謹(jǐn)慎地）表達(dá)，說出。