Every day in my practice I treat moms are who giving it their all and falling apart. And it isn’t their fault.

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THE UNREALISTIC EXPECTATIONS WE HAVE OF WOMEN.

It seems the odds are against new moms these days. (If you already know what I’m talking about, then feel free to scroll ahead to the next section on Prozac.)

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BYE-BYE MIDDLE CLASS.

It used to be the case that the average American family could be sustained on a single income, usually earned by the man while the woman stayed home with the children. With our changing culture and general socioeconomical decline as a nation, however, the middle class in Americans has become dwarfed, and now families heavily rely on the income earned by women (which, by the way, is only about 70-80% of what men earn for the same work). That’s put a lot of pressure on women to work through their pregnancies and postpartum periods.

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JUST GIVE BIRTH IN THE FIELD.

The average American woman works through her pregnancy up until she goes into labor, often not getting enough rest during this vital time in her and her baby’s life. Even if she could theoretically sustain her finances by leaving work, taking a leave of absence or quitting means losing her health insurance, and so she’s somewhat stuck at work.

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TOO MANY DISEMPOWERING BIRTHS & C-SECTIONS.

The average American woman delivers her child in a hospital setting, where she has a 30% chance of undergoing a C-section – a major abdominal surgery. At least 10% of the C-sections performed in American hospitals are unnecessary (and that’s a modest estimation). Even during vaginal births, women often feel victimized by their hospital experiences, whether it’s being forced to interventions they don’t want, or having too many hospital staff in the birthing room. If her C-section wasn’t planned, she has an 80% chance of developing postpartum depression. Maybe she feels impulses throw her baby down the stairs, but is afraid to tell anybody about it. (I swear; if you feel this way, new Momma, you're not alone.) If she’s had a C-section, she is also unable to sit up in her bed or walk more than a few feet without assistance, as her abdominal muscles have just been cut. She’s also lost more blood than she would have if she’d a vaginal birth, and she’s more likely to have problems with milk supply. The pain meds given to women after this surgery tend to cause constipation as well.

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THE POSTPARTUM “HONEYMOON.”

The first few days of baby’s life are typically filled with miracle and wonder (to quote Paul Simon), as mama falls deeper and deeper in love with her baby. Time moves differently in those early days, with baby nursing every 1-3 hours and mama sleeping in fits and spurts in her bed, in the rocking chair, and on the couch. The outside world slips away as the new family nests and dreams and marvels. ...These are not only some of the most precious moments of a woman's life, but also some of the most important for her child. If I could wave a magic wand, I would surround every new mother and babe in a bubble of security, so that all mom has to think about is her baby. This would allow the bond to form between the two, for breastfeeding to become best established, and for mom to get the rest she needs for her own health and for her milk supply to keep up. ...But the honeymoon is a choppy one for most American mothers, and too short for much of the biological itch of bonding to be scratched.

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BACK TO WORK ALREADY?

One week later, momma is having a panic attack because she has to go back to work. Or is it two weeks later? For some women, a maternity leave only lasts four days.

There are no laws mandating the minimum maternity leave that an American employer must give his employees.

There are likewise no laws about paternity leave for dads who want to bond with their new babies. She falls asleep during meetings because she’s up all night with her new baby. She comes home from work exhausted, but her work has just begun.

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MAINTAINING MILK SUPPLY AT WORK.

Mama works 8-hour days and tries to pump in the bathroom during breaks. A mechanical pump is a poor substitute for a baby’s mouth, however, so although the nipple stimulation helps her eek out a few ounces at work, mom’s supply of breast milk invariably decreases once she’s back on the job site. Producing and pumping enough milk for her babe becomes a full time obsession. She eats lactation cookies at her desk and prays. Or maybe she gives up and buys formula, feeling like a failure (which she isn’t).

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DAYCARE, ILLNESS, & ANTIBIOTICS.

If mom is a single parent or if her partner works, then baby is likely sent to daycare, where he’ll catch cold after ear infection after hand-foot-and-mouth.

Sick kids need to stay at home with their parents, but that can’t happen in America, where most of us live paycheck-to-paycheck and missed work days can quickly have devastating effects on a family’s finances.

That’s part of why we see so many unnecessary antibiotic prescriptions now for babies and very young children.

The majority of ear infections, for example, will pass on their own without antibiotics.

…But if the kid is on antibiotics, you can send them back to daycare within 24 hours, which is a compelling deal for most parents. This is part of why we have so many unnecessary antibiotic prescriptions (not to mention uncessary vaccines like Rotavirus) nowadays.

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ONLY BAD MOMMIES LET THEIR BABIES CRY. (NOT!)

The weeks pass, and now she’s got a six month old who doesn’t sleep at night because everybody is posting articles about how if you let your baby scream it out you’re a horrible monster doing major psychological damage to your child. (Insert: pediatricians everywhere rolling their eyes.) The only way the little peanut will calm down for 5 minutes so that momma can take a shower is if she hands him the iPad. She feels like a jerk every time she sees his face illuminated by the glowing screen. She knows TV and tablet exposure is harmful before the age of 2, but she’s just trying to survive here. She tries to breathe when she reads Facebook posts that insinuate she’s a horrible parent. (By the way, if you’re going crazy trying to follow the hard-on-moms advice found in American mommy blogs, you’ll likely find the book Bringing Up Bebe entertaining.)

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I LEAK URINE, BUT WHATEVER.

Nobody has offered her pelvic floor physical therapy, despite the fact that she pees a little every time she coughs. 10 sessions of pelvic floor PT are offered to every woman in France postpartum, and is a huge help for many women. (I offer this service to women, and it’s truly a game changer for them.)

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SEX, ANYONE?

At some point her partner might start asking for sex, and it’s likely the last thing on this earth she will be interested in, she’s so exhausted. Plus she feels fat and her belly is still loose. One mom once told me, “I would rather mop everybody’s floor on my entire block than have sex.” Plus, there’s that whole leaking urine thing.

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I HAVE TO BE SKINNY & PRETTY TOO?

Between work and caring for baby, there’s not a shred of energy to spare for exercise. Besides, when she does start to drop pounds, her milk supply goes down and her baby screams with hunger. Sure, there’s formula, and maybe she’ll go that route, all the while reading articles on Facebook about breast fed babies have lower rates of allergies and autoimmune disease, and how nursing is a great way to burn calories and drop the “baby fat.”

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SIX VACCINES IN ONE VISIT? ARE YOU NUTS!?

The pediatrician is pushing six – six! – vaccines at the 2 month well baby visit, which sounds absolutely crazy.[1] So she drinks more coffee and reads Dr. Sears’ , Dr. Thomas', and Dr. Romm’s books on vaccination and cries because the pediatrician has threatened to fire her from the practice if she doesn’t bring her baby in soon for those shots. He rolls his eyes when momma asks about doing a delayed schedule. She is “that mom.” She hates being “that mom.” But dang it, this is her child’s health! (Which might just be how she winds up in my office, bringing in her baby for a visit and then having a meltdown 10 minutes into it when I ask how she’s adapting to motherhood.) (By the way, if you’re “that mom,” then I’m very likely the right doctor for your family.)

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GIMME A BREAK.

Her friends wish she’d call them more. Her partner wants more sex, or at the very least for her to stop snapping at him/her. Her baby takes and takes and takes. Her boss notices her performance at work isn’t as good lately, but thankfully hasn’t fired her.

Her body is a battlefield. She’s exhausted.

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HERE, HAVE SOME PROZAC.

She goes to her doctor to talk about all of this. She thinks she’s going crazy. Her doctor says, “I know it’s hard, but you’re a new mom – it’s supposed to be hard,” and then hands her a prescription for Prozac.

Really? Just give her Prozac?

Just numb her so she can endure the abuse? Last I checked this didn’t work so hot for women in the 1950’s, who got hooked on their “mother’s little helpers” (valium). This all sounds normal to you?

Maybe, just maybe, the issue isn’t one of cranking more productivity out of American women. Maybe we’re just asking too much of them.

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IT IS NOT IN YOUR HEAD AND YOU ARE NOT WEAK.

Dear Mama, you are doing your best, and you are doing a phenomenal job. The reason you feel like you're losing is because you're playing a game that cannot be won, like one of those gimmicky arcade games that never lets you beat the omega level despite how many quarters your stuff into the machine and how much you play. Your thyroid is a mess because your endocrine system was beaten into the ground by the insane demands you've been expected to meet. You can't be well rested and happy and have a strong milk supply and a flat tummy and look pretty and have a tidy home and excel in your full time job and have awesome sex with your partner and do attachment parenting and get up five times a night with your baby and be fully educated about the best healthcare choices for your child and make it look like your life is perfect on Facebook. I'm sorry to be such a Debbie Downer here, but you just can't. It's not realistic. Any mama who says she can do it all is lying and/or on antidepressants.

You can do anything, but you can't do everything.

Yet this is precisely what American society expects of you.

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BETTER IS POSSIBLE.

As somebody born and educated in Canada, I know that us American women can have it better. I recently went back to Montreal to visit with some friends, many of whom have babies and young children. I was curious to see how my neighbors to the North were juggling motherhood with breadwinning. It was also a really fun trip for me, because I got to snuggle with a lot of cute babies! It was also incredible eye-opening. Here’s what I learned:

CANADIAN MOMS ENJOY ONE YEAR OF PAID MATERNITY LEAVE.

Thanks to laws protecting them and to government subsidies, my friends are collecting 55% of their normal salaries for twelve full months while staying home with their babies. They have options on which parent takes how much time, when, and for how long. They can take shorter leaves and earn a greater percentage of their salaries too, if they prefer.

My Candian friends, by the way, aren’t exhausted. They’re tired. There’s a difference.

They have little bags under their eyes and big smiles across their faces. They spend long nights with their babies and then crash on the sofa the next day until noon. Motherhood is hard, and sometimes they lose it. But they’re rolling with the punches, and ultimately loving it. Not one of them has postpartum depression or anxiety. (Which isn’t to say that Canadian women don’t develop depression, to be fair.)

Time at home isn't a "luxury" for mom. It's essential for her health. And it's crucial for her baby's development.

Mom’s presence at home in that first year of life means that baby is more likely to get breastfed and have good bonding time with mom/dad/co-parent. Furthermore, by being home and not in daycare surrounded by snot-nosed kids, the Canadian baby is much less likely to get sick with serious infectious diseases during her first year. She’s also at a lower risk of receiving excessive antibiotic prescriptions that will increase her risk of allergies and autoimmune diseases later in life, because if she gets sick mom or dad will be able to stay home with her while her immune system figures out for itself how to fight off infections. This will make her stronger and healthier in adulthood, and possibly even reduce her chances of getting cancer later in life. [2] .

CANADIANS ALSO GET AFFORDABLE DAYCARE.

When their kids get a little older, my friends in Quebec will pay $7 per day for daycare. That’s not a typo. Seven dollars. Per day. And those who are low income will receive a subsidy to drop that price even lower. So the money that mom earns when she goes back to work will go toward supporting her household, and not get used up on childcare expenditure. How many American women leave their jobs altogether because daycare costs about as much as they earn, making it a wash? Canadian moms, on the other hand, can afford to return to work and therefore pay tax dollars back into the system that just helped them out. Canada is by no means the only country that’s taking care of its mothers. But it’s the only country in North America that’s doing so, and it serves as a close-up example to us of what we could have if we demanded it unapologetically.

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THE TIME FOR CHANGE IS NOW.

I hope you’ll help spare another woman the abuse you’ve endured by advocating for better rights for women in America. At the very least, we need paid maternity leave and affordable daycare options.

Just about every civilized, developed country in the world offers women this basic support. Why not America?

Yes, you’re a new mom, and it’s a hard job. But you’re not supposed to be this tired. And I know you already have a million things on your to-do list. But please, make sure that voting is one of them. There are a lot of women in this country. We comprise a substantial voting body. Our health – and the health of our children – matters. Our voices matter. It’s time we be heard.

. . FOOTNOTES: [1] The CDC recommends doing the second dose of hepatitis B, and the first doses of rotavirus, HiB, DTaP, Polio, and Pneumococcal shots at age 2 months. Many doctors make it seem like fewer shots by carrying 5-in-1 combination vaccines, which deliver 5 shots in a single poke. In my experience, and in talking with other pediatricians, we see a lot more negative reactions with these combination shots than with the individual ones. [2] To learn more about the link between NOT getting fevers and flus and cancer, check out my Flu? Congratulations! article.

Moms Giving it their All and Falling Apart