Great Expectations: Mental Health during Pregnancy and Postpartum
by Caroline Freedenberg, LICSW, LCSW, LCSW-C, PMHC
"You must be so excited!" Feels like the only thing you're allowed to feel when you're pregnant or just had a baby.
And scared, overwhelmed, sad. And don't forget feeling guilty that you're not feeling pure excitement and awe. If this is you, please know you're not alone or broken.
These complex emotions are especially difficult for people who have: experienced pregnancy loss, had difficulty conceiving, have learned difficult news about their pregnancy, had always envisioned themselves as mothers, have been very sick, have a strained relationship with or lost a parent or loved one, hadn't planned on this pregnancy, were hoping to make partner or get a promotion soon, whose relationship is not the most stable or healthy, have never experienced mental health concerns before, had been in remission and feeling greater stability in their mental health… and now these feelings, these unexpected and unwelcome extra emotions are here intruding on "what's supposed to be" the joyful party.
It's perfectly okay to feel many things at once, or to experience waves of more positive emotions alongside waves of neutral and negative feelings. One of the most difficult things that happens during pregnancy or after birth is navigating our internal experiences (physical sensations, emotions, thoughts) while also navigating our expectations of ourselves and that experience, or internalizing what we think other people expect us to feel, do, and think. That gives us quite the case of "shoulds." Really, those are just choices, a menu of "coulds."
The onslaught of unsolicited advice, "just wait until," and "at least you're not" comparisons, plus the relentless social media algorithm working to terrify and pressure you, it's a lot. It's perfectly normal to not know what you're doing; you're embarking on uncharted territory, in a new role that changes so much of your day-to-day life. Have we paused to wonder: do other people really know what's best for you, in this pregnancy, in your life right now? People who care about us are usually coming from a place of love, but it can feel like pressure and judgment, and like we’re letting everyone down.
Please remember that every birth is natural, even when baby is conceived with reproductive technology, facilitated by pain medication, happening in a tub, bed, or an operating room, and whether baby comes through the sunroof or the door. The NICU is nobody's idea of a good time, and we're so grateful it exists. How we feed, protect, care for, and teach our children is based on doing our best with the information and resources we have.
Scary thoughts happen, and they happen to all of us. We're biologically driven to be vigilant and protect baby; it's an incredible amount of responsibility, and they are so fragile and helpless. People with and without depression, trauma, and anxiety can have distressing “what if” thoughts about bad things happening to their baby or partner. These thoughts and images are often vivid and upsetting, called intrusive thoughts, and they are distressing precisely because we don't want bad things to happen. The shame and guilt about these thoughts grow in the darkness and isolation of not sharing. It doesn’t allow for the relief and commonality of a sister or friend saying "me too," "I thought I was the only one," or "yes, I had a thought that ___."
When we're facing uncertainty, we tend to want more information and a solid plan. A good plan can feel like armor against bad things happening, hence the researching, podcasts, books, classes, hours of Googling, careful and impulsive purchases, and the need to follow all the rules while somehow also "not stressing yourself out." Sometimes we get stuck in indecision and overwhelmed by choices, trying to minimize risk and maximize benefit. Sometimes we get rigid about who can do things, how, and exactly when. This control-seeking behavior comes from fear of "messing up" and trying to prevent those intrusive thoughts from becoming real. It makes sense; we’re just trying to do our best, and it can also get overwhelming and interfere with enjoyment.
Sometimes facing uncertainty looks like putting the device down and acknowledging the uncertainty and the incredible shift that's happening. There's a real humanness in not trying to optimize everything and in bringing our expectations into alignment with reality. Being pregnant and becoming a parent is a time of inherent uncertainty and a gap in knowledge and experience, but babies are resilient, mistakes are often productive learning experiences, and it's your baby's first time around the sun, too. Agency is one of the most powerful forms of self-care: recognizing where we can choose and have control, and bringing acceptance to where we cannot. There is no such thing as being a perfect mother, but there are a million ways to be a great mother, and recognizing that helps you be the perfect mother for your baby.
If you're having a hard time, it's never too late to talk to someone. One in five women and one in ten men experience a change in their mental health during pregnancy or in the first year after birth. Postpartum anxiety, rage, OCD, trauma, and depression are common, and they are treatable. Working with a therapist can help you find more balance and a space to talk through what feels difficult and overwhelming, a place where all of your internal experiences are accepted and there are no expectations of how you should be or feel.
We often slide to the bottom of our own priority list when we're focused on caring for others. But you deserve support (full stop). If it helps to have evidence that therapy is beneficial for your family, here’s what we know:
Therapy helps
better attune to your child, supporting healthy, secure attachment
manage stress, regulate your emotions, and cultivate a stable environment for them
support effective communication in your relationship to better resolve conflicts and support each other during this challenging time
help you address unresolved personal or intergenerational trauma, so you can be the cycle breaker and set the stage for your child's long-term emotional well-being
Caroline Freedenberg, LICSW, LCSW, LCSW-C, PMH-C, is a Licensed Clinical Social Worker who specializes in supporting women, parents, and families through life's transitions, with a particular focus on perinatal mental health. Caroline is passionate about helping clients build resilience, strengthen self-compassion, and feel more confident and connected during pregnancy, postpartum, and beyond. She works with clients experiencing anxiety, depression, obsessive-compulsive disorder (OCD), post-traumatic stress, fertility challenges, pregnancy and infant loss, parenting stress, and relationship concerns.
Caroline takes a collaborative and strengths-based approach to therapy, integrating evidence-based treatments, including Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and Dialectical Behavior Therapy (DBT), to meet each client's unique needs. She is committed to creating a supportive, nonjudgmental space where clients feel seen, heard, and empowered to move toward healing and meaningful change. For more information about scheduling an appointment with Caroline, please reach out to us at info@hope-wellness.com.
