Therapy During Pregnancy and Postpartum: Preparing for More Than the Baby

I came to perinatal mental health work from two directions: as a clinician and as a mother. In many ways, it was becoming a mother that showed me what was missing.

I prepared for birth in many of the ways we are taught to prepare. There were appointments, books to read, things to buy, baby gear to research, and lists of everything we would need. I had a beautiful baby shower and so many of the things that were supposed to help me feel prepared.

Looking back, though, there were deeply important parts of preparation that I didn't even know to consider. No one asked me how comfortable I was taking up space, how I related to pain and uncertainty, or how easily I could ask for help. No one asked me what it might be like to make noise during labor or what would happen inside of me if I didn't feel in control. No one helped me think about how comfortable I would feel advocating for myself if something didn't feel right. And no one prepared me for how becoming a mother might change the way I understood my own childhood.

Then came postpartum.

I remember completing the standard mental health screening at my 6-week postpartum visit. Ten questions about how I was doing. Those questions have value, and screening absolutely matters, but they didn't come close to getting to the heart of what I was experiencing.

I struggled more silently than I would have expected, even with clinical training and mental health knowledge. That experience became part of what ultimately drew me more deeply into maternal mental health care and led me to become a Perinatal Mental Health Certified therapist through Postpartum Support International (PSI).

Since doing this work, I can't tell you how many times I have heard a woman say some version of,

I was prepared for birth. I wasn't prepared for what came after.

And “what came after” can mean so many different things. For some women, there were unexpected complications during birth or a much more difficult physical recovery than anticipated. For others, there were concerns about the baby's health, feeding, weight gain, or development.

Sometimes there was an unexpected NICU stay, and the postpartum experience a mother had imagined was suddenly replaced by medical equipment, separation, uncertainty, and fear.

Sometimes everything appeared medically “fine,” but the transition itself was much harder than expected.

Maybe the baby blues didn't seem to lift. Maybe anxiety began creeping into more and more of the day. Maybe she couldn't sleep even when the baby was sleeping, or frightening intrusive thoughts appeared that she was terrified to tell anyone about.

Maybe she expected to feel an immediate connection with her baby and instead felt numb, frightened, overwhelmed, or simply unlike herself. She knew something didn't feel right, but she didn't have language for what was happening.

And sometimes the people around her didn't have that language either.

We often tell new mothers to “ask for help if you need it.” But in order to ask for help, a woman first has to recognize that what she is experiencing may require help. She needs language for it, and ideally, the people closest to her need some of that language, too.

A partner needs to know what to notice. Family members need to understand that a perinatal mental health concern doesn't always look like a mother crying all day or saying she feels depressed. Women themselves deserve to know that postpartum anxiety, OCD, trauma responses, and other perinatal mood and anxiety disorders can show up in ways they may never have been taught to recognize.

This is one of the reasons I have become so passionate about the idea that postpartum preparation should begin before postpartum.

What If Birth Preparation Was About More Than Preparing for a Baby?

Our culture has become very good at preparing materially for babies. We make registries, research strollers, decorate nurseries, attend classes, and buy gadgets designed to solve problems we don't even know whether we'll have yet.

We have showers and gender reveals, and there seems to be an ever-growing list of things to plan, purchase, and do. Some of these things are joyful and helpful. I had a beautiful baby shower myself.

I also remember feeling completely overwhelmed opening gift after gift in front of everyone. Then I felt guilty for feeling overwhelmed because I thought I was supposed to simply feel grateful. It seems like a small moment now, but I think it captured something I would come to understand much more deeply about motherhood.

Two things can be true at the same time.

You can be grateful and overwhelmed. You can desperately want a baby and struggle through pregnancy. You can love your baby more than you knew was possible and still grieve parts of your old life. You can experience motherhood as an incredible gift and also need somewhere to talk honestly about how hard it is. Those experiences do not cancel each other out. Perhaps preparing for motherhood means making room for that complexity before the baby ever arrives.

Emotional Preparation for Birth

Over the years, my understanding of birth preparation has expanded considerably.

One resource that influenced me was Birthing From Within, which introduced me to ways of thinking about birth that extend beyond understanding the mechanics of labor.

Today, when I work with women during pregnancy, we might use traditional talk therapy, expressive arts, somatic therapy, or values-based work to explore what birth brings up emotionally.

What is your relationship with pain? What are your fears about birth? How comfortable are you making noise or taking up space? What happens inside of you when you don't feel in control?

We might explore how easily you ask for help, whether you trust yourself to say no when something doesn't feel right, and how comfortable you feel advocating for yourself with an authority figure.

We can also think about what you need from your partner or birth team in order to feel safe, respected, supported, and heard.

These questions can be particularly meaningful for women with histories of trauma, anxiety, people-pleasing, body-image concerns, difficult family relationships, or experiences in which their needs and boundaries weren't always respected.

Birth asks quite a lot of us. It asks us to inhabit a rapidly changing body, tolerate uncertainty, receive care, communicate our needs, and trust other people while remaining connected to ourselves. Those are things we can prepare for, too. The goal isn't to create the perfect birth experience. We cannot control birth that way. The goal is to enter the experience knowing yourself a little more deeply.

Preparing for Postpartum, Not Just Birth

There is another preparation conversation I wish we had more often: What will you actually need after the baby comes? For me, one of the answers was remarkably simple. Food. I needed someone to nourish me (literally and emotionally). In hindsight, I didn't necessarily need more things. I needed care.

Since then, I've learned about beautiful ways people are reimagining preparation for postpartum. Friends and family can organize meal trains or gather before birth to prepare freezer meals together. I've also facilitated blessingways, gatherings that focus less on gifts for the baby and more on honoring, nurturing, and supporting the woman who is becoming a mother.

There isn't one right way to prepare. That's actually the point. Instead of simply replicating what everyone around us is doing, we can ask what would genuinely support you.

Who will feed you? Who can you call when you haven't slept?

Who can come over and care for you without expecting you to host them?

Who will notice how you are doing rather than only asking about the baby?

Does your partner know what changes in your mental health to pay attention to?

Do you both know what you will do if you begin feeling unlike yourself?

What will you do when you're both exhausted?

Who is part of your village, and what will you actually need from them?

These are postpartum mental health questions. And I believe they are birth preparation questions, too.

Perinatal Mental Health Is More Than Postpartum Depression

When people hear “maternal mental health,” they often immediately think about postpartum depression. But perinatal mental health is much broader. The perinatal period generally includes pregnancy through the first year postpartum.

During this period, women can experience depression, anxiety, OCD, trauma symptoms, intrusive thoughts, and other perinatal mood and anxiety disorders, often referred to as PMADs.

There are also experiences that can increase vulnerability or require more specialized support, including a traumatic birth, pregnancy or infant loss, medical complications, or having a baby admitted to the NICU.

This is one reason specialized perinatal mental health care matters.

As a Perinatal Mental Health Certified therapist, I have advanced training in recognizing and screening for perinatal mental health concerns and helping women access appropriate support and intervention when needed. But I also want women to know something important.

You don't need to have a diagnosis to deserve support during this transition.

Therapy can be preventative. It can be preparatory. It can simply be a place to tell the whole truth about what becoming a mother is actually like.

Birth Trauma, NICU Experiences, and EMDR Therapy

Not every birth feels beautiful or empowering. Sometimes birth is frightening. Sometimes it is medically complicated. Sometimes a woman feels powerless, unheard, frightened for herself or her baby, or disconnected from what is happening to her body.

Sometimes a baby requires NICU care, and the beginning a mother imagined is suddenly replaced by medical equipment, separation, uncertainty, and fear.

You can be profoundly grateful that you and your baby are okay and still feel traumatized by what happened. Both can be true.

This is one area where I may incorporate EMDR therapy into my work with mothers. When an experience remains emotionally or physically “stuck,” EMDR can help process aspects of the experience that the nervous system may still be responding to as though the danger is happening now.

We aren't trying to erase what happened. We are helping your mind and body integrate the experience so that the past can begin to feel like the past.

Motherhood Can Wake Up Your Own Childhood

This is one of the most profound things I see in maternal mental health therapy. Sometimes becoming a mother changes the way you understand being a daughter.

A woman may look at her baby and experience a love and protectiveness that feels almost indescribable. And then another thought appears.

Why didn't someone protect me like this?

Why wasn't my mother more emotionally available to me?

Why was I expected to handle so much on my own?

If my parents loved me, why did growing up hurt so much?

Experiences that we previously minimized, rationalized, or simply learned to live with can look very different when viewed through the eyes of a mother. Motherhood doesn't necessarily create these wounds. Sometimes it gives us new eyes with which to see them.

Old attachment wounds, mother wounds, emotional neglect, unmet childhood needs, and what I sometimes think of as frozen grief can begin coming to the surface. That can be painful. It can also become an invitation to heal.

When Your Coping Skills No Longer Match Your Stress

I sometimes think about mental health as the relationship between what we're carrying and the resources we have available to carry it. Before becoming a mother, perhaps your coping skills adequately matched your stress. You exercised. You slept. You saw friends. You went to therapy. You had routines. You had quiet. You could take a break after a difficult day.

Then you had a baby. The coping skills didn't necessarily disappear. The equation changed.

Now there may be sleep deprivation, feeding, physical recovery, hormonal changes, relationship adjustments, childcare, work, financial pressures, and the relentless responsibility of meeting another person's needs. And there may be far less time and space available to care for yourself. Suddenly, the things that worked before aren't enough. That doesn't necessarily mean you're failing at coping. It may mean the amount you're carrying has changed. Therapy can help us find that gap and begin asking a more useful question: What do I need now?

Pregnancy, Postpartum, Body Image, and Eating Concerns

Pregnancy and postpartum also ask women to navigate enormous physical changes in a culture that already places tremendous pressure on women's bodies. For someone with a history of disordered eating, body dysmorphia, restriction, binge eating, compulsive exercise, or body shame, pregnancy and postpartum can be especially complicated.

There can be joy about what your body is doing alongside discomfort with how it looks or feels. There can be a desire to nourish your body alongside fear about weight changes or a sense of losing control. Old eating disorder thoughts or behaviors can sometimes resurface during periods of significant change or stress.

This is one place where somatic therapy and mind-body awareness can become particularly useful. The goal isn't to demand that you love every change your body goes through. Instead, we can work toward remaining connected to your body, noticing what is happening within it, responding to its needs, and developing a more compassionate relationship with the body carrying you through this transition.

Matrescence: You Aren't Just Having a Baby. You're Becoming a Mother.

There is another word I wish more women knew: matrescence.

Matrescence describes the developmental transition of becoming a mother.

I think naming it matters because a baby isn't the only one being born. A mother is emerging, too. Across cultures and throughout history, transitions into motherhood have often been witnessed and supported by community, elders, and other women. Today, many women describe feeling profoundly alone while trying to figure it all out.

So we turn to the village available at 2 a.m. We scroll. We search. We compare ourselves to strangers. We look for the right sleep schedule, feeding approach, parenting philosophy, developmental activity, routine, or method that will somehow confirm that we're doing this correctly.

We have access to an extraordinary amount of information. But information isn't the same thing as support. Sometimes what we need isn't another answer from the internet. We need a warm, grounded, regulated person in the room with us. Someone who can help us sort through all of the noise and ask a different question. What matters to you?

This is where I often incorporate values-based work from Acceptance and Commitment Therapy. Your values can become your compass as you navigate motherhood. Instead of asking what you are supposed to be doing, we can begin asking who you want to be as a mother. What matters in your family? What do you want your children to experience in relationship with you? What patterns do you want to carry forward, and which patterns might end with you?

And perhaps one of the most important questions is this: How can I remain connected to myself while becoming a mother?

You Don't Have to Wait Until You're Struggling

If there is one thing I wish more women knew, it is that therapy during pregnancy and postpartum does not have to begin when something is wrong. It can be part of the preparation.

We can prepare for birth by learning about labor and making decisions about where and how we hope to deliver. We can prepare materially by choosing the car seat, setting up the nursery, and making sure we have the things our baby will need. But we can also prepare emotionally.

We can talk about what birth brings up for you before you are in the middle of it. We can explore your relationship with pain, control, vulnerability, asking for help, and self-advocacy.

We can think about your mental health history and identify places where you may be more vulnerable during pregnancy or postpartum.

We can prepare the people around you, too. We can talk about what support actually feels supportive to you, what your partner should know, what changes you both might pay attention to, and who you will call if you begin to feel unlike yourself. And we can prepare for the transition that happens beyond birth.

Because you are not only preparing to care for a baby. You are preparing for a significant transition in your own body, relationships, identity, rhythms, and sense of self.

You are becoming a mother. You deserve care in that transition, too.

Perinatal and Postpartum Therapy in Rhode Island

I offer specialized perinatal and maternal mental health therapy for women during pregnancy, postpartum, and the transition into motherhood. I see clients in person in Cranston, Rhode Island, and virtually throughout the state.

As a Perinatal Mental Health Certified therapist, my work may include emotional birth preparation, postpartum anxiety or depression, birth trauma, NICU experiences, pregnancy after loss, body image and eating concerns, relationship changes, matrescence, and the attachment or childhood wounds that motherhood sometimes brings back to the surface.

Depending on your needs, I may integrate EMDR, somatic therapy, expressive arts, attachment-focused therapy, and values-based work into our sessions.

You do not need to know exactly what you need before reaching out. You also do not need to wait until you are in crisis. If you are pregnant, postpartum, or navigating the transition into motherhood and wondering whether therapy might be supportive, I offer a free 15-minute consultation. We can talk about what is bringing you to therapy, what you are looking for, and whether my approach feels like a good fit.

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Perinatal & Maternal Mental Health Therapy: Learn more about my specialized approach to supporting women through pregnancy, postpartum, and the transition into motherhood.

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EMDR Therapy: Learn more about EMDR and how I use trauma-focused therapy to support healing from experiences that continue to feel unresolved.

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Additional Maternal Mental Health Support

Postpartum Support International offers education, support groups, provider resources, and additional support for pregnant and postpartum individuals and their families.

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