I remember my first pregnancy with my oldest kid like it was yesterday. There was so much anticipation, excitement, nervousness, and curiosity about what would unfold, alongside a growing frustration that it already felt so hard.
I suffered from hyperemesis gravidarum, a pregnancy complication marked by severe nausea and vomiting. Feeling constantly unwell seemed to take away any possibility of fully experiencing the joy I thought I was supposed to feel while growing this little life. Before I knew it, the third trimester came and went, and I was being induced to have my first baby.
After more than 24 exhausting hours of labor, my son was finally born. I remember struggling to fall asleep in the uncomfortable hospital bed that night, eventually bursting into tears and feeling overwhelmed by a sense of despair.
I had spent nearly a year observing and caring for all the physical changes and transitions happening in my body as it prepared for this new life. Yet when he finally arrived, the massive emotional and mental shifts of postpartum hit me like a semitruck.
Since then, I have gone on to have two more children. I've experienced pregnancy and postpartum as a mother, and I now also work with women navigating these transitions as a perinatal therapist. Through both experiences, I've come to understand that perinatal mental health is about so much more than whether someone develops postpartum depression or anxiety.
It is about the emotional experience of becoming a parent - and making space for everything that can come with it.
What is perinatal mental health?
Perinatal mental health refers to our emotional and psychological well-being during pregnancy and the postpartum period. It encompasses a wide range of experiences, including both diagnosable mental health conditions and the very real emotional challenges that can accompany the transition to parenthood.
These can include:
Anxiety
Depression
Perinatal OCD
Trauma and birth trauma
Adjustment difficulties
Grief and loss
Relationship changes
Identity shifts
Intrusive thoughts
Feelings of overwhelm, shame, or inadequacy
Traditionally, we have often used the word “postpartum” to describe mental health difficulties that occur after birth. But we now have a broader understanding of how much emotional and psychological change can happen throughout the entire perinatal period, not just after the baby arrives.
Pregnancy itself can bring significant changes to our bodies, relationships, identities, routines, and expectations. And after birth, the transition can feel especially abrupt. Hormonal changes happen rapidly, sleep can become fragmented, our responsibilities change overnight, and suddenly we are caring for another human being while simultaneously trying to figure out who we are in this new role.
It makes sense that this period can come with a wide range of emotions.
Becoming a parent is a major life transition
There is often an expectation that pregnancy and new parenthood should be among the happiest times of our lives. And for many people, there is genuine joy. But joy and struggle can exist at the same time.
You can love your baby and still feel overwhelmed. You can feel grateful to be a parent and still grieve aspects of your old life. You can have wanted this baby desperately and still find yourself thinking, What have I gotten myself into?
These experiences do not make you a bad parent. They make you human.
There can also be a particular kind of shame that comes with struggling during a time when we believe we are supposed to feel grateful, connected, and happy. We may wonder why everyone else seems to be handling things better, or question what our difficult emotions say about us as parents.
This is one of the reasons I believe it is so important to create space for the full emotional experience of pregnancy and parenthood. There is room for joy, grief, love, resentment, excitement, fear, gratitude, sadness, connection, disconnection - and everything in between.
What is a “normal” adjustment, and when should I be concerned?
The transition to parenthood can be incredibly intense. Going from being responsible primarily for yourself to caring for a completely dependent human being is a profound life change. Add in sleep deprivation, physical recovery, hormonal shifts, changes in relationships and routines, and the pressure many of us place on ourselves to “get it right,” and it is understandable that the perinatal period can feel emotionally challenging.
You may experience:
Overwhelm
Irritability
Increased stress or anxiety
Exhaustion
Sadness
Difficulty concentrating
Feeling unsure of yourself
Changes in your relationship with your partner
A sense of grief for your previous life or identity
Some emotional ups and downs are a normal part of adjustment. But if you notice symptoms that feel persistent, intense, difficult to control, or are interfering with your ability to function, it may be time to seek additional support.
This might look like:
Anxiety that feels difficult to control
Persistent sadness or hopelessness
Constant guilt or feelings of inadequacy
Feeling disconnected from your baby or yourself in a way that doesn't improve
Intrusive or frightening thoughts that are distressing to you
Panic attacks
Avoiding activities because of fear
Re-experiencing or feeling distressed by a traumatic birth
Feeling like you cannot cope
Significant difficulty functioning day-to-day
This list is not exhaustive, and you do not have to experience a specific symptom - or meet a particular threshold of suffering - to deserve support.
You are allowed to ask for help simply because this is hard.
Caring for your perinatal mental health
There are many ways we can support our mental health during pregnancy and postpartum. What works will look different for everyone, but here are a few practices I frequently encourage with my clients - and in my own life.
Give yourself grace.
It is so easy to question ourselves when we are feeling vulnerable, and the perinatal period is an especially vulnerable time.
Am I doing this right? Is the baby fussy because of something I did? Should I ask for help? Am I a good mother?
The list goes on. There is no rulebook for parenthood and no perfect way to raise a baby. We are learning as we go. Giving ourselves grace means practicing a different kind of internal dialogue - one that is less critical and more compassionate. Instead of asking, “What am I doing wrong?” we might tell ourselves “This is really hard and I am a good mother by simply showing up today.” The more we can get on our own team, the more space we create to listen to ourselves, trust our intuition, and respond to what we and our babies actually need.
Ask for help.
We cannot, and were never meant to, do parenthood alone.
We simply do not have enough hands, time, or emotional bandwidth to carry everything by ourselves. One of the most valuable skills we can practice during the perinatal period is asking for help before we reach our breaking point.
That might mean asking a friend to bring you a coffee, asking someone to hold the baby while you take a shower, accepting a meal, or telling your partner that you need an hour to yourself.
Asking for help can be difficult, especially if we have internalized the belief that we should be able to handle everything ourselves. But allowing others to care for us is not a sign of inadequacy. It is part of being human. There is no gold medal for doing as much as you can by yourself in this journey of parenthood.
Move your body.
Movement can be a helpful way to support mood and regulate stress. This does not have to mean returning to your pre-pregnancy workout routine or pushing yourself physically.
A three-mile run, a five-minute walk around the block, stretching in your living room, or simply getting outside for some fresh air can all count.
The goal isn't productivity or “getting your body back.” It is simply finding small ways to reconnect with your body and give yourself a change of scenery.
And if you can do it with a friend, even better.
Keep a sense of normal.
This is something I frequently encourage with my perinatal clients.
Growing a child and becoming a parent can be a major life transformation. It is natural for that kind of change to bring adjustment stress and emotional upheaval. When everything feels different, maintaining a few familiar pieces of your life can provide a sense of stability.
Maybe that means continuing your daily dog walk, staying connected with a close friend, listening to your favorite podcast, going to yoga, getting coffee at your favorite place, or simply taking ten minutes each day to do something that reminds you of you.
You don't have to put your entire identity on hold just because you've become a parent.
Connect with others.
One of the most valuable coping skills I can think of during the perinatal period is staying connected to people you feel safe with.
When we are stressed or overwhelmed, it can be tempting to isolate. We may worry that other people won't understand, or that admitting we're struggling means something is wrong with us.
But connection can be incredibly grounding.
Having someone you can be honest with, someone you can tell, “I'm really struggling today,” -without needing to make it sound better-can make a tremendous difference.
This might be a partner, friend, family member, therapist, postpartum support group, new-parent group, or another parent who simply understands what this season feels like.
Sometimes, being reminded that you are not the only one can be powerful in itself.
You don't have to do this alone
Perinatal mental health is becoming a more widely recognized part of maternal and family health, but it can still be one of the most easily overlooked aspects of the transition into parenthood.
We spend so much time preparing for the physical experience of pregnancy and birth. We research car seats, strollers, feeding, sleep, birth plans, and what to pack in our hospital bags. But preparing for the emotional experience of becoming a parent can be just as important.
There is no single way you are “supposed” to feel during pregnancy or postpartum.
If you're struggling, you don't need to convince yourself that someone else has it worse. You don't need to wait until things become unbearable. And you don't need to have a diagnosis to deserve support.
As a licensed clinical social worker and therapist specializing in trauma-informed and perinatal mental health, I believe therapy can provide a space to slow down, make sense of what you're experiencing, and reconnect with yourself during a period of enormous change.
Becoming a parent changes so much. You deserve support as you navigate who you are becoming, too.
Megan Shih Psychotherapy provides therapy for individuals navigating pregnancy, postpartum, parenthood, shame, vulnerability, relationships, and the many emotional complexities that can come with becoming-and being-a parent.