Pregnancy comes with changes that are easy to see. Often, pregnancy and the postpartum period change more than you expect. Your body changes, appointments fill your calendar, and preparations for a baby start to take up more time. Other changes are harder to anticipate because they involve how you feel about yourself, your relationships, and the life you are preparing to enter.
A deeply wanted pregnancy can still bring uncertainty. Feelings about your own childhood may surface. A relationship that felt familiar before pregnancy can begin to change as both partners consider becoming parents. As well, for someone who has experienced infertility or pregnancy loss, becoming pregnant can also bring fears that friends and family may not fully understand.
Counseling during pregnancy and the postpartum period provides space for these experiences before they become overwhelming. It can also provide continuity through a life stage that extends beyond pregnancy and birth. What matters in therapy can change as pregnancy progresses, the baby arrives, and the realities of becoming a parent begin to take shape.
Pacific Behavioral Healthcare provides pregnancy and postpartum counseling for women and couples in Seattle and Bellevue, with online therapy available throughout Washington State plus telehealth services in participating PSYPACT states.
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Pregnancy Can Feel Different From How You Thought It Would
Plenty of information is often available about what happens physically during pregnancy. Emotional changes can be harder to anticipate.
Someone who spent years imagining pregnancy may be surprised by how little the real experience resembles her dreams. Excitement can exist alongside worry. Physical changes that seem manageable one week may feel exhausting the next. Medical appointments can be reassuring, but they can also become a source of anxiety when there is uncertainty about a pregnancy.
There can also be pressure to enjoy pregnancy. Friends and relatives may be excited, particularly when the pregnancy was planned or took a long time to achieve. Admitting that pregnancy feels difficult can become uncomfortable when everyone around you expects it to be a happy time.
When Pregnancy Affects Your Mental Health
Emotional shifts during pregnancy aren’t always normal. Depression, anxiety, trauma symptoms, or an existing mental health condition can require more focused care. Mental health concerns may begin during pregnancy, continue from before pregnancy, or become more difficult during this period. The American College of Obstetricians and Gynecologists recommends screening for depression and anxiety early in prenatal care, later in pregnancy, and during postpartum visits.^1
Changes in sleep, energy, appetite, and concentration can also be hard to interpret during pregnancy because they overlap with the physical experience of pregnancy. A psychologist can look beyond an individual symptom and consider how someone has been feeling, how long it has been happening, and whether it is affecting daily life.
Pacific Behavioral Healthcare explores these concerns in more detail in Pregnancy and Mental Health Finding the Right Support.
Pregnancy After Infertility Can Bring Its Own Emotional Challenges
A positive pregnancy test can be the moment someone has hoped for throughout months or years of fertility treatment. Reaching that point doesn’t necessarily erase the experience that came before it.
Trying to conceive can involve repeated cycles of waiting. There may have been appointments, procedures, medications, tests, difficult decisions, and disappointing results. Pregnancy loss can add another experience that affects how a future pregnancy feels. By the time pregnancy occurs, uncertainty may already feel familiar.
When It Is Difficult to Trust That Everything Will Be Okay
Pregnancy milestones may carry a different meaning after infertility or loss. Waiting for an ultrasound or test result may bring back memories of earlier appointments. Reassurance can help in the moment without completely settling the worry about what could happen next.
People close to you may assume the difficult part is over once pregnancy occurs. That can make it harder to explain why relief and happiness have not replaced every other feeling. Gratitude for a pregnancy and fear of losing it are not mutually exclusive experiences.
After months or years of fertility treatment, it can be difficult to stop bracing yourself for disappointing news. You may hold your breath before an ultrasound or find reassurance in one appointment that lasts only until the next. Even sharing the pregnancy with family and friends can feel complicated when part of you is still afraid something could go wrong. Counseling during pregnancy gives you somewhere to talk about that fear without being told to relax, stay positive, or focus only on being grateful.
For a closer look at support while trying to conceive, read Fertility Counseling for Individuals and Couples in Washington State.
Becoming a Mother Can Change How You See Yourself
Preparing for a baby involves plenty of practical decisions. The personal questions are often harder to answer.
Work may have been an important part of someone’s life for years, and it may be difficult to imagine what a career will look like alongside caring for a baby. Independence can feel different when another person depends on you throughout the day. Friendships may also change when schedules and priorities no longer align.
None of this means someone is reluctant to become a mother. It means motherhood is being added to an already existing life.
You Do Not Have to Lose the Person You Were Before Motherhood
Some people believe or expect that becoming a mother should immediately become the most important part of someone’s identity. Motherhood can be enormously important without making every other part of life irrelevant.
The adjustment may be especially noticeable after the baby arrives. Activities that once happened without much thought can suddenly require planning. Time alone may become scarce. Returning to work may feel very different from what was expected during pregnancy.
You can love being a mother and still miss being able to leave the house without planning around a feeding schedule or arranging childcare. However, you may miss uninterrupted time with your partner, focusing on work all day, or simply deciding how to spend a few hours on your own. One does not need to apologize for these feelings in therapy. Counseling gives you a place to talk about what you miss while also helping you make sense of your life now.
Becoming Parents Can Change Your Relationship
Pregnancy changes a relationship before a baby ever comes home. Both partners prepare for parenthood, but they don’t necessarily experience that preparation the same way.
The pregnant partner is living with the physical reality of pregnancy every day. Her partner may feel excited and involved while still experiencing the pregnancy from a different position. Those differences can affect conversations about sex, medical decisions, work, finances, family involvement, and what life will look like once the baby arrives.
A practical disagreement can also reveal something larger. Deciding who will get up during the night may turn into a conversation about work schedules and whose sleep matters more. A discussion about grandparents visiting after birth may reveal very different expectations regarding privacy and family involvement.
Intimacy Can Change Before and After Birth
Sexual intimacy may also change during pregnancy. Desire can increase, decrease, or feel different. Physical discomfort, body changes, fatigue, anxiety, and concerns about the pregnancy may all become part of a couple’s sexual relationship.
Sex can feel very different after having a baby. You may be tired from being up at night, uncomfortable as your body heals, or simply not ready to be touched after spending much of the day feeding and holding a baby. Your partner may be missing the closeness you shared before the birth and wondering when sex will feel like part of the relationship again. Neither experience is wrong, but it can be difficult when you are not ready at the same time.
These differences do not automatically indicate a relationship or sexual problem. They do, however, give couples something new to communicate about. Counseling can help when those conversations are difficult, especially when partners start assuming what the other’s response means.
The Postpartum Experience Is About More Than Recovering From Birth
The first weeks after birth can revolve around the baby’s immediate needs. Feeding, sleeping, diaper changes, medical appointments, and figuring out why a baby is crying can quickly set the day’s rhythm.
Meanwhile, recovery from pregnancy and birth is still happening. The postpartum period also includes emotional adjustment, changing relationships, sexuality, sleep and fatigue, and developing confidence in caring for a newborn.
A woman’s own adjustment deserves attention too. Becoming a mother can change how a woman feels about her body, her relationship, her independence, and even parts of her identity that once felt familiar. Research on what women value during the postpartum period shows this adjustment goes well beyond physical recovery. Feeling supported as both a woman and a mother is an important part of the postpartum experience.^2
When the Birth You Imagined Is Not the Birth You Had
Pregnancy can come with a picture of how the birth will unfold. Maybe you imagined your partner beside you, holding your baby immediately afterward, taking the first photos, and having that emotional moment you have seen in movies and heard other parents describe. Even when you know birth is unpredictable, it is hard not to imagine what meeting your baby will be like.
Your actual birth may look very different from that picture. Labor may become frightening very quickly. An emergency C-section may mean there is no time to absorb what is happening. You may remember people moving around the room, medical conversations you didn’t fully understand, or feeling as though decisions were being made faster than you could process. You may have been separated from your baby afterward or been too physically unwell to hold or feed your baby the way you had hoped.
Once the immediate danger has passed, everyone else may be ready to celebrate. You may still be trying to understand what happened.
A Difficult Birth Can Stay With You After You Go Home
Leaving the hospital doesn’t necessarily mean leaving the birth experience behind. A particular moment may keep coming back to you. You might replay what someone said in the delivery room, remember how frightened you felt, or wonder whether something could have happened differently.
The feelings of a traumatic birth do not disappear once you get home. Even after you are home with your baby, parts of the birth may still feel very close. You might replay a particular moment from the delivery or wonder whether something could have happened differently. Going back to the hospital for a postpartum appointment may bring up feelings you were not expecting. Hearing someone else happily describe their birth can be difficult too, especially when your own experience still feels frightening or unfinished. These thoughts, intrusive memories, or reminders of the traumatic birth may bring back distressing feelings and could be signs of childbirth-related posttraumatic stress.^3
There can also be grief for the birth you did not get to have. That does not mean you are ungrateful for your baby. The experience mattered to you, and losing the moments you had imagined can hurt even when you are relieved that the birth is over.
Therapy gives you a place to tell the whole story without having to end it with “but at least the baby is healthy.” An experienced, compassionate therapist can help you work through what happened, including the moments that still feel frightening, confusing, or difficult to think about. You don’t have to minimize your experience just because others believe the outcome should make everything that happened along the way feel okay.
Adjusting to Life With a Baby
The first meeting with a baby is often imagined as an immediate, overwhelming moment of connection. When that feeling is not there, questions can start to creep in. Feeding may carry similar expectations. Breastfeeding may be harder than expected, plans may need to change, or feeding decisions may become emotionally charged because of others’ advice and opinions. A mother may spend her days caring for her baby while privately wondering why she doesn’t feel the way she expected.
Those thoughts are not always easy to share. Everyone around her may be celebrating the new baby, while she worries about what her feelings mean. Counseling offers a private place to talk about those early weeks, including fears about bonding or motherhood that may feel too difficult to say anywhere else.
These experiences can affect confidence during a time when new parents are already learning so much. Counseling can help separate the pressure surrounding what motherhood is “supposed” to feel like from what is actually happening.
When Pregnancy or Postpartum Mental Health Needs More Attention
Not every difficult day during pregnancy or postpartum indicates a mental health condition. There are also times when symptoms deserve assessment rather than being attributed to hormones, lack of sleep, or the demands of having a baby.
Depression and anxiety can occur during pregnancy as well as after birth. Trauma symptoms may follow a frightening pregnancy or delivery. Some people experience intrusive thoughts or significant anxiety that makes it difficult to rest even when there is an opportunity to sleep. A previous mental health condition can also return or become more difficult during the perinatal period.
ACOG recommends screening for depression and anxiety during pregnancy and postpartum, with appropriate assessment, treatment, monitoring, and follow-up once concerns are identified.^1
Therapy is one part of care. Depending on the concern, coordination with an obstetric provider, primary care physician, psychiatrist, or another health professional may also be appropriate.
Counseling Can Support More Than a Mental Health Crisis
Pregnancy and postpartum counseling is not limited to treating a diagnosed mental health condition. Sometimes the reason for starting therapy is harder to put into a single category.
Pregnancy may have brought memories or family experiences back to the surface. Communication with a partner may have become more difficult. Someone returning to work may be struggling with a decision she felt confident about before the baby arrived. Infertility or pregnancy loss may still be affecting how a current pregnancy is experienced.
Becoming a mother can suddenly make everyone an expert. Family members, friends, other parents, and even strangers may have advice about what worked for them and what they think should work for you. Much of it is well-intentioned, but sometimes advice isn’t what a mother needs.
Sometimes a mom just wants to say feeding has been hard, she misses her old routine, or something about the birth is still bothering her. An exhausted mother may not be looking for another solution or suggestion. She may simply want someone to listen without correcting, reassuring, or telling her what to do next. Counseling can give a woman room to talk openly about what is happening and feel heard before deciding whether anything needs to change.
Support can also change over time. The concerns discussed during pregnancy may not be the concerns that matter most three months after birth. Continuing therapy allows the work to change as life changes.
Pregnancy and Postpartum Counseling at Pacific Behavioral Healthcare
There is no single reason someone begins pregnancy or postpartum counseling. Some women are looking for treatment for anxiety, depression, trauma, or another mental health concern. Others want support with a difficult pregnancy, infertility, changes in their relationship, the transition to motherhood, or an experience that seems harder than expected.
Pacific Behavioral Healthcare provides individualized pregnancy and postpartum counseling based on what is happening in a person’s life, rather than assuming everyone needs the same support. Therapy can begin during pregnancy, after birth, or while working through fertility concerns.
Contact Pacific Behavioral Healthcare to Schedule an Appointment.
Pacific Behavioral Healthcare offers in-person therapy in Seattle and Bellevue, WA, secure online therapy throughout Washington State, and telehealth services in participating PSYPACT states.
About the Author:
Dr. Shira Olsen, PhD, LPsy, CST, CCPS, DST Director of Betrayal Trauma Therapy | Pacific Behavioral Healthcare
Dr. Shira Olsen is a Washington State-licensed clinical psychologist, PSYPACT-registered Psychologist, and Certified Sex Therapist at Pacific Behavioral Healthcare. She has extensive clinical and research expertise in sexuality, trauma, and intimate betrayal. Dr. Olsen co-developed the Posttraumatic Growth Model for Intimate Betrayal (PTG-IB), an innovative trauma treatment designed to help clients heal after betrayal trauma.
References:
- American College of Obstetricians and Gynecologists. (2023). Screening and diagnosis of mental health conditions during pregnancy and postpartum (Clinical Practice Guideline No. 4). Obstetrics & Gynecology, 141(6), 1232–1261. https://doi.org/10.1097/AOG.0000000000005200
- Dekel, S., et al. (2024). Preventing posttraumatic stress disorder following childbirth: A systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 230(6), 610–641.e14. https://doi.org/10.1016/j.ajog.2023.12.013
- Finlayson, K., Crossland, N., Bonet, M., & Downe, S. (2020). What matters to women in the postnatal period: A meta-synthesis of qualitative studies. PLOS ONE, 15(4), e0231415. https://doi.org/10.1371/journal.pone.0231415
