Pregnancy and Emotional Health

August 30, 2017

Everyone expects pregnancy to be a time for joy and happiness, right? But, for many women, it’s not that simple. Dr. Emma Basch, NYC based clinical psychologist, shares her tips for preparing for pregnancy, gathering support systems, and coping once the baby comes. 


Congratulations – you’re pregnant! You’ve scheduled your OB or midwife appointment, you’re taking your prenatal vitamins, and eating healthfully. But are you taking care of your emotional health? While the media has popularized (poked fun at) the image of the hormonal pregnant woman, weeping uncontrollably at commercials while eating a pint of ice cream, the truth is no laughing matter. The reality is that pregnancy is a time of incredible psychological vulnerability. In fact, the majority of women who experience mental health symptoms postpartum note that their symptoms began during pregnancy, with 14-25% of pregnant women experiencing depression, anxiety or another perinatal mood or anxiety disorder (PMAD). This is especially true if you have a history of depression, anxiety, or another mental health concern.

Why aren’t we talking about this?

Given the high rate of emotional distress during pregnancy, it is a shame we are not giving this issue more serious media and medical attention. There are several reasons for this. First and foremost is shame. The way we talk about pregnancy and the way we often talk to pregnant women silences the experiences of many women who are afraid to admit how different their emotions are from the expectations of others. There is also stigma within the healthcare field, which may lead some medical providers to dismiss a woman’s symptoms.

Another challenge is that many of the symptoms associated with depression or anxiety during pregnancy are quite similar to experiences typical of pregnancy. For example, sleep problems, changes in appetite, a sense of “brain fog” or difficulty concentrating, and fatigue are all typical experiences of pregnancy. However, when these experiences happen with great frequency or intensity, and/or are coupled with additional symptoms such as loss of interest in things you used to enjoy, anxiety, feeling of guilt or hopelessness, they may indicate depression or anxiety.

What can we do about it?

Given that untreated depression, anxiety, or other mental health concerns during pregnancy carry serious consequences for the pregnant mother, the developing fetus and the family as a whole, it is critical that women and their families seek support and treatment. Depression, anxiety, and other mental health concerns are readily treatable via a variety of treatment options. This is what I recommend:

  • If you have a history of mental health concerns, talk to your OB or midwife before getting pregnant. If you are not currently connected with therapy, get connected with a therapist that specializes in PMADs so that you have support in place, or know where to turn if you are not feeling well. If you are or have been on medication to treat any mental health concerns, schedule a consultation with a psychiatrist who specializes in working with pregnant women so you can be fully informed about your medication options during pregnancy. Get your team in place before becoming pregnant or before symptoms arise. If you can, clue your partner or family in to what signs and symptoms to look out for and how they can best help.
  • If you are experiencing mild or transient symptoms, consider lifestyle changes to support your mental health. For many women, interventions such as exercise, yoga, meditation, and getting plenty of sleep can be helpful.
  • Consider a support group – online or in person – to connect with other women going through similar experiences.
  • Consider working with an experienced therapist who works with pregnant women who are having mental health concerns. I recommend “interviewing” several therapists to find a great fit.
  • Medication can be a great asset in treating depression and anxiety in pregnancy. While not without some risk, there is lots of good research on the safety of medication during pregnancy. Connect with a psychiatrist who has experience treating pregnant woman.
  • Prepare for life after you give birth. Given that many women who experience symptoms in pregnancy experience them postpartum as well, think about creating a postpartum support team. Include family or friends who could be helpful, perhaps connect with a postpartum doula, and think about how to continue therapy or other care after baby comes.

Most importantly, know that you are not alone. I’ve seen far too many women suffer in silence during pregnancy. There is support and there is hope.


Screen Shot 2016-05-05 at 9.56.20 PMEmma Basch is a licensed clinical psychologist who maintains private practices in Manhattan and Brooklyn. She specializes in women’s mental health, with a focus on the perinatal period and has received training from the Postpartum Stress Center and Postpartum Support International. For more information, you can check out her website at dremmabasch.com.