The Depression That Comes Before Baby: Pregnancy Therapy in Washington, DC for Antenatal Depression
When we talk about depression and motherhood, we tend to talk about what happens after the baby arrives. Postpartum depression has, fortunately, become much more widely recognized. But depression can also begin during pregnancy.
For some women, this is especially confusing. Pregnancy is supposed to be a time of anticipation. Perhaps you wanted a baby for years. Perhaps you went through infertility treatment or experienced previous losses. Perhaps you simply assumed that once you became pregnant, you would feel happy.
Instead, you feel depressed or disconnected.
And alongside the depression may come another question: Why do I feel this way when this is something I wanted?
Therapy can also offer something beyond symptom relief. It can provide a place to become curious about what pregnancy—and the enormous transition already underway—means to you.
The Pregnancy You Imagined and the Pregnancy You Experience
Long before becoming pregnant, many women have some idea of what pregnancy will be like.
Perhaps you imagined feeling excited when you saw your body begin to change. You thought you would feel connected to the baby growing inside you. You imagined telling friends and family, preparing a nursery, choosing a name, or thinking about the person your child might become.
The actual experience may be very different.
Instead of excitement, there may be anxiety. Instead of feeling connected to the baby, you may feel strangely detached. You might have strange dreams. You may be exhausted, nauseated, irritable, frightened, or simply not feel much of anything.
The difference between the pregnancy you imagined and the pregnancy you are actually experiencing can itself become painful.
There is the original feeling—sadness, fear, anger, numbness—and then there is the judgment of the feeling.
I should be happier.
Other women would be grateful to be in my position.
Why don't I feel the way I thought I would?
Sometimes the imagined experience of pregnancy has to be grieved too. You may have gotten the pregnancy you wanted without getting the experience of pregnancy you expected.
When Your Body Begins Changing Without Your Permission
Pregnancy also creates an unusual relationship with one's body.
Your body is still your own, and yet something extraordinary is happening within it that you cannot completely direct.
Your shape changes. Your breasts change. Your appetite may change. Your energy changes. You may experience nausea, pain, insomnia, constipation, swelling, or physical sensations you have never experienced before.
And these changes continue whether or not you feel psychologically prepared for them.
For some women, this is exciting. For others, it can be frightening. And sometimes it is both.
A woman who has historically managed uncertainty through planning, competence, self-discipline, or control may find pregnancy particularly disorienting. There are certainly things she can do to care for herself and her pregnancy, but there is also a fundamental limit to how much she can control.
The body is doing something on its own timetable.
For some women, that loss of control can feel terrifying.
Pregnancy may therefore bring questions about the body that go beyond appearance.
What happens to me when my body feels unfamiliar?
What does it mean to depend upon a body I cannot completely control?
How do I experience vulnerability?
What does it feel like to have another person growing inside me?
These questions will mean something different to every woman. Therapy can provide a place to discover what they mean to you.
Becoming a Mother Begins Before the Baby Arrives
Pregnancy is not only a biological process. It is also a psychological transition.
Before the baby has arrived, something has already begun to change.
You may find yourself thinking differently about your career, your relationship, your parents, your childhood, your body, your independence, or the future.
The identity you have known is beginning to make room for another identity: mother.
That process is not always seamless.
For a woman who has spent decades building a life, becoming a mother can raise difficult questions about what will remain and what will change.
What will happen to my work?
What will happen to my relationship?
Will I recognize myself?
Will there still be room for the person I was before?
These questions can coexist with tremendous anticipation about the baby.
But they can also involve grief.
Something new is beginning, and something about the old arrangement of one's life is ending.
The Confusion of Conflicting Feelings
Pregnancy can also bring feelings that are difficult to reconcile.
A woman may have longed to become pregnant and find herself frightened once she is. She may feel excited about becoming a mother and simultaneously experience a powerful sense of loss. She may feel tenderness toward the baby growing inside her at one moment and resentment, distance, or even a wish to escape the pregnancy at another.
These contradictions can be deeply confusing.
How can I have wanted this and also feel this way?
What does it mean that part of me wishes I could go back to my life before I was pregnant?
Why don't I feel the way I thought I would?
Sometimes the feelings themselves are frightening. But the uncertainty about what they mean can be frightening too.
A woman may become preoccupied with figuring out which feeling is the "real" one. She may worry about what an unwanted thought or feeling says about her, the pregnancy, or the kind of mother she is becoming. She may even worry about what these thoughts are “doing” to her baby.
There can be considerable pressure—from oneself and from the culture surrounding pregnancy—to resolve these contradictions quickly. To decide that one feeling is true and the other doesn't really count.
A psychodynamic approach does not necessarily require that resolution.
Instead, therapy can provide a place where contradictory feelings can exist long enough to be thought about.
Rather than immediately deciding what a feeling means, there can be curiosity about why this particular feeling is emerging now, what it evokes, and how it connects to the enormous psychological transition already underway.
For some women, one of the most difficult aspects of pregnancy may be tolerating the fact that they can have feelings they do not yet fully understand.
Pregnancy Can Bring the Past Closer
Becoming a mother can also change how you think about your own childhood.
You may find yourself thinking about your mother differently. Memories that seemed unimportant may suddenly feel significant. You may think about what you received from your parents, what you wished you had received, and what you hope to do differently.
Sometimes this happens quite consciously.
At other times, the past may appear less directly—in anxiety, dreams, fears about the baby, irritability toward a partner, or a feeling that something is wrong that is difficult to put into words.
Pregnancy can bring earlier experiences of dependency, care, separation, vulnerability, or loss psychologically closer.
The question in therapy isn't necessarily whether the past "caused" the depression.
It may be more useful to ask: Why is this particular experience affecting me in this particular way now?
Pregnancy Therapy Isn't About Teaching You to Feel Differently
When someone is depressed during pregnancy, it can be tempting for the people around her to reassure her.
You'll feel differently once the baby comes.
Try to enjoy this.
You wanted this for so long.
Usually these comments are intended to help. But they can leave a woman feeling even more alone with what she is actually experiencing.
Psychodynamic therapy offers a different kind of space.
The goal isn't to persuade you that pregnancy is wonderful or to replace every frightening thought with a reassuring one.
It is to become curious about your experience.
What does becoming a mother mean to you?
What is changing in how you understand yourself?
What does the loss of control over your body evoke?
What are you afraid you will lose?
What do you imagine you will gain?
What feelings seem particularly difficult to allow yourself to have?
And what might your depression be occurring alongside that has not yet been possible to put into words?
There may not be immediate answers to these questions.
Part of the work can be developing the capacity to stay with uncertainty long enough for something about your experience to become clearer.
Psychodynamic Therapy for Antenatal Depression in Washington, DC
Depression during pregnancy is real depression, and it is important to take it seriously. Depending on the severity of symptoms, treatment may involve psychotherapy, consultation with an obstetric or psychiatric provider, medication, or a combination of approaches.
Psychodynamic therapy can be one part of that care.
It provides a place not only to ask "How do I stop feeling this way?" but also:
"Why does becoming a mother feel this way to me?"
Pregnancy can reorganize one's relationship to the body, identity, partner, parents, work, dependency, control, and future—all before the baby has arrived.
For some women, that transition is joyful. For others, it can be frightening or depressing. For many, it contains feelings that are much more complicated than either category allows.
Therapy can offer a place where those feelings do not have to be resolved before they can be spoken about—and where the particular meaning of this pregnancy, for this particular woman, can gradually be discovered.
Start Psychodynamic Therapy in Washington, DC, Bethesda, MD, and Chevy Chase, MD
If you're depressed during a pregnancy you wanted, you are not doing this wrong, and you are not alone. The feelings that don't match what you expected — fear, numbness, grief, ambivalence — deserve to be understood rather than explained away. Psychodynamic therapy offers a place to become curious about what this pregnancy means to you, without anyone insisting you should just feel grateful or that you'll feel better once the baby comes. Antenatal depression is real, and it deserves real care. You can start therapy with Nina Van Sant, LICSW by following these simple steps:
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Other Services Offered with Nina Van San, LICSW
Psychodynamic therapy is not the only service that I offer from my Washington, DC-based practice. I am happy to offer support in a variety of forms, including postpartum therapy, psychoanalysis, and therapy for teens and older adults at different developmental stages. I also provide support for expats and international professionals who are managing cultural adjustment, relocation stress, and the stress that major life changes can bring. You can visit my blog or about page for more support today!