Nobody Told Me Pregnancy Would Be This Mentally Exhausting
We all grew up with a version of what pregnancy was supposed to look like. A glowing woman in a rocking chair, knitting tiny clothes, a light breeze carrying in the soft promise of everything that is coming. Morning sickness, maybe. A few extra trips to the bathroom. A belly that grows and a heart that fills.
Nobody told us about the other kind of exhaustion.
The one that shows up somewhere around eight weeks and settles quietly into everything. The appointments to track and reschedule. The research that never quite ends, about food and vitamins and birth plans and whether you need a doula and what your body is doing and whether it is doing it right. The worry that arrives without warning and does not leave.
If pregnancy has felt harder than you expected, not just in your body but in your mind and your heart, I want you to know you are not alone. And you are not doing it wrong.
The Gap Between What We Are Told and What We Feel
There is an enormous gap between the way pregnancy is often described and what many women actually experience. We grew up with the expectation of glow, joy, nesting, a sacred time of connection and anticipation. The reality for many women is something messier and more complicated. It can even feel, at times, like we have been lied to.
According to the Policy Center for Maternal Mental Health, maternal mental health disorders affect approximately 20% of women in the United States. Anxiety disorders are among the most common, with the highest rates occurring during early pregnancy at 25.5%. Maternal depression is just as common during pregnancy as it is in the postpartum period, a fact that continues to surprise many people, including many healthcare providers. And over the last decade, the mental health of US mothers has measurably worsened. Between 2016 and 2023, mothers reported a nearly 65% increase in fair to poor mental health.
And yet the dominant cultural narrative is still that this is supposed to be one of the best times of your life. If it does not feel that way, something must be wrong with you. Nothing is wrong with you. The gap between expectation and experience is real.
The Cognitive Load Nobody Names
A 2024 review published in Nature Mental Health introduced a concept that many pregnant women will recognize immediately: the mental load. It describes the invisible cognitive labor of tracking, anticipating, planning, and managing all the things that come with growing a human and preparing for a life to arrive.
This mental load begins in pregnancy and does not wait for the baby to arrive. It includes:
Researching and tracking prenatal care
Making decisions about nutrition, exercise, and supplements while navigating a flood of often contradictory information
Managing appointments across multiple providers
Planning for birth, educating yourself, making decisions, and communicating your preferences
Preparing for parental leave and the logistics of returning to work
Thinking through childcare, finances, and the practical realities of what comes next
Managing the worries: about the health of the pregnancy, about labor, about whether you are doing everything right
This is an enormous cognitive undertaking. It is largely invisible, largely unacknowledged, and largely carried alone or disproportionately by the pregnant person. Research on the maternal brain confirms that this mental load has real neurological impact. It is not a metaphor. It is actual cognitive labor, happening continuously, with no scheduled breaks.
The Emotional Load Is Real Too
Beyond the cognitive, there is the emotional terrain of pregnancy that does not get enough honest conversation.
The anxiety about whether the pregnancy will be okay. The fear about labor and what it will be like. The complicated feelings that arise when the pregnancy was planned, or when it was not, or when it came after loss. The identity questions that can feel disorienting, particularly for women who have built strong, clear senses of self that are now in some process of reorganization.
Researchers use the term matrescence to describe the profound transition of becoming a mother. It is not unlike adolescence in its scope, touching biological processes, social roles, relationships, and sense of self simultaneously. And like adolescence, it is rarely talked about honestly while it is happening.
What makes this even harder is how often women's emotional experiences during pregnancy go unacknowledged by the people caring for them. A 2025 study cited by the Policy Center for Maternal Mental Health found that 62% of women felt judged or treated unfairly during the perinatal period. Many described their mental and emotional experiences being minimized by providers. If that has happened to you, please know: your experience was real, and you deserved better.
Why Prenatal Mental Health Support Is Often Overlooked
Most of the attention in perinatal mental health care has historically been focused on the postpartum period. This makes some sense. The postpartum period carries significant risk, and there are now more established screening protocols and awareness campaigns around postpartum depression. But it has created a gap in care during pregnancy itself, when so many women are quietly struggling without the language or the permission to ask for help.
The scale of that gap is significant. According to Behavioral Health News and the Policy Center for Maternal Mental Health, almost 75% of women experiencing maternal mental health conditions never receive treatment. Many of those gaps begin in pregnancy, when symptoms are present but attributed to normal discomfort, when screening does not happen, or when a woman does not feel she is struggling enough to deserve support.
Here is what the research actually tells us. An NIH-supported clinical trial published in Nature Medicine in 2024, led by researchers at the Johns Hopkins Bloomberg School of Public Health, found that women who received prenatal mental health intervention had 81% lower odds of developing postpartum depression compared to women who received standard care alone. Treating mental health during pregnancy is not just about feeling better right now. It is prevention for what comes next.
You Are Allowed to Need Support Before the Baby Arrives
There is an idea, sometimes spoken and often just felt, that therapy and mental health support are for after the crisis, after the baby, after you have more clearly crossed some threshold into struggling. But that is not how mental health works, and it is not how good care works either.
If pregnancy is bringing up anxiety, fear, grief, complicated feelings about your relationship, your identity, your history, or any of the thousand things it can surface, you do not have to wait. You do not have to be at a breaking point to deserve support. Feeling overwhelmed during pregnancy is not a character flaw or a sign of things to come.
At Dr. Emma Basch and Associates, we work with pregnant individuals at every stage of the journey. We provide in-person therapy in Washington, DC, and telehealth in Maryland, Virginia, and 40 or more states. We would be honored to be part of your support.
Reach out to connect with a perinatal specialist →
Emma Basch, PsyD is a licensed psychologist and the founder of Dr. Emma Basch and Associates, a Washington, DC practice specializing in perinatal mental health, women's mental health, and trauma. She is a certified Perinatal Mental Health specialist (PMH-C) and has spent more than a decade supporting women through every stage of the reproductive journey, including pregnancy itself.Learn more about Dr. Basch →
Frequently Asked Questions About Mental Health During Pregnancy
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Anxiety during pregnancy is very common. According to the Policy Center for Maternal Mental Health, anxiety disorders affect approximately 20% of pregnant women, with the highest rates occurring in early pregnancy. Some degree of worry is a normal part of pregnancy. But when anxiety is persistent, intrusive, or getting in the way of daily functioning, that is a sign that it has moved beyond typical pregnancy experience into something that deserves real attention and care. You do not have to manage this alone.
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Yes, and this is one of the most important and underrecognized findings in perinatal mental health research. An NIH-supported clinical trial published in Nature Medicine in 2024 found that prenatal mental health intervention reduced the odds of postpartum depression by 81% compared to standard care. Addressing anxiety, depression, and emotional overwhelm during pregnancy is not just about feeling better now. It is one of the most effective things you can do to protect your mental health in the months after your baby arrives.
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Prenatal therapy looks different for everyone depending on what brings you in. For some women, it is anxiety management and building tools for navigating the uncertainty of pregnancy. For others it is processing grief from previous losses, working through fears about birth or parenthood, or navigating the identity shifts that come with this transition. A good perinatal therapist will meet you where you are and build a plan that reflects what you actually need, not a generic approach to pregnancy discomfort.
References
Policy Center for Maternal Mental Health. (2026, July). Maternal mental health fact sheet. Retrieved from policycentermmh.org
Behavioral Health News. (2025, July). America's hidden maternal mental health crisis. Retrieved from behavioralhealthnews.org
Surkan, P. J., Malik, A., Perin, J., Atif, N., Rowther, A., et al. (2024). Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: A randomized phase 3 trial. Nature Medicine, 30, 730-737. doi:10.1038/s41591-024-02809-x
National Institute of Mental Health. (2024, February 27). Talk therapy cuts risk of postpartum depression. Retrieved from nimh.nih.gov
Staneva, A., Bogossian, F., Molyneaux, E., and Wittkowski, A. (2024). The maternal brain: Matrescence, mental load and mental health. Nature Mental Health. doi:10.1038/s44220-024-00254-4
MGH Center for Women's Mental Health. (2024). CBT intervention delivered by non-specialist providers significantly reduces risk of postpartum depression. Retrieved from womensmentalhealth.org