Is your fetus a tangerine or a pear this week? Does it even matter? Pregnant people have long measured their pregnancies in fundal height, in countdowns to the next scan, to the next test. But reproductive psychiatrists Dr. Alexandra Sacks and Dr. Catherine Birndorf know there is much, much more to learn, and to prepare for, during pregnancy. Their book, What No One Tells You: A Guide To Your Emotions From Pregnancy To Motherhood, is intended to fill that gulf with practical, even-handed information about the many moods of expectant- and early parenthood. "No matter how much time you've spent envisioning this moment, your experience is likely to be different from how you envisioned it," they write in the book. Underline it.
Beyond the pictures of babies in little nightcaps and miniature Osh Kosh a mother might post to Instagram, her emotional life is a true electric lightshow, and we have paid almost no attention to it until recently. Those working in the relatively new field of reproductive psychiatry (it wasn't until 1994 that the National Institutes for Health mandated the inclusion of women in medical studies) have drawn attention to the prevalence of perinatal mood and anxiety disorders (PMADs), which affect as many as 20 percent of pregnant and postpartum women, per Postpartum Support International, and greatly benefit from early detection and care. Sacks and Birndorf, co-founder and medical director of The Motherhood Center of New York, have worked to demystify psychiatric conditions related to pregnancy and postpartum, but also normalize the profound mix of unease, joy, ambivalence, and every other emotion that make up what Sacks terms "matrescence" — an anthropological term used to describe the transition, not unlike adolescence, a person goes through as they become a mother. If 20 percent of women experience a PMAD, Birndorf points out, that leaves 80 percent of mothers who deal with challenging ups and downs as a part of the basic-cable package of maternal emotions. This book deals with all of those feelings and thoughts.
If I had to summarize the challenges that await a mother ahead of perhaps the biggest thing to ever happen to her — the arrival of her child — it might look a bit like a Ninja Warrior contestant standing on the starting line. They don't know if they're going to end up in the drink or summit Mt. Midoriyama, because they've never been there before. It is all new. It is a literal leap into the unknown.
What No One Tells You takes you through each trimester through the fourth explaining the friction points you might encounter, like feeling disappointed when you find out the gender, telling your parents you are pregnant and finding you have triggered their own fears of aging (time is going so fast! Aren't grandmas supposed to be old people?), disliking your changing body, or feeling guilty about abandoning your career at a crucial moment. Simply seeing those private thoughts in print — thoughts you perhaps fancied were unique to you — is powerful. But at every step of the way Birndorf and Sacks go further, normalizing the experience and providing tools for dealing with the unease.
Multiple times a day you may ask yourself, Am I doing this right?
From conception through early parenthood, you're dealing with both changes to your own body (hormonal and otherwise) and lifestyle, and also with the ripple effects to your partner, your existing children, if you have them, and to your friends and extended family and workplace. There are many moving pieces! Plus there is the twist of having a new person to learn and look after, as the book notes: "Multiple times a day you may ask yourself, Am I doing this right? and wonder, Where are the real grown-ups? What are they thinking, leaving me alone with this child?"
There might be intrusive thoughts, there might be anxiety (there will probably be some anxiety!), there will be a mix of positive and negative thoughts about motherhood. Being primed to expect a spectrum of feelings has the power to reduce the stigma around these experiences. Shame or guilt about the parenting experience can lead to social isolation, which in turn can contribute to depression. The book discusses treatment for PMADs, and offers tips from cognitive behavior therapy on addressing unhelpful thoughts.
"People panic sometimes when they are experiencing discomfort," Sacks told me previously, and a serving of knowledge around what you are feeling can be profoundly comforting. "We should not be afraid of the feelings that come with things that are rarely easily acquired," Sacks said of the unease during periods of growth like early motherhood.
Not to belabor my Ninja Warrior analogy, but if, at the starting line, you understand there will be a water challenge, three spinning logs, and a spider wall, you can mentally prepare for them.
Motherhood is no different, so let's talk about it.
What No One Tells You: A Guide To Your Emotions From Pregnancy To Motherhood is out now from Simon & Schuster.
If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.