After years of engaging with parenthood from a distance, it’s time for a psychiatrist specializing in women’s mental health to take her own advice.
I’m not someone who dreamed of motherhood as a girl. Quite the opposite. In my early 30s, I had a recurring nightmare in which I was unknowingly pregnant and the fetus felt like a parasite invading my body.
Growing up in South Asian culture, which valorizes women’s childbearing and mothering responsibilities above all else, was one reason for my fear. I also got divorced in my late 20s. Becoming a mom didn’t seem like it was in the cards for me and I was OK with that.
Despite these life experiences, I became a physician specializing in maternal mental health. After I graduated from my psychiatry residency and chose to focus on perinatal psychiatry, my therapist gently suggested that my decision was perhaps a healthy coping mechanism — a way for me to “try on” motherhood from a comfortable distance. There was something pulling me close to motherhood, but the role did not feel safe for me to experience myself — until now.
Currently, I am 34 weeks pregnant. I’m coming to motherhood at the age of 38. My partner and I had the privilege of making this choice to become parents later in life, using assisted reproductive technology to conceive. And I know that my career and life experiences have provided me with a better understanding of what I was afraid of and with the ability to prepare for motherhood in the ways that matter most.
Ambivalence about motherhood is normal.
In psychoanalytic terms, you could say I was “conflicted” for many years. In day-to-day life, we often also call this “ambivalence” — the feeling of having two contradictory emotions at once.
At work, I helped my patients seek relief from postpartum depression and anxiety, with the aid of psychotherapy and, sometimes, medication. Simultaneously, I saw my friends go through the chaos of early parenthood. In one instance, a college friend visited me in my tiny Washington, D.C., apartment, and we were held hostage by her son’s nap schedule to a comical degree, unable to enter my bedroom or turn on any lights for 48 hours.
I wondered why someone would want to put themselves through so much hardship. I knew the data and I wrote about the difficulties of motherhood — having a child in America was not an attractive proposition to me.
But I still wanted to keep my options open. At 35, my partner and I met with a fertility doctor about freezing my eggs. He and I learned that the success of egg freezing was more difficult to predict in a woman’s mid-30s. For the greatest likelihood of success conceiving in my late 30s, we would need not only to freeze embryos but also genetically test them — both of which are more expensive and time-consuming than freezing eggs.
It was during the year of researching how to freeze my eggs and make embryos that I began to notice the positive aspects of motherhood in my clinical work. I had taken care of enough patients to see that even those suffering from severe perinatal mood and anxiety disorders got better with treatment. In one session, a patient who had experienced a depressive episode during pregnancy described the delight she felt when her daughter first grasped her fingers, and later, recognized her face and started babbling. In witnessing these women soak up the pleasures of motherhood despite the dark times, I became less fearful and more curious about how I would feel in the role.
Soon after, my partner and I started trying to have a baby. After seven tedious months, I got pregnant, only to have a first trimester miscarriage over Thanksgiving in 2020. The loss was emotionally and physically painful even with a good support system to lean on. But looking back, the part that stands out to me was how happy I was to be pregnant for those few weeks. That unexpected joy gave me clarity that we were making the right choice.
Since I was 37 at the time, we decided to pursue in vitro fertilization, and after about a year of hormone injections and multiple medical procedures, I got pregnant again. The baby now growing inside me does not feel like a parasite or an alien and every time I feel a kick I get a jolt of excitement.
But, that doesn’t mean my ambivalence has gone away. My career requires me to pour myself into my work in an almost singular fashion. Once I become a mother, I won’t have that luxury.
I’m meeting the next version of me.
I recently spent an hour of my Saturday trying to find baby sheets that will fit the crib listed on our registry. Why aren’t baby products standardized? This was yet another example of the mental load of motherhood, I posted on Instagram.
I got an influx of recommendations on the “best” baby sheets to purchase. Instead of relief, I felt enraged — the responses only proved my point further. The pressure to perform motherhood, to research all these products and show that you care about every little detail can feel oppressive, not to mention that in cisgender heterosexual couples, this expectation is generally reserved for mothers.
During the transition to motherhood, I’ve needed to take some of my own advice.
Make a habit of spending mental energy on yourself.
Instead of decorating a nursery or reading parenting books, I am using this time to prioritize my well-being, knowing that every choice I make in service of my own mental health will serve this baby well. Having previously suffered from depression and anxiety, I am at high risk for a postpartum mood disorder. Staying on medication, getting enough sleep and creating a social support network are three evidence-based interventions for preventing postpartum anxiety and depression. I am preemptively taking a selective serotonin reuptake inhibitor during pregnancy (with the support of my doctors). I’ve also hired a postpartum doula and contacted a pelvic floor physical therapist for the inevitably bumpy recovery. Putting time and resources into my own mental health is not selfish — it’s what matters most.
Yet, I am exceedingly fortunate: I have a supportive partner and health insurance that allows me to see a therapist, and I am part of a household with two stable incomes. My close friends, all of whom have kids, even offered to make me a baby registry. Which brings me to my second point.
Recognize the need for systemic change.
Many families are not in a position of privilege to make the choices I have available to me during this vulnerable time. The seemingly simple intervention of making sure I’ll be able to get some sleep as a new mom is out of reach for many in a country where fewer than 5 percent of fathers take more than two weeks of leave, and one in four mothers return to work in two weeks. Black and Latina women have an even more difficult time getting mental health support in early parenthood.
As I’ve written in the past, we need broad social change. For example, a Swedish study found that when fathers were given flexible paid paternity leave, there was a 26 percent decrease in prescription anti-anxiety medications for postpartum moms.
That said, alongside the fight for social change, small choices can help you feel a sense of control when living in an inequitable system. The weight of motherhood is far too heavy of a load to carry on your own. Say yes when friends or family offer a postpartum meal train instead of reflexively declining the help. Set limits on the time you spend researching products and instead put that energy into activities that serve your well-being.
Open yourself up to excitement in the face of fear.
My due date is approaching, and I still spend time in therapy talking about my trepidation. I am coming to motherhood armed with the knowledge of what happens when things go terribly wrong, and with the tools to stay emotionally healthy. I know I will be changed by the experience. Sometimes I just question whether I will like the new version of myself.
Perhaps I am afraid of how much love I might feel for this baby, my therapist says. Maybe she’s right. I’m terrified and excited to get to know this next version of myself, in the same way that I’m terrified and excited to get to know our child.
Dr. Pooja Lakshmin, M.D., is a board-certified psychiatrist specializing in women’s mental health and a clinical assistant professor at the George Washington University School of Medicine. She is the founder and CEO of Gemma, a digital education platform focused on women’s mental health, impact and equity, and the author of a book on the tyranny of self-care coming in 2023.