You Can Love Your Baby and Still Not Be Okay
You can love your baby and still not be okay.
You can feel deeply grateful to be a mom and still miss your old life.
You can feel bonded and anxious. Excited and exhausted. Overwhelmed and completely in love with this new person.
And sometimes, when someone asks, “How are you doing?” you find yourself talking about how wonderful everything is because you're not quite sure how to explain that you aren't doing so well.
Matrescence, the transition into motherhood, is often compared to adolescence: a period of incredible change in which your body, brain, relationships, and sense of self are all shifting at once. Your body is suddenly healing after pregnancy and birth, trying to find a new normal. Your hormones continue to shift. You take on new roles and responsibilities. Your relationships change. Your sense of self changes, even as you tackle feeding schedules, sleepless nights, and endless diaper changes.
Our society often talks about having a baby in the same way we talk about getting married or graduating college. It is an accomplishment, a rite of passage, and a joy. And it is all of those things. But it is also more transformational than that.
Having a baby is a little like exploding your house so you can build a better—or at least different—one. The end result may be the best thing you've ever done, but living through the explosion can be brutal.
And postpartum mental health doesn't happen in isolation from the rest of the body. Pregnancy, birth, sleep disruption, hormonal changes, physical recovery, nutrition, medical conditions, relationships, and psychological factors can all shape how someone feels during this transition.
This is something I've become increasingly interested in as I work with mothers navigating postpartum anxiety and OCD: sometimes the psychological piece is front and center, and sometimes there are physical or medical factors that deserve attention, too. That's why I was excited to invite Natalie Marchione, DNP, PMHNP-BC, founder of Rooted Postpartum Care, to contribute to this conversation.
Natalie brings a psychiatric and medical perspective to postpartum care and takes a broad view of the physical and emotional changes that can accompany the transition into motherhood. Her perspective offers a helpful complement to what we know about postpartum anxiety and OCD—and a reminder that caring for postpartum mental health can mean paying attention to the whole person.
The Postpartum Transition: Understanding the Physical and Psychiatric Changes After Pregnancy and Birth
By Natalie Marchione, DNP, PMHNP-BC
Rooted Postpartum Care
Bringing home a new baby is often described as one of life's happiest moments. Yet it is also one of the most physically demanding transitions a person can experience.
In the weeks and months after birth, the body is recovering from pregnancy and delivery while adapting to major hormonal changes, fragmented sleep, new nutritional demands, and—in many cases—breastfeeding. At the same time, a new mother is learning to care for an entirely dependent human being while adjusting to an enormous change in her daily life.
These changes don't just affect the body. They can affect how we feel, think, sleep, concentrate, and cope.
The brain and body are constantly communicating, and factors such as sleep, nutrition, hormonal changes, physical recovery, and underlying medical conditions can all influence emotional wellbeing. That doesn't mean that postpartum depression, anxiety, or OCD have a single physical cause. These are complex conditions influenced by biological, psychological, and environmental factors.
But when a mother says, “I don't feel like myself,” it can be useful to consider the whole picture.
Hormones and the Postpartum Transition
Immediately after delivery, estrogen and progesterone—hormones that reached very high levels during pregnancy—drop rapidly. These changes are normal and expected, but they are part of the significant physiological transition that occurs after birth.
Other hormonal systems are changing as well. Thyroid function can fluctuate during the postpartum period, while oxytocin and prolactin play important roles in lactation and the postpartum experience.
Hormones alone don't explain postpartum depression or anxiety, but they are one piece of the larger picture of postpartum recovery.
Physical Recovery and Nutrition
Pregnancy and birth place substantial demands on the body.
Pregnancy requires nutrients to support fetal growth and maternal changes, while childbirth itself involves physical recovery and, for some women, significant blood loss. Breastfeeding can create additional nutritional demands.
Iron deficiency, for example, can contribute to fatigue, dizziness, difficulty concentrating, irritability, and other symptoms that may overlap with what a mother is experiencing emotionally.
Other medical or nutritional concerns can also contribute to symptoms such as fatigue or brain fog. This doesn't mean that every postpartum mental health symptom has a nutritional or medical explanation. It simply means that physical recovery is worth considering alongside mental health.
Sometimes that means talking with your medical provider about symptoms that don't feel right. Sometimes it means looking at nutrition, sleep, or other aspects of recovery. And sometimes it means recognizing that a mother needs more mental health support.
Sleep Is Part of Mental Health, Too
Sleep deprivation is one of the most obvious—and most difficult—parts of early parenthood.
New mothers may sleep in short stretches for weeks or months. Even when a baby is technically sleeping well, nighttime feeding, pumping, pain, physical discomfort, and the constant anticipation of waking can make restorative sleep difficult.
Sleep deprivation can affect mood, concentration, irritability, and our ability to regulate stress. It can also make existing anxiety feel much more intense.
Of course, telling a new mother to “just get more sleep” is not particularly useful when there is a newborn who needs her.
Instead, sleep can be something to consider as part of the larger support system around a mother. Sometimes that means asking a partner or family member to take over a feeding, accepting help with household tasks, or talking with a healthcare provider when sleep problems become overwhelming.
A Whole-Person Perspective
None of this means that postpartum anxiety or depression can be explained by hormones, nutrition, sleep, or laboratory values alone.
Mental health is complex, and every mother's experience is different.
Some mothers primarily benefit from psychotherapy. Others benefit from medication. Some need medical evaluation or treatment for a physical condition. Many need several forms of support at the same time.
The goal isn't to replace mental health treatment with a focus on the body.
It's to remember that postpartum mothers are whole people.
When a mother says she doesn't feel like herself, it can be worth asking both:
How are you doing emotionally?
and
How is your body recovering?
Sometimes the answer to one helps us understand the other.
When the Mind Tries to Make Postpartum Certain
By Erin Cook, PsyD, PMH-C
Licensed Clinical Psychologist
One of the things I find most interesting about the postpartum period is that the same uncertainty that makes motherhood so profound can also make it fertile ground for OCD. You suddenly have something you care about more than almost anything else in the world, and you're responsible for keeping a tiny, vulnerable person safe. You're sleep deprived, your routines have disappeared, your body may feel unfamiliar, and there is an enormous amount you simply cannot control. For most people, that uncertainty is uncomfortable. For someone vulnerable to OCD, it can become a problem the brain desperately wants to solve.
The thoughts themselves can be frightening: What if I drop the baby? What if I accidentally hurt the baby? What if I lose control? What if I don't actually love my baby enough? What if something is terribly wrong?
These are examples of intrusive thoughts—unwanted thoughts, images, or impulses that can be deeply upsetting. Having an intrusive thought isn't the same thing as wanting something to happen, and a frightening thought isn't evidence that it is meaningful, predictive, or reflective of who you are.
What matters clinically is what happens next.
For some mothers, the thought is frightening but passes. For others, the brain starts treating the thought as a problem that needs to be solved. Why did I think that? What does it mean? What if it means something about me? What if I can't trust myself?
That can lead to checking the baby's breathing, Googling symptoms late into the night, asking a partner for reassurance, mentally replaying something that happened hours earlier, or monitoring your own feelings to make sure you're bonding “correctly.” You might also begin avoiding situations that trigger the fear—like being alone with the baby, carrying them down the stairs, or using certain objects around them.
That's where an intrusive thought can become part of an OCD cycle.
When OCD Starts Asking You to Prove You're a Good Mother
Postpartum OCD doesn't always look like the stereotypical fear of contamination or illness.
Sometimes the obsession is about whether you're a safe enough, loving enough, or responsible enough mother.
You may repeatedly check your baby's breathing. You may research illnesses or developmental milestones. You may ask your partner to reassure you that you're a good mother. You may mentally review an interaction from hours earlier to make sure you didn't somehow cause harm.
And sometimes the compulsion is not doing something at all.
You might avoid being alone with your baby.
You might avoid carrying them down the stairs, bathing them, driving with them, or using certain objects around them because your brain has attached danger to those situations.
From the outside, some of these behaviors can look like particularly careful parenting.
But there's an important difference between taking reasonable precautions and trying to eliminate uncertainty.
And postpartum OCD can make that distinction especially difficult because, as a new parent, you really are responsible for another person's safety.
A Note About Postpartum Psychosis
It's important to distinguish the intrusive thoughts that can occur with postpartum anxiety and OCD from postpartum psychosis.
In postpartum OCD, intrusive thoughts are typically experienced as unwanted and frightening. The person recognizes them as thoughts and is distressed by them.
Postpartum psychosis is different. It can involve hallucinations, delusions, paranoia, severe confusion, or losing touch with reality.
Postpartum psychosis is a psychiatric emergency and requires immediate medical evaluation.
If you or someone you know is experiencing symptoms of psychosis, seek urgent medical help rather than trying to manage them as anxiety or OCD.
The Goal Isn't to Make Postpartum Feel Certain
The postpartum period is full of uncertainty.
You can't guarantee that your child will never get sick.
You can't guarantee that you'll never make a parenting mistake.
You can't guarantee that you'll always feel bonded, patient, or joyful.
For someone with OCD, the instinct can be to respond to that uncertainty by trying harder to eliminate it.
But the goal isn't to become a mother who never worries.
It's to become a mother who doesn't need certainty in order to keep living her life.
That may mean learning to let an uncomfortable thought pass without analyzing it, resisting the urge to repeatedly check or seek reassurance, or gradually returning to situations you've been avoiding.
That's where ERP (Exposure and Response Prevention) can help. Rather than teaching you how to prove that your fears won't happen, ERP helps you practice responding differently to uncertainty and to the thoughts, feelings, and situations that trigger your OCD.
Importantly, ERP is not about forcing yourself to do something dangerous. It is about learning to stop treating uncertainty and unwanted thoughts as emergencies.
If you're spending hours checking, researching, avoiding, seeking reassurance, or trying to figure out what your thoughts mean, you don't have to wait until you're completely overwhelmed to seek support.
Postpartum anxiety and OCD are treatable. And getting help doesn't mean you're failing at motherhood.
Supporting the Whole Person
Postpartum mental health isn't exclusively a problem of the mind or the body.
Sometimes a mother needs her iron checked. Sometimes she needs more sleep and practical support. Sometimes she needs medication. Sometimes she needs psychotherapy. Sometimes she needs ERP.
Often, she needs more than one of these things.
Whole-person care doesn't mean deciding that every psychological symptom has a biological explanation. It means staying curious about the whole person.
And for mothers experiencing OCD, that also means recognizing when trying to figure out exactly what's wrong has itself become part of the OCD cycle.
You don't have to solve every uncertainty of motherhood before you can feel like a good mother.
You can take care of your body. You can take care of your mind. And you can learn to live with the things neither one can make certain.
About Natalie Marchione
Natalie Marchione, DNP, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner and founder of Rooted Postpartum Care. She holds a Doctor of Nursing Practice from the University of Maryland, Baltimore and is a Certified Postpartum Nutrition Specialist. She has advanced training in perinatal mental health and functional and integrative medicine and is licensed in Maryland, Washington, DC, and Wyoming.
Wondering If What You're Experiencing Is OCD?
Postpartum anxiety and OCD can be incredibly confusing—especially when you're not sure whether you're experiencing normal new-parent worry, intrusive thoughts, or something more.
You don't have to figure that out on your own.
At Red Elm Psychotherapy, we specialize in perinatal anxiety and OCD, including postpartum OCD, and provide evidence-based treatment such as Exposure and Response Prevention (ERP).