When Pregnancy Doesn’t Feel Like You Thought It Would
Last month, I was speaking to a group of moms when someone raised her hand and asked a question I hear more and more often:
“Can a PMAD happen during pregnancy? I thought it only shows up after the baby is born.”
It’s a great question that doesn’t get talked about nearly enough.
Most people have heard of postpartum depression or anxiety, but far fewer realize that Perinatal Mood and Anxiety Disorders (PMADs) can absolutely show up during pregnancy. In fact, for many women, the symptoms begin long before the delivery room.
This matters because when PMAD symptoms go unnoticed, women may feel alone or like they’re “just not handling pregnancy well”. A PMAD going without help impacts both mom and baby.
Pregnancy Comes With a Lot
Pregnancy brings physical discomfort, hormonal shifts, nausea, exhaustion, sleep challenges, and a whole range of emotions. It’s normal to have days where you feel overwhelmed or not quite like yourself.
But there’s a difference between typical pregnancy symptoms and something that needs more support.
And that difference can be hard to spot if you don’t know what to look for.
A Side-by-Side Comparison
Typical Pregnancy Symptoms
These are uncomfortable, but generally manageable:
Emotional ups and downs that come and go
Worry that eases with reassurance
Sleep issues caused by discomfort
Fatigue from physical changes
Occasional irritability
Appetite changes from nausea or cravings
Self-esteem generally stable — you still feel like “you”
Pregnancy symptoms affect your body, and they usually respond to rest, reassurance, or time.
PMAD Symptoms During Pregnancy
These are more persistent and more disruptive:
Intense or lingering sadness, anxiety, or dread
Racing or intrusive thoughts that won’t stop
Feeling overwhelmed most days
Sleep changes driven by fear, worry, or restlessness
Loss of joy or emotional numbness
Feeling disconnected, hopeless, or ashamed
Self-esteem feels fragile — like you don’t quite feel like yourself anymore
PMAD symptoms affect your body, mind, and ability to function, and they often last more than two weeks.
A Helpful Way to Make Sense of It
Here’s one way I often explain the difference to clients:
Pregnancy symptoms are uncomfortable.
PMAD symptoms are overwhelming.
Pregnancy symptoms come in waves.
PMAD symptoms tend to persist.
Pregnancy affects your body.
PMAD affects your body and your sense of self.
If you feel like you’re losing joy, losing yourself, or losing your ability to function that’s a sign you deserve extra support.
Why This Matters
When PMAD symptoms show up during pregnancy and go unnoticed, women often:
Blame themselves
Assume they’re “just hormonal”
Feel guilty for struggling
Delay getting the help they need
Feel isolated even with support around them
But when symptoms are identified early, women get the support they need sooner, and outcomes are significantly better for both mom and baby.
We’re Here to Support You
At Clark Counseling, we specialize in perinatal mental health and support women through pregnancy, postpartum, and all the messy, beautiful seasons in between.
If something you’re experiencing feels intense, persistent, or “not like you,” we’d love to support you.
