Today I knelt on the floor, changing my son’s diaper. I placed my index finger along the ridges of indentation on his skin, just below his hip, as I loosened the tape. My brain instantly cued me to comfort him, anticipating that he might start to cry. It’s one of the many essential tasks on my unending mental to-do list.
Motherhood, I’ve discovered through trial and error, and through my work as a clinical psychologist, is a series of a million “cues” like this. After becoming a mother, I stepped into a new time zone, one where countless little gestures and reflexes happen each day without me even being conscious of them.
Motherhood represents a dramatic and often “traumatic” change to our brains, albeit a normal one. That’s why I’ve dedicated my career to helping patients — particularly new mothers — navigate the postpartum stage with evidence-based therapy.
As a society, we’re completely unprepared to support mothers, but the most unprepared of all are the actual mothers. With only four percent of research funds dedicated to women’s health, it makes sense that even after decades of analysis, we still have a scant understanding of the maternal brain. Some new moms may not know that they’ll undergo a comprehensive rewiring: Their brains are pruning what it doesn’t need, and amassing massive new neural networks — millions of pathways that make Mom brilliant at caring for a child, even when doing something as mundane as changing a diaper. (Or maybe especially when changing a diaper.)
This stage, termed matrescence, marks a profound neurocognitive developmental phase. The brain develops these changes with a clear focus on keeping a baby alive. Along with that focus comes intense emotions, such as guilt when you get a babysitter, or deep-seated shame when you don’t know how to swaddle your infant.
That postpartum rewiring period can be one of tremendous growth, but I also know all too well how it can be studded with landmines. Even though this was my area of expertise as a psychologist, postpartum depression and anxiety took me by surprise. Curled up on my closet floor in tears, I diagnosed myself in real-time, and thanks to medication and therapy, I made it through to the other side. Through therapy, I learned that I was in a nascent stage in my brain’s adaptation to motherhood, and understood the power of my own brain’s neuroplasticity. My brain was changing because of the normative trauma of giving birth and caring for an infant. Once I began to understand what was happening, both physiologically and psychologically, I began to thrive.
Not all new mothers are so lucky. For new mothers without access to a postpartum mental health support network, these collective traumas can pile on to a back that’s already breaking. The numbers indicate that we have a maternal mental health crisis in the United States: One in five women will experience a postpartum anxiety or mood disorder, and postpartum mental health conditions are the number one complication resulting from childbirth.
Those psychological conditions are in contrast to everything women are taught to expect about the mothering experience. We somehow think we’ll automatically know how to accomplish the necessary tasks on all fronts with ease, but we now know that the concept of “maternal instinct” is a myth. And being a Supermom is especially impossible when you’re facing an unfair division of labor, increased mental load, and lack of affordable childcare. Mothers are nonetheless forced to rise to every relentless challenge that new motherhood brings.
Imagine if we prepared women, families, partners, and society to understand the developmental phase that changes a new mother’s brain, body, psyche, relationships, identity, and hormones — instead of buying them cashmere-lined swaddles and booger-sucking devices and hoping for the best. Imagine if we told mothers that they’ll feel like their brain is foggy, forgetful, and interrupted, due to sleep deprivation and stress. And that all of it is perfectly natural.
Mothers are still afraid of reporting their symptoms, for fear they’ll be viewed as unfit.
It’s imperative that we educate pregnant mothers about this very fact — to anticipate the vast functional and structural neuroplastic changes that reorganize her brain. And we should warn them that these same incredible changes make mothers more vulnerable to postpartum mental health conditions, thanks to the extensive and rapid brain development that’s happening. (For example, only two percent of the population has obsessive compulsive disorder, but the base rate in mothers is nine percent, because the ways that the brain adapts to make mothers hypervigilant to protect their babies are also hallmark symptoms of OCD.)
Normalizing and validating the need for proactive mental healthcare postpartum might alleviate or prevent suffering. The current rates of postpartum depression are considered underestimates, because mothers are still afraid of reporting their symptoms for fear they’ll be viewed as unfit.
I instruct all women to prepare for the postpartum period while pregnant, by scheduling an appointment with a therapist in advance. So many otherwise high-functioning women come to my office suffering more than they need to. In fact, those same women are more vulnerable to postpartum issues, because it’s especially disorienting to go from CEO in their personal and professional lives to a beginner in motherhood overnight. The ones that seemingly have it all together may well be suffering the most.
Society doesn’t prepare mothers for what’s to come once the baby arrives, including the brilliance, the bliss, and the risks. But when new mothers are given grace, education, and time to heal and adjust to their new normal, they tend to flourish. And that can ultimately pave the way to a healthier, more resilient society.
Dr. Nicole Pensak is a Harvard and Yale-trained Clinical Psychologist certified in Postpartum Mental Health and the Author of RATTLED, How to Calm New Mom Anxiety with the Power of the Postpartum Brain. RATTLED was awarded Best Book for Parents by Zibby Owens, featured on Reese Witherspoon’s Hello Sunshine and The Bright Side Podcast, and named by Audible as Most Anticipated Reads 2025 in Well-Being.
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