It’s 3am. The house is finally quiet. You’re holding the baby, or standing over the bassinet, or lying awake listening to the monitor — and a thought lets itself in.

Is she breathing?

You just checked. You check again. You put your hand on her chest. You watch for the rise and fall. You lie back down. Ninety seconds later: but is she sleeping the right way? Is the swaddle too close to her face? Did I strap the carseat right this morning — was the chest clip at armpit level — should I go check the manual again?

On repeat. All night. Every night.

Or maybe your brain sends the other kind: an image, out of nowhere, of something terrible happening to the baby. The stairs. The bath. The street. Your stomach drops, your whole body goes cold — and then the second thought arrives, the one that does the real damage: What kind of mother thinks something like that?

If your brain is like my brain, you know the checking loop personally. And I want to tell you what I have told hundreds of women in my office, usually while they stared at the floor because they couldn’t say it to my face:

You are not the only one. You are not even unusual. And what your brain is doing has a name — and it’s treatable.

The most common secret in motherhood

Here is what the research says, and what every perinatal clinician knows: the majority of new mothers experience intrusive thoughts — unwanted, distressing thoughts or images about harm coming to their baby. The majority. Not a troubled few. Most.

For most mothers they come as what-ifs and worst-case images. For many, they come as the loop: check the breathing, check the sleep position, check the straps, check the temperature of the room, check the breathing again. Checking that never quite buys the relief it promises. Googling symptoms at 2am. Asking your partner “but are you SURE she’s fine?” for the fourth time and hating yourself a little for asking.

When the worry is constant, physical, and steals the sleep you could be getting — racing heart, dread, a brain that will not power down even when the baby is finally quiet — that’s postpartum anxiety. When the thoughts get stuck and demand rituals to quiet them — the checking, the re-checking, the reassurance-seeking, the avoiding — that’s postpartum OCD. Together they are among the most common complications of the postpartum year, and almost nobody is told they exist. The six-week visit screens for depression. Nobody asks who’s been checking the chest clip five times per car ride.

So mothers assume this is just what motherhood feels like. It is not. This is what untreated anxiety feels like, wearing motherhood’s clothes.

Why your brain is doing this

Here’s what I share with moms in session: the circuitry that lights up in a mother’s brain when her baby cries overlaps with the very circuitry that lights up in OCD. That’s not a coincidence — it’s design. New-parent brains are built to become preoccupied: to scan, to loop, to check. It’s a primitive survival system, and for most of human history it earned its keep.

Which is great when it’s tempered to the reality we actually live in — the one with monitors that read the room temperature and socks that read the baby’s heartbeat. Your alarm system was calibrated for an era when checking genuinely was the only technology available. It was probably very helpful in the Victorian era. It has not gotten the memo that it’s 2026.

So when that system runs a vivid worst-case simulation, or demands one more check, it’s a smoke detector going off while you’re cooking. Loud, terrifying — and evidence that the alarm works, not that the house is burning.

The checking trap

Here’s the part I most need the checking mothers to hear, because it’s the mechanism nobody explains:

Checking feels like the cure and works like the fuel.

When you check the breathing, you get relief — for about ninety seconds. But each check quietly teaches your alarm system that the checking was necessary. That the danger was real. So the alarm fires again, a little sooner, a little louder. More checks, less relief, worse sleep — and a mother who is somehow more anxious in month four than she was in week two, and can’t understand why.

You’re not weak-willed. You’re caught in the best-documented loop in anxiety science. And the way out is not “just stop worrying” — it’s treatment that retrains the alarm, which perinatal therapists do every single day.

Read this part twice

For the mothers whose unwanted images are the scariest kind — the ones where the harm comes from you — one clinical distinction, because it is the difference between years of silent shame and one honest conversation:

The horror is the reassurance.

These thoughts are what we call ego-dystonic — they attack your values instead of expressing them. The disgust, the cold-water shock, the instant no your whole body produces: that reaction is diagnostic. It tells us the thought is anxiety, not intent. Mothers with intrusive thoughts are, if anything, the ones checking too much, standing farther from the stairs, being over-careful — an abundance of caution their own mind manufactured. A thought that horrifies you is your alarm system misfiring. And the thought was never the danger. The silence is.

What to do with the 3am thought

If this essay found you where you live: tell one safe person. A perinatal therapist is ideal — postpartum anxiety and OCD are bread-and-butter work for us, they respond beautifully to treatment (therapy built for exactly this loop, sometimes with medication support), and the relief women feel when we don’t flinch is its own intervention. And sleep — real, protected sleep — is not a luxury in this picture. It’s medicine.

If you’re the partner, the mother, the friend who just got told: your entire job is to not flinch. “That sounds exhausting and really common — let’s find you someone to talk to” is a complete response. One more thing, lovingly: answering “are you sure she’s fine?” for the tenth time feels kind, but the more useful kindness is helping her get to someone who can retrain the alarm — because your reassurance is on the same ninety-second timer as her checking.

You were never a bad mother. You were never losing your mind. You were a mother with a smoke detector wired to a bullhorn, doing the hardest job there is on the least sleep you’ve ever had.

If you need support now: call or text 988 (Suicide & Crisis Lifeline) · Postpartum Support International: 1-800-944-4773 (call or text; Spanish text 1-971-203-7773) · National Maternal Mental Health Hotline: 1-833-TLC-MAMA.

It’s never just hormones. And you were never the only one awake.

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If this season is heavy, we’re here. Mamaya Health provides therapy and medication management built around the seasons of a woman’s life — pregnancy, postpartum, and perimenopause. In-network, in person in Nashville & Murfreesboro, and virtual across TN, TX, AR, FL, AL & GA. Programs and coaching available nationwide. → mamayahealth.com/intake

Providers: refer a patient in 30 seconds.

The stories, as always

Our podcast episodes on postpartum rage and sleep deprivation record this week — the other two things nobody warns you about. If you have a story — the moment the rage showed up, what night four actually did to you, the checking loop you’ve never admitted to — I’d be honored to hold it.

Anonymous or first name only. Typed or a 2-minute voice memo. Nothing airs without your ok — I confirm with you first, every time.

Share your story → https://forms.gle/sBGkpiBPChva9fXU9

The uncontrollable movements, the falling, the things her body did without her permission — severe depression, they said. Attention-seeking, they implied. A few months later she had a grand mal seizure in her kitchen, and the diagnosis became epilepsy. It had been epilepsy the whole time. The only thing that changed was that her body finally produced evidence dramatic enough to be believed.

Another woman, thirty-one, called her doctor after three years of low mood, persistent crying, anxiety that had started to eat her relationship and her job. She had done everything we tell women to do — she tracked it, she waited to be sure, she made the appointment. She asked for blood work, wondering if something hormonal was underneath it.

She was told to document her cycle for two months and offered the contraceptive pill. She left the appointment — her words, the words of a thousand women — feeling like a silly woman with a bit of PMS.

Three years of symptoms. One appointment. Zero tests.

And a third, forty-six, who wrote something I want you to read slowly:

I hate feeling like a shell of the person I used to be. I hate the mood swings and the way I treat my husband when I’m in the thick of it. I hate not being able to think before I say things. I hate not feeling attractive. I hate the insecurities. I hate the constant body aches.

She wasn’t asking for a miracle. She was asking a question women in their forties ask into the void every single day: Is this just being a woman my age — or is this a symptom of something?

The fact that she couldn’t tell the difference is not her failure. It’s ours.

These are not rare stories

I have sat with women for years while they told me these stories — and here is what I need you to know: they are not outliers. They are the pattern.

The research says what women have been saying:

Women wait longer for pain relief. In emergency departments, women presenting with acute abdominal pain waited significantly longer than men to receive pain medication — and were less likely to receive it at all. This finding has been replicated enough times that it has a name in the literature; researchers were writing about “the girl who cried pain” more than two decades ago, and the gap still hasn’t closed.

Medicine was not tested on us. In 1977, the FDA formally recommended excluding women of childbearing potential from early-phase drug trials — and for a generation, that’s largely what happened. And look, I get it. From a clinical research perspective, we make trials harder. We have periods and pregnancies and life transitions like perimenopause that complicate the data. We are not clear-cut data points — our biology ebbs and flows with our cycles and seasons, and two X chromosomes run a different chemistry than an X and a Y. But “harder to study” became “not studied at all,” and medications that are still prescribed every day were dosed, studied, and approved based on male bodies only.

It took until 1993 for federal law — the NIH Revitalization Act — to require the inclusion of women in NIH-funded clinical research. 1993. Within the lifetime of most women reading this. And it took until 2016 for the NIH to require researchers to even consider sex as a biological variable in the preclinical research that comes before human trials. Privately funded trials still aren’t held to the NIH’s standards.

If you want one image for what that era of medicine left behind: in 2013, the FDA cut the recommended Ambien dose in half for women — twenty years after it came to market — because women metabolize it differently and were waking up impaired. Nobody had looked.

So what does this mean for women today? We are being prescribed medications and interventions that often had limited to no research on an actual woman’s body. The interactions, the reactions, the side effects, the medication not working or not working as well — these are all real things.

Your medication and your hormones are having a conversation your doctor may never have mentioned. Estrogen is deeply involved in the brain’s serotonin system. When estrogen drops — premenstrually, in postpartum, across perimenopause — the floor an SSRI is standing on can shift. Women have reported for years that their antidepressant “stops working” at certain points in their cycle, or starts failing them in their forties. For years, that got filed under anecdote. The pharmacology was there the whole time: same woman, same dose, different hormonal season, different drug. Clinical reports suggest a meaningful share of women notice cycle changes on SSRIs — the interaction runs in both directions — and the “poop-out” phenomenon women describe in perimenopause tracks precisely with what estrogen does to serotonin pathways.

Women weren’t imagining it. Medicine just wasn’t listening in a language it respected.

The season nobody reads

Nowhere is this pattern more expensive than perimenopause.

The earliest signs are almost never hot flashes. They’re the ones that get a woman referred to Mamaya — or dismissed entirely: anxiety that arrives out of character. Rage that frightens her. Brain fog and word-finding failures that make a smart woman quietly wonder if something is deeply wrong with her mind. Waking bolt upright between 2 and 4am for no reason. Joint pain. Itchy ears — yes, really. Pain with sex she’s too embarrassed to raise in a fifteen-minute visit. A cycle that changes the rules without notice. A libido that has disappeared and is quietly straining the marriage she adores — compounded by shame, and a deep disorientation at no longer understanding her body or who she is anymore.

Bring that list to an appointment and watch what happens. The anxiety gets an SSRI. The sleep gets sleep hygiene tips. The fog gets “we all forget things.” The cycle gets “that’s normal at your age.” Five symptoms, five referrals, five dismissals — and no one in the room ever says the word perimenopause, because nobody was assigned to read the season. Only the symptoms.

Here’s why this matters beyond the suffering, which would be reason enough: we now understand that the menopause transition is a critical window for a woman’s cardiovascular health, metabolic health, and long-term brain health. Dismissing perimenopause isn’t just rude. It’s a missed intervention at the exact moment intervention matters most.

What dismissal actually does

I’ll tell you what I see clinically, because this is the part the research undercounts.

A woman who is dismissed doesn’t just leave without answers. She recalibrates. She learns that her testimony about her own body is unreliable currency — and often, that’s a lesson she has been taught by the medical system for years. So the next symptom, she waits longer. Reports less. Rounds down. By the time she’s in my office, she’s often spent years pre-apologizing for her own experience — I’m sure it’s nothing, I know everyone’s tired, I don’t want to be dramatic.

She’s not asking for a miracle. She was never asking for a miracle. She’s asking to be believed before she needs ten specialists, two binders of medical records, and a seizure in her kitchen to prove it.

Believing women is not a courtesy. It is a clinical intervention — the first one, the cheapest one, and the one everything else depends on.

So here’s my question

How many doctors before someone believed you?

Tell me your number. Tell me the story — the appointment, the sentence they said, the moment someone finally listened (or the fact that no one has yet). Because the answer to “how many doctors” should be one.

It’s never just hormones. And it was never just in your head.

💛 If something in this found you where you live:

Subscribe to get these essays every Tuesday — free, always. →

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If this season is heavy, we’re here. Mamaya Health provides therapy and medication management built around the seasons of a woman’s life — pregnancy, postpartum, and perimenopause. In-network, in person (TN, TX, AR, FL, AL, GA) and virtual. → mamayahealth.com

Providers: refer a patient in 30 seconds.

Have a story for the show? It’s Never Just Hormones launches Sept 8 — every episode starts with a real woman’s story, anonymous if you want. → https://forms.gle/sBGkpiBPChva9fXU9

In a Massachusetts courtroom right now, jurors are reading a dead-tired mother’s diary.

“I want help. I want to be well,” Lindsay Clancy wrote, in the months before she killed her three children — Cora, Dawson, and Callan — in January 2023. “I have crazy brain fog. I feel like I can’t make a plan. I live moment to moment waiting for the next nap time.”

A jury will decide whether she was criminally responsible. That is their work, and it is sacred work — they owe those three children nothing less than total rigor. I will not do their job from my keyboard, and this essay will not argue her case in either direction.

But the prosecutor said something in her opening statement that I cannot let stand unanswered: “This is not a public debate about women’s mental health and how the medical system treats women.”

Inside that courtroom? She’s right. The question there is about one woman, three children, and one January night.

Outside that courtroom, this must become exactly that debate — because somewhere tonight, another mother is journaling her own brain fog in the same diligent handwriting, and her family doesn’t have the words for what they might be watching. The courtroom decides the past.

So let me give you the words. This is the conversation I have had, in one form or another, hundreds of times as a perinatal therapist. It is some of the most sacred work I have ever done — sitting with women through intrusive thoughts, through days without sleep, through thoughts of not wanting to be here. Those women remain in my heart. Their courage and their healing are a good part of why I do any of this at all.

First: psychosis is human, not monstrous

Here is something almost no one tells families, and it changes everything once you know it:

Psychosis can happen to any human being who does not sleep.

Take a trained Marine — the most conditioned nervous system we know how to build — and keep him awake for three days straight, and his brain will begin to distance from reality. Sit with an Alzheimer’s patient whose nights have come apart, and you will watch the same drift. This is not weakness and it is not character. It is neurology. The sleeping brain does the housekeeping that keeps us oriented to what is real. Take the sleep away long enough, and any brain — yours, mine — begins to lose the thread.

Now look at what we ask of a postpartum woman. She is living inside a perfect storm with three fronts colliding at once:

The hormone cliff. The moment the placenta is delivered, progesterone — which has been climbing for nine months — drops back to its pre-pregnancy baseline. Not tapered. Dropped. It is among the most abrupt hormonal shifts a human body ever experiences, and it lands on the brain within hours.

Total responsibility. She is now keeping a brand-new human alive — one who is completely reliant on her, around the clock, with no shifts and no relief crew.

Engineered sleep deprivation. A newborn feeding schedule is, by its very design, incompatible with the consolidated sleep a brain needs to stay tethered. Not for one bad night. For weeks.

Any one of these would strain a healthy mind. We hand all three to a woman at once, send her home from the hospital in forty-eight hours (or less), and call it normal.

For most women, the brain holds. For some — especially those with underlying vulnerability — the storm breaks something loose. That is postpartum psychosis: rare (roughly one to two in every thousand births), fast-moving, and a genuine psychiatric emergency. Not a harder version of the baby blues. A different phenomenon entirely — and with rapid treatment, one from which the overwhelming majority of women fully recover, harming no one.

Second: the two things every family confuses — and the difference that saves lives

If you learn nothing else from this essay, learn this distinction. I have watched the absence of it hurt women in both directions.

Intrusive thoughts are common, and they are not dangerous. The majority of new mothers experience them: sudden, unwanted, horrifying images — what if I dropped him, what if the knife, what if the stairs. This has been me. If this is you, reading at 3am with your heart pounding: the horror you feel about these thoughts is precisely the evidence that they are not intentions. They are anxiety — your threat-detection system stuck on maximum, scanning for danger and finding it in your own imagination. Terrified is not the same as dangerous. In session, I tell mothers: the thought is not who you are; your fear is the true character. Women who tell no one carry this alone for months, convinced they are monsters, avoiding the very care that would bring relief in weeks. I am here to tell you plainly — if this is you or has ever been you: you are a mother with an alarm system that loves your baby too loudly.

Psychosis is rare, and it is different in kind. Not fearing a thought — believing it. Voices that instruct. Certainties that arrive from nowhere. Confusion about what’s real. Paranoia, or sudden religious preoccupation that doesn’t sound like her. And here is the cruelest feature: it can wax and wane. A woman can be lucid at a 17-minute appointment and unraveling by nightfall. Women literally hang on one moment at a time, one minute at a time. Which is why the people who see her at midnight — partners, mothers, sisters — matter more to detection than any screening form filled out in a waiting room.

When we refuse to name either of these, we get the worst of both worlds: mothers with harmless intrusive thoughts hiding in shame, certain they’re “going crazy” — and families of women in true psychosis watching an emergency without knowing its name.

One conversation fixes both. It should happen in every childbirth class, every discharge packet, every OB visit: here is what intrusive thoughts are, and why they’re safe to say out loud. Here is what psychosis is, and why it’s a 911 call. We teach infant CPR to every new parent for an event far rarer. We could teach this.

Third: what the timeline shows — about all of us

Stay out of the verdict; look only at the reported system timeline, because it belongs to every American family:

A woman reporting escalating insomnia, anxiety, despair, and confusion about what was real. A shifting lineup of prescriptions from various clinicians. A specialized postpartum program that discharged her after a single day. A psychiatric hospitalization measured in days. A final appointment that lasted seventeen minutes.

“I want help. I want to be well.”

Sit with the profundity of that timeline, because it is the most devastating part of this story and the most important. According to the reporting and her lawsuit, Lindsay Clancy was prescribed thirteen different psychiatric medications. She saw a psychiatrist, two nurse practitioners, a therapist, and an ER doctor. She was admitted inpatient.

And yet she fell through the cracks.

This was not a woman who failed to ask. There was no lack of effort, no lack of wanting, no lack of trying. She did every single thing we tell struggling mothers to do — and the system kept handing her back.

That is not one clinician’s failure. That is a design revelation. Look at how care for a postpartum woman is actually structured in this country:

• Her OB/GYN discharges her at six weeks if everything looks “normal” — right as the hardest months begin.

• Pediatrics doesn’t own the parent. They own the baby. She sits in that office a dozen times a year as the invisible adult holding the patient.

• Primary care hasn’t seen her in over a year — she was pregnant, and pregnant women live at the OB’s office.

• Psychiatry oftentimes has a waitlist — and even fewer specialists trained in reproductive and perinatal psychiatry at all.

• The ER and inpatient units are built to stabilize a crisis — not to manage an ongoing illness. They are the net at the bottom of the cliff, not the fence at the top.

So who cares for the mom? Who holds the mom? Who is the constant thread in her story — the one who knows her baseline, who notices when something has gone awry, who can see that a new prescription is aggravating instead of calming, who coordinates the care, who gets her in front of the rare experts actually trained in reproductive mental health — before an illness becomes a crisis, or worse?

Right now, in America, the honest answer is: usually no one. Our system is not built to catch women — it is built to process them.

No one positioned close enough, seeing her often enough. No one with the time to actually sit with the suicidality — to stay in the room with the pain long enough to understand its shape. We rush to the assessment checklist, the safety plan, the discharge criteria. We manage the liability instead of holding the person.

And the numbers say exactly what that costs. Suicide is among the leading causes of death for women in the postpartum year — and the numbers have been RISING in recent years. Rising. Going the wrong direction. Roughly 30 percent of pregnancy-related deaths occur between day 43 and day 365 — which is to say: after the six-week checkup. After the attention falls away. After she becomes isolated, and then lost. And while we finally have FDA-approved medications specifically for postpartum depression, there is no medication approved specifically to treat postpartum psychosis. For the most dangerous condition in maternal mental health, we are still improvising.

One more truth, from inside this work: we only ever talk about postpartum psychosis when it reaches a headline. But the women are here every day. In our practice we sit daily with women navigating the hardships of postpartum — grief, anger, resentment, disorientation, intrusive thoughts, OCD — and yes, sometimes mania and psychosis too. They are not headlines in a newspaper, but it is for sure their headline. It is all-consuming for them, and it is the context that — if not accounted for and understood — could lead to a discharge, or the wrong prescription, or worse, no treatment at all. They are mothers, getting better here at Mamaya, because someone finally held the thread.

She wrote it all down — the data was there, in her own hand. What the timeline suggests was missing is the thing this entire essay is about: the name, said out loud, by someone trained to say it and empowered to act on it — and a system built to hold her once it was said. Not process her. Hold her.

And there is a piece of this that goes almost entirely misunderstood outside clinical circles — so let me say it plainly, as general education and not as commentary on any one case. Prescribing for a woman who is not sleeping is genuinely tricky. The standard first-line antidepressants — the Prozacs and Zolofts of the world — help enormously in many situations. But in a woman whose presentation is already energized, wired, sleepless — particularly if there’s an undiagnosed bipolar-spectrum vulnerability underneath, or a first-time onset — those same medications can pour fuel on the fire: more activation, more anxiety, more insomnia, more intrusive thoughts. The medication isn’t the villain; the blindness to the context is. I have experienced this in the past with more than one patient of mine, and the collaboration between therapist & psychiatrist, the change of medication, and support for sleep are essential here. A prescriber seeing her for minutes, without the observations of a therapist who sits with her weekly, is working with a fraction of the picture — and in this territory, the missing fraction is where the danger lives.

This is the literal reason integrated care exists — teams where the therapist and the prescriber work under the same roof and actually talk to each other, where “she seemed more wired this week, and she’s still not sleeping” travels from the therapy chair to the prescription pad in a day instead of never. It’s the model Mamaya Health is built around, because fragmented care isn’t a bureaucratic inconvenience in maternal mental health. It’s a clinical risk.

Because here is what else we don’t have in this country: mother-baby psychiatric units, where a mother in crisis is admitted with her baby and treated without being severed from the bond she’s terrified of losing. The UK has demonstrated this model successfully. We have almost none. We discharge mothers back into the exact isolation and sleeplessness that lit the fire — and we schedule a follow-up.

It’s never just hormones. And sometimes — rarely, catastrophically — it is a five-alarm neurological emergency wearing the mask of a tired new mother. Both things can be true. Knowing the difference is the entire point of naming.

What every family should know

Print this. Share it. Especially with the people who will be around a new mother at night:

• Not sleeping for several days — not “tired”: unable to sleep, even when the baby sleeps

• Confusion, disorientation, rapid swings — moments of clarity alternating with moments that don’t make sense

• Saying things that aren’t like her — sudden paranoid fears, religious preoccupations, certainty about things that can’t be true

• Hearing or seeing things others don’t

• Any spoken thought of harm — hers or the baby’s — delivered WITHOUT horror. (The fear of what is being thought or spoken around harm is the healthy signal. The absence of that emotional touchpoint is the alarm.)

If you see this constellation: this is an emergency room visit or a 911 call — tonight, not at the next appointment. And it has to be the family’s call to make, because the illness itself can take away her ability to know she is ill. You will not be overreacting. Clinicians who work in this field would rather see a hundred false alarms than one missed emergency.

Cora. Dawson. Callan.

Whatever the jury decides, we owe those three children more than our grief and our verdicts. We owe the next family the words — spoken early, taught everywhere, and backed by a system that treats a mother’s unraveling mind with the same urgency we’d bring to her unraveling heart.

She wrote “I want help” in her own handwriting.

The least we can do is learn to read it in time.

— Amy

If you are a new mother frightened by your thoughts, you are not broken and you are not alone. My favorite resource in this world is Postpartum Support International: call or text their helpline at 1-800-944-4773 (text en español: 1-971-203-7773) for support, online groups, and directories of perinatal-trained providers near you. PSI is not an emergency line — if you are in immediate danger, call 911 or call/text 988. And if this essay made you think of a woman in your life — check on her tonight.

I had spent over three years working in behavioral health & clinical information systems — overseeing development, project managing, coordinating and testing the systems that hold our health data for therapists & patients. And I had lost three pregnancies. Somewhere in the middle of that grief, an idea took hold of me: what if the problem was that we simply didn’t understand miscarriage well enough — the data, the patterns, the signals? What if someone could build something that helped identify it, maybe even prevent it? So I enrolled at Northeastern for a second master’s, in personal health informatics, to try.

Then, while I was studying fun things — like SQL — I finally got pregnant with Kinley.

An early bleeding episode nearly threw us into yet another loss — and instead gave us the answer three losses never had: my body needed Lovenox to stay pregnant. A daily injection, a high-risk label, and first-trimester nausea that didn’t negotiate. Something had to give, and it was the program. I dropped out of the degree I’d enrolled in to gain the skills to build the technology that could prevent other women from going through this — because staying pregnant had become my full-time work.

Sit with that irony for a second. I’ve had years to, and it still catches me.

Then we made it through the first trimester — the longest twelve weeks of my life — and the next reality arrived on schedule: I needed a job. Income. Insurance. A high-risk pregnancy in America does not run on hope. So I started interviewing, and I walked into every room carrying two secrets: the baby I was terrified to lose, and the baby I was terrified they’d find out about.

I wore baggy shirts. I did not say a word.

If I had not been holding my belly, would it have been obvious?

Not because I’m dishonest. Because I was doing math — the same math so many women have done in an interview chair: if they know, I don’t get hired. If I don’t get hired, we don’t have income. If we don’t have income, we don’t have insurance. And I am high-risk, and I cannot be pregnant in this country without insurance.

I don’t know if hiding was right. I know it was rational.

And a world where hiding your child is the rational choice is a world with a problem.

The story has a good ending, by the way. I found a role as a school-based therapist — a job I still hold dear. The team & my immediate boss were amazingly supportive. Those kids and families were something special, and so was the school. I showed up pregnant, then very pregnant, and I did work I’m proud of the entire time. I also had Kinley in July, so it fell perfectly over the summer. Which is sort of the point: the hidden pregnancy never made me less capable. Only less hireable.

The hiding I’ve witnessed

Here’s what I’ve learned since, sitting in the therapist’s chair: my baggy shirt has a thousand versions.

I have held the stories of women who didn’t announce their pregnancies for months — not for strategy, but because after a loss or a stillbirth, celebration doesn’t feel safe. Women who did not want the baby showers, or the setting up of nurseries — because that felt too real. That’s one kind of hiding.

And then there’s the other kind — the professional kind.

Women who hid pregnancies from clients and bosses.

Women navigating fertility appointments, new medications, hormonal fluxes — in silence.

Women who watched colleagues celebrate pregnancies at work while they returned to their desks from a pregnancy loss — gutted, and silent.

Women who sat on the news of a pregnancy through performance review season.

Women who came back from leave and never once mentioned their child in a meeting, who kept the school’s phone number on silent, who learned to say “I have a conflict” instead of “my daughter is sick” — because somewhere along the way, having a child came to mean that the woman — her time, her knowledge, her effort, all that she has to give — is now unavailable. A liability. Divided priorities. The quiet assumption that more effort, more output, more dedication will come from someone else — anyone else — over her.

Both hidings are exhausting. Both are rational. And that’s the indictment.

Here’s what the data shows

If you think the fear is in our heads, the research would like a word.

In a landmark Stanford study, sociologist Shelley Correll sent out matched resumes — identical qualifications, one signaling motherhood, one not. Mothers were roughly half as likely to be called back or recommended for hire, and were offered about $11,000 less in starting salary — because evaluators rated them as less competent and less committed. The same signal on a man’s resume? Fathers were rated as MORE competent and more committed than men without children. Her child is a liability; his is a credential. Same child.

Researchers call it the motherhood penalty, and it’s why the pay gap between mothers and childless women is now bigger than the gap between women and men.

Then the pandemic ran the experiment on a national scale. When childcare and schools closed, more than 2.3 million women left the U.S. labor force between February 2020 and February 2021 — and mothers were three times as likely as fathers to be carrying the majority of the childcare that pushed them out. It took years for women’s workforce participation to claw its way back — and the system that shoved them out the door hasn’t meaningfully changed. The waitlists are still years long. The camps still fill in January. The care still collapses with a text on a Saturday night.

That’s not millions of individual women making millions of individual “choices.” That’s a design.

When a woman hides her pregnancy in an interview, she isn’t being deceptive. She’s reading the data correctly.

So what do we do with this?

Here’s the part I only see clearly now: the woman in that interview chair had gone back to school specifically to make women’s health more visible — to build systems that could see what we keep missing. And there she sat, hiding her own. That contradiction isn’t mine alone. It belongs to every woman working twice as hard to fix a system while concealing what the system would punish her for. So — what do we actually do with it?

If you’re the one hiding right now — the pregnancy you haven’t announced, the loss nobody at work knows about, the “I have a conflict” that means my daughter is sick — hear this first: you are not deceptive, and you are not weak. You’re reading the data correctly. But know what the hiding costs, because decades of research on emotional suppression say it’s not free — the energy it takes to edit half your life out of every workday sentence is measurable, physiological, and enormous. Every woman who’s done it says it in plainer words: the hiding was the heaviest part. If the anxiety you can’t explain has a baggy shirt somewhere in its history, that’s not a coincidence — and it deserves care that asks about your conditions, not just your symptoms.

If you’re on the other side of the desk — the hiring manager, the leader, the person deciding on the promotion — your assignment is different: make the hiding unnecessary. Not with a policy memo, but in the split seconds. Run your own audit: when a resume signals fatherhood, do you quietly read stability? When it signals motherhood, do you quietly read risk? Same child. The penalty lives in that split second — and so does the fix. And when someone on your team finally stops hiding — mentions the appointment, brings the baby, says the real reason — how you respond in the next five seconds teaches everyone watching whether it’s safe.

And for all of us: the motherhood penalty survives on silence. Every time a woman tells the baggy-shirt story out loud — every time it turns out the person who hid was your best hire, your strongest leader, the founder on the stage — the calculation gets a little harder to defend. That’s how a thousand rational hidings become unnecessary: one visible story at a time.

It’s never just hormones. Sometimes it’s a baggy shirt at twelve weeks, three losses nobody at the table knows about, and an interviewer you can’t afford to trust.

I got the job. I loved the job. And I shouldn’t have had to hide a heartbeat to get it.

So tell me — what has the hiding looked like for you? I’ll go first. I just did. 🤍

— Amy

📣 Something is coming this September. It’s Never Just Hormones is becoming a podcast — and it won’t sound like the usual interview show. Every episode opens with a real woman’s story — the 3am moment, the kitchen-floor moment, the no-one-prepared-me moment — read aloud, anonymously or credited, always with permission. Then I bring in the expert she needed in the room, and together we unpack the season she was in and what actually helps.

Stories like the ones you’ve been telling me these past few weeks. Stories like the one I just told you.

And here’s your opportunity to participate: if you have a moment no one prepared you for — from any season: infertility, loss, postpartum, the return to work, perimenopause, all of it — I’d be honored to hold it, and it may open an episode this fall. Share your story here → It takes five minutes, anonymous is welcome, and I read every single one.

It’s Never Just Hormones is written by Amy Green, LCSW, PMH-C — therapist, founder of Mamaya Health, and mom of two.

If this season feels heavy, you don’t have to carry it alone. Mamaya offers therapy and medication management for women in Tennessee — usually within the week, most major insurance accepted. Get started here →

Not ready for therapy? Our $39/month text coaching and self-paced programs → meet you where you are.

Providers: referring a patient takes about 30 seconds. Refer here →

And if someone forwarded this to you — subscribe here → to get these essays in your inbox

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That’s when my phone buzzed.

It was our nanny. She was quitting. By text. Effective immediately.

Her reason — and I promise you I am not making this up — was that my three-month-old needed to be held more than she could have ever imagined, and her shoulders simply couldn’t take it.

She was a baby. Holding is the literal job.

I stood there in the middle of my own holiday party, phone in hand, trying so hard to be present with my team. The postpartum hormones were all too real as a flood of anxiety (and sweat!) washed over me. It’s Saturday night, and I have no childcare on Monday.

In the theme of holiday parties & Christmas in July- let’s pause here for a holiday-themed family picture for a solid giggle. This one has been picked up by Popsugar multiple times on their “25 Hysterical Holiday Card Photo Fails That Probably Look Just Like Yours“.

Moving on — that text wasn’t the beginning of our childcare story. It wasn’t even the worst chapter. It was just the one that arrived mid-party, in writing.

Let me tell you the whole thing.

Kinley: paying to get in line

We wanted Kinley for a long time before we got her. We had three miscarriages before she arrived. So by the time she was here — safe, in my arms — I wasn’t taking anything for granted. Including, apparently, the great American childcare hunt.

We applied to no fewer than ten daycares. Not “toured.” Applied. Each with an application fee of $150 to $250, just to be considered — just to be a name on a list. Do that math: you can spend two thousand dollars before a single provider has agreed to watch your child. And even with all of that, childcare was not guaranteed by the six-week leave I had at the time — it was just now an option, because we had paid to get on the list.

We did not get any spots. Not at six weeks, not at four months.

Two things can be true: I was so glad to be able to stay home with Kinley and have that first year with her, and, I did not have a choice. Without family in the area who could tag in, or more money to hire from one of the nanny agencies (as social workers at the time, this was not in our budget), staying home was the only option.

It always makes me wonder how many women are placed into this situation — forced to stay home and not work, even if they would want to — because of childcare. We have to abandon these parts of ourselves, or set them to the side, because the support just is not there. The part that feels hard is the lack of choice or autonomy around this. The argument around choosing to have kids is not the point here, rather — the point is that women are living in a society where the choice to have a child now also includes playing a never-ending whack-a-mole game of piecemealing childcare together so that they, too, can have an identity & self beyond the role of “mother.”

I ended up finding a Spanish immersion daycare program at six months (I speak fluent Spanish, and I was thrilled — the one silver lining in the chaos), and we finally got a spot at Primrose at a year old, right around when I went back to work full-time.

Quinn: the waitlist that made me furious

There are six years between my girls. That gap has its own story — secondary infertility is a beast, and we tried to adopt during COVID — but those are stories for another day.

When we finally got pregnant with Quinn, I learned something that made me furious, jealous, envious, sad, and gutted — all in one messy bundle of emotions. Families were putting their unborn children on daycare waitlists. And those unborn, hypothetical babies were ahead of my actual, breathing, born child.

Sit with that for a second. To hold a spot, you have to be confident enough in a pregnancy to plan around it months ahead. As a loss mom — as someone whose body had made no such promises, a body in which day-to-day I struggled to trust — that kind of confidence was a luxury I had never once been able to afford. I couldn’t assume a pregnancy would last, so I couldn’t get in line early, so even a full year after Quinn was born, we still had no childcare.

The system quietly rewards exactly the certainty that so many of us have had ripped away all too soon.

And — no shade to the moms and women who have done this — I get it. The desperation of having childcare lined up when your baby comes is real too. Two things can be true, right?

The six weeks that weren’t

With Quinn, I “took” six weeks of maternity leave. I put that in quotes because my mother-in-law still likes to remind me she spotted my laptop open in the postpartum room. What entrepreneur is actually off? I had a team then who truly honored my leave and held everything down, and I remain grateful for their support. But by week four I needed help — and with no daycare, “help” meant turning to nannies. To Care.com I went, with a posting for full-time help.

Which brings us back to that Saturday night in December.

The nanny years

Our first nanny — the holiday-party texter — lasted from October to December. Two months, one text, done.

Our second nanny was the one who called in sick two hours before my first pitch. You already know how that one goes: Quinn came with me, on my hip, onto the stage.

Our third nanny, Lily, was extraordinary. She was my cornerstone through an entire spring & summer — the person who made it possible for me to work and breathe at the same time — and then she did the thing wonderful young people do, and left for college. Whoever ends up with Lily someday is lucky beyond words.

The au pair — and the thread it hung on

After Lily, we followed my cousin’s lead and hosted an au pair — and for two years, she was our answer. But I want to be honest about what that answer required: a private spare bedroom, money down before she ever arrived (we saved for a few months to be able to do this), a monthly stipend, and learning to live with a new person in our home. It was a wonderful experience for our family, and truly, I don’t know how else we would have had consistent, reliable care.

And here’s the part that still unsettles me: in spring of 2025, when we were set to re-up, the entire au pair program was nearly on the chopping block — it runs on two-year visas, and immigration policy had thrown all of it into question. Thousands of families like mine were one policy headline away from losing their childcare. That’s how thin the thread is.

We could not reapply at that time as a result, and had to go back to the drawing board. Quinn was about to turn three, and fortunately the school Kinley attends accepts kids at three — and because we had been a longstanding family, they let us swing Quinn in a month before her third birthday (thankfully, she was potty trained and ready to go!).

The revolving door

Here’s what no one warns you about: you don’t solve childcare. You just keep re-solving it. Daycare, then school, then — the current beast — summer.

I do not know what it is like where you live, but in Nashville, you sign up for summer camps and day programs in January or February, the winter before. Miss that window and you are, quite literally, the last one standing with a kid and a prayer. I honestly don’t know if it’s this brutal everywhere. (If it’s better where you live, please tell me. We are not above moving.)

Next up — the middle & high school admission games… I will take all the advice I can get, friends.

The load no one sees

And underneath all of it — the childcare waitlists, the childcare-cancelling texts, the phone call from school that they are sick and need to get picked up, the January deadlines — is the mental load. The planning, over and over and over again, for care that keeps dissolving. And we’re expected to carry it invisibly, because the kids can’t be seen. We can’t be perceived as distracted, as having other priorities. Somewhere along the way, being a mom got equated with not being dedicated enough, not working hard enough, not wanting it enough.

It is the opposite. Literally everything I do is for these girls. I work hard and I want them to see me work hard.

I want them to look up and see someone going after her dreams — not in spite of them, but because of them.

When people question my balance or my dedication, it’s usually an honest question. But it floors me every time. I have had to become excellent at balance. And sometimes balance looks like bringing them with me — into the meeting, onto the stage — so they grow up knowing this is possible for them, too. And, at the same time, I can show up and be incredible at what I am building, doing, and leading. One does not rule out the other. The same skills that make me a great mom are the same skills I apply to my work — dedication, determination, reflection, authenticity, attention to detail, strategy, planning, building, and so many more. Motherhood has refined these skills — in a fire, albeit — because trying to do all of it forces you to get excellent, to know how to say no, and to truly align your priorities — because there is little room for anything else until they are 18.

Why I’m telling you this

I run a company built on one idea: a woman’s mental health can’t be read by symptoms alone. You have to read the season she’s in — and the conditions she’s living under. Childcare is one of those conditions.

When we talk about maternal anxiety, burnout, the crushing mental load, we can’t pretend it floats free of the fact that keeping a child cared for in this country is a second full-time job stacked on top of your actual job — one that costs a fortune (it’s basically a mortgage payment at this point), is not guaranteed once you join the waitlist, and can end at any moment with a text at 7 p.m. on a Saturday.

And this is not even addressing the mothers who have kids with additional needs — chronic medical needs, autism, special needs, feeding therapy, mental health therapy — kids who may at times get in trouble at school, or get sick and need to stay home. Our work and systems do not account for this context. They only account for what was, foundationally, the industrial revolution perspective: get up, go to school or work, go home, repeat. Like a machine. No disruptions, no changing rhythms, no ebbs and flows. Nothing but consistent, repeated, similar output.

For women to be measured against this expectation does not account for the context of being a woman who has chosen motherhood. It also does not account for the millions of additional skills and the excellence she brings to the table daily as a result of managing and maintaining the mental load — for herself, her family, her kids, her job, and so much more. The duality that women are able to hold is profound, and I continue to be in awe of the women I am surrounded by on the daily.

The context is key.

It’s never just hormones. Or lack of sleep. Or debilitating depression. Sometimes it’s ten waitlists, a nanny’s text mid-party, and a January camp deadline you didn’t know existed.

I continue to get through this because I have an amazing partner/husband, a devoted team, resources that allow us to pay for school & extra help, and — for two years — an au pair. Most women don’t.

“Figure it out on your own” is not a childcare policy.

And if I am really honest, way back in January (which may as well be five years ago at this point), I forgot to sign up for one specific week of said summer camp for the oldest — so this past week, she and the youngest were home with me while I parented and worked full time.

Because the mental load is real. And I am very human.

So tell me — what has it looked like for you? I read every reply.

— Amy

It’s Never Just Hormones is written by Amy Green, LCSW, PMH-C — therapist, founder of Mamaya Health, and mom of two.

Have a story for the podcast? Tell me about the moment no one prepared you for → Share your story

If this season feels heavy, you don’t have to carry it alone. Mamaya offers therapy and medication management for women in Tennessee — usually within the week, most major insurance accepted. Get started here →

Not ready for therapy? Our $39/month text coaching and self-paced programs → meet you where you are.

Providers: referring a patient takes about 30 seconds. Refer here →

And if someone forwarded this to you — subscribe here → to get these essays in your inbox.

I’d spent the whole day at the Nashville Entrepreneur Center — working on the deck, practicing my speech, getting ready to pitch that evening as part of our Project Healthcare event. My youngest, Quinn, was four months old and home with our nanny (even though we’d been on five daycare lists before she was born, we still hadn’t gotten a single open spot — because finding daycare in America is hard, but that’s for another post). And now, two hours before I was set to go live, I had no childcare.

I remember standing in my kitchen, phone in one hand, Quinn on my hip, doing the math every working mother knows by heart: no backup, no time, no options. I had rehearsed that pitch a hundred times. I had not rehearsed doing it with a baby.

So I sat there and I had the argument with myself. You know the one.

Reschedule. You can’t show up like this. They won’t take you seriously. A real CEO wouldn’t walk in with a baby on her hip. Hide it. Fix it. Apologize for it.

For years, that voice had a lot of power over me. The unspoken rule of the room is that you’re supposed to arrive as if you have no other life — no child at home, no 2 a.m. feedings, no small person who needs you more than any deck ever will. You’re supposed to leave the mother at the door and bring only the operator. Wear the dress. Make sure your makeup is on and your hair is done. You want to belong in the spaces you’re trying to be in, so you have to look the part.

But I didn’t have that option that day. So I made a different choice.

I brought her.

I walked into that room with my daughter in my arms and said some version of, “My childcare fell through, so she’s joining us. Thank you for understanding.” And then — heart pounding, absolutely certain I’d just torpedoed the whole thing — I got ready to pitch. Haley, who led our Project Healthcare cohort at the NEC, was kind enough to offer to hold her for me, but Quinn was on the verge of crying, and I knew that if that started while I was up there, I might just start crying too. Because what a day for both of us.

So my name was called, and I walked up — with Quinn in my arms.

Here’s what I was too scared to see in that moment, and what I’ve never forgotten since:

She wasn’t a liability in that room. She was the entire point.

I was standing there asking people to believe in a company built for women exactly like the one I was living out loud — a mother, stretched thin, holding it all, falling through the cracks of a system that was never built for her. And I almost walked in pretending none of that was true. I almost hid the very thing that made me the right person to build this.

The women Mamaya exists for are mothers. The gap I’m trying to close is the one I was standing in that morning, baby on my hip, no backup, doing the impossible math. My daughter didn’t make me less credible in that room. She made me the most credible person in it.

The women Mamaya exists for are also the women who may one day want to be mothers. Making motherhood and parenthood invisible does a disservice to the women coming after us. They don’t see us do it — and so they think they have to keep it all together, pretend everything is fine, and treat this whole part of their life and identity as something to hide or keep separate. When in fact, it is one of the most valuable parts of who we are.

Afterward, a few women — students at Vanderbilt at the time — walked up to me to say thank you. There’s a saying in infant mental health: you cannot be what you cannot see. Because I took that risk and brought Quinn with me, because I pitched with her in my arms as an entrepreneur, they told me they could now see it too — that this could be something possible for them. I never walked into that room thinking that would be any part of the impact I’d have. And yet there I was, listening to these women tell me otherwise.

I pitched for two more years after that moment before I secured our first formal investment for Mamaya Health. But that’s not the part I carry.

The part I carry is that I stopped apologizing.

I stopped treating motherhood as the thing to hide in order to be taken seriously, and started understanding it as one of the truest sources of my authority. I don’t lead despite being a mother. A lot of days, I lead because I am one — because I know, in my body, what the women we serve are carrying.

So to every founder, every leader, every woman who has ever done that frantic kitchen math and felt like she had to choose between being taken seriously and being a mother:

You don’t have to leave her at the door.

She might be the most convincing thing you bring into the room.

— Amy

For over a decade, I've sat with women in the hardest seasons of their lives: the ones no one prepared them for, the ones that don't fit neatly on a symptom checklist. Pregnancy. Postpartum. The fog of perimenopause. The quiet grief of a loss you're expected to just move past. And in almost every one of those rooms, a woman had already been told some version of the same thing: it's probably just your hormones.

It's never just hormones.

The same anxiety, exhaustion, or rage means something completely different depending on the season a woman is in. Read the symptom without the season, and you miss the woman entirely. That one idea has shaped everything I've built — as a clinician, as the founder of Mamaya Health, and as a mother who's lived more of these seasons than I ever expected to.

This newsletter is where I write about all of it.

Some weeks it’ll be clinical — what the research actually says about hormones and mental health, and what it means for real women. Some weeks it’ll be personal — what I’ve learned in the therapy chair, in the delivery room, and in the years I spent building a company to fix a system that keeps failing women. And some weeks it’ll be the honest, behind-the-scenes view of doing this work while living it.

Here’s what I believe, and what you can expect from me: that context isn’t a side note — it’s the whole story. That therapy is a lifeline, not a luxury. And that women deserve care built for the season they’re actually in.

If any of that resonates, I’d love for you to stay.

Subscribe below, and I’ll meet you here every week.

— Amy

Amy Green is a Licensed Clinical Social Worker (LCSW, PMH-C) and the Founder of Mamaya Health. She writes about women’s mental health across every season of life. More at amylynngreen.com.