When Motherhood Feels Harder Than You Expected: Understanding Perinatal Anxiety and Depression in Asian American Families

Written by Linda Clossey (LICSW), Asian Therapist in Massachusetts

Published August 2026

Many new parents expect exhaustion. They expect sleepless nights, feeding schedules, and adjusting to a completely different routine.

What often catches people off guard is the emotional experience. The constant worry. The guilt. The feeling that everyone else seems to be handling parenthood better.

The thoughts that sound like:

"I should be grateful."

"Other people have it harder."

"Why am I struggling so much when I wanted this baby?"

For many Asian and Asian American parents, these experiences are further complicated by cultural expectations around family, sacrifice, achievement, and emotional expression. Conversations about postpartum depression, anxiety, and maternal mental health may be limited or absent altogether.

Instead of recognizing emotional distress as something worthy of care and support, many people learn to push through it silently.

At Elephant Room Counseling, we often work with Asian and Asian American adults who find themselves questioning why they cannot relax, why they feel overwhelmed all the time, or why parenthood feels so different than they imagined. The answer is often more complex, and more understandable, than they realize.

What Is Perinatal Mental Health?

Perinatal mental health refers to emotional and psychological well-being during pregnancy and throughout the first year after childbirth.

While postpartum depression is widely discussed, it is only one part of the picture. Perinatal mental health concerns can include:

Perinatal depression
Perinatal anxiety
Panic attacks
Obsessive-compulsive symptoms
Health anxiety
Trauma-related responses following birth
Increased irritability or anger
Sleep-related distress
Relationship stress and disconnection

Research suggests that approximately 1 in 7 women experience postpartum depression¹, while anxiety disorders during the perinatal period are also common and may occur independently or alongside depression (Wisner et al., 2013). These experiences are not signs of weakness, failure, or a lack of love for one's child. They are common mental health conditions that deserve attention and treatment.

Why Perinatal Anxiety Often Goes Unnoticed

Many people expect postpartum depression to look like sadness. Perinatal anxiety often looks very different.

It may show up as:

Constant checking on the baby
Difficulty sleeping even when the baby is asleep
Racing thoughts
Fear that something terrible will happen
Excessive researching and Googling
Feeling unable to relax
Persistent self-criticism
Difficulty trusting others with childcare

A parent may say:

"I know logically everything is okay, but I can't stop worrying."

"My mind won't turn off."

"I feel responsible for preventing every possible problem."

For individuals who already have perfectionistic tendencies, high achievement standards, or anxiety before becoming parents, the transition to parenthood can intensify these patterns.

The Cultural Layer: Why Asian American Parents May Struggle in Silence

Mental health does not exist separately from culture. Many Asian American adults grew up receiving messages such as:

Work hard.
Don't complain.
Be grateful.
Put family first.
Don't burden others with your problems.

These values often come from resilience, sacrifice, and survival. At the same time, they can make it difficult to acknowledge emotional suffering. Parents may find themselves thinking:

"My parents immigrated here with nothing."

"They had it harder than I do."

"I shouldn't be struggling."

The result is often guilt layered on top of anxiety or depression. Instead of seeking support, many people attempt to cope alone. Asian Americans are less likely to utilize mental health services compared to many other racial and ethnic groups, with stigma and cultural beliefs often serving as barriers to care (Abe-Kim et al., 2007). https://doi.org/10.1176/ajp.2007.164.8.1182 This can be especially challenging during the perinatal period when support is often needed most.

Intergenerational Expectations Can Add Stress

For many Asian American parents, having a child also brings family dynamics into sharper focus. Questions arise around:

Parenting styles
Boundaries with grandparents
Cultural traditions
Feeding practices
Sleep routines
Discipline
Language and identity

A new parent may feel pulled in multiple directions. They may want to honor family traditions while also making decisions based on their own values. They may feel grateful for family support while simultaneously feeling overwhelmed by criticism or unsolicited advice. This tension can create significant emotional strain.

Sometimes clients tell us:

"I feel guilty setting boundaries."

"I know they're trying to help, but I feel like I can't make my own decisions."

These experiences are common and often connected to broader patterns within family systems.

Parenthood can activate unresolved attachment wounds, old family roles, and longstanding expectations that previously stayed in the background.

The Link Between Sleep, Anxiety, and Emotional Overload

Sleep deprivation affects nearly every new parent. However, for individuals experiencing perinatal anxiety or depression, sleep disruptions can become especially significant.

Poor sleep was found associated with increased symptoms of postpartum depression and anxiety (Okun et al., 2018).

https://doi.org/10.1016/j.smrv.2017.04.005

Many parents find themselves trapped in a cycle:

Anxiety makes it difficult to sleep.
Lack of sleep increases anxiety.
Increased anxiety creates more mental and physical exhaustion.

Over time, this cycle can leave people feeling emotionally depleted. What begins as normal adjustment may start to feel overwhelming and unsustainable.

What Culturally Responsive Therapy Can Offer

Many Asian American adults have attended therapy before but felt misunderstood. A therapist may understand anxiety but miss the role of culture. They may understand family conflict but overlook immigration experiences, intergenerational expectations, or cultural values. Culturally responsive therapy recognizes that emotional distress does not occur in a vacuum.

For perinatal clients, therapy may include exploring:

Identity changes after becoming a parent
Family expectations and obligations
Boundary setting
Perfectionism
Self-compassion
Relationship changes
Attachment patterns
Anxiety management skills
Emotional regulation strategies

The goal is not to reject cultural values. Instead, therapy can help clients decide which values they want to carry forward and which expectations no longer serve them. For many clients, this process creates more flexibility and self-trust.

When Is It Time to Seek Support?

You do not need to wait until things become unbearable. Consider reaching out if:

Anxiety feels constant or difficult to control
You are frequently overwhelmed or tearful
You feel emotionally disconnected from yourself or others
Guilt is affecting daily functioning
You are struggling with family conflict
You feel trapped by perfectionism
You rarely experience moments of rest
Your symptoms have persisted for several weeks

Many people assume they need to be in crisis before seeking therapy. In reality, therapy can be helpful long before a crisis develops.

Common Questions

Is it normal to feel anxious after having a baby?

Yes. Some anxiety is expected during major life transitions. However, if worry becomes persistent, overwhelming, or interferes with daily functioning, it may be helpful to seek professional support.

Can fathers and non-birthing parents experience perinatal mental health concerns?

Absolutely. Research suggests that fathers and non-birthing parents can also experience depression, anxiety, and adjustment-related stress during the perinatal period.

Does therapy help with postpartum anxiety?

Research suggests that psychotherapy, including cognitive behavioral therapy and interpersonal approaches, can reduce symptoms of perinatal anxiety and depression (Cuijpers et al., 2008).
https://doi.org/10.1016/j.cpr.2007.10.003

Do I need to have postpartum depression to benefit from therapy?

No. Many parents seek therapy because they are struggling with stress, identity changes, family dynamics, perfectionism, or anxiety rather than depression specifically.

Can I attend therapy virtually?

Yes. Telehealth therapy in Massachusetts allows many clients to access support from home while managing parenting responsibilities and busy schedules.

Taking the Next Step

If you are struggling to set boundaries with family while trying to honor your cultural values, you are not alone.

At Elephant Room Counseling, our team of Asian therapists works with adults across Massachusetts navigating intergenerational tension, guilt, and relational stress.

You do not have to choose between connection and self-respect.

If you are located in Massachusetts, you can request an appointment today.

Request an appointment

References

Wisner et al., 2013 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1666651
Colonnesi et al., 2011 https://pubmed.ncbi.nlm.nih.gov/21722034/
Pietromonaco & Powers, 2015 https://www.sciencedirect.com/science/article/abs/pii/S2352250X14000128
Jawaid et al., 2018 https://doi.org/10.1016/bs.pmbts.2018.03.003
Roisman et al., 2002 https://doi.org/10.1111/1467-8624.00467