Trimester zero: Why couples head to therapists to prepare for pregnancy

Sakshi and her husband Palash, 31, had covered the usual preconception checklist — folic acid, iron levels, nutrition and fitness. The therapy was Sakshi’s addition. Anxiety runs in her family: her grandfather had it, her father showed similar symptoms, and she was diagnosed with an anxiety disorder in college for which she took medication. Although she is not dealing with mental health issues now, she opted for therapy during Trimester Zero. Her aim is to break the cycle of generational anxiety, prepare for a healthy pregnancy and raise a resilient child.

The Srivastavas belong to a growing demographic of urban Indian couples who seek a holistic approach that includes physical and mental readiness before conceiving. Dr Charan Teja Koganti, neuropsychiatrist at KIMS Hospitals, Hyderabad, has noticed there are two distinct cohorts getting mental health care during the pre-conception phase.

“The first arrives carrying diagnosed anxiety or depression and seeking treatment before pregnancy complicates it. The second arrives unburdened by clinical history but heavy with everything else, like career ambitions, financial pressures, misaligned partner timelines, eroding support from extended family, and a deep fear of passing inherited inadequacies—emotional or financial—onto a child not yet conceived,” says Dr Koganti.

CAREER GOALS

Mumbai-based architect Nidhi Sharma, 29, says pandemic-induced job loss had a lasting effect on her mental and physical well-being. “Ever since, I’ve felt stressed. I was overthinking and ruminating all the time, and my sleep cycle became disrupted,” she says.

At first, the effects seemed confined to her mind. But gradually, her body began to reflect the strain as well. “My menstrual cycle became irregular,” Sharma says. Around the same time, she came across social media discussions linking chronic stress to reproductive health issues.

When she began planning her pregnancy, she decided to seek medical advice to understand her physical and mental health. “I felt I had no choice but to consult a gynaecologist, who eventually referred me to a psychiatrist,” she says.

At Marengo Asia Hospitals in Gurugram, psychologist Dr Munia Bhattacharya has been seeing a growing number of women seeking mental health support during Trimester Zero.

One of her recent patients, a 31-year-old HR manager, had finally reached a hard-won sense of stability in her career when she began grappling with obsessive, intrusive thoughts.

“She had always managed to balance work and family responsibilities,” says Dr Bhattacharya. “But as she began thinking about motherhood, she became increasingly anxious about losing the professional footing she had worked so hard to achieve.” At the same time, the woman felt unexpectedly detached from the idea of becoming a mother.

“She described a sense of numbness towards motherhood and was caught in a pattern of catastrophic thinking,” she says. She adds that such concerns are becoming common among women who have spent years overcoming personal and professional challenges to build fulfilling lives and careers.

“It is perfectly normal for women not to feel excited about planning a family,” she says. “Demanding work schedules and the constant pressures of the workplace often leave little room to think about motherhood. For some, the desire simply doesn’t emerge in the way they expected, and that can bring feelings of guilt.”

In such cases, therapy can help challenge catastrophic thinking while also examining the deeper fears and anxieties that lie beneath those concerns.

MEN CARRY IT TOO

Jyoti and Rakesh Dhoundiyal, both in their early thirties from Uttarakhand and now living in Delhi, say the pressure to have a child began just two years into their marriage. “We wanted to wait until we were financially stable, and Rakesh often felt he hadn’t done enough to support a family comfortably,” says Jyoti. Persistent questions from family and friends left him anxious and eventually depressed. He began therapy and medication about seven months before conception. “He is doing much better now, and today we have an eight-month-old daughter,” she says.