It’s clear that antenatal depression exists, but it’s not clear what should be done for it. We know too little, and none of the options are uncomplicated. But understanding some of the complexities might help millions of women who confront this condition feel less alone and make more informed decisions.

I was deeply moved by my conversations with the women whose experiences I drew on in this article, most of whom felt that their struggles had not been validated. They thought their despondent pregnancies were bizarre, outlying experiences. Some had been too ashamed to tell their husbands, their doctors, their mothers — and many of them spoke to me with evident pain when recalling what they had been through. To celebrate an experience that started in secret pain is no easy task, and mothers who had antenatal depression described how it cast a caul over motherhood.

We still have retrograde ideas about how pregnant women should feel, and we need to revise them — not only for depressed women but for all women. Pregnancy is portrayed and talked about almost exclusively as a time of rapture and fulfillment. But it involves a major shift in identity, a whole new conception of self that can lead to depression and anxiety. Change — even positive change — is stressful, and in this way pregnancy can constitute a kind of elective trauma. An abrupt transition into selflessness is not immediately appealing to everyone. Pregnant women long given to self-doubt may question their ability to take care of the child. A society that glorifies motherhood while resisting basic accommodations like guaranteed extended maternity leave makes the identity shift more frightening and abrupt than it needs to be. People given to anxiety now have a harrowing array of new anxieties to grapple with. As one woman I interviewed observed, “The things that make motherhood joyful also make it terrifying.” We should strive for a more pluralistic idea of pregnancy — for one that accommodates a wide range of moods and attitudes.

The British psychoanalyst Rozsika Parker has argued that competent mothering requires two warring impulses — to nurture the child on one hand, and to push him or her into the world on the other — and suggested that maternal ambivalence was the catalyst for achieving these apparently opposed objectives. But modern society has stigmatized the pushing and sentimentalized the clinging, and so we have denied basic truths and caused ambivalent mothers to see themselves as bad even though ambivalence can be highly productive. Mothers often exaggerate, to themselves and to others, their protective, adoring feelings, and they discount their feelings of irritation or anger as weaknesses. But a child should meet with irritation and anger some of the time; he or she should understand what those emotions are, what provokes them, how they are expressed and how they are resolved. Depression is obviously not desirable, but openness about it is tied to being honest about the challenges that motherhood entails. And that openness must begin prenatally if it is to be realized once a child has entered the picture.

There are many things that can help depressive women: the love of a supportive partner and friends, of course, but also acknowledgment of their illness and ready access to effective treatment. Most who battle antenatal or postpartum depression are committed to their children, and are trying to commit to the identity that is motherhood. For some expectant mothers and new parents, love seems to be automatic; it wafts them instantly up to a new level of consciousness. Others have to climb a very steep staircase to reach the same heights. The fact that the exercise can be agonizing and that some women cannot quite make it does not dull the intent behind it. Depression calls on resources some women have and some women don’t, including a capacity to hatch intimacy out of despair. Wanting to love your child is not the same thing as loving your child, but there is a lot of love even in the wanting.