• Before becoming pregnant, I came out as nonbinary but didn't change much of my appearance.
• After giving birth, I felt detached from myself and knew I needed to make changes.
• Giving birth became the fuel I needed to start hormone replacement therapy finally.

My morning sickness began at six and a half weeks. I told others it was like having a monthslong stomach bug.

As I fought nausea while teaching lesson after lesson in my elementary classroom, I wondered if this would be the hardest part of being pregnant. Over the next eight months, I was lucky enough to have a medically uncomplicated journey, with every doctor's visit note filled with the word "unremarkable."

But as the nausea let up, I still felt off. I blamed it on the hormones when I couldn't bring myself to get dressed and go to important social events for friends and family. I did it again when I declined a free professional pregnancy photo shoot. As my bump grew and I began to receive the excited swell of compliments, I drifted farther from myself. Soon, I avoided all mirrors.

My pregnancy became the final straw, and I started gender-affirming care.

I had already come out as nonbinary

A few years prior, I had come out to my husband as transgender and nonbinary. He and I were raised in conservative Christian homes, but his response was instantly supportive and celebratory. Over the following year, I told my siblings and friends and received waves of encouragement.

Now that I was "out," there were so many gender-affirming things I theoretically wanted to do to my appearance, but, to me, they felt too large to comprehend.

I told a member of my support system, "I would love top surgery, but that sounds way too scary."

I decided I would just stick with sharing my pronouns. Eventually, I thought I would tell my workplace. I could still blend in and switch back to she/her when I felt unsafe. I told myself that I needed to pass as a cis woman.

Despite trying different hairstyles over the years, I had never quite felt like myself. Usually, a fun sweater I had thrifted or my floral Doc Martens would brighten my day.

Everything changed when I gave birth

Surprisingly, giving birth was amazing. Again, I was lucky and had a quick four-hour labor and delivery — free of complications. I instantly burst into emotional tears when I held my son for the first time. He was, and continues to be, one of the brightest lights in my life.

But 10 weeks postpartum, I began to notice I was entirely detached from my body. I did not want others to see me. I shied away from photos with my son. Every limb and piece of flesh felt separate from myself, just as it had in pregnancy.

When I stopped breastfeeding, it did not go away, and I began to panic that I wouldn't have the small presence I had enjoyed in my physical self again.

I found community and made some gender-affirming changes

My therapist, who is also nonbinary, encouraged me to find things that brought me joy. I decided to start with being social. I made plans for a handful of coffee dates with friends, including one with my husband, to see one of his friends I had met once before.

This friend had been an acquaintance, but this time, when we met at a café, he let me know that he was trans as well. We began texting, and he mentioned his own gender-affirming care, always stating he was open to questions from other members of the trans community.

So I asked: Do the T shots hurt? Is top surgery a hard recovery? Do any insurance companies cover it? How do you find trans community?

A few weeks later, I cut my hair. I had dreamed of a short haircut for over a decade but had told myself my face was not structured the right way. Instead, as I looked in the mirror at the salon, I smiled at myself for the first time in over a year. It was glorious.

My new friend began to invite me to queer events. I enjoyed styling my short hair. I bought a binder, new clothes, and began showing up in queer spaces. I heard poetry, danced to goth music, and engaged in deep discussions about parenthood and queerness with a stranger at a queer dive bar takeover.

A few weeks later, I began hormone replacement therapy.

Becoming a parent helped fuel my gender journey

I suddenly realized that I could love being a parent and transition, too. I could live for my son and myself.

Beginning gender-affirming care postpartum made my lost body into a home. I will never be thankful enough that, as I was drifting away from myself, I found community.

I am proud to be a transgender parent. It's an honor to raise my beautiful son with my husband and to fill his childhood with a lovely and gender-diverse community.

Transitioning postpartum has not only been a way of choosing myself, but showing up authentically makes me the parent my son needs.

• A new study found that postpartum depression rates doubled over the past decade.
• Mothers interviewed by Business Insider shared a range of symptoms, including anxiety and OCD.
• Researchers say early intervention is key, but some are scared to share their symptoms.

When Bri Ramos was pregnant with her second child, she was already worried about the symptoms she experienced with her first. The lack of motivation or excitement. The severe anxiety that, up until having her first child, she never dealt with before.

Then, she started having panic attacks in her second pregnancy.

"I was like, 'Oh, here it goes again,'" Ramos, 36, told Business Insider. Her doctor saw Ramos "walking right into some bad postpartum" and took a proactive approach: prescribing Ramos Zoloft shortly after she gave birth.

Ramos is one of the many mothers diagnosed with postpartum depression. A new study from JAMA found that postpartum depression diagnoses have doubled in the last decade.

Dr. Nehaa Khadka, a maternal and child health epidemiologist at Kaiser Permanente Southern California and lead researcher on the study, told Business Insider her team was surprised by how high the rise was.

While it could be partly due to increased awareness and screening, there seems to be more at play.

Rates of depression and loneliness are on the rise, and were turbocharged during the pandemic. Emerging cultural pressures to return to work quickly or to be the perfect parent can play a role too, therapists say.

Behind the research, many mothers with PPD say they still feel misunderstood, left in the dark, and lacking resources.

Working mothers are forced to slow down

Ramos, the founder and creative director of an ad agency, said one of the hardest postpartum adjustments for her was accepting a "new season" of her life.

"So many women go through an identity crisis because it's like, 'I've been this high-achieving career woman, and now I am at home for the next six or 12 months taking care of a child,'" she said. She had to take time to figure out who she was as a mother, separate from her usual work routine.

Not every working mom has the ability to take time off and transition into motherhood. There is no national paid maternity leave in the US; full-time working moms have to rely on their employers' individual policies. This puts mothers in a precarious position: if they can't take more time off to recover, their depressive symptoms can impact their productivity, putting their jobs on the line.

When Stephanie Fornaro had her second child at 33, she had "just an overwhelming feeling of doom and sadness." She also felt resentment toward her husband when he went to work, leaving her fully in charge of their son.

Because her symptoms were physically debilitating, she quit her software sales job for two years. Not working contributed to her depression, too.

"When you're accustomed to a demanding job and 'performing' and then you go to a slower pace, and solitude, it's a major adjustment that I think many underestimate," Fornaro, 39, said.

Plowing ahead, potentially ignoring postpartum depression symptoms, can lead to quicker burnout — and leaving a career entirely.

Justine Sterling Converse runs a women-owned event strategy and management company in Texas. She remembers many of her close friends in the industry jumping back into full-time work after taking three months of maternity leave. They all quit shortly after, unable to balance motherhood with working long hours and weekends.

Once she started having children of her own, Converse realized how hard it was to return to full-time work so soon. "12 weeks is just when you're starting to have a routine with your baby," Converse, 40, and a mother of four, told BI.

It was harder with postpartum symptoms. Converse was diagnosed with postpartum OCD, something she hadn't heard of before. In her office of 10 full-time workers, she said about 75% of them have experienced postpartum depression, anxiety, or OCD.

It's partly why her company policy includes 16 weeks of maternity leave and a 50% "transition" month for mothers to ease back into working full-time. Converse, who recently gave birth, is in a transition month herself and said it's been a huge help.

"I willed myself to not go through postpartum again," Converse said. "And I still did."

Postpartum depression can be hard to identify

Symptoms of postpartum depression range from intense mood swings to thoughts of harming your baby. While it's common to feel "baby blues" when you first give birth, PPD is much more severe and can last for weeks or months.

Still, it's one thing to know about postpartum depression. It's another thing to identify it in yourself when you experience new symptoms.

"As a new mom, you're in survival mode," Fornaro said. She knew something was off, but didn't have the space and time to take stock of it all and see it for what it was. "Now, I can reflect and go, 'Wow, I really was struggling.'"

Fear of judgment has kept some new parents from reporting their PPD, said Dr. Clayton Shuman, who led a 2022 study on how the pandemic influenced a rise in postpartum depression rates. He said patients might hold back on sharing their symptoms like being unable to bond with their baby, "to avoid the stigma and guilt."

Ramos believes more openness around the subject is helping.

Out of her tight-knit friend group, four out of five women have had kids. All of them have had postpartum depression or anxiety, and openly discuss their symptoms. While Ramos experienced a lack of joy, a friend had intrusive thoughts about her newborn's health.

In contrast, when Ramos' older sisters experienced PPD nearly two decades ago, one of them "just sat in her closet and cried." She thought her depressive symptoms were normal and, at the time, told no one.

In other countries, maternity leave is different

Postpartum symptoms can last for years, much longer than the three to four months of maternity leave many US full-time employees get.

In contrast, European countries like Greece and Iceland offer 26 weeks of leave or more. Some, like North Macedonia, allow parents to take additional leave if they need to, without fearing for their job security.

For American mothers without as many federal safety nets, extra help makes all the difference. Fornaro's husband worried about her postpartum depression and offered to pay for a nanny, which she initially refused. "It took a lot of convincing and setting aside my pride," she said.

Looking back, she said hiring extra help was the "best decision" for her family. Her nanny not only made every day more manageable, she offered crucial emotional support and helped Fornaro bounce back.

In Ramos' experience, even the smallest interventions can radically change postpartum symptoms. She said she is grateful her doctor was so quick to diagnose her and prescribe medication; it made for a much smoother experience with her second child.

"I'm just so thankful that I got to enjoy him being a baby and having fun with him," she said, remembering how overwhelmed she was when she had her daughter four years earlier. "I was just in a completely different state of mind."