For many women, having a baby is the most significant physical, social and emotional upheaval they have ever experienced.

Following childbirth and the start of parenthood, women often describe positive emotions, such as:

Joy
Love
Surprise
Amazement
Euphoria
Delight
Tenderness
Protectiveness
Feeling of achievement.

However, because parenthood is a constant and demanding job, most women’s experiences are not always like the usual media images: two happy parents with a clean, cuddly, well-fed, sleeping baby.

During pregnancy, you have to deal with changes in your lifestyle and everyday routines. Later you are preoccupied with your baby’s health, behavior patterns, and temperament.

All this requires enormous physical stamina and emotional commitment. It is not surprising that parents, especially mothers, find it hard to cope at times.

The importance of support

Let’s be raw and honest here. Postpartum, or postnatal, depression has much more to do with a lack of emotional support than with any pre-existing mental health problems.

We were meant to have our babies surrounded and supported by our communities.

Modern women have adapted to not having a support system in place and it’s usually manageable when we are the main support providers. When we need to be supported, however, many of us don’t have the help we need.

Although this is hard to hear, the main reason why women develop postnatal depression (or other postnatal mental illness) is because practical and emotional support isn’t available for us after giving birth.

Unrealistic expectations

Many women feel they must keep up with their previous roles and what’s expected of them. Even if support is available, we’ve been raised to believe it’s better not to ask for it. Instead, we carry on and keep investing in others, putting their health and well-being ahead of our own.

Most women want to be good mothers and if they are achieving anything less than perfection, it can seem like an enormous disappointment. Other people’s expectations of pregnancy and motherhood are also unrealistic.

Some unhelpful beliefs are:

I’ll always enjoy parenthood
I will lead a healthy lifestyle for my baby
My life won’t change
Having a baby will improve my marriage or relationship
I will instinctively know how to look after my baby
I will always feel content and in control
There is something wrong with my mental health if I can’t cope
Mothers immediately recognize and love their babies
Good mothers don’t have negative feelings towards their children
All other women don’t have any mental health problems and are coping well.

These unrealistic expectations can lead women to blame themselves and be reluctant to seek help, worrying that they will be labeled as ‘inadequate’ or ‘a poor mother’, rather than realizing it takes time to adjust to motherhood. The task of motherhood is enormous and there are lots of things to learn.

Many women feel ashamed if they are not coping. They believe this should be the happiest time of their lives. It is important to acknowledge to yourself that it is okay to tell people and seek help, if you are feeling depressed, anxious, angry, or confused.

Symptoms of postpartum/postnatal depression

Persistent low mood, together with symptoms of postnatal depression, for a period of 2 weeks or more, can indicate clinical depression. This might require further assessment and treatment.

Some of the symptoms of postnatal depression are:

Feeling unable to cope
Pre-occupation with obsessive or morbid thoughts
Thoughts of harm to yourself or your baby
Confusion and guilt
Anxiety or panic attacks
Finding that your moods change dramatically
Crying uncontrollably or feeling teary
Unrealistic feelings that you are inadequate
Always feeling either exhausted or hyperactive.

If you are concerned about the way you are feeling, or how you are coping with parenthood, talk to your healthcare providers: midwife, health visitor, doctor, or maternal and child health nurse. Ask them to refer you to an experienced health care professional in mental health services.

Alternatively, if you have family and friends you trust and who listen to you in a supportive way, talk to one of them about how you are feeling.

Depression following childbirth should not be confused with the ‘baby blues’.

Up to 80% of women experience baby blues, which tends to peak three to five days after giving birth and is caused mainly by hormonal changes at birth. Women have frequent rapid mood swings and often feel teary and a bit overwhelmed for a few days.

It is important to realize that depression is a treatable condition and one from which you can recover. It takes time, however, and appropriate medication and counseling, as well as confidential emotional support from family and friends.

Treatment options include individual counseling, psychological treatment, couple counseling, support groups, medication, and admission to a hospital or mother and baby unit.

Edinburgh postnatal depression scale

The Edinburgh postnatal depression scale is a questionnaire-based tool designed to identify women who are developing perinatal depression. It’s usually the first step taken towards diagnosing antenatal and postnatal depression.

When mental health care providers are first contacted by midwives, health visitors, doctors, or the women themselves and they see risk factors or symptoms of postnatal depression this scale is normally used to assess the woman’s mental health.

It’s a very useful tool, not only when major depression is happening but also to check whether a woman is at risk of developing perinatal depression (postnatal or antenatal depression).

You can read more about it in Edinburgh Postnatal Depression Scale | Take The Test.

How PND affects the mother

Giving birth is probably the most important rite of passage a woman goes through. Pregnant women dream about the time when they become mothers and it’s quite common, especially in western countries, to leave babies and children out of social life. Most women, and people in general, don’t really know what having a baby implies until they have one. There’s hardly any information about what to expect and about how things are going to develop.

If giving birth didn’t go as you expected, or if you’ve read all the books and taken all the new parents’ courses and your baby still behaves like the demanding individuals babies are, you might find yourself completely overwhelmed. Many women experience perinatal anxiety during the last weeks of pregnancy. If not properly managed they could develop postnatal depression.

What might postnatal depression look like?

When a mother has postnatal depression she usually finds no joy in such a magnificent life-changing event.

She might feel overwhelmed by sadness as she cannot explain or described why she feels the way she does. She has a healthy beautiful baby but still feels sad and miserable for no apparent reason
She cries for no apparent reason and feels vulnerable and guilty – especially if her expectations aren’t met or if other family members or friends insist on how wonderful her life should be or try to downplay the importance of how she’s feeling
This can quickly escalate to serious mental conditions and thoughts of self-harm, which can damage not only her mental health but her physical health, too.

What to do

If you or your partner have symptoms of depression or are not sure but you can see something isn’t quite right:

Don’t just think it will pass, or that it’s only a phase and it will get better
Seek immediate medical attention, talk to the right mental health professional and get appropriate treatment if necessary.

How PND affects attachment

A baby also has expectations after birth and they should be considered. During pregnancy, a baby has been preparing and waiting to meet her mother. Everything is in place to develop a secure attachment between mother and baby.

During the first few months of a baby’s life, the baby is biologically wired to be next to her mother 24/7, to have all her needs taken care of, and to complain when those needs aren’t met.

Mother and baby develop a lifelong bond that will help the baby grow into an emotionally stable adult. Our adult mental health depends a lot on this initial bonding with our mothers.

If you have postnatal depression and are reading this, there’s a lot you can do for your baby’s mental health and, above all, for your own mental health.

Look for help

Mental health problems are very common. There’s nothing to be ashamed of and there are people with specialized training to help you overcome postnatal depression or any other mental illness.

Talking therapy

Talking with a professional about how we feel helps untangle trauma and bring our mental health problems to the surface. When they are buried deep, they are still there and they just cause hurt. Previous mental health problems are also still there and we carry them around like a huge weight. If we do nothing about them, they won’t disappear but will weigh more and more and make us more prone to developing postnatal depression or other mental illnesses.

Talk to your baby

No matter what, include your baby in what’s happening in your life. Your baby needs to know you’re there and that you’re including her. She needs to know there is something wrong but it’s not her fault. She especially needs to know you love her very much but you are unwell at the moment.

Explain that she isn’t the cause of your feelings. They are there and you’re vulnerable but you’re going to get better. Tell her that she’s safe and loved, that her mother, her family, and her friends love her very much and that you’re blessed by her appearance in your family.

The detachment of mothers from their babies happens because some adults forget about the baby’s mental health. Thinking that a baby needs only food and sleep and that we must keep her away from family problems is the beginning of her own future mental health problems.

Babies are part of the family and they should be included. They feed on the family hormones (this is also literally true if you’re breastfeeding) and they feel the stress, the tension, and the negative energy in their environment.

When you include your baby, talk to her and explain what’s going on with your hormonal flow changes. You’ll start to secrete love hormones and your stress hormone levels will decrease. You’ll start to feel better and so will your baby.

This is the best advice I can give you. Embrace your baby completely into your life – even in the shadowy areas. There’s so much your baby can do for your mental health.

Does PND improve on its own?

Postnatal depression can improve or be sorted out without medical or pharmacological help. But antenatal and postnatal depression won’t improve on their own. You need to put in the work, talk to your baby, make use of psychological therapies and stress management techniques, do a self-help course, and seek professional advice. Postnatal depression is a medical condition that requires change and work.

Will I get PND again?

If you have a history of depression or of previous perinatal depression you’re at higher risk of developing postnatal depression. This doesn’t mean that you will experience postnatal depression every time you have a baby.

When postnatal depression is handled appropriately it shouldn’t come back.

Sometimes, antidepressant treatment just addresses the symptoms of postnatal depression but it doesn’t go to the root cause of it. Sometimes, pharmacological treatment gives you the false idea that you’re better. Mental health problems require a lot of talking therapy and a lot of psychological investment in finding the cause.

Depression is like a physical wound: you cannot just cover it. You must clean it, look after it, dress it and apply treatment, depending on its severity. Once it heals it will always leave a scar. And scar tissue, even emotional scar tissue, will always be more fragile.

Can PPD start late?

Postnatal depression can appear from the first few weeks until a year after birth. It can also happen before birth. In this case, it’s called antenatal depression.

If depression happens after the first year, it’s not considered postnatal depression.

Postpartum mental health

The postpartum period can be mentally challenging and various mental health problems can arise after birth.

Baby blues

Baby blues is described by the national institute of health as a feeling of sadness and mood swings that happens in the first few days after giving birth. It’s caused by the hormonal changes the woman’s body experiences right after giving birth. It’s completely physiological, and might be accompanied by other symptoms, such as tiredness or trouble sleeping. It resolves on its own after a few days.

Postpartum depression

Although commonly known as postnatal depression, postpartum depression is the correct terminology, as ‘postpartum period’ refers to the experience of the woman who gives birth, and ‘postnatal period’ refers to the newborn baby’s early days.

Depression is the most common postnatal mental health problem. Although it isn’t usually considered a medical emergency, families affected by postnatal depression might feel differently.

Postpartum psychosis

Postpartum psychosis is a major mental health disorder. You might be experiencing postpartum psychosis if you have any of the following symptoms:

Severe agitation
Hallucinations
Seeing, hearing, or smelling things that are not there.
Seek immediate medical help if any woman is experiencing these symptoms in her postpartum period.

Other mental disorders that affect a woman’s mental health, such as bipolar disorder or obsessive-compulsive disorder, are not specifically related to the postpartum period but can make postnatal depression worse. Contact your health visitor or health care professional of choice for advice about this.