The first few weeks of life with a newborn are rarely like a TV nappy advert. Although most women have many joyful memories from the early weeks of having a new baby, it can also be a very emotional and overwhelming time. Not only will you be recovering from giving birth and probably not getting much sleep, but you may also be learning to feed, soothe, wash and change the newest addition to your family.
Amidst all this chaos, it can be hard to find the time to look after yourself and talk about your feelings. Many new mothers struggle with feeling low and/or anxious and it is important to be aware that there are many sources of advice, help and support.
It is extremely important that women feel able to have an open and honest conversation about their mental health during the postpartum period. Studies estimate that mental health conditions account for around 10% of deaths of new mothers in the UK in the six weeks after having a baby. Mental health conditions are also the leading cause of deaths among UK-based women between six weeks and a year following childbirth. The good news is that with prompt diagnosis and appropriate support and treatment, most new mothers with mental health difficulties make a full recovery.
This post will summarise the different causes of low mood that you might experience as a new mother. We will also explore the circumstances whereby someone might need to seek help, and the various treatment options available for those with postpartum mental health struggles.
What are the “baby blues”?
The “baby blues” are a very common phenomenon that usually begin in the week following childbirth and can last until until a baby is 10 to 14 days old. Women with baby blues can experience low mood, feelings of mild depression and frequent episodes of tearfulness.
It is believed that the baby blues are caused by sudden hormonal (oestrogen) and chemical changes in the female body after childbirth. As an example: oestrogen levels fall more than 100-fold in the three days immediately following baby’s delivery.
It is not the same as postnatal depression.
Symptoms of the baby blues:
Common symptoms of the baby blues include:
🌟 Low mood
🌟 Anxiety and/or restlessness
🌟 Feeling irritable, touchy or grumpy
🌟 Recurrent and/or sudden crying spells (including bursting into tears) without any clear cause
🌟 Feeling emotional and/or overwhelmed
While these symptoms might be distressing–particularly at a time where you likely expected to feel very happy–they are completely normal.
How can I treat the baby blues?
The baby blues are a normal part of the postpartum experience and, unfortunately, there are no specific treatments available. However, the good news is that, for most new mothers, the symptoms are mild and will pass in a few days.
Everyone will have different “feel-good” strategies for challenging times, and the most important thing to do in the days following childbirth is what feels right to you. If possible, try to indulge (even if just for a few minutes) in some activities that help you relax and unwind–whether that is exercise, reading a good book or taking a bubble bath.
Some women find it helpful to:
🌟 Talk about their feelings with their partner, a close friend or family member.
🌟 Write down how they are feeling in a journal or notebook.
🌟 Ask those close to them for help with tasks around the house (e.g. cleaning, cooking meals or gardening).
- It is not easy to ask for help, but remember that this is a very temporary time, and involves massive upheaval in your life. Managing day-to-day tasks on top of everything can feel overwhelming.
- It can be helpful to think about the tasks that can be outsourced for a few days/weeks to take some of the pressure off, and consider if you have the resources for someone to help with cleaning, meal delivery/ meal prep boxes, childcare for other children.
🌟 Carve out some time for a stress-free social engagement with loved ones (for as long or as short as feels comfortable).
🌟 Pause to take a few deep breaths when they are feeling low, overwhelmed or tearful. Hypnobirthing or mindfullness techniques can be a practical way to focus your thoughts. Have a look at some apps you can download like Calm and Headspace.
🌟 Take some fresh air breaks, whether that is sitting in the garden, going for a walk or doing the shopping.
What is postpartum depression?
Postpartum (or postnatal) depression is a type of depressive illness that develops after having a baby. The symptoms are similar to that of depression that develops outside of childbirth, with low mood often being the main complaint.
Postpartum depression can impact on a new mother’s ability to take care of herself and her baby and might make simple, everyday tasks (including childcare) feel like a struggle.
Postpartum depression is common, affecting more than one in ten women within a year of childbirth. The symptoms of postpartum depression usually develop within two to eight weeks of giving birth, but they can begin up to a year after the birth of a baby.
A smaller proportion of women have depressive symptoms which start during pregnancy and continue after childbirth.
What causes postpartum depression?
There is rarely a single cause for postpartum depression, and it is most often believed to be the result of a combination of stresses and life circumstances.
Evidence suggests that a woman is more likely to have postpartum depression if she has/has had:
🌟 Previous mental health difficulties, such as depression and/or anxiety
🌟 Depression and/or anxiety during pregnancy
🌟 Recent stressful/emotional life circumstances (e.g. bereavement, relationship breakdown or loss of a job)
🌟 Poor social support from her partner, family and/or friends
🌟 Marriage or relationship difficulties
🌟 The baby blues
🌟 Suffered domestic violence or previous abuse
🌟 Arrived in a foreign country as an asylum seeker or refugee
In a small number of cases, postpartum depression is linked to a chemical imbalance, such as low levels of Vitamin B12 or an underactive thyroid. This can be easily screened for with a blood test and treated by your doctor if necessary.
It is important to remember that, for many women, there are no clear causes or contributing factors to their postpartum depression. Also: having experienced one (or more) of the circumstances above does not mean that you will definitely develop postpartum depression.
Symptoms of postpartum depression:
Women with postpartum depression can experience one, some or many of the following symptoms:
- Psychological
🌟 Low mood (e.g. feeling unhappy or tearful for some, most or all of the time)
🌟 Feeling irritable, hopeless and/or unable to cope
🌟 Loss of interest in daily tasks and activities (including those you previously enjoyed)
🌟 Poor memory, difficulty concentrating and/or inability to make decisions
🌟 Loss of interest in sexual intercourse
🌟 Intrusive negative thoughts and/or feelings of guilt
🌟 Anxiety (which can include panic attacks)
🌟 Withdrawing from social contact with other people, including friends and family
🌟 Low self-confidence
🌟 Mood swings, which can range from feeling agitated to apathetic
🌟 Thoughts of self-harm and/or suicide
- Physical
🌟 Changes to your appetite (e.g. loss of appetite or comfort eating)
🌟 Lack of energy and/or feeling excessively tired
🌟 Sleeplessness (difficulty falling or staying asleep, even when you are feeling exhausted)
🌟 Aches and pains
🌟 Feeling generally unwell and/or “not yourself”
- Relationship with your baby
🌟 Difficulty bonding with your baby
🌟 Extreme anxiety about the baby (e.g. worrying that your baby is unwell or unsafe)
🌟 Loss of interest in the baby, which might include feeling apathetic towards your relationship with the baby and/or taking care of the baby
🌟 Concerns that you might harm your baby (either accidentally or intentionally)
How do I know if I have the baby blues or postpartum depression?
The baby blues and postpartum depression have a lot of symptoms in common–including low mood, tearfulness and irritability–and it can sometimes be difficult to tell the two conditions apart.
Generally, your symptoms are more likely to be linked with postpartum depression if they are:
- Severe
- Lasting for longer than two weeks
- Interfering with your ability to function (e.g. eat and sleep)
- Interfering with your ability to bond with and/or take care of your baby
The only person who can safely and appropriately diagnose your symptoms is a healthcare professional. If you think that you might have postpartum depression (or have any symptoms of concern), it is important that you contact your local health professional promptly to arrange a consultation.
Where can I get help for postpartum depression?
It is important to remember that postpartum depression is an illness that can and should be treated and you do not have to struggle alone. Prompt advice, support and treatment can ensure that depression does not blemish your experience of new motherhood.
The first step in getting support is to contact an appropriate healthcare professional, such as your healthcare visitor, midwife or GP.
Most healthcare visitors are trained to recognise the symptoms of postpartum depression and will have practical techniques that can help. If it is felt that your symptoms require assessment by a doctor, your healthcare visitor will be able to support you in accessing this help.
A small number of mothers with postpartum depression will need to be seen by mental health services. Your GP can refer you to a perinatal mental health clinic if required (specialist mental health services for pregnant women or new mothers with babies less than a year old).
⚠️ If, at any point, you feel that you are unable to take care of yourself and/or your baby OR you have any thoughts about harming yourself, harming your baby and/or suicide, you MUST seek urgent help. You can access urgent help in the following ways:
- Your local emergency department
- Your local emergency phone line (e.g. 999 in the UK)
- Phoning your GP clinic during opening hours to request an urgent appointment
- Phoning a mental health crisis line (you will likely be given a number to call if you have been seen by mental health services)
- Call the Samaritans helpline on: 116 123
Treatment for postpartum depression:
The support and treatment a new mother needs for postpartum depression will depend on how severe her symptoms are. Available treatment options include:
- Self-help strategies
Self-help techniques are most often used for women with mild depressive symptoms. The Royal College of Psychiatrists recommends a number of strategies that new mothers might find helpful in managing their symptoms. You have the flexibility to use as many (or as few) of these strategies as appeal to you, in whatever combination feels the most comfortable.
Examples of recommended self-help techniques include:
🌟 Discuss your feelings with someone understanding, such as your partner, a friend, family member, health visitor or GP.
🌟 Take all opportunities to rest and catch up on sleep (e.g. try and rest whenever your baby is sleeping).
🌟 Try to eat healthy food regularly, even if you do not have a steady appetite.
🌟 Incorporate some exercise into your daily routine; your health visitor may be able to recommend some local mother and baby exercise groups.
🌟 Consider joining local parent-and-baby groups which can help you build a strong social network. The National Childbirth Trust offers a range of local parent socials, including “mum meet-ups” and coffee groups.
🌟 Access postnatal depression support services, such as telephone advice lines, online communities or in-person support groups. BabyCentre has a welcoming and friendly online community for women battling postnatal depression. PANDAS (postnatal depression awareness and support) provides free telephone and e-mail support, face-to-face group meetings and Facebook groups for new parents struggling with depression. See below for other support resources that you might find helpful.
🌟 Read self-help books and websites. Mind has published lots of excellent material on postnatal depression, including first-hand experiences from new parents.
🌟 Consider making an individualised post-birth Wellbeing Plan (an easy-to-use template is available from the Tommy’s charity website).
🌟 Avoid alcohol, smoking and drug-use, which are dangerous to your and baby’s health and can make depression worse.
The full list of self-help techniques can be accessed here.
- Talking therapies
If self-help techniques alone have not controlled your symptoms, you might be referred by your GP for talking therapy (counseling). There are a range of counseling options available for postnatal depression, including cognitive behavioral therapy (CBT). Although individual counseling strategies might vary, the aim for them all is to enable you to work through your feelings in a safe and supportive environment.
- Medication (anti-depressants)
Anti-depressant medications are used in cases of severe postnatal depression, or where talking therapies alone have not resolved your symptoms. These might be used in combination with talking therapies or on their own. There are several types of anti-depressants available, and your prescribing physician (e.g. GP or mental healthcare professional) will be able to advise on the best choice for you.
It is important to tell your doctor if you are breastfeeding before starting anti-depressant treatment. For most anti-depressants, there is no evidence that they cause any harm to breastfed babies and you will usually be supported to continue breastfeeding (if this is your choice). However, there are some circumstances where this advice might change, such as if your baby is unwell or was born prematurely. Your doctor will be able to get the most up-to-date information from the UK Drugs in Lactation Advisory Service to help support you in making a decision about medical therapy and breastfeeding.
We have previously published a blog post on general medication use and breastfeeding, which can be read here.
⚠️ What if my symptoms are more severe?
Postpartum (postnatal) psychosis is a rare but serious mental health illness that affects around 1 out of 1000 new mothers. Symptoms begin in the days to weeks after childbirth and are more extreme than those linked with postpartum depression. If not treated quickly, postpartum psychosis can become life-threatening, so it is essential to seek urgent help.
Common symptoms of postpartum psychosis include:
🌟 Rapid mood swings (e.g. fluctuating between high and low moods)
🌟 Believing things that are not true (delusions)
🌟 Seeing or hearing things that are not there (hallucinations)
🌟 Feeling suspicious, frightened or fearful
🌟 Manic mood (e.g. feeling “high” or “on top of the world”)
🌟 Behaving strangely and/or out of character
If you, or a loved one, are concerned that you have any symptoms of postpartum psychosis, you must see a healthcare professional immediately. You can access urgent help by: phoning your GP or local emergency number (e.g. 999), attending your local Emergency Department or contacting a crisis team (if you have been previously seen by mental health services).
Women with postpartum psychosis are almost always treated in hospital. In many situations, care can be provided in a specialist mother and baby unit (where your baby can stay with you). The majority of women with postpartum psychosis make a full recovery if treatment is started promptly.
Outlook
Postpartum depression is a common mental health illness that requires support and treatment. It is not a normal part of life with a new baby, a sign of weakness or something that you should be able to “snap out of.”
Most importantly, postpartum depression does not mean that you are a bad parent or that your baby will be taken away from you. In fact, accessing help is acting in the best interests of you and your baby. The good news is that most women respond very well to treatment and make a full recovery with appropriate support.
Useful Resources
- The Association for Postnatal Illness (APNI) publishes information on postpartum depression and offers free telephone, e-mail and online chat support and advice: https://apni.org/contact/
- The Samaritans run a 24/7 365 telephone line to support you with any worries, concerns or difficulties that you might have (during pregnancy, after childbirth and beyond). They also have an excellent self-help app: https://www.samaritans.org/how-we-can-help/contact-samaritan/talk-us-phone/
- Home-Start is a local community network of volunteers that run parent and baby groups (including specialist postnatal support groups) across the UK: https://www.home-start.org.uk/homestart-groups
- Netmums offers friendly and relaxed peer support via their online Maternal Mental Health Drop-In Clinic: https://www.netmums.com/coffeehouse/drop-clinic-984/maternal-mental-health-995/
- Action on Postpartum Psychosis (APP) has published excellent online resources, including personal accounts from sufferers. A moderated support forum is available on their website, as well as one-to-one messaging: https://www.app-network.org/what-is-pp/getting-help/
References
(1) Antenatal and postnatal mental health: clinical management and service guidance. National Institute for Health and Care Excellence. Published: December 2014. Updated: February 2020. https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations#principles-of-care-in-pregnancy-and-the-postnatal-period-2
(2) Feeling Depressed After Childbirth: Your Pregnancy and Baby Guide. NHS. Published: August 2018. https://www.nhs.uk/conditions/pregnancy-and-baby/feeling-depressed-after-birth/
(3) Postnatal Depression. Royal College of Psychiatrists. Published: November 2018. https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-natal-depression
(4) Overview: Postnatal Depression. NHS. Published: December 2018. https://www.nhs.uk/conditions/post-natal-depression/
(5) The Baby Blues: what to Expect. National Childbirth Trust. Published: January 2018. https://www.nct.org.uk/life-parent/how-you-might-be-feeling/baby-blues-what-expect#tag-target-1
(6) Postnatal Depression (PND). Tommy’s. Published: October 2018. https://www.tommys.org/pregnancy-information/im-pregnant/mental-wellbeing/specific-mental-health-conditions/postnatal-depression-pnd
(7) Your Mental Health After the Birth. Tommy’s. Published: May 2019. https://www.tommys.org/pregnancy-information/labour-birth/after-birth/your-mental-health-after-birth
(8) Postpartum Psychosis for Carers. Royal College of Psychiatrists. Published: November 2018. https://www.rcpsych.ac.uk/mental-health/problems-disorders/postpartum-psychosis-in-carers
(9) Postpartum Psychosis. NHS. Published: September 2017. https://www.nhs.uk/conditions/post-partum-psychosis/
(10) MBRRACE-UK release: MBRRACE-UK: Saving Lives, Improving Mothers’ Care. National Perinatal Epidemiology Unit (NPEU). Published: November 2019. https://www.npeu.ox.ac.uk/news/1917-mbrrace-uk-release-mbrrace-uk-saving-lives-improving-mothers-care-2