Postpartum depression: signs after having a baby

Feeling down, tearful, anxious or irritable in the first days after giving birth is very common. This is often called the baby blues. It usually starts a few days after the birth and goes away within about two weeks, especially with good support from family.

Postpartum depression, also called postnatal depression, is different. It lasts longer, it is heavier, and it can start any time from pregnancy until a year after the baby is born. It is more than feeling sad: strong anxiety is common too.

A simple way to think about it: if the low feelings are still there after two weeks, or if they are getting worse, talk to someone. You don't need to be sure which one it is. Only a doctor can tell what's going on.

Signs some women notice after having a baby include:

• a low mood that does not lift, or feeling empty
• finding it hard to enjoy anything, even the baby
• feeling hopeless, overwhelmed or unable to cope
• trouble sleeping, even when the baby is asleep
• difficulty feeling close to your baby
• feeling guilty, worthless, or like a bad mother
• crying a lot, or feeling numb
• feeling tired and low on energy all the time
• frightening thoughts about harming yourself or your baby

Frightening thoughts like these are a known sign, and they can be very upsetting. Having them does not mean you will act on them. Telling someone is the step that gets you help, so please do say them out loud.

Many of these signs are the same as the signs of depression in women at other times of life. What makes this different is the timing, and how much is already being asked of you.

Family often sees the change before the new mother can name it. Things they may notice include:

• she seems flat, tearful or withdrawn, not just tired
• she stops eating properly or can't sleep when she has the chance
• she seems frightened, or keeps checking the baby again and again
• she says she is a bad mother, or that the baby would be better off without her
• she does not want to hold the baby, or seems distant from the baby
• she cuts herself off from friends and family

If you are family, ask gently and listen without judging. Offer practical help: take the baby for a feed or a walk so she can sleep, bring food, handle visitors. And help her talk to a doctor.

Not every mother with postnatal mental health problems feels sad. For some, the main feeling is worry: constant fear that something bad will happen to the baby, checking again and again, a racing mind and being unable to rest even when exhausted.

Some worry is part of caring for a newborn. When it takes over, stops you sleeping or enjoying your baby, or comes with panic, it is worth talking to someone. Read more about anxiety after childbirth and how anxiety can feel in women.

There is rarely a single reason. Hormone levels shift sharply after birth, and that plays a part in the baby blues. But hormones are unlikely to be the only cause.

Other things that can make it more likely include:

• a past experience of depression or other mental health problems
• little support at home, or feeling alone
• exhaustion, a difficult birth, or problems with feeding
• stressful living conditions, money worries or major life events
• violence or abuse at home
• low self-esteem or a difficult childhood

The World Health Organization notes that almost any woman can develop mental health problems during pregnancy or in the first year after birth. It is not a sign that you are a bad mother, and it is not something you brought on yourself.

Fathers and partners can have depression after a baby too.

In many Indian families, the weeks after birth are full of rules, visitors and advice. You may be at your mother's home, or in a house full of elders. Everyone is focused on the baby, and it can feel impossible to say, "I am not okay."

Some things that can help:

• Pick one person: your partner, your mother, a sister or a friend. Tell them what you feel, in plain words.
• Ask for specific help: "Can you take the baby for two hours so I can sleep?"
• If an elder says "every mother feels this" or "it will pass", you can say: "I know. But it's been more than two weeks, and I want to talk to a doctor."
• Ask your gynaecologist or your baby's doctor at the next check-up. They see this often, and it is part of their job to ask.

Before the baby arrives, if you can, talk to your family about how they can support you after the birth. UNICEF suggests this as one way to protect against postpartum depression.

Talk to someone if low mood, anxiety or tearfulness lasts more than two weeks after the birth, if it is getting worse, or if it starts later in the first year. The sooner you talk to someone, the sooner you can get support.

A Nari health counsellor can listen, help you put what you are feeling into words, and book you with a Nari doctor. The doctor looks at your mood and your body together after the birth and decides what you need next. Counsellors never give medical advice; medical decisions come from a Nari doctor.

Call 112 now if:

• you have thoughts of harming yourself or your baby and feel you might act on them, or you can't keep yourself or your baby safe
• a new mother suddenly seems very confused, sees or hears things that are not there, has strange beliefs, or seems very high, restless or unlike herself, especially in the first two weeks after birth

That second set of signs can be postpartum psychosis. The NHS says it is a serious illness that usually starts suddenly in the first two weeks after birth, and that it is a medical emergency.

Nari 1 is not an emergency service. If you are thinking of harming yourself, or you are in danger, call 112 now. For free mental health support at any hour, call Tele-MANAS on 14416 or 1-800-891-4416, a Government of India helpline. Our page on urgent help lists what to say when you call.

• When the baby was born, and when the low or anxious feelings started.
• Whether it has lasted more than two weeks, and whether it is getting worse.
• Sleep: can you sleep when the baby sleeps?
• Eating, energy, and how you feel about the baby.
• Any frightening thoughts. Say them; they are a sign, not a confession.
• Any past depression or anxiety, including before or during pregnancy.
• How much help you have at home.