Postnatal depression

Having a baby is one of the most life-changing, emotional events you’ll experience. We talk about why you might cry and how to get help if you need it. 

Why am I crying after I’ve given birth? The ‘baby blues’

You might be wondering why the tears just won’t stop flowing right now. Yet you’re exhausted from giving birth and now have your newborn baby to care for, and their seemingly relentless demands. It is completely normal for new parents to feel overwhelmed with your new roles and responsibilities and tearful in the first few days after baby arrives (Shaw et al, 2006).

Mums have another reason to cry. The levels of pregnancy hormones drop rapidly three to ten days after giving birth. This comes at the same time as a rise in the hormones that cause milk production (Pilkington et al, 2016)

This double whammy of big hormonal and life changes is why many new mums can feel tearful around day three after giving birth, as their breastmilk comes in. It is normal to feel like this whether you are breast or bottle feeding.

What do the baby blues feel like?

In addition to feeling tearful you might also feel: 
-    Irritable and snappy with those close to you
-    Irrational and very emotional, even about small things
-    Anxious and under-confident about how you are looking after your baby

Maya* describes her experience of the baby blues:

‘The midwife came on day three to check on the baby and I. We were struggling with feeding, I had sore nipples and a house full of relatives. 
When the midwife told me my baby had mild jaundice, even though I knew it was nothing to worry about I just couldn’t stop crying.

Eventually I was even laughing while crying because I knew I didn’t need to be upset but just couldn’t stop the tears! 
It was only in hindsight I realised it was day three and the classic day for the baby blues to make an appearance.’

While it is very normal to feel tearful during the first couple of weeks, make sure you tell people close to you how you’re feeling. You need as much support as possible while you get used to life with your new baby.

What if I can’t stop crying?

If you are still feeling tearful more than two weeks after having your baby you might be experiencing a postnatal mental health problem .    Some women experience depression, others experience anxiety , but many with anxiety don’t realise they have a postnatal mental health problem. 

Depression and anxiety are the most common postnatal mental health problem and affect 15% to 20% of women in the year after they give birth (NICE, 2018). Postnatal depression (PND) is the most common of all (Khajehei et al, 2017). A small number of women – around 1 to 2 per 1,000 – develop postpartum psychosis

While it can be hard-hitting, the good news is that it is very treatable. It is important to get help, as unlike the baby blues, a postnatal mental health problem won’t go away on its own.

Depression can feel different for everyone. There are many possible symptoms of postnatal mental health problem - you might experience a few of them, but it’s very unlikely you’d have them all. 

Some symptoms of a postnatal mental health problem

Feelings
●    Feeling a sense of inadequacy or being unable to cope
●    Feeling guilty about not coping, or about not loving your baby enough
●    Feeling very low, or despondent
●    A lack of enjoyment or pleasure in life or things (called anhedonia)
●    Feeling tired and lethargic, or even quite numb. Not wanting to do anything or take an interest in the outside world
●    Wanting to cry often or even constantly
Fear and anxiety
●    Having obsessive fears about your baby's health or wellbeing, or about yourselves and other members of the family
●    Having an overpowering anxiety, often about things that wouldn't normally bother you, such as being alone in the house
Behaviour
●    Being unusually irritable, which makes the guilt worse
●    Being hostile or indifferent to your partner and/or baby
●    Having difficulty in concentrating or making decisions
Physical symptoms
●    Having panic attacks, which strike at any time, causing rapid heartbeat, sweaty palms and feelings of sickness or faintness
●    Experiencing physical symptoms like headaches
●    Loss of appetite or comfort eating
●    Insomnia 
Disturbing thoughts 
●    Having thoughts about harming yourself or your baby
●    Having thoughts about death and/or suicide

Lisa*, a mum of one, described her experience of PND symptoms:
‘I imagined PND meant you couldn’t get out of bed and couldn’t look after your baby but it wasn’t like that for me. I adored my baby and did everything “just right” for her. But I felt alone in a crowd, like I was silently drowning and no one could see me. 

‘I was crying more often and the reasons were less and less rational. I just carried on until one day I begged my husband not to leave me alone. We all then realised this wasn’t just baby blues.’ 

What should I do if I think I need help?

Speak to someone: It can feel really hard to speak about having these feelings as you may feel vulnerable or open to being judged when you have a small baby. But it’s so important to talk to someone as PND doesn’t usually get better on its own:

  • Health visitors are there to support mums who feel low, anxious or depressed – ask for help, don’t suffer in silence.
  • Your six-week check with your GP is a good time to raise any concerns you might have about how you’re feeling. Try to get the appointment booked with a GP you like and trust. If you don’t get the right one at first, ask to see someone else.
  • Get practical support from someone you trust, such as  helping you book appointments and coming with you for moral support.
  • Find baby classes and postnatal support groups specifically for mothers with a postnatal mental health problem. It can be reassuring to be around others who feel the same as you. Your GP or health visitor can help with this.
  • Be open to forms of treatment like counselling, therapy, and taking medication if that’s what your GP advises . They’ll also be able to prescribe medication that you can take if you’re breastfeeding. You’ll also be able to talk through any questions or concerns with your health visitor.
  • Ask your health visitor for a series of listening visits (Segre et al, 2011; NICE Clinical Knowledge Summaries, 2015)
  • Avoid some types of social media that show you images of ‘perfect mothers’ or makes you feel inadequate about how you’re coping .
  • Try supportive social media if you’d like to talk to other mums but the thought of getting out feels overwhelming right now. You’ll find lots of forums and networks online that can help. 
  • #PNDHour is an online peer support group that runs every Wednesday at 8pm via Twitter. 
  • @PNDandMe. Anyone can join in to discuss topics about antenatal and postnatal depression, such as self-care, medication and seeking help.

Lisa sought help from her GP when her symptoms became too much to cope with. 
‘That appointment was a breakthrough for me. I finally felt safe. She prescribed me a mild dose of anti-anxiety medication, which worked wonders. All the while I had biweekly appointments with her to check up on me. She also referred me for free baby massage classes with other mums with PND. It was amazing to see other women just like me.’

Remember that PND doesn’t always begin straight after having a baby. It might affect you months or even up to a year down the line. Get help at any time. 

I think someone I know might have a postnatal mental health problem. What should I do?

If you’re a partner, relative or friend of someone you think might have a postnatal mental health problem, try gently helping them open up to you about how they’re feeling. Supportive partners can play a big role in preventing depression from getting worse (Pilkington et al, 2017).  Offer to book appointments and attend them together. 

It might surprise you but partners can get postnatal mental health problems too. If the mum is feeling low, the chances are their partner might also be affected. In one study, around 2.4% to 18% of the fathers were reported to be experiencing anxiety in the year after their baby was born (Leach et al, 2016).

Seeing your GP or talking with your health visitor are good starting points.  

*Names have been changed

This page was last reviewed in August 2018

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Mind has an info-line: 0300 123 3393.

The Association for Postnatal Illness has lots of helpful information on their website.

The Purple Crying website looks in detail at the stage in your baby’s life when they cry more than at any other time.

Understanding childhood also have a range of resources available online and to download, developed by child psychotherapists, including a leaflet on crying.

There’s also useful information on the NHS website.

The NSPCC helpline provides help and support to thousands of parents and families.

Khajehei M, Doherty M (2017). Exploring postnatal depression, sexual dysfunction and relationship dissatisfaction in Australian women. Br J Midwifery. 25(3):162-172. Available at: https://www.magonlinelibrary.com/doi/10.12968/bjom.2017.25.3.162 [accessed 18th October 2018].

Leach LS, Poyser C, Cooklin AR, Giallo R (2016) Prevalence and course of anxiety 
disorders (and symptom levels) in men across the perinatal period: a systematic 
review. J Affect Disord. 190:675-686. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26590515 [accessed 18th October 2018].

NICE Clinical Knowledge Summaries (2015) Depression - antenatal and postnatal. Available at:  https://cks.nice.org.uk/depression-antenatal-and-postnatal#!scenariorec… [accessed 18th October 2018].

NICE (2018) Antenatal and postnatal mental health: clinical management and service guidance. Available at:  https://www.nice.org.uk/guidance/cg192  [accessed 18th October 2018].

Pilkington PD, Whelan TA, Milne LC (2016) Maternal crying and postpartum distress: the moderating role of partner support. J Reproductive Infant Psychol. 34(1):64-76. Available at:   https://www.tandfonline.com/doi/abs/10.1080/02646838.2015.1067884 [accessed 18th October 2018].

Segre LS, Stasik SM, O'Hara MW, Arndt S (2010) Listening visits: an evaluation of the effectiveness and acceptability of a home-based depression treatment. Psychother Res. 20(6):712-21. Available at:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226338/ [accessed 18th October 2018].

Shaw E, Levitt C, Wong S, Kaczorowski J; McMaster University Postpartum Research Group (2006) Systematic review of the literature on postpartum care: Effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth. 33(3):210-20. Available at:  https://www.ncbi.nlm.nih.gov/pubmed/16948721  [accessed 18th October 2018].

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