Pregnancy & after birth

Many people expect to feel glowing in pregnancy. But depression can start before birth too. Worldwide, about 1 in 10 pregnant women experience a mental health condition, mainly depression.

Sickness, poor sleep, money worries and fear about birth can all add up. Feeling low or anxious for two weeks or more is worth telling your midwife, OB-GYN or doctor about.

Things linked to higher risk

• A history of depression or bipolar disorder, yourself or in your family
• Depression in a previous pregnancy
• Life stress, like money or work pressure
• Little or no support around you
• Past trauma
• The physical and emotional demands of birth and newborn care

In U.S. reviews of deaths during pregnancy and the year after (2017 to 2019), mental health conditions were the most common underlying cause, at 23%. More than 80% of pregnancy-related deaths were judged preventable.

This is why asking for help early matters, and why partners, family and friends should know the warning signs too.

In the first days after birth, many new mothers feel weepy, worried, irritable or exhausted. These are the baby blues. They are mild, they come and go, and they usually fade by themselves within about two weeks.

What helps

• Eating regularly and drinking enough water
• Letting others cook, clean or hold the baby
• Sleeping whenever you can, even in short naps
• Talking about how you feel with someone you trust

Postpartum depression is more intense than the baby blues and lasts longer. It often starts within the first weeks or months after birth, but it can begin during pregnancy or any time in the first year. Without help, it usually does not get better on its own.

It can feel like

• Crying more than usual, or feeling angry
• Doubting you can care for your baby; feeling like a “bad mother”
• Feeling distant from your baby, or struggling to bond
• Feeling very tired, but unable to sleep even when the baby sleeps
• Losing interest in things you used to enjoy
• Sadness, emptiness or hopelessness that will not lift
• Thoughts of harming yourself or your baby

Cognitive behavioral therapy (CBT) helps you notice and change unhelpful thoughts and habits. Interpersonal therapy (IPT) focuses on relationships and life changes: improving communication, building support and setting realistic expectations.

Other things that help

• Parent-and-baby or postpartum support groups
• Practical help from family and friends
• Rest, gentle exercise and small things you enjoy

Good places to start are your OB-GYN, midwife, family doctor, or your baby’s pediatrician. Baby check-ups are a chance to mention how you are doing too.

Words that can help

• “I haven’t felt like myself since the baby came.”
• “The low feelings have lasted more than two weeks.”
• “I’m having thoughts that scare me.”
• “Can you help me find a therapist or support group?”

Some new parents feel a constant sense of danger, even when nothing is wrong. Postpartum anxiety is excessive worry that starts after birth or adoption. It affects about 1 in 5 women, and it often shows up alongside depression.

It can look like

• A racing heart, tight chest, nausea or feeling on edge
• Avoiding people, places or outings because they feel risky
• Checking on the baby again and again, even when you know they are fine
• Racing thoughts and always expecting the worst
• Trouble sleeping even when you have the chance

What helps

• A new-parent support group, in person or online
• CBT, which helps you notice and calm worried thinking
• Daily movement, gentle yoga and eating well
• Help from family and friends so you can rest

Some new parents have sudden, unwanted thoughts or pictures of their baby being harmed, or even of harming the baby themselves. These are called intrusive thoughts. They are upsetting precisely because they are the opposite of what you want.

Having these thoughts does not mean you will act on them. In fact, feeling alarmed by them is a sign you are unlikely to hurt your baby.

Perinatal OCD (obsessive-compulsive disorder) is when obsessive-compulsive patterns start or get worse during pregnancy or the year after birth. It can begin while you are still pregnant, though it is much more likely to start after the baby arrives.

OCD has two parts. Obsessions are unwanted thoughts, images or urges that keep coming back and cause fear or disgust. Compulsions are things you do, over and over, to try to make the fear go away or keep something bad from happening.

Common intrusive thoughts

• A frightening thought of harming the baby yourself, which you find horrifying
• A sudden picture of the baby falling, drowning or getting hurt
• Fear of germs or contamination making the baby ill
• Unwanted sexual or violent thoughts that go against everything you believe

Common compulsions

• Asking others over and over if the baby is okay, or if you’re a good parent
• Avoiding being alone with the baby, or avoiding the baby altogether
• Avoiding things, like never going upstairs with the baby in case you fall
• Checking again and again that the baby is breathing
• Washing hands every time you touch the baby

Harm-related thoughts are the most common type. About 3 in 4 women who develop perinatal OCD do so in their first pregnancy or after their first baby. Between one-third and almost half also have symptoms of depression.

Each check brings a moment of relief, which teaches the brain that the danger was real and checking “worked.” So the fear comes back stronger. Therapy gently breaks this loop.

What helps

• Acceptance and commitment therapy (ACT): learning to let thoughts come and go without fighting them
• A partner who understands, and who gently stops giving constant reassurance once therapy begins
• CBT, especially exposure and response prevention (ERP): facing the fear in small steps without doing the compulsion, until the anxiety settles by itself
• Rest and practical help, since exhaustion makes intrusive thoughts louder
• Telling a perinatal mental health professional exactly what the thoughts are. They have heard it before

In OCD, the thoughts feel frightening, wrong and “not me.” In psychosis, similar thoughts can seem normal or justified to the person. Being upset by your thoughts is a sign that you are very unlikely to act on them.

Signs can include

• Any talk of harming herself or the baby
• Barely sleeping, or not feeling the need to sleep
• Being very confused or not knowing where she is
• Fast-changing moods
• Feeling detached from herself or the world
• Racing thoughts, being very restless or “high”
• Seeing or hearing things that are not there
• Strong beliefs that are unlikely to be true
• Very low mood, guilt or hopelessness

A person with postpartum psychosis may not realise they are unwell. That is why it helps if partners, family and friends know the signs before the baby arrives.

Higher risk with

• A family history of postpartum psychosis or serious mental illness
• A first baby
• Having had postpartum psychosis before
• People with bipolar disorder or a schizophrenia-type illness
• Severe lack of sleep

It can also happen to someone with no history of mental illness at all. That is why everyone around a new mother should know the warning signs.

What to do

• Call 911 or go to the emergency room now
• Don’t argue about what is real. You can say, “I can see you’re scared. Let’s get help.”
• Don’t leave her alone, or alone with the baby
• Don’t make her feel trapped or threatened
• Stay calm and speak slowly and quietly

The most severe symptoms usually last 2 to 12 weeks, and full recovery can take 6 to 12 months or more. Most people recover fully with the right care. Hospital care is nearly always needed at first. For treatment choices, talk with your clinical provider.

After recovery, some women feel low, anxious or shaken for a while, or find bonding harder at first. This is understandable, and support helps.

If you have had postpartum psychosis and are thinking about another pregnancy, plan early with your care team. The chance of it happening again is higher, but planning can lower the risk, and many people have more children without it returning.

Partners and families can be deeply shaken by postpartum psychosis. It is important for them to get support for themselves. Practical help like sharing night feeds, protecting her sleep and keeping the home calm makes a real difference.

Postpartum Support International says about one in ten dads experiences postpartum depression, and 5 to 15 percent of dads develop an anxiety disorder during pregnancy or the first year after birth.

Partners may not say “I’m depressed.” If a partner seems very different from usual for weeks, it is worth a gentle, honest check-in.

PSI offers support for dads: a dads’ online support group, volunteer fathers with lived experience, a weekly call with mental health professionals, and the HelpLine at 1-800-944-4773.

Partners are often the first to notice that a new mother is struggling. They can help by encouraging a visit to the doctor, going to appointments, and taking on night feeds or chores.

Ways to help

• Go with her to appointments
• Help with daily tasks, like baby care and the home
• Offer emotional support: listen without fixing
• Protect her sleep with shared night feeds

Postpartum anxiety can start after birth or adoption. Any parent can feel overwhelmed by the huge change a new baby brings, whatever their role or how the baby joined the family.

Some parents feel close to their baby during pregnancy or right after birth. For others, the bond grows more slowly. The NHS says every parent bonds at their own pace.

The American Academy of Pediatrics says bonding has no time limit. It can take months to learn your baby’s personality.

Small ways to connect

• Eye contact and gentle play
• Responding warmly to their sounds and cries
• Skin-to-skin cuddles when you can
• Talking, reading and singing to your baby

Postpartum thyroiditis affects about 1 in 20 women during the first year after giving birth. It often starts with an overactive phase, which can bring irritability, tiredness, trouble sleeping and a fast heartbeat. Some women then have an underactive phase, with tiredness, feeling cold and trouble concentrating.

The underactive phase can be mistaken for the baby blues. NIDDK advises talking with your doctor if these symptoms show up in the first months after birth, or if you develop postpartum depression.

Many new mothers say they love their baby but miss their old life: their freedom, their body, their work, their friends. Feeling both at once is normal. It doesn’t make you ungrateful or a bad parent.

Things that can help

• Find other new parents who are honest about the hard parts
• Keep one small thing that is just yours: a walk, a podcast, a hobby
• Let your idea of a “good mother” be kind and realistic
• Spend time with friends who knew you before the baby

Stretch marks, a softer tummy, scars from a C-section, changing breasts: these are common after pregnancy. Pressure to “get your body back” can add to stress at an already hard time.

Gentler ideas

• Buy a few comfy clothes that fit your body now
• Move for energy and mood, not to shrink
• Mute accounts selling “bounce back” plans
• Remember what your body has done

Lack of sleep is one of the hardest parts of early parenthood, and severe lack of sleep is linked to postpartum psychosis risk. Sharing night feeds and baby care protects sleep and mood.

Under the Pregnant Workers Fairness Act, employers with 15 or more workers must make reasonable changes for limits linked to pregnancy, childbirth or related conditions, unless it causes undue hardship. The EEOC lists postpartum depression among these related conditions.

Examples of changes

• More or longer breaks
• Schedule changes or working from home
• Time off for health appointments
• Time off to recover from childbirth

If you are breastfeeding or pumping, most U.S. workers have the right to break time to pump for one year after birth, in a private space that is not a bathroom.

Steps

• Write down what is hard and what would help
• Ask your manager or HR, in person or in writing
• Keep notes of when you asked and what was said
• If you are treated unfairly, you can contact the EEOC (eeoc.gov)

Words that can help

• “Do you want me to come with you to the appointment?”
• “I believe you.”
• “This isn’t your fault.”
• “What would help most this week?”
• “You’re a good mom. Struggling doesn’t change that.”

If she shares scary, unwanted thoughts about the baby, stay calm. These thoughts are common after birth, and being upset by them is a good sign. Thank her for telling you, and help her talk to a perinatal mental health professional.

Try to avoid

• “Enjoy every moment.”
• “It’s just your hormones.”
• “You should be grateful.” / “At least the baby is healthy.”
• “When are you having another?”
• Comments about her body, weight or how tired she looks

If you’ve said something that landed badly, it’s okay to say, “I’m sorry, that came out wrong. I want to understand.” Repairing is part of caring.

Ideas

• Bring a meal, do a grocery run, or fold the laundry
• Drive her to appointments
• Help find a therapist or support group, and make the first call with her
• Take a night feed so she can sleep a long stretch
• Watch the baby or older kids so she can have an hour alone

Instead of “Let me know if you need anything,” try a specific offer: “I’m bringing dinner Tuesday. Is 6 okay?” It is much easier to say yes to.

Get urgent help if she

• Seems confused, very “high,” or isn’t sleeping at all
• Sees or hears things that aren’t there, or believes things that seem very unlikely
• Talks about harming herself or the baby, or seems calm about such thoughts
• Talks about wanting to die or being a burden

Stay with her, don’t leave her alone with the baby, speak calmly, and call 911 or go to the emergency room.

Watching someone you love struggle is hard. Partners of new mothers can become depressed themselves, and families of women who have had postpartum psychosis are often deeply shaken. Your wellbeing matters too.

Look after yourself

• Get some sleep and real meals
• Reach out to the PSI HelpLine, which supports partners and families too
• See your own clinical provider if you feel low or anxious for weeks
• Share the load with other family and friends
• Talk to someone you trust about how you’re feeling

Postpartum Support International runs more than 50 free online support groups led by trained facilitators, including groups for dads and in Spanish. It also runs a weekly “Chat with an Expert” call with licensed mental health professionals.

Joining a support group for new parents is one of the things that can ease postpartum anxiety.

Practical help from family and friends is one of the most useful supports after a baby. A neighbour who takes the older kids for an hour can give you the rest you need.

Ideas

• Set up a meal schedule for a friend with a new baby
• Start a regular stroller walk with another parent
• Swap childcare with another family

Many faith and cultural groups have parent groups or volunteers who bring meals and visit. Some cultures have traditions of caring for a new mother in the weeks after birth. If talking about mental health feels hard in your community, starting with one trusted person is enough.