Baby blues, postpartum depression and caring for yourself as a parent

Feeling weepy and up and down for a few days after birth is common and usually settles within 2 weeks. That is the baby blues.¹ If low mood, worry or numbness lasts longer, or gets worse, it may be postpartum depression, which affects about one in five mothers in India and can be treated.² Fathers can be affected too.³

Is it baby blues or postpartum depression?

Baby blues start in the first days after birth and usually pass within 2 weeks. If low feelings go on past 2 weeks, get worse, or leave you unable to cope, it may be postpartum depression.¹

With the blues, you may cry over small things, feel irritable or anxious, and swing between joy and tears. Between these moments you still feel like yourself. Rest, food and kind words help.

Postpartum depression (also called postnatal depression) feels different:¹

• Low mood, and little joy in anything
• Feeling hopeless, guilty or worthless, or that you are a bad mother
• Worrying or feeling afraid all the time, or feeling restless and irritable
• Trouble sleeping even when you have the chance to rest
• Trouble bonding with your baby
• Thoughts of suicide, or of harming yourself or the baby

It can start in pregnancy or any time in the first year.¹

How common are the baby blues?

Very common. A review of 26 studies found that about 39% of new mothers had the baby blues, though the figure ranged widely between studies.⁴

The blues are thought to be linked to the sharp drop in pregnancy hormones after birth, plus pain, broken sleep and the shock of caring for a newborn. They are not a sign of weakness or a sign that you do not love your baby. They do mean you need support and rest in those first days.

How common is postpartum depression in India?

About 22% of Indian mothers, or roughly one in five, have postpartum depression according to a review of 38 Indian studies.²

That review included more than 20,000 women. When studies that measured mood in the first 2 weeks were left out, the figure was still 19%.² A major review gives estimates of 13% to 19%, mostly from studies outside India.⁵

The Indian review found these risk factors: money worries, domestic violence, a past history of mental illness, conflict in the marriage, little support from the husband, and the birth of a girl.² Every one of these is something families can change or soften.

What causes postpartum depression?

There is rarely one cause. It is usually a mix of body changes, stress, and lack of support.

The risk factors are much the same as for depression at other times of life, along with sensitivity to the hormone changes after birth.⁵ The first 6 months after delivery seem to be the time of highest risk.⁵

Things that raise the risk include a past episode of depression or anxiety, a hard birth, a baby in the NICU, feeding problems, a baby who cries a lot, and pressure from family. A mother who has been told to stay in one room for 40 days, away from friends, can feel very alone. None of this is her fault.

Can postpartum depression affect my baby?

It can, if it is not treated. The good news is that treating the mother protects the baby too.⁶

The AAP notes that untreated postpartum depression is linked to more early stopping of breastfeeding, family stress, and a higher risk of the baby being neglected or harmed.⁶ It falls at a key time for the baby's brain development. But depression can be treated well, and the effects on the baby can be buffered.⁶

This is why Dr Dutta asks mothers about their mood at baby check-ups. The AAP recommends that paediatricians screen mothers at the baby's check-ups at 1, 2, 4 and 6 months.⁶

Can fathers get postnatal depression?

Yes. About 1 in 10 fathers have depression during pregnancy or in the first year after birth.³

A large review of 43 studies put the figure at about 10%, with higher rates 3 to 6 months after birth.³ A later review of 74 studies found about 8%.⁷ Fathers' depression was linked with mothers' depression, so when one parent is struggling, check on the other.^3,7

In fathers, depression often looks like irritability, anger, working very long hours, drinking more or pulling away from the family, rather than crying. Many Indian fathers feel they must be the strong one. Talking to a doctor is a strong thing to do.

What are intrusive thoughts after having a baby?

Intrusive thoughts are sudden, unwanted pictures or ideas of the baby being hurt. They are very common in new mothers and do not mean you will act on them.⁸

In a study of 100 new mothers, every one had unwanted thoughts of accidental harm, such as dropping the baby. Nearly half had unwanted thoughts of harming the baby on purpose.⁸ These thoughts were more common with high stress and low support, and they were not linked to rough parenting.⁸

The thoughts feel horrible precisely because you love your baby. If they take up a lot of your day, make you avoid the baby, or come with checking rituals, talk to your doctor. This can be postpartum anxiety or obsessive compulsive disorder (OCD), both treatable.

What is postpartum anxiety?

Postpartum anxiety is constant worry or panic after birth that is out of proportion and hard to switch off. It often comes with, or without, low mood.

Signs include a racing heart, not being able to sit still, checking the sleeping baby again and again, fear of being left alone with the baby, and not sleeping even when you can. It can begin during pregnancy too.

It responds to the same help: talking therapy, support, and sometimes medicine. Please mention it at your check-up. Doctors will not judge you or take your baby away.

What is postpartum psychosis and when is it an emergency?

Postpartum psychosis is a rare, severe illness that can appear soon after birth. It is a psychiatric emergency, because of the risk to both mother and baby.⁹

Between 0.25 and 0.6 of every 1,000 births are followed by a first episode.⁹ Signs include:

• Confusion, or seeming not herself
• Seeing or hearing things that are not there
• Strange beliefs, such as thinking the baby is evil or in danger
• Being very high, restless or talkative, with little or no sleep
• Severe low mood with thoughts of death

Take her to hospital the same day. Do not leave her alone with the baby. Most women need hospital care, and treatment works well.⁹ A mother with bipolar disorder, or a past episode, needs a plan with her psychiatrist before the birth.

Is it safe to take antidepressants while breastfeeding?

For most mothers, yes. Several antidepressants pass into breast milk in tiny amounts, and many mothers can keep breastfeeding while taking them.^10,5

A pooled analysis of 57 studies found that sertraline, paroxetine and nortriptyline usually gave levels in the baby too low to measure.¹⁰ Fluoxetine and citalopram reached higher levels in some babies.¹⁰ Reviews agree on certain medicines that suit breastfeeding mothers.⁵

Do not stop breastfeeding, or refuse treatment, out of fear. Talk to your doctor about which medicine fits you and your baby. Tell your paediatrician too, so we can watch the baby's feeding, sleep and weight. If your baby was premature or is unwell, the choice may need more care.

Does talking therapy help postpartum depression?

Yes. Talking therapies help, and some can even prevent postpartum depression in mothers at risk.^5,11

Controlled trials support several individual and group therapies.⁵ A Cochrane review of 28 trials with almost 17,000 women found that psychological and social support lowered the number of women who developed postpartum depression.¹¹ Home visits by nurses or midwives, phone support from other mothers, and interpersonal therapy (which focuses on relationships and role changes) looked most promising.¹¹

In India, counsellors at many hospitals and the national Tele MANAS line can help you find this kind of care.¹²

How can partners and family help a new mother?

Practical help, rest and listening without judging all help. In the Indian review, lack of support from the husband was one of the risk factors for postpartum depression.²

• Take over one night feed or settling so she gets one longer stretch of sleep.
• Cook, clean and handle visitors.
• Ask "How are you?" and wait for the real answer.
• Do not blame her for having a girl, for feeding problems, or for crying.
• Let her see friends, and go out for a short walk.
• Go with her to the doctor if she is low.

Grandmothers carry a lot of wisdom about babies. The most useful thing they can do is mother the mother.

How can I look after myself as a new parent?

Lower your standards for the house, accept help, and protect your sleep and food. You cannot pour from an empty cup.

• Sleep when someone else can hold the baby, even for an hour.
• Eat regular meals and drink water, especially if breastfeeding in the heat.
• Get out of the house each day, even to the balcony or the lane.
• Talk to another mother. You will find you are not the only one struggling.
• Limit social media that makes you feel you are failing.

Single parents and couples without family nearby need to build support on purpose: a neighbour, a friend, a paid helper, a parents' group. Asking is not failing.

How do couples adjust to their new roles after a baby?

Expect your relationship to feel strained for a while. Talking about who does what, before resentment builds, helps most couples through it.

New fathers often feel left out or unsure how to help, while mothers may feel they carry everything. Agree on clear jobs: one parent bathes, the other does the night nappy. Sit together for 10 minutes a day without the baby being the only topic. Depression in one partner is linked with depression in the other, so look after each other.³

Where can I get help for postpartum depression in India?

Start with your obstetrician, your baby's paediatrician or your family doctor. You can also call Tele MANAS, the free national mental health helpline, on 14416 or 1-800-89-14416, at any time of day.¹²

Tele MANAS was set up in 2022 and routes calls to trained counsellors in your own language.¹² Many medical colleges, including in Kolkata, have psychiatry and perinatal mental health clinics.

When should I get urgent help?

Get help the same day, or go to the emergency department, if you or your partner notice:

• Thoughts of suicide or of harming the baby that feel like plans, not just fears
• Seeing or hearing things, confusion, or very odd beliefs⁹
• No sleep for nights on end with a very high or racing mood⁹
• Not eating, not drinking, or not able to care for yourself or the baby

Book a doctor's visit soon if low mood, worry or numbness lasts more than 2 weeks, or if the baby blues are getting worse rather than better.¹