"Am I a bad mother?": Why women hide postpartum depression and how to help them

The first weeks with a baby rarely look like the pictures on social media. Up to 85% of women experience the baby blues after childbirth: tearfulness, anxiety and mood swings that resolve on their own within a few days. But some mothers face postpartum depression.

Perinatal psychologist Tetiana Pershyna of the Municipal Nonprofit Enterprise "Perinatal Center of the City of Kyiv" told UNN in an interview about the signs of postpartum depression and how to cope with this condition.

How does postpartum depression differ from the baby blues, and how can one understand that it is no longer just fatigue?

The baby blues are a normal, temporary emotional reaction after childbirth, related in particular to hormonal changes. They are also associated with physical exhaustion, lack of sleep, stress and adjustment to the new role of a mother. They occur in many women during the first days after childbirth, usually peak on days 3–5 and resolve within two weeks. This condition goes away without special treatment provided the mother receives support and rest. Postpartum depression, however, is a clinical condition that requires assessment by a specialist and, when necessary, psychotherapy and medication. Postpartum depression can develop during the first weeks or months after childbirth. In some cases, it begins during pregnancy. 

There are certain manifestations of postpartum depression: 

• persistent sadness, low mood or a feeling of emptiness; 
• loss of interest in and enjoyment of things that were previously important; 
• pronounced anxiety, feelings of guilt, worthlessness or hopelessness;
• difficulty handling everyday tasks and caring for oneself or the child; 
• sleep and appetite disturbances that cannot be explained solely by the newborn's schedule. 

However, symptoms can vary. Depression does not necessarily manifest as constant crying, and a mother may not always realize on her own that she needs help. 

How common is postpartum depression? 

Unfortunately, postpartum depression is actually a fairly common condition. And it is important to understand that it is neither a rare complication nor a sign that a woman is failing at motherhood. Approximately 1 in 7–8 women may experience postpartum depression. At the same time, prevalence depends on the country, living conditions, diagnostic criteria and the period over which symptoms are assessed.

For comparison, the baby blues, meaning temporary emotional changes, are experienced by a significant proportion of mothers—up to 80–85%. Approximately 10–15% of women experience postpartum depression, according to many international estimates. In other words, these are not isolated cases. That is precisely why it is important to recognize the symptoms, not dismiss a woman's experiences and not explain everything solely by hormones.

Does postpartum depression occur in men who become fathers?

Yes, fathers can also respond to the birth of a child with depression. In the academic literature, it is called paternal postpartum depression. According to a meta-analysis of 47 studies involving more than 20,000 men, approximately 8.75% of fathers experienced symptoms of depression during the first year after the child's birth. Important contributing factors may include lack of sleep, new responsibilities, financial difficulties, relationship problems and previous episodes of depression. If such a condition is observed in the partner, the risk of depressive symptoms in the man also increases. Men also undergo biological changes, including hormonal changes, although they are not identical to the changes women experience after childbirth. 

One should not simply attribute a man's prolonged irritability or emotional withdrawal to fatigue or say, "He is getting used to his role as a father." If the symptoms persist and impair everyday life or relationships, consultation with a specialist is needed. Depression can be treated. The birth of a child is a major psychological adjustment for both parents, and both need support.

What, then, are the main causes of this type of depression: hormones, lack of sleep, circumstances or something else?

Postpartum depression usually does not arise from a single cause but results from a combination of biological, psychological, and social factors. And importantly, it can develop even in a woman who very much wanted a child, has a loving partner, and has never previously experienced any mental health disorders. Such depression may be caused by biological and hormonal changes, physical exhaustion and sleep deprivation, psychological factors, social circumstances and relationships, previous predisposition, and health conditions. 

It is important to remember that depression is not a character weakness, ingratitude, or a consequence of a woman not loving her child enough.  And one more thing: having risk factors does not mean that depression will necessarily develop. Their absence does not guarantee protection either. Therefore, the best approach is not to look for someone to blame, but to notice symptoms in time, assess the mother's condition, and ensure that she receives the necessary help.

Am I right in understanding that it is possible to predict the likelihood of depression developing during pregnancy? 

The risk of developing depression can be assessed during pregnancy, but it is not yet possible to predict with certainty who will develop it.  Certain categories are at increased risk. These include those who have had depression or anxiety disorders in the past, as well as women who have experienced depression or anxiety during the current pregnancy and those who have already had postpartum depression. Bipolar disorder or other mental health disorders, a history of psychiatric treatment, and depression in close relatives are also risk factors.  

Psychosocial circumstances are also important. Women who lack emotional and practical support, those who have conflicts with their partner, or those experiencing domestic violence are at increased risk. In general, experiences of violence, traumatic events, and loss are also relevant. Independence and financial stability matter as well. Women experiencing an unwanted or crisis pregnancy and significant stress are also at increased risk. 

Another group of factors concerns the course of pregnancy, childbirth, and the child's condition. Complications during pregnancy or a traumatic childbirth experience can trigger the development of depression. This may also occur if a woman experiences prolonged pain, pronounced exhaustion, and difficulties recovering after the birth of her child. Premature birth, the child's illness, and admission to an intensive care unit are also risk factors. 

All these factors are associated with an increased risk, but none of them alone means that depression will necessarily develop. 

The risk of developing depression can be identified during pregnancy. There are two approaches: discussing the woman's condition with her and using validated screening questionnaires. This refers to a clinical interview and the Edinburgh Postnatal Depression Scale (EPDS). According to the recommendations of the American College of Obstetricians and Gynecologists, screening for depression and anxiety disorders should be conducted during the first prenatal visit, repeated later in pregnancy, and after childbirth. 

It is important to understand that these scales help identify symptoms but cannot reliably predict future postpartum depression in a woman who currently feels well. And one more important detail: a woman may have no obvious risk factors during pregnancy but may experience a difficult birth, separation from her child, or another event—for example, war, separation from her husband, or forced relocation—that changes her condition. Therefore, prevention does not end with the birth of the child.

What symptoms should alert loved ones and the woman herself? 

If a woman experiences persistent sadness, low mood, or a feeling of emptiness. There may also be a loss of interest in and pleasure from things that were previously important. Marked anxiety, feelings of guilt, worthlessness, or hopelessness. Difficulties with everyday tasks and caring for herself or her child may arise. Important markers include disturbances in sleep and appetite that cannot be explained solely by the newborn's schedule. Symptoms can vary. Depression does not necessarily manifest as constant crying, and it is important to remember that a mother may not always recognize on her own that she needs help. 

We often hear that motherhood is joy… 

There is indeed a persistent social expectation that a woman should be happy, and mothers hide how they are feeling. The problem is often not only the condition itself, but also that a mother does not dare to say how badly she feels, even when she already needs help. Studies describe shame, guilt, fear of judgment, and a lack of understanding of one's own symptoms as significant barriers to seeking help. A woman may perceive depressive symptoms as proof of her own inadequacy — "I am a bad mother." Fear may sound like: "They won't understand me" or "What if they consider me dangerous to my child?"

Guilt often sounds like: "I am doing something wrong." Shame goes deeper: "There is something wrong with me." As a result, a woman tries not simply to hide her symptoms — she hides them even from herself. She may convince herself that it is ordinary fatigue, that she just needs to endure it, or that others have it even worse. The main point is this: a mother may remain silent not because she does not need help, but because she is afraid of the consequences of being open. Therefore, it is not enough simply to tell her where to seek help. It is necessary to create conditions in which she can speak honestly about her condition.

When is it necessary to seek help? 

If symptoms do not go away within two weeks, worsen, or significantly interfere with daily life, you should not wait — you should see a doctor. But it is important to remember: if a mother is already feeling very unwell, do not wait two weeks. If thoughts of suicide, thoughts of harming oneself or the child, hallucinations, or delusional beliefs occur, urgent medical assistance is needed.                                

Let us imagine that a woman has consulted a perinatal psychologist — how does the work with the patient proceed? How long does it usually last? 

Working with a perinatal psychologist is not simply a conversation about how a woman feels after the birth of a child. It is professional psychological assistance aimed at the mother's emotional state, her adaptation to motherhood, her relationships with the child and loved ones, as well as experiences that may accompany pregnancy, childbirth, and the postpartum period. Psychological support may be sufficient for adjustment difficulties, but in the case of depression, an assessment of the severity of the condition is needed, and sometimes cooperation with a psychiatrist or a medical psychotherapist is also required. The duration depends on the reason for seeking help, the severity of the symptoms, and the method of psychological assistance. Usually, a session lasts 45–60 minutes, and at the beginning sessions are held once a week. As the condition improves, sessions may become less frequent.                                               

When is help from a psychiatrist necessary? 

In moderate or severe depression, consultation with a psychiatrist and medication may be necessary, in combination with psychotherapy or without it, depending on the clinical situation. If there are suicidal thoughts, dangerous thoughts concerning the child, hallucinations, delusions, or a sudden severe disorganization of behavior, an urgent medical assessment is needed.

Most cases of postpartum depression can be treated with medications compatible with breastfeeding. The diagnosis itself does not mean that the mother will have to stop breastfeeding. The choice of medication depends on the severity of the depression, the symptoms, previous treatment experience, and the age and health of the infant. The most important thing is not to leave depression untreated solely because of fear of harming the child. The medication should be prescribed by a doctor who is aware of the breastfeeding and can assess the condition of both the mother and the child. You should not start taking an antidepressant, change its dosage, or stop it abruptly on your own. 

Can postnatal depression go away on its own? What might be the consequences of not receiving treatment? 

Postpartum depression sometimes goes away without treatment, but it is not advisable to rely on that. It can last for months, worsen, and negatively affect both the mother’s condition and her interaction with the child. 

If it is not treated, the consequences for the mother may include prolonged suffering, impaired day-to-day functioning, increased feelings of guilt and isolation, and the risk of suicide. For the child, emotional contact, early development, and daily care may become more difficult. It is important to convey to the mother that help is needed not because she is coping poorly, but because she herself deserves care, and her well-being is important for the entire family. 

How exactly can a partner and loved ones help a woman with postpartum depression? 

A mother with postpartum depression needs not only words of support, but also practical help that reduces her burden and gives her the opportunity to receive treatment. Relatives often sincerely want to help, but sometimes try to cheer a woman up in ways that make her feel even more guilty. What a partner and family can really do is take on part of the burden rather than wait to be asked. Instead of simply asking, "How can I help?", offer something specific: "I’ll make dinner today and take the baby after feeding so you can rest".  It is important to help her regain a sense of having a life of her own.

Another aspect worth highlighting is the need to listen without judgment. And, importantly, to help her seek professional assistance. 

People who are in a distressed or depressed state often hear phrases like "don’t be sad" and "everything will be fine"... The usefulness of such words is questionable. What would be better to say instead to a mother going through a difficult period? 

It is better not to say: "But you wanted a child so much! Why are you unhappy?" If you want to say something, it is better to say:  "You can love your child and at the same time be going through a very difficult period. You do not need to justify your feelings". Do not say that everyone has given birth and coped, so you will cope too. Instead, say that you can see how difficult things are for her, that she does not have to manage everything on her own, and offer help. When a woman is not getting enough sleep, do not say that everything will pass once she gets some sleep. Show understanding and say that lack of sleep is genuinely exhausting, offer help, and add that you want to know how she is really feeling emotionally. It is a very bad idea to urge a woman to pull herself together for the sake of the child; instead, make her understand that she is important not only as a mother, but deserves care and help in her own right. Do not invalidate her feelings or say that she is exaggerating. It is better to say: "I may not fully understand what you are going through. But I want to hear you and not invalidate your feelings".

Do not say that taking antidepressants is incompatible with breastfeeding; instead, offer to find a doctor together who can help choose appropriate treatment. 

We have already talked about how women often hide their condition. What should one do if a woman denies that she is feeling unwell?

This is a very important question, and probably one of the most difficult aspects of working with postpartum depression. If a woman denies that she is feeling unwell, there is no need to try to convince her otherwise at all costs. Denial does not necessarily mean that she is unaware of her condition. Sometimes a woman genuinely does not understand what is happening to her, while at other times she understands but is afraid to acknowledge it even to herself. You can proceed in several stages. Do not argue with her feelings. Do not ask whether she is feeling unwell—ask about specific things. It is necessary to understand what exactly lies behind the denial. Do not demand that she acknowledge the problem; offer help instead. And if you see an immediate danger, seek emergency medical assistance without delay. 

Is there anything that can be done to reduce the risk of developing depression? 

In the first weeks after the birth of a child, a woman needs recovery, a sense of safety, support, and permission to be imperfect. Allow yourself to rest. Eat and drink regularly. Move a little – without forcing yourself. Don’t demand constant happiness from yourself. Talk to at least one person every day. Set aside at least 10 minutes for yourself. And once a day ask yourself: "How am I really doing?". 

What concerns do mothers most often come to you with as a perinatal psychologist, and what surprises them the most? 

One of the most common questions is: "How can I avoid feeling tired?" Mothers ask themselves whether they love their child enough, as well as why everything irritates them, even attempts by loved ones to help. Women often experience constant worries about their child’s safety and health. They also ask when they will feel like themselves again and whether it is normal to sometimes want to spend time without the child. Women are also concerned about changes in their relationship with their partner. There are very many questions. 

But what surprises mothers most is that loving a child does not mean having to feel happy every minute. You can love your child and at the same time be exhausted, irritated, or sad. Not all mothers feel an immediate bond – it may develop gradually. You can miss the life you had before the child was born and not regret the child’s arrival. These feelings do not contradict one another. The need for help is not a sign of weakness. Recovering after childbirth and caring for an infant are a major burden. A mother’s psychological state is not merely a matter of willpower. It is affected by physical recovery, sleep, hormonal changes, previous experience, relationships, and life circumstances. You can be a good mother without matching the image of an "ideal mother." Sometimes a woman feels better not when she is given yet another piece of advice, but when she hears for the first time: "What you are feeling does not make you a bad mother. Let’s figure out what is happening to you." 

What would you like to say to a woman who is reading this now and recognizes herself?

I would say this to her:  "You are a very good mother. Even if you do not feel the happiness people told you about. Even if sometimes you want to cry, run away, be alone, and for at least a few hours stop being the person everyone needs something from. Even if you love your child but are finding it difficult. Very difficult. You have the right to feel tired. You have the right to grieve your former life. You have the right not to know what the right thing is and not to feel an immediate connection with your baby. Motherhood does not require you to give up who you are. Do not demand that you become happy immediately. Do not compare yourself with idealized images of motherhood. Try to do just one thing for yourself today: eat, rest, ask someone to stay with you, or honestly say: "I’m having a hard time right now." And please do not remain alone with pain that does not go away. You do not have to wait until it becomes even stronger. Help exists, and you do not need to earn the right to receive it. You matter. Not only as a mother. As a person. As a woman. As yourself.  Caring for you is not something that can be put off until the child grows older and all the tasks are done. You, too, deserve someone’s warm hands, attentive gaze, and simple words: "I see you. I hear you. You do not have to go through this alone." Sometimes the first step toward feeling better is allowing yourself not to pretend that everything is fine. Taking care of yourself does not mean loving your child less. It means remembering that you matter too".