Your mind in pregnancy and after birth: what is normal, and when to ask for help

01

Baby blues, and when it is more than that

In the first few days after birth, many women feel weepy, anxious or irritable without an obvious reason. These baby blues usually settle within two weeks of the birth.

If the low feelings last beyond two weeks, get worse, or make it hard to cope, speak to a doctor.

Perinatal depression can begin in pregnancy, soon after the birth, or at any point up to a year later. Anxiety can also appear for the first time in pregnancy, or return if you have had it before. Signs include:

• A low mood on most days, or no longer enjoying things you used to like
• Feeling hopeless, guilty or like a “bad mother”
• Constant worry, restlessness or irritability
• Trouble sleeping even when the baby is asleep and you have the chance to rest
• Finding it hard to feel close to your baby
• Thoughts of harming yourself or your baby

The chances are higher if you have had depression or another mental health condition before, if you lack support, or if you face relationship problems, recent hard events, a premature or unwell baby, or abuse at home. None of this is your fault.

02

Frightening thoughts about your baby

Many new parents have sudden, unwanted thoughts or images of the baby coming to harm, sometimes by their own hand. One NHS perinatal mental health service says that all new mothers have worrying thoughts about the baby being hurt by accident, and about half have thoughts of harming the baby in some way.

Having a thought is not the same as acting on it. These thoughts often fade with time. If they come many times a day, cause intense distress, or get in the way of caring for your baby, they may be part of depression or obsessive-compulsive disorder (OCD), and both respond well to treatment. Telling your doctor is safe and sensible.

03

Postpartum psychosis: rare, but an emergency

Postpartum psychosis affects around 1 in 1,000 mothers after giving birth. It usually starts suddenly in the first two weeks, often within hours or days, though rarely it begins several weeks later.

Signs include seeing or hearing things others cannot, unusual beliefs or suspicions, feeling high or overactive, quickly changing moods, and marked confusion. The mother may not realise she is unwell, so family often need to act. Get help the same day. With the right treatment, most women recover fully.

The risk is higher if you have bipolar disorder or schizophrenia, if you have had postpartum psychosis after an earlier birth, or if there is a family history of mental illness, especially postpartum psychosis.

04

Treatment: talking, medicines and a shared decision

Talking therapies such as cognitive behavioural therapy (CBT) help many women with depression and anxiety. UK guidance from NICE suggests considering CBT for moderate or severe depression, alone or with medicine.

Medicines in pregnancy and breastfeeding mean weighing one set of risks against another. NICE asks doctors to discuss the risks of each treatment alongside the risks to your health and parenting if the illness goes untreated, so that you can make an informed choice. The NHS notes that many antidepressants can be taken while breastfeeding, so tell your doctor if you are feeding.

If you are already taking medicine and find out you are pregnant, do not stop it on your own. Speak to your doctor first. If a change is needed, it is usually made gradually, with closer follow-up and support.

05

Partners and families matter

Fathers and partners can also become depressed after a baby arrives. If you are the partner, keep an eye on your own sleep and mood, and say so if you are struggling.

In many Indian families, a new mother is cared for by relatives, often at her parents’ home, with special foods and a period of staying indoors. These customs can be a gift when they give her rest, and work best when they are gentle rather than strict. Ways to help:

• Protect her sleep. Someone else can settle, change and burp the baby at night, and she can nap by day.
• Keep visitors few and short in the early weeks, and let her decide when she is ready for more.
• Ask how she is feeling and listen, without brushing worries aside as “just hormones”.
• Go easy on criticism about feeding or handling the baby.
• If she seems very low, confused or not herself, contact a doctor quickly.

06

If you have had problems before, plan ahead

If you or a close relative have had depression, anxiety, bipolar disorder or postpartum psychosis, tell your obstetrician and psychiatrist early, ideally before you conceive. NICE advises that women with a current or past severe mental illness who are planning a pregnancy be considered for advice from a specialist perinatal mental health service.

According to the NHS, after one episode of postpartum psychosis there is about a 1 in 2 chance of it happening again after a later birth, but early help and a clear plan can reduce that risk. A good plan covers medicines, who will watch for warning signs in the first two weeks, how nights will be shared, and whom to call. Share it with your family.

Speaking up early is not making a fuss. These conditions are treatable, and the sooner help starts, the sooner you can feel like yourself again.