Low Mood After the Birth: Baby Blues, Postnatal Depression and What Helps

In the weeks after a birth, almost everyone asks about the baby. Very few people ask the mother how she is, and if she says she is not coping, she is usually told she is lucky, or tired, or that this is simply what motherhood feels like.

It is not. A pooled analysis of Indian studies found postnatal depression in about 22% of mothers — roughly one in five, higher in urban settings at 24% and in hospital-based studies at 23%. It is common, it is nobody's fault, and it responds to treatment.

Baby blues, or something more

Baby blues start around day three to five, peak in the first week and settle by about two weeks. Most women get them: weepiness, irritability, feeling overwhelmed, mood that swings within a single hour. They need rest, food, help and kindness — not treatment.

Postnatal depression is different in three ways: it lasts longer than two weeks, it goes deeper, and it stops you functioning. It is worth knowing that it often does not look like crying at all.

That last one deserves a plain statement, because it keeps women silent: intrusive thoughts are common in anxiety and depression, and having them does not mean you will act on them, and does not mean your baby will be taken away. Saying them out loud to a doctor is the fastest route to feeling better.

Who is more likely to get it

The Indian risk factors are, depressingly, mostly social rather than medical:

• Little practical or emotional support, or conflict in the household, particularly with in-laws or a partner.
• Disappointment in the family about the baby being a girl. This appears in the Indian research as a genuine risk factor, and it is still a reality in many homes.
• Financial strain and poor living circumstances.
• A difficult or frightening birth, a caesarean, a premature or unwell baby, or an unplanned pregnancy.
• Previous depression or anxiety, including in a past pregnancy.
• Feeding problems, which both cause and are worsened by low mood — see breastfeeding in the first month.
• Anaemia and nutritional deficiency — low haemoglobin, vitamin D and B12 all appear in the Indian data, and all are correctable. See anaemia.

The things worth ruling out

Before assuming it is "just" mood, three physical causes are checked because they imitate depression and are easy to treat: anaemia, thyroid disease — postpartum thyroiditis typically appears in the months after delivery, see thyroid in pregnancy — and vitamin B12 or D deficiency. These are blood tests done at the clinic, and they are worth doing in any woman who is exhausted and low months after a birth.

How it is assessed

There is a short, well-validated questionnaire used worldwide for exactly this: the Edinburgh Postnatal Depression Scale, ten questions about the past seven days. It takes two minutes, it is not a test you can fail, and it is a way of starting an honest conversation rather than a diagnosis on its own. One of its questions asks directly about thoughts of harming yourself, which is deliberate.

A proper assessment then covers how long it has been going on, how you are sleeping and eating, how you feel about the baby, what support you have, and whether anything is frightening you.

What helps

Two things that do not help: being told to be grateful, and waiting to see whether it passes. Untreated depression tends to last longer, and it affects feeding, bonding and the baby's development — which is the argument for treating it, not another reason for guilt.

When it is an emergency

Three situations need help the same day, not an appointment next week:

• Thoughts of harming yourself, or of ending your life.
• Thoughts of harming the baby that feel like something you might act on.
• Losing touch with reality — hearing voices, strange beliefs, severe confusion, not sleeping at all for days. This can be postpartum psychosis, which is rare, usually begins in the first two weeks, and is a medical emergency. It is treatable, and recovery is the norm.

If any of these apply, call Tele-MANAS, the national mental health helpline, on 14416 — free, day and night, in multiple Indian languages — or go to a hospital. Tell someone in the house now rather than waiting for the right moment.

If you are the husband, mother or mother-in-law reading this

What helps is specific, not general: take the night feed so she gets one unbroken block of sleep, take over a task without being asked, and do not comment on her weight, her milk or the baby's crying. Ask "how are you?" and wait for the answer. If she says she is not coping, believe her, and take her to a doctor rather than telling her to be strong.

And if the family is disappointed about the sex of the baby, understand plainly that this is one of the documented risk factors for a mother becoming ill. It is not a small thing.

Will it happen again?

Having had postnatal depression raises the chance of it happening after a future birth, which is useful information rather than bad news: it means the next pregnancy can be planned with support in place, and treatment started early rather than after months of struggle. Tell whoever looks after your next pregnancy.

What happens at the clinic

Mood is asked about at the postnatal visits, not left to be raised. Assessment, the questionnaire, blood tests for anaemia, thyroid, B12 and vitamin D, treatment, and referral to a psychiatrist or psychologist where that is the right step, all happen here. Scans, where one is needed, are arranged by referral. Our guide to the first six weeks after delivery covers the rest of postnatal recovery.

You can bring your partner or your mother to the appointment. Very often, having someone else hear it said out loud by a doctor is the thing that changes what happens at home.