‘Baby Blues’ and postpartum psychosis: Women’s mental health after having a baby

The postpartum period refers to the time between giving birth and a new mother’s physical and emotional recovery from all the changes that have taken place; during this time, she faces her new role and different routines. The duration of this stage varies for each woman. Verónica Fernández López, a family and educational counselor, and Paula García Otero, a pharmacy technician and lactation consultant, say that it is important to end misinformation and taboos and talk more about the issue. Together, the two experts conduct an in-person and online workshop called Postpartum: A Hidden Reality to help shine a light on the issue and offer information, training and support.

Fernández explains that their workshops highlight certain issues that usually go unnoticed or are ignored by the people in a woman’s life; postpartum women themselves may also hide them for different reasons: “Major physical, mental, hormonal and emotional changes occur in the postpartum period that cause many women to feel emotionally imbalanced, and even surprise them. Because of this lack of knowledge, they may not accept their new reality and may feel guilty or sad.”

The expert notes that many women do not share their experiences with their peers and social circle for fear of being judged. “A woman may truly desire the arrival of her child. However, with it comes the loss of an acquired lifestyle, family structure, freedom, time... to a greater or lesser degree, that entails a mourning period that a woman must go through, consciously or unconsciously,” Fernández says.

Because of their effects on the mother and/or the baby during pregnancy and after childbirth, Fernández highlights three special cases in postpartum mental health:

1. Baby blues: these are episodes of melancholy or sadness that occur between two and four days after delivery and usually go away two or three weeks after the birth. The baby blues are very common and do not affect the care of the baby or the mother herself.
2. Postpartum psychosis: this is a much less common condition. Postpartum psychosis is more serious and requires immediate psychiatric attention. The most representative symptoms are delirium and hallucinations, which can endanger the lives of both the mother and the newborn.
3. Postpartum depression: there is no consensus on the term. Some specialists define it as part of a major depression, meaning that symptoms last for at least six months and affect the patient’s entire life. Other experts refer to it as perinatal, prenatal or postnatal depression. It can occur during pregnancy or after childbirth and emerge at any time in the first year after giving birth.

Postpartum fear and loneliness

García points out that, in general, society does not adequately care for mothers or sufficiently value the postpartum stage. She adds that a lack of empathy and follow-up care for women can cause new mothers to feel alone during this time. “The physical and emotional readjustment that a woman must face after childbirth can bring out her fears and insecurities,” she explains.

This lactation consultant also talks about the mother’s physiological and normal tendency to not want to separate from her baby, which can cause clashes in the family as a result of misunderstandings. According to the expert, relatives should be at the woman’s side, caring for and protecting the mother-baby dyad to help strengthen the bond. She emphasizes that “the postpartum period doesn’t only refer to the period of confinement.” García argues that a lack of understanding is at the root of the problem. “People forget that it is counterproductive to judge and pressure the mother with unsolicited advice. Loneliness is the concept that the women I see in counseling sessions mention most frequently. Without guidance and monitoring [a mother’s] health, the symptoms are identified late; in advanced stages, they can lead to pathologies like postpartum depression or physical problems,” she says.

Of lactation, she explains that if a woman decides to breastfeed her baby, it usually involves a high prevalence of cracking and mastitis, which can cause a woman to give up on nursing her baby early. According to the expert, “breastfeeding is one of the [issues] that worries women most; it is often the initial reason for counseling and is a determining factor in cases of postpartum depression.”

Counselors like García serve as valuable figures who listen to mothers, answer their questions and resolve doubts. On many occasions, counselors are the first to identify complications in a woman’s health and, if necessary, they refer the new mother to the appropriate physician or specialist.

“To better cope with the postpartum period, it is best to get training beforehand by attending workshops, childbirth preparation talks and specific counseling and parenting groups to be able to identify the warning signs about our wellbeing during this stage,” says García. Being in contact with other families in the same situation is also helpful and offers a valuable learning experience: “The baby’s wellbeing depends directly on the mother’s.”

Postpartum depression

Family counselor Verónica Fernández López explains that postpartum depression can present as sadness or anhedonia (loss of pleasure); anxiety, irritability, low self-esteem, sleep disturbances, low energy and changes in weight or appetite are also common symptoms.

Biological changes, genetic predisposition and the circumstances surrounding motherhood (such as an unwanted or unexpected pregnancy or having suffered depressive episodes in the past) are all factors in the onset of postpartum depression.

Fernández points out that the most serious cases of postpartum depression can affect the mother’s care and hinder maternal functions such as her connection with her baby. She also notes the crucial role of education in preventing it, alongside support from those around her and professionals.

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