• Pregnancy and birth are huge psychological, physical and emotional events 

  • Therapist Kristina Matej describes how to spot postnatal depression and what to do about it

  • We have therapists specialising in PND – find them here

Postnatal depression is way too common in today’s world, especially in Western society. It ranges from feeling moody and ‘not oneself’ to, at the other extreme, experiencing a psychotic event.

The underlying causes are:

  • Exhaustion through lack of sleep
  • Hormones adjusting and uterus shrinking while the body recovers
  • Trauma (past or from the birth experience)

Lack of appropriate support often exacerbates any symptoms the new mother might be experiencing. Additional aggravating factors are an identity crisis, previous poor mental health, unstable relationships (partner and/or family), addictions (especially alcohol or drug use) and lack of safety (lack of accommodation, food or money, war, domestic abuse etc).

In an ideal world

Ideally, for at least the first six weeks, the new mother should be completely taken care of by her family and community, so she can entirely focus on her new baby and her recovery. 

By six weeks most women fully recover physically from birth, even after a caesarean section. The mother adjusts to new sleeping patterns and is starting to be able to expand her activities beyond just sleeping and breastfeeding. This is the natural process, giving the mother the opportunity to rest properly.

The challenges

Sadly, many mothers are not afforded such care unless they literally pay for it in form of nannies, cleaners and night nurses. Too many women are forced back to work almost immediately after giving birth. But prolonged separation of mother and baby in the first year is often very traumatic for both mother and baby and alone can lead to PND (postnatal depression) or PPA (postpartum anxiety).

Breastfeeding on demand has been shown to prevent or at least lessen the symptoms of PND, so anything that disrupts that process poses a risk to the mother’s mental health if she is not adequately supported.

The lack of supportive community is particularly sensitive point for women as we have evolved to be a part of extended family, to be surrounded and held by women of all generations. The community would take care of chores, cooking, older children, and of the mother’s sleep and wellbeing, giving her time to adjust and recover.

How to spot PND

The symptoms of postnatal depression are quite varied. The most common are a persistent feeling of sadness and low mood, lack of enjoyment and loss of interest in the wider world, lack of energy and feeling tired all the time, trouble sleeping at night and feeling sleepy during the day, difficulty bonding with your baby, withdrawing from contact with others, difficulty concentrating and making decisions, and frightening thoughts – for example about hurting your baby (intrusive thoughts). Sometimes fathers suffer too.

How to lessen the impact or even prevent it

There are few things anyone can do, regardless of situation or resources.

  • Stop and take honest stock of your mental health. If you struggle to gain clarity, try journaling your feelings three times a day for a couple of weeks. It is ok to have a low mood or feelings of anger every so often, but if these are the prevalent feelings, something is clearly amiss. Once you know how you feel and what you think most of the time, the next step is to realise that you are not your feelings and thoughts. These are just passing through and are not permanent unless you keep hold of them. Mindfulness and meditation are great tools for managing unruly thoughts and feelings and there are plenty of free resources online and in person through charities.
  • Our bodies are great messengers, so tuning in and listening to what they are telling us, can be really crucial to combating PND. It is important for a new mum to regularly check in with her body, feel beyond the tiredness and report anything remotely suspicious to her midwife, GP or health visitor. An effective way to tune into your body is to do (or follow a recording of) a full body scan meditation, tap gently on every part of the body while in the shower or bath, or simply make a list of body parts and go through it one item at a time.
  • Exhaustion and sleep deprivation can easily slip into PND, so learning how to rest effectively is really important. As well as sleep, wakeful rest is incredibly important for physical and mental health. You don’t need any resources to practice active rest, just a discipline to prioritise it.
  • Conscious breathing is a great way to rest your body and mind, to re-set your mood, to calm or energise you, bring you to the present moment and connect with yourself. Whenever you stop and focus on your breath, you are practicing conscious breathing. It is as simple as that and research shows that it greatly reduces stress and its negative effects, especially if practised regularly. Make an effort to practise conscious breathing as often as you can, and if you struggle, tie it to another activity like going to the toilet, having a cup of tea, walking the dog or having a shower. Once a day for half a minute is better than nothing.
  • Ask for help. But be specific about what you need (maybe a friend wants to help by holding baby, while you’d prefer them to cook you a meal). And if you have a partner, ideally discuss division of responsibility before the baby arrives into the world and remember that looking after a baby is a full-time job, so cooking and chores should at least be shared.

Professional support

This is one of those ‘put your oxygen mask on first’ moments, where in order to be able to look after others, you must take care of yourself first. When you are not well, those closest to you, especially children, will suffer with you. So if you still feel you are struggling, contact a therapist. The sooner you catch postnatal issues, the easier it is to get out of them, and the less trauma all round.

I am not talking of luxurious baths, massages and having your nails done (although there is no harm in those), but taking care of your mental and physical health postpartum can literally be a matter of life and death.

Fortunately, nowadays there are lot of sources of help and support, so even if you feel all alone, don’t hesitate to reach out. We all have the capacity to enjoy motherhood, we’re just never meant to do it without a community to hold us. So let’s create our own community, our own ’village’ that it takes to raise a child.

Kristina Magdolene Matej is a verified welldoing therapist specialising in the mental wellbeing of mothers 

Further reading

How EMDR helped me recover from birth trauma

My mental health tips for other new mothers

7 self-care tips for managing the intensity of becoming a mother

Why postnatal rest and recovery matter