Baby blues or postnatal depression? How to tell the difference

The baby blues are common and tend to lift within about two weeks

In the days after a birth, many women find themselves crying without a clear reason, feeling irritable or on edge, or swinging between joy and tears in the same afternoon. This is often called the baby blues. It tends to start a few days after the birth and to fade gradually.

Several things feed into it at once: the sudden fall in pregnancy hormones, broken sleep, a body that is still recovering, and a large, abrupt change in daily life. None of it means something is wrong with you or with your feelings for your baby.

Rest when the baby sleeps if you can, eat regularly, and let people help at home. Saying how you feel out loud, to your partner or a close friend, often takes some of the weight off.

NICE postnatal guidance advises that women are asked, at around 10 to 14 days after the birth, whether these feelings have passed. If they have not, the next step is to consider postnatal depression.

Signs that it may be more than the baby blues

Postnatal depression can start at any point in the weeks or months after birth, and sometimes it follows straight on from the baby blues. Anxiety after birth is common too, on its own or alongside low mood. These signs deserve attention when they last beyond about two weeks or keep returning:

• feeling low, flat or hopeless for most of the day, on most days
• losing interest or pleasure in things, including time with your baby
• constant worry, a sense of dread, or panic attacks
• feeling unable to cope, or that you are failing as a mother
• trouble sleeping even when the baby is asleep, or wanting to sleep all the time
• pulling away from family and friends
• unwanted, frightening thoughts that push into your mind, such as harm coming to the baby

Intrusive thoughts like these are distressing and are often part of anxiety. Having them is different from wanting to act on them, and talking about them is how help begins. Thoughts of harming yourself or your baby, or a sense that you might act on a thought, need urgent help, as set out below.

Confusion or unusual beliefs in the days or weeks after birth can be a sign of postpartum psychosis. It is rare, comes on quickly and needs emergency care straight away.

Your partner or family may notice the change before you do

Depression can arrive slowly, and exhaustion after a birth makes it easy to explain away. People close to you may see it sooner: you have stopped enjoying things, seem withdrawn, cry most days, or worry far more than you used to.

NICE postnatal guidance encourages women, and their partners and families, to tell a healthcare professional about changes in mood or behaviour that are out of character. If you are a partner or relative reading this, it is reasonable to say gently what you have noticed, and to go along when she raises it.

Partners can also become low or anxious after a birth, and the same advice applies to them.

Postnatal depression is common, and it can be treated

Postnatal depression is an illness, not a failing, and it is not your fault. It can affect any woman, including those who have never had mental health problems before.

Treatment depends on how much it is affecting you. It may involve practical support at home, guided self-help, a talking therapy such as cognitive behavioural therapy, and sometimes medicine. When medicine is considered, its possible side effects and how it fits with breastfeeding are part of the discussion, so that the decision is yours, made with the facts in front of you. Mentioning it early means support can start early.

How to bring up your mood at the postnatal check

The check at about 6 to 8 weeks after birth covers your emotional health as well as your physical recovery. You may be asked how often, over the past weeks, you have felt down or lost interest in things. Answer with how it really is, not how you think a new mother ought to feel.

If it is hard to say aloud, write it down beforehand and hand over the note, or ask your partner to come with you. Say how long it has lasted, how often it comes, and what it stops you doing. Details like these say far more than ‘I’m just tired’.

There is no need to hold it back until the check. If low mood or anxiety has gone on beyond about two weeks after the birth, or is getting worse, raise it with your doctor or midwife sooner.