Why Do I Feel Sad After Giving Birth?

Having a baby can be an emotional roller coaster," said Shiby Abraham, MD, FAPA, Program Director of Psychiatry Residency at St. Catherine of Siena Hospital. "Being a mother of three children and a psychiatrist, I can understand some of those emotions that all mothers face.”

Dr. Abraham shares what you need to know about postpartum mental health and the importance of finding support and professional help.

 

Why do I feel sad after giving birth?

A newborn brings a range of emotions for a mom—joy, excitement, fear, anxiety and stress. But some women experience more significant distress. Some experience “baby blues” symptoms that go away shortly after delivery or peripartum depression (formerly postpartum depression) when symptoms persist. In rarer instances, some will experience bipolar or psychotic episodes. 

Pregnancy causes rapid changes to a woman’s body, including hormonal changes while pregnant and after giving birth. Hormonal changes (sex, thyroid, and stress hormones) affect physical, emotional and mental health.

Many women experience a rapid hormone decline—estrogen and progesterone plummet—after delivering a baby that can cause “baby blues” and even peripartum depression. By around six months, postpartum hormonal changes in estrogen and progesterone typically reset to pre-pregnancy levels. 

In addition to hormones, a new mother deals with stress from factors like fatigue, physical recovery from the delivery, and lack of support. Due to genetics, family history and environmental stressors, some women are more prone to develop symptoms of mental illness after giving birth.

Feeling sad or depressed is not a sign of weakness and does not mean you are incapable of being a good mother. Mental illness should be seen as similar to a physical disorder where many factors can be the cause and treatment options can be sought. 

You are not alone; help is available to ensure good health for you and your baby.

 

What is postpartum “baby blues”? 

Nearly 70 percent of all new mothers experience “baby blues.” The duration is usually one to two weeks and does not interfere with daily activities or require medical intervention. (You should still call your doctor to share your symptoms.)

“Baby blues” typically begin within two to three days after delivery and can last up to two weeks. “Baby blues” will be classified as peripartum (formerly postpartum) depression when symptoms last over two weeks.

 

What are the symptoms of "baby blues"? 

Symptoms include:

• Mood swings
• Crying spells
• Feeling anxious
• Feeling overwhelmed
• Decreased appetite
• Difficulty sleeping 

 

What is peripartum (formerly postpartum) depression?

A recent study found that one in seven women may experience peripartum depression the year after giving birth.  

Peripartum depression presents with more severe symptoms than postpartum blues. Symptoms last more than two weeks and professional help is needed.

 

What are the symptoms of peripartum depression?

Symptoms include:  

• Decreased appetite
• Inability to sleep or sleeping too much
• Overwhelming tiredness or loss of energy
• Less interest and pleasure in activities you used to enjoy
• Intense irritability or depressed mood with crying often
• Decreased concentration
• Psychomotor retardation (sluggish or diminished body movements, usually accompanied by a slowing of thought processes)
• Feelings of guilt or being a bad mother
• Feeling isolated or intentionally isolating 
• Difficulty bonding with your child
• Feeling hopeless
• Feeling helpless 
• Suicidal thoughts
• Thoughts of harm to self and child 

 

What are the risk factors for peripartum depression?

• Any new mother (or gestational carrier/surrogate) can experience symptoms of peripartum depression or other mood disorders.
• Women who have had a previous history of depression, mood disorders or suicide attempts
• Women who have a previous history of peripartum depression
• Women who have additional psychosocial stressors or lack of support from family and friends
• Family history of depression and mood disorders 

 

Can fathers get peripartum depression? 

Peripartum depression in new fathers can often be overlooked, but studies show they also experience symptoms of peripartum depression. These symptoms include low mood, fatigue, and changes in sleep and appetite. 

Nearly 4% of fathers experience depression the first year after their child’s birth. Risk factors include younger age, previous history of depression, financial difficulties, and other psychosocial stressors. 

 

What is peripartum bipolar disorder?

Bipolar disorder can emerge during pregnancy or postpartum, marked by intense mood changes referred to as “highs” for the manic/hypomanic phase and “lows” for the depressed phase. A mixed episode is when the highs and lows occur simultaneously.

Bipolar illness can emerge during pregnancy or the postpartum period. Risk factors include a previous mood disorder and a family history of mood disorders.

 

What are the symptoms of peripartum bipolar disorder? 

Symptoms during the “high” phase include:

• Elevated mood 
• Increased energy with decreased need for sleep
• Spending hours at night cleaning excessively or doing other goal-directed activities without the need for sleep
• Racing thoughts
• Excessive spending for items not needed
• Reckless and impulsive behavior
• Grandiosity
• Mood swings
• Flight of ideas—jumping from topic to topic 
• Disorganized thoughts
• Hyperverbal
• Difficult to interrupt

The “low” phase is typically marked by a “crash” or “coming down” with symptoms of major depression. 

 

What is peripartum psychosis?

Symptoms of peripartum psychosis are a serious medical emergency and require immediate attention. Call 9-1-1 immediately if you are concerned about harming yourself or others.

Peripartum psychosis is an extremely rare but serious condition.  According to the American Psychiatric Society, it occurs in one or two women out of every 1,000 deliveries. The onset is usually sudden within the first two weeks after delivery but can appear any time within the first year.  

 

What are the symptoms of peripartum psychosis?

Symptoms include:

• Hallucinations (auditory or visual; sometimes violent commands)
• Delusions or strange beliefs
• Insomnia
• Increased energy
• Paranoia
• Agitation
• Thoughts of harming child/children or self

 

What are the risk factors for peripartum psychosis?

• Personal history of bipolar disorder or psychosis 
• Family history of bipolar disorder or psychosis

 

Find Care at Catholic Health

Talk to your obstetrician-gynecologist about a referral to a mental health professional and the resources available to help you feel better. Do not self-diagnose or think it will "just go away!" A mental health professional will provide you with the best treatment options based on your diagnosis and discuss any concerns you may have, such as taking medication while breastfeeding.

Remember: help is available and you are not alone!

At Catholic Health's Good Samaritan Hospital (West Islip, NY), our Mother’s Circle of Hope group provides a safe place for moms to share their feelings, meet other women with similar experiences, and learn ways to cope and recover.

Call our confidential support line at 631-376-HOPE (631-376-4673) to speak to an experienced, caring professional and learn about helpful resources. You can also email circleofhope@chsli.org.  

Call (866) MY-LI-DOC (866-695-4362) to find a Catholic Health physician near you.