Although having a baby is a joyous occasion for most women, it is very common for mothers to feel sad, afraid, angry, or anxious after childbirth. Most new mothers have these feelings in a mild form called postpartum blues-sometimes called "baby blues" or "maternity blues." Postpartum blues usually go away in a matter of days.

Instead of this relatively mild sadness and anxiety, about 10% of new mothers develop a more troubling condition called postpartum depression. Postpartum depression lasts longer, is more intense, and often requires counseling and treatment. Postpartum depression can develop with any birth, not just the first.
Many new mothers are surprised at how fragile, alone, and overwhelmed they feel after the birth of a child. Their feelings don't seem to match their expectations. They wonder, "What have I got to be depressed about?” They fear these feelings somehow mean they are bad mothers.
In fact, about 70-80% of women have baby blues after childbirth. These feelings of depression, anxiety, and anger usually begin about 2-3 days after birth. At this time, new mothers may feel sad, weepy, anxious, and moody. For no clear reason, they may feel angry at the new baby, their partner, or their other children. They may cry unexpectedly. Sometimes they may have trouble sleeping, eating, and/or making decisions. They almost always question whether they are able to handle the important new responsibility of caring for a new baby. These feelings may subside and recur in the first few days after childbirth. As bewildering and scary as these feelings seem, they usually last only briefly-a few hours to a week or so-and go away without the need for treatment.
About 10% of women who give birth develop postpartum depression. In contrast to the baby blues, postpartum depression is marked by more intense feelings of sadness, anxiety, or despair that disrupt the mother's ability to function. If not recognized and treated, postpartum depression may become worse or may last longer than it needs to.
There are a number of signs and symptoms indicating that a new mother may be developing, or already has, postpartum depression. These include:
  • Baby blues that don't go away after 2 weeks, or strong feelings of depression and anger that begin to surface 1-2 months after delivery.
  • Feelings of sadness, doubt, guilt, helplessness, or hopelessness that seem to increase with each week and begin to disrupt a woman's normal functioning. The woman may not be able to take care of herself or her baby. She may have trouble handling her usual responsibilities at home or on the job.
  • Not being able to sleep even when tired, or sleeping most of the time, even when the baby is awake.
  • Marked changes in appetite.
  • Loss of interest in things that used to bring pleasure.
  • Extreme concern and worry about the baby, or lack of interest in or feelings for the baby. The woman may feel unable to love her infant or her family.
  • Anxiety or panic attacks. The woman may feel frightened of being left alone in the house with the baby.
  • Fear of harming the baby. These feelings are almost never acted upon by women with postpartum depression but they can be very frightening and may lead to guilty. feelings, which only makes the depression worse.
  • Thoughts of self-harm, including suicide.
Some women appear to have a higher risk of postpartum depression. These women include those who have had postpartum depression before, and those with a psychiatric history. Recent stressful events, such as loss of a loved one, family illness, or moving to a new city also appear to increase a women's risk for postpartum depression. There is no evidence that postpartum depression is related to age or number of previous children. There is evidence, though, that the lack of a supportive partner may be a major factor.
In rare cases-about 1-3 in every 1,000 births-the mother will develop a more severe mental illness or psychosis. Women with a personal or family history of manic depression (bipolar disorder) or schizophrenia appear to be at increased risk for such disorders.

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