Her husband occasionally tried to reason with her. He could hold the baby tightly, he pointed out. “But what if you fall down the stairs?” she would reply.
Thiago-Munoz is now a lactation consultant, postpartum doula, and founder of Clementina Health, a postpartum and lactation telehealth company. Her work is informed by what she experienced after giving birth—and by what she wishes the people around her had understood. “I just didn’t feel joy in anything,” she says. “I felt like I was supposed to be happy because, wow, this major thing just happened. And I was happy, but I wasn’t joyful.”
Both the “baby blues” and postpartum depression can cause sadness, tearfulness, irritability, and feeling overwhelmed after giving birth, says Dr. Kelli Burroughs, an ob-gyn and vice chair of clinical affairs and patient experience at the University of Texas Medical School in Houston. But the baby blues are generally mild, begin within the first week after delivery, and improve within about two weeks. Postpartum depression lasts longer and interferes more significantly with daily life.
It doesn’t always look the way people expect, either. Sometimes, the moms who are suffering the most appear to have everything under control, says Jayme Scarfo, a licensed professional counselor in Surprise, Ariz., who specializes in working with pregnant and postpartum women. They’re showering, cooking, going to the gym, and insisting: “It’s hard, but don’t worry. I’ve got it.”
Consider who should initiate that conversation, too. “The best person to ask those hard questions is often going to be whoever she feels the least pressure to perform for,” Scarfo says. That might be a sister, best friend, therapist, or fellow mom—not necessarily her partner or mother.
Don’t argue with how she feels
When someone declares they’re a “terrible mother,” your instinct might be to disagree. Of course you’re not! You’re doing an amazing job. But depression and anxiety symptoms can start to feel like part of someone’s identity, says Emma Basch, a clinical psychologist in Washington who specializes in perinatal mental health. Trying to prove her wrong might leave her feeling even more misunderstood.
Skip the sunny reassurances, like “Enjoy every moment,” “They’re only this little once,” and especially “You just had a baby—you should be happy.” Those comments suggest she can simply choose her way out of what she’s experiencing. “Postpartum depression is a true medical condition,” Burroughs says. “This is not a sign of weakness. This is out of the control of the new mom.”
Acknowledge that the thought sounds scary, and gently ask more: “How often are you having these thoughts?” “Do you feel like you might act on them?” “Do you feel safe right now?” “Who can we call together?”
Know when it’s an emergency
Talking about suicide or harming the baby does require immediate intervention, Basch says. The same is true of signs of postpartum psychosis, which can include hallucinations, delusions, paranoia, confusion, or a decreased need for sleep accompanied by a surge of energy. “It’s not a layperson’s job to diagnose,” she says, “but it’s a layperson’s job to take action.”
“Let me know if you need anything” might sound kind. But it puts the burden back on the person who’s already overwhelmed. She hears “ball’s in your court,” Scarfo says, and “a depressed mom is not picking up the ball. She has 17 other things to do.”
Be careful not to turn helping into unwanted visits. Scarfo and her sister-in-law used to leave meals on each other’s porches and say: “I’m dropping off dinner at 6. I’m going to leave it on the porch, and I’ll text you when it’s there.” There was no expectation that the recipient would invite anyone inside or make conversation. “It doesn’t put that burden of gratitude on the new mom,” Scarfo says—“that burden of performing or hosting.”
Take the legwork out of getting help
Basch has seen loved ones do that legwork themselves and say: “I found a few therapists who specialize in postpartum mental health. I’d be happy to help you connect with one.” You might offer to make the call, accompany your loved one to an appointment, or watch the baby while she goes.
The provider can then reach out to the patient without necessarily revealing who called, Burroughs says. They’ll usually open by saying: “I’m just calling to check on you. I want to see how your recovery is going.” Then, they’ll ask how the new mom feels emotionally on a scale of 1 to 10, whether she’s bonding with the baby, how often she feels sad, and whether she’s having more good days or bad ones. Those specific questions can make it harder for serious symptoms to disappear behind “I’m fine.”
Keep showing up
Continue checking in without demanding a response: “Thinking of you today. No need to text back.” Keep offering specific help, even if your loved one turns you down the first time. Scarfo suggests making it clear that you’ll come over whether she wants to run an errand alone or lie down on the couch while somebody else handles the chaos around her.
Thiago-Munoz still remembers the neighbor who noticed that she had stopped taking her dog on his usual 9 a.m. walk. If Thiago-Munoz hadn’t appeared by 9:15, her neighbor came over and walked him herself. “I honestly never would have asked her to take the dog for a walk,” she says. “I didn’t have the capacity to look for someone to do it. She knew my routine.”
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