Afraid to Admit You’re Struggling After Baby? Talking About It Can Help

The year after a baby arrives is the most significant period of mental health risk in a woman’s lifetime. What makes the first postpartum year even more difficult are the expectations around motherhood.

“We have this societal myth that everything’s supposed to be perfect. You wanted this baby, you got the baby, and everything will be lovely and easy,” says Susan Hatters-Friedman, MD, a reproductive psychiatrist at University Hospitals. “Meanwhile, your hormones are going wild, your body’s adjusting from delivery and a new and vulnerable little person needs you for everything, including every three hours, every night.”

Dr. Hatters-Friedman shares how to support your mental health after having a baby – and why the single most protective thing you can do is talk about what you’re feeling (even when it’s uncomfortable).

Why Speaking Up Lowers Your Risk

Many new mothers stay quiet about mental health symptoms for one common and understandable reason: they’re afraid that sharing their symptoms will mean others think they can’t take care of their children.

Dr. Hatters-Friedman, whose research has studied this pattern, says the fear may be real, but the reality is actually the opposite. “If you share your symptoms and that leads to treatment, the risk of actual harm to you or your children goes down,” she says. “If you don’t report symptoms, you can’t get treatment. That’s the real risk.”

The most encouraging part of speaking up about your symptoms? Treatment works. Postpartum depression, anxiety and obsessive-compulsive disorder (OCD) respond well to therapy, medication or a combination – and the sooner these conditions are identified, the more effective the treatment path can be. On the other hand, staying silent about symptoms can allow a readily treatable condition to become more serious and challenging to treat.

The first postpartum visit with your obstetrician is just one opportunity to talk about postpartum mental health. A mother who is struggling will typically prioritize frequent pediatrician visits during the first year of her baby’s life, when her own risk is highest. Many pediatricians screen mothers for depression and anxiety during those visits. If yours doesn’t ask, you can still bring it up.

You can also speak to a primary care doctor, a lactation consultant, a home visiting nurse or any other healthcare providers you see. You don’t need to find the right specialist first, or wait for a scheduled appointment. A phone call to anyone on your care team is enough to start the conversation, and they can point you toward the right help.

What About Those Scary Thoughts?

Intrusive thoughts are at the top of the list of things new mothers are most reluctant to share. These sudden, unwanted, often vivid mental images can include something terrible happening to the baby or even harm a mother herself might cause.

These thoughts are far more common in the postpartum period than people realize, even in women without a clinical diagnosis. They are also a key feature of postpartum anxiety and postpartum OCD, which occur considerably more often than postpartum psychosis. The defining quality of an intrusive thought is that the person having it finds it disturbing and at odds with what she actually wants or believes.

That distress is what distinguishes an intrusive thought from psychosis, in which a person loses touch with reality and the thoughts feel true to her. The distinction, says Dr. Hatters-Friedman, is vitally important when it comes to women getting the help they need. “People often think having an intrusive thought means you’re going to harm your child,” she says. “But anxiety alone is not associated with parents who actually harm their children; that’s psychosis. Intrusive thoughts alone do not increase the risk of harm.”

When shame keeps these thoughts hidden, the symptoms are left untreated. A clinician trained in perinatal or reproductive mental health can tell the difference between anxiety-related intrusive thoughts and something more serious, but only if you tell them what’s going on.

How to Support Your Postpartum Mental Health

Supporting postpartum mental health starts with recognizing what makes this time so challenging: trying to keep everything together when you’re in survival mode. Dr. Hatters-Friedman compares postpartum mothers to a pitcher of lemonade. “You’re pouring out glasses for everyone in the family, and nobody is refilling the pitcher,” she says. The key, she says, is to reset expectations and go back to basics by emphasizing the essentials.

• Say yes to sleep (whenever you can). Getting enough sleep is critical to mental health, and worth raising with your doctor if you’re not getting enough. Whether you’re power-napping when the baby sleeps or asking for help overnight, look for ways to catch up whenever possible.
• Give yourself permission to stop breastfeeding. If nursing is the barrier between you and adequate sleep and mental health, stopping is a reasonable choice, despite what society tells you. “I’ve had patients tell me I’m the only person who has ever said it’s okay to stop,” says Dr. Hatters-Friedman. “We need to let moms know that their health is just as important as the benefits of breast milk.”
• Keep moving. Gentle activity and fresh air work wonders, and neither requires a gym membership. You don’t need to train for a 5K or commit to a five-day strength training routine; a daily walk with the baby counts.
• Find some time for you. This can seem like an impossible goal when your time feels like anything but yours. But just an hour here and there doing something that makes you feel like yourself – watching a favorite TV show, listening to music you love, engaging in a hobby – can connect you to the person you were before your baby arrived.
• Resist the myth of perfection. Lowering your standards about what’s enough – whether it’s how tidy your home is or how many to-dos you check off each day – is a legitimate mental health strategy. “I’m not saying let everything go downhill,” says Dr. Hatters-Friedman. “But if it’s a choice between cleaning up your house or fitting in a nap, take the nap.”

For Partners, Co-Parents and Friends

The people who surround a new mother have two important jobs. “The first priority is to simply take things off the new mom’s plate,” says Dr. Hatters-Friedman. That might mean handling a night feeding so she gets an uninterrupted stretch of sleep, taking the baby for a few hours or handling tasks that would otherwise sit on her list.

Second, if she tells you something that worries you, don’t assume she’s already mentioned it to a healthcare provider, or that the doctor will somehow figure it out. “People assume doctors have crystal balls and can see everything that’s going on, but we don’t,” says Dr. Hatters-Friedman. “Don’t assume it’s being handled – speak up.” Sharing a concern about a new mother with a healthcare provider can seem like a betrayal, but sometimes it’s the only path to getting help.

Whoever makes that first call, the good news is there are many avenues to getting help. A reproductive psychologist or psychiatrist is skilled in evaluating and treating postpartum symptoms, but not every community has one available. An obstetrician or pediatrician is a good starting point; practices often know which local therapists have successfully treated their patients. From there, treatment is individualized: therapy alone works for many people, and others also find benefit from medication.

The most important thing is to speak up. “The postpartum year is hard in ways our culture doesn’t prepare anyone for,” says Dr. Hatters-Friedman. “Struggling is not a verdict on your capabilities as a parent, and you – and your baby – deserve to get the help you need.”

Where to Get Help Now

Dr. Hatters-Friedman recommends the following resources in addition to your care provider.

• National Maternal Mental Health Hotline: 1-833-TLC-MAMA (1-833-852-6262), free and confidential, 24/7
• Postpartum Support International: 1-800-944-4773
• 988 Suicide & Crisis Lifeline: call or text 988 24/7
• If you or someone you care for is in immediate danger, call 9-1-1 or go to the nearest emergency room

Related Links

University Hospitals offers specialized mental health care for pregnancy and the postpartum year, including psychologists embedded directly within obstetric care and reproductive psychiatrists who see patients during pregnancy and after delivery.