When motherhood feels heavier than expected: Understanding postpartum depression and anxiety

Written by Melissa Freestun, perinatal psychologist, Self Psychology www.selfpsychology.com.au 

IG: @_selfpsychology 

There is a version of new motherhood that gets sold to women over and over again. It is soft  light, sleepy cuddles, grateful tears, and a kind of glowing exhaustion that still somehow  looks beautiful. 

And then there is the version many women quietly live. 

The version where Baby is here, everybody asks if you are “over the moon”, and instead you  feel flat, frightened, numb, ashamed, or like you are failing at something that is supposed to  come naturally. The version where you are functioning on the outside, but inside your mind  feels loud, dark, relentless, or far away from yourself. The version where you love your baby,  yet do not feel like yourself at all. The version where you cry in the shoulder and think, “this  isn’t what I thought it would be like.” 

That is often where postpartum depression and anxiety begin: not always dramatically, but  painfully, privately, and in ways that can be easy to dismiss. 

In Australia, this is not rare. Data from The Australian Institute of Health and Welfare (AIHW)  says perinatal mental health conditions affect an estimated 1 in 5 mothers. Postnatal  depression affects about 1 in 7 women in the first year after birth. Postnatal anxiety affects  around 1 in 5 Australian women. And these rates could very well be under reported.  

That matters, because many women still assume that if they are struggling, they must be the  exception. They are not. They are often standing in the middle of a very common  experience, feeling very alone. And at times, they may be unlikely to admin how they’re  feeling to anyone, and even more unlikely to seek help. 

National guidelines recommend that all women be screened for signs, symptoms, and risk  factors of perinatal mental health conditions. But AIHW also notes that screening and data  collection are not yet consistent across Australia. In other words, many women are asked  the right questions, but not all women, not in the same way, and not always at the right time.  

It does not always look like sadness 

One of the reasons postpartum depression and anxiety can be missed is that they do not  always look like what people expect.

Sometimes postpartum depression looks like crying all the time. But sometimes it looks like  emotional numbness. Irritability. Pulling away. Feeling hopeless. Rage and anger. Not  enjoying anything. Struggling to eat, sleep, think clearly, or make simple decisions.  Symptoms can include feeling low or numb, helpless or worthless, losing interest in others  including your baby, changes in sleep or appetite, fatigue, concentration problems, and  thoughts of harming yourself or your baby.  

Postpartum anxiety can be even easier to hide because it is often misread as “just being a  good mum” or “being highly strung”. The Centre of Perinatal Excellence (COPE) describes  postnatal anxiety as ongoing disturbing thoughts or feelings of worry and tension that affect  

day-to-day coping. It is more than being careful. It is the mind that will not switch off. It is the  body that cannot settle. It is being exhausted but unable to rest because your nervous  system is behaving as though danger is always just around the corner.  

For some women, the most distressing part is not low mood at all, but the thoughts. Intrusive  thoughts after having a baby are common and can sometimes be a sign of depression,  anxiety, or obsessive-compulsive disorder. These thoughts are often distressing precisely  because they feel so foreign and frightening. They are something to speak up about, not  something to hide.  

The baby blues are real, but so is something more 

It is also important to say that not every hard feeling after birth is postpartum depression. 

About 4 in 5 new mums experience the “baby blues” in the first few days after birth, usually  around days 3 to 5. This can include tearfulness, sensitivity, irritability, anxiety, and feeling  overwhelmed. Those feelings are common and usually pass within about 10 days. Postnatal  depression is different. With postnatal depression, symptoms last longer than 2 weeks, are  often more severe, and usually interfere with your ability to function. 

That distinction matters because women are often told, “It’s normal, you’ve just had a baby.”  Sometimes that is true. Sometimes it is not. If the heaviness is lingering, worsening, or  affecting your capacity to cope, it deserves attention. 

Why this happens is not simple 

There is no single reason a woman develops postpartum depression or anxiety. Usually, it is  a layered story rather than a single cause. 

There are several factors that can increase risk of postnatal anxiety and depression,  including a personal or family history of mental illness, low social support, previous trauma or  abuse, recent stressful life events, pregnancy loss, a difficult pregnancy or birth, and having  an unwell or hard-to-settle baby. Having risk factors does not mean you will definitely 

become unwell, and some women develop postnatal anxiety or depression without any  obvious risk factors at all.  

This is part of what can make the postpartum period so confusing. A woman can have a  wanted baby, a supportive partner, a healthy infant, and still feel terrible. She can also have  a difficult birth, feeding problems, a colicky baby, sleep deprivation, pain, isolation, financial  stress, relationship strain, or a history that motherhood unexpectedly stirs up. Often it is not  one thing. It is the cumulative load. 

And there is another layer people do not talk about enough: identity. Motherhood can be  joyful and disorienting at the same time. You can love your baby deeply and still grieve your  old rhythms, your old body, your old confidence, your old ease. That does not make you  ungrateful. It makes you human. 

Why women stay quiet 

Many women do not stay silent because they do not know something is wrong. They might  think something is off, but not necessarily wrong. They stay silent because they are afraid of  what it means. 

Afraid they will be judged. Afraid people will think they are not coping. Afraid of being seen  as a bad mother. Afraid that if they say the scary thoughts out loud, someone will  misunderstand them. Afraid that everyone else seems to be managing better. Afraid about  what people might say. 

Signs of postnatal depression are sometimes missed or dismissed as a normal part of life  with a new baby. Perinatal depression is often not recognised because symptoms are  viewed in the context of pregnancy or adjustment to the baby, and stigma can prevent  women from seeking help.  

Silence can look very competent from the outside. A woman can still be feeding, settling,  smiling, attending appointments, replying to messages, and getting through the day while  feeling mentally and emotionally unwell. 

What help can look like in Australia 

Help does not have to begin with a dramatic disclosure. It can begin with one honest  sentence. 

“I’m not feeling like myself.” 

“I’m more anxious than I expected.” 

“I’m having thoughts that are scaring me.” 

“I’m crying all the time.” 

“I’m functioning, but I’m not okay.”

In Australia, a good first step can be your GP, midwife, or child and family health nurse.  These health professionals can ask about how you have been feeling, use questionnaires  such as the Edinburgh Postnatal Depression Scale, and discuss treatment options.  Treatments can include psychological therapies, medicines, and self-care measures.  

The current Australian perinatal mental health guideline also recommends structured  psychological interventions such as cognitive behavioural therapy and interpersonal  psychotherapy for women with mild to moderate depression in the perinatal period, along  with psychoeducation and facilitated self-help where appropriate.  

For women living regionally, juggling feeds and naps, or simply struggling to get out the  door, online options can also be part of the picture. Healthdirect lists MumMoodBooster as a  free Australian online program for postnatal depression, designed for women anywhere in  Australia, and also lists THIS WAY UP’s mental health programs for anxiety and low mood  during pregnancy and postpartum.  

Sometimes practical support is mental health support too. More sleep. Someone bringing  dinner. Somebody holding the baby while you shower or rest. Fewer visitors. More honesty.  Less pressure to perform motherhood beautifully. 

When it is urgent 

Most postpartum depression and anxiety are treatable and should be taken seriously, but  there is also a rarer condition that needs urgent medical attention: postpartum psychosis. 

Postpartum psychosis is rare but serious, can come on very suddenly from hours after birth  up to 12 weeks postpartum, and may involve hallucinations, paranoia, or delusions.  Postpartum psychosis is a medical emergency and says early help is vital.  

If you or someone you love has severe confusion, is not sleeping at all, seems disconnected  from reality, is hearing or seeing things that are not there, or is at risk of harming themselves  or the baby, seek urgent help immediately through emergency services or the nearest  emergency department.  

If you need support today 

In Australia, these are good places to start: 

• In an emergency: Call 000 or go to the nearest emergency department if you or  someone else is in immediate danger.  

• Lifeline: 13 11 14, 24/7 crisis support.  

• Your Family GP 

• Birth Trauma Australia (BTA): 1800 686 628 https://birthtrauma.org.au

• Centre of Perinatal Excellence (COPE): 1300 740 398 https://www.cope.org.au • Perinatal Anxiety and Depression Australia (PANDA): 1300 726 306.  http://panda.org.au 

A hopeful ending, because one is deserved 

Postpartum depression and anxiety can make the world feel small. They can convince  women that this is just who they are now. That they have broken somehow. That they should  be coping better by now. That asking for help would only confirm their worst fears about  themselves. 

But that is what these conditions do: they distort, they isolate, and they whisper lies in a very  convincing voice. 

The truth is that postpartum depression and anxiety are common, recognisable, and  treatable. There are evidence-based therapies, medical supports, helplines, online  programs, and clinicians who understand this territory. Australian guidance is clear that  women should be screened, supported, and offered timely care.  

So if this article feels a little too familiar, let that be information, let it feel supportive and  comforting. Do not let it be something to feel ashamed of. 

You do not need to be at breaking point before you reach out. 

You do not need to wait until it gets worse. 

You do not need to prove that you are struggling “enough”. 

You are not wasting someone’s time when you ask for help. 

And you do not need to do this alone. 

The hopeful part is not pretending this season is easy. 

The hopeful part is knowing that with the right support, it can feel different from here.