Postpartum Stress: The Big Picture

by Lee Safran, MFT

Becoming a Parent 

In our culture, we are taught to expect that having a baby is the happiest time in a woman’s life. And for most women, childbirth and early parenting do provide great joy and fulfillment. Yet, the truth is that women are more at risk of experiencing emotional difficulties following the birth of a baby than at any other time in their lives. It is a true disservice to women and their families that the “myths of motherhood” stop women from acknowledging the range of feelings they actually have, and discourage them from seeking needed information and support.

Pregnancy, childbirth and the postpartum period provide women with one of the most stressful and anxiety-producing life transitions that they will ever experience. Overwhelming physical and hormonal changes are coupled with sleep deprivation, new responsibilities and a new identity. Up to 80% of women experience some emotional stress after the birth (or adoption) of a new child — known as “the baby blues.” For many, these responses are brief and resolve on their own. Other women experience stronger reactions, and require a supportive plan to address and alleviate their concerns.

Reactions may include:

    • feelings of depression or hopelessness
    • extreme irritability and restlessness
    • intense anxiety or fear
    • intrusive, repetitive thoughts or images
    • trouble focusing, remembering, or making decisions
    • difficulty sleeping (even when the baby is asleep)
    • feelings of guilt, inadequacy or worthlessness
    • uncontrollable crying and irritability
    • fear of harming the baby or oneself
    • headaches, chest pains, heart palpitations, numbness, and/or hyperventilation.

The Range of Postpartum Stress Responses

- The “Baby Blues” affects up to 80% of new moms and includes frequent tearfulness, irritability, anxiety and poor sleep. These symptoms usually occur within the first three days following birth, and resolve within a few weeks.

- Postpartum Depression (PPD) affects up to 20% of new mothers and is more debilitating than the “blues.” It can appear at any time in the first year after birth and is characterized by despondency, tearfulness, fatigue and feelings of inadequacy and guilt. It may include an over-concern about the baby or a lack of interest in the baby. Ranging from mild to severe, these symptoms may leave the mother feeling ashamed, withdrawn and unable to mobilize support for herself and the baby.

- Postpartum Anxiety and/or Panic Disorder can include intense anxiety or fear, rapid breathing, chest pain and/or shaking and dizziness. It is experienced by up to 10% of new mothers.

- Postpartum Obsessive Compulsive Disorder (OCD) is characterized by intrusive, repetitive thoughts (sometimes including images of harming the baby), compulsive behavior to avoid these thoughts, and anxiety and depression. It is experienced by 3 – 5 % of new mothers.

Postpartum Psychosis (found in 0.1% of new mothers) is a serious but rare reaction which can include hallucinations, delusions, severe insomnia and extreme irritability. It usually occurs within hours or days after delivery and requires immediate medical attention.- Postpartum Psychosis (found in 0.1% of new mothers) is a serious but rare reaction which can include hallucinations, delusions, severe insomnia and extreme irritability. It usually occurs within hours or days after delivery and requires immediate medical attention.

- Prenatal Stress Reactions are experienced by many women during pregnancy or following a miscarriage or termination of pregnancy. These responses can be very similar to “the blues” and the range of other postpartum stress responses.

What Causes Postpartum Emotional Reactions?

There are many causes including biological, psychological, cultural and highly individualistic factors. Factors that are believed to contribute to postpartum depression include dramatic hormonal changes taking place before and after birth; a history of depression (either personally or in a blood-relative); a colicky, hard-to-care-for baby; chronic sleep deprivation and fatigue; previous postpartum stress response; a predisposition to perfectionism and self-criticism; lack of social supports; and/or isolation.Many women do not experience postpartum reactions right away, but may be surprised to feel the onset a number of months after delivery. Postpartum depression can occur any time during the baby’s first year of life.


Postpartum emotional responses are extremely responsive to social support and professional care. There are many things that women can do to take care of themselves. At the top of the list is prioritizing getting rest. It is important to let go of the “to do” list and to try to nap when the baby naps. If the baby wakes often through the night, finding support for nighttime feedings can help tremendously. Studies show that individuals need five hours of uninterrupted sleep each night to complete a full sleep cycle.It is important to fight isolation and for new moms to find communities where they can talk freely. Partners, family and friends can learn about postpartum emotional stress and can help both by listening and helping with household chores. It also helps to get out of the house, take walks or go on outings.

Finding Solutions

With up to one in five new moms experiencing a postpartum stress reaction, one of the most important things for a woman to know is that what she is experiencing is not her fault. Most women who experience difficult prenatal or postpartum emotions are aware that something is wrong but are reluctant to seek help. Many women experience guilt and are afraid that they will be judged as not good-enough moms. Some are concerned they will be prescribed medication at a time when they are pregnant or breastfeeding. These are important and legitimate concerns, but it is also important for each woman to remember that she is not alone in her experience.

Lee Safran is a Marriage and Family Therapist (MFT) who specializes in prenatal, postpartum and parenting issues. She runs an ongoing Postpartum Stress Support Group in Berkeley, California. She can be reached at 510-496-6096 or visit