After the birth: baby blues or postnatal depression?

1. Before you begin

It is four o'clock in the morning. The baby has gone back to sleep after the feed, at last. You ought to be sleeping too. You are lying in the dark, phone in hand, and for the third time this week you type: "baby blues, how long". Your son is five weeks old. Everyone keeps telling you he is beautiful, and it is true. You, though, feel as if you are playing a part. You cry in the shower so that nobody hears.

Perhaps you are reading this guide for someone else. Your partner no longer laughs and keeps saying she is not up to it. Or perhaps it is you, the father, who comes home from work later and later without understanding why the house weighs on you so much.

Three things, straight away.

The baby blues last a few days; anything that lasts more than two weeks deserves to be mentioned to a professional. The easy tears of the first days are very common and fade on their own. A sadness, an anxiety or an emptiness that settles in or gets worse is no longer the baby blues, and recognising it is the condition for getting better.

Depression after a birth says nothing about your love for your child. It affects about one woman in eight during pregnancy or in the year that follows, and it affects fathers too. The "I am a bad mother" that goes round and round in your head is part of the illness, just like the fatigue. It can be treated.

Only one situation cannot wait until the next day: postpartum psychosis. It is a loss of contact with reality that occurs after giving birth. It is rare, it starts suddenly, most often in the first two weeks, and section 4 describes the signs that should raise the alarm. Caught in time, it responds well to treatment.

If frightening images about your baby go through your mind, read section 6 without delay: these thoughts are very common in new parents, and they do not mean what you fear.

2. The first days: the baby blues

What it is

On the third or fourth day, often, something gives way. You cry at an advert for nappies. You go from laughter to tears within the same hour. A harmless remark hurts you for the whole day. You feel overwhelmed and raw, and at the same time happy, which adds to the confusion.

This is the baby blues, also called postpartum blues, "postpartum" referring to the period that follows the birth. A meta-analysis, that is, a study that pools the results of many others, brought together twenty-six studies: about four mothers in ten go through it. The baby blues generally appear in the first week, and the NHS, the British public health service, gives a simple marker: they usually pass within two weeks of the birth. Nobody knows exactly why they occur, at a time when pregnancy hormones are falling sharply and nights are already broken. They need no treatment, and they say nothing about your abilities as a mother.

What helps

This is not the time to entertain guests well, nor to tidy up. It is the time to sleep as soon as someone can take the baby, even for an hour, and to keep visits short: you can love your family and still ask them to come back the following week. Tell the midwife, too, what you are feeling: she knows how to spot what is not the baby blues.

What should make you think of something else

The baby blues are brief, they fluctuate, and they leave room for moments of joy. Talk to a professional in the following situations.

• The tears, low spirits or anxiety last beyond two weeks, or get worse instead of easing.
• Nothing gives you pleasure any more, even on days when you have been able to sleep.
• You cannot sleep even though someone is looking after the baby.
• Thoughts of death come to you, and in that case you talk about them the same day.

Total sleeplessness without tiredness, elation, confusion or strange ideas on the fifth day are not the baby blues, even if they occur at the same time: they belong to section 4.

3. Postnatal depression

What it is

A depressive episode is a state that lasts: for at least two weeks, nearly every day, mood is low or pleasure has disappeared, and other functions are affected at the same time, such as sleep, appetite, energy, concentration or self-esteem. When such an episode occurs after a birth, it is called postnatal depression, also known as postpartum depression.

The American classification of mental disorders, the DSM-5-TR, speaks of depression "with peripartum onset" when the symptoms began during pregnancy or in the four weeks following the birth. In practice, many professionals, like the British guidelines, take in the whole of pregnancy and the first year after the birth: a depression that begins in the fifth month falls fully within the scope of this guide.

A meta-analysis of nearly a hundred studies estimates that about 12% of women, roughly one in eight, have depression during pregnancy or in the year that follows. It does not always begin after the birth: in a large American study, among the mothers identified as depressed a few weeks after giving birth, a third of the episodes had begun during pregnancy, and a quarter before it.

What it feels like

Many parents describe a sadness, or more often an emptiness, the feeling of watching their own life through a pane of glass. Pleasure disappears, even in front of the first smile. Guilt fixes on your role as a parent: "my baby deserves a different mother", "everyone manages except me". Irritability passes for bad temper, anxiety becomes almost constant, and sometimes the idea comes that it would be better not to be here any more.

Why it so often goes unnoticed

First, several signs of depression blend in with the life of any new parent: everyone is tired and sleeps badly. What better distinguishes depression is the loss of pleasure, guilt, hopelessness, and being unable to sleep when you finally have the chance.

Next, a new mother is expected to be happy. A review of forty studies shows that many women cannot manage to say what they feel, or do not recognise depression because of misconceptions. Some see it as proof that they are not cut out to be mothers; others are afraid of being judged dangerous, or even of having their child taken away. And those who suffer most sometimes appear to be coping best: the baby is clean, fed, weighed on time, and nobody sees what it costs.

Feeling empty towards the baby

You look after your baby properly, and you do not feel what you expected. Yet love at first sight is far from the rule. In a British study from 1980, about four in ten mothers who had just had their first child remembered feeling indifferent the first time they held the baby, and most had developed affection for the baby within the week. This figure should be taken with caution, because the study is old and relied on memories, but it shows that this uncertainty in the first moments is nothing exceptional. In depression, this emptiness can last. It often improves along with mood, and it can also be worked on in its own right (section 15).

What increases the risk

Research reviews find the same factors: a history of depression, anxiety or bipolar disorder (an illness of mood in which phases of depression alternate with phases of elation), a lasting conflict with the partner, insufficient support, and stressful events piling up. The American recommendation on prevention adds low income, and being a very young or single mother. These factors increase the risk; they decide nothing.

4. Postpartum psychosis: the emergency

What it is

A psychosis is a state in which a person partly loses contact with reality: they may hear or see things that others do not perceive, which are called hallucinations, or be absolutely convinced of things that are false, which are called delusions. After a birth, it is most often mixed with a mood disorder, an unusual elation or a depressive collapse, sometimes both in turn.

It is rare, and the figures vary depending on how cases are counted. A review carried out with researchers from the World Health Organization finds, depending on the study, between about one and two and a half cases per thousand women giving birth; if only hospital admissions for a very first psychosis or phase of elation are counted, there is less than one case per thousand births. It begins suddenly, most often in the first two weeks, and can get worse very quickly. It is an emergency because a mother in this state can put herself in danger, or put her baby in danger, without being aware of it.

The signs

They are often noticed by those around her before she notices them herself.

• She no longer sleeps at all, even when someone is looking after the baby, and she does not feel tired.
• She is agitated, talks a lot and fast, or her mood changes from one hour to the next.
• She seems confused, as if she no longer understood what is happening around her.
• She expresses strange ideas, very often about the baby: that the baby is ill without anyone seeing it, has been swapped, is under threat, or is destined for an extraordinary fate.
• She hears voices or sees things that nobody else perceives.
• Those who know her say: "she is not herself any more".

What to do, the same day

Do not wait for the next appointment, or for a night's rest.

1. Call the emergency services in your country, or go with her to the emergency department.
2. Do not leave her alone, or alone with the baby, until a doctor has examined her. This is a protection, for her as much as for the child.
3. Tell the staff that she has recently given birth, and for how many nights she has not been sleeping.

In the United Kingdom, the National Institute for Health and Care Excellence, the public body that writes medical guidelines, asks that a woman suspected of having postpartum psychosis be assessed by a psychiatric team within four hours. Treatment most often takes place in hospital, and several countries have mother and baby units, psychiatric services where the mother is admitted together with her child.

It can be treated

According to the British public health service, most women recover completely with the right treatment, even if it takes several months. In a Dutch study of sixty-four women admitted to hospital for a first episode, nearly all achieved complete remission, that is, the disappearance of the signs of psychosis and of severe mood disturbance. A medical check-up is part of the care, because some of these psychoses have a physical cause that can be treated, such as an infection or a disease of the thyroid, the gland in the neck that regulates a large part of how the body works.

Who is most at risk

The risk is higher in women who have bipolar disorder or schizophrenia, an illness in which episodes of psychosis can come back, in those who have already had postpartum psychosis, and in those with a close relative, such as their mother or a sister, who has had postpartum psychosis or bipolar disorder. In women who have bipolar disorder or who have already had postpartum psychosis, a meta-analysis estimates that about one in three relapse after giving birth, and that in women with bipolar disorder the risk is clearly higher without preventive treatment during pregnancy. But postpartum psychosis also occurs in women with no history at all.

If you belong to one of these groups, the best protection is prepared during pregnancy: a written plan with the psychiatrist, the doctor who specialises in mental disorders, and with the maternity unit, setting out how your sleep will be protected and which number to call at the slightest doubt.

5. Anxiety after the birth

Depression is talked about a great deal, anxiety much less. Yet a meta-analysis of more than a hundred studies estimates that about 15% of pregnant women, and 10% of mothers in the six months after the birth, have an anxiety disorder, that is, anxiety intense and lasting enough for a professional to diagnose it. Anxiety and depression often go together.

It often fixes on the baby. You get up five times a night to check that the baby is breathing. You type their symptoms into the internet, then other symptoms. You cannot bear anyone else holding them. In some parents, it takes the form of panic attacks: a sudden surge of fear, a racing heart, shortness of breath, the feeling of dying or going mad, then everything subsides within a few minutes.

A new parent is watchful, and that is a good thing. Worry becomes a problem when it takes up hours, when it stops you sleeping while the baby sleeps, when you can no longer leave the baby with anyone, or when each reassuring answer calms you for only a few minutes. Checking and seeking reassurance, that is, the need to be reassured again and again, bring relief in the moment, then the doubt returns, a little stronger. They can be reduced in stages, as section 13 describes. If the worry is about everything, our programme Constant worry: generalised anxiety disorder sets out the method; if it takes the form of panic attacks, see Panic attacks and agoraphobia.

6. The thoughts that frighten you

What happens

You are going down the stairs with your daughter in your arms, and the image forces itself on you: she slips from your hands. Or you are chopping vegetables, she is in her bouncer, and the thought springs up: what if I hurt her with this knife? You put the knife down, feeling sick to your stomach. In the evening you put all the knives away in the top drawer, and you tell no one.

These are intrusive thoughts: thoughts that spring up without being sought, that go against what you want, and that shock precisely for that reason.

They are almost universal

A Canadian study followed a hundred women up to the third month after the birth. All of them reported intrusive thoughts of an accident happening to their baby, and nearly half reported unwanted thoughts of harming the baby deliberately. These were more frequent in mothers who were very stressed or lacked support, and the study found hardly any link between them and rough behaviour towards the child. Fathers have them too: in a small American postal survey, more than half of the forty fathers of newborns who replied reported them.

The researchers who study these thoughts explain them like this: becoming a parent suddenly increases the feeling of being responsible for a fragile and precious being, and the attention paid to everything that might threaten that being. This change makes you alert, and it also gives enormous weight to the images of danger that cross your mind. The more the child matters, the more these images shock.

What makes them a problem

It is not the thought. It is the meaning you give it, "if I think it, it means I could do it", and what you then do to protect yourself from it: avoiding bath time, hiding the knives, asking over and over "are you sure I would never do that?". Each of these actions brings relief for a moment, and stops you discovering that the thought has no power. So it comes back more often.

When this cycle takes up a lot of room, it is called obsessive-compulsive disorder, or OCD: unwanted thoughts that keep coming back and frighten you, the obsessions, and actions or avoidances meant to silence them or cancel them out, the compulsions. A meta-analysis shows that this disorder affects a little over 2% of mothers in the year after the birth, compared with about 1% of women in general, and its obsessions then typically concern harm coming to the baby through the parent.

Telling them apart from a danger

This is the question that terrifies parents, and it is one a professional knows how to answer. Four very different situations can look alike on the surface.

The intrusive thought. It springs up, it horrifies you, and you do everything to avoid it. It is not a danger to your baby; it is a source of suffering for you, and it can be treated.

The idea that does not horrify. It seems right or necessary, and often comes with total sleeplessness, confusion or strange convictions about the baby. It is an emergency signal: it is found mainly in postpartum psychosis (section 4), sometimes in very severe depression, and medical help must be sought the same day.

Despair that extends to the baby. In severe depression, the thought of dying can include the child: "I cannot leave my baby in this world without me". This is an absolute emergency, the same day (section 19).

Anger that rises. This is not an image that horrifies, but an impulse, when the baby has been screaming for an hour: the urge to shake them, to make them be quiet. It is a real risk, and it can be prevented. Put the baby down on their back in their cot, go out, close the door, calm down for about ten minutes while calling someone, then come back. The British public health service makes the point: this happens to many parents, and there is no shame in asking for help.

The fear that your child will be taken away

It silences many parents. Professionals trained in perinatal mental health, that is, the mental health of the period surrounding the birth, know that these thoughts are common, and that people with OCD do not act on them. The questions they will ask you, about what you feel when the thought comes, about what you do next and about your sleep, are there to tell these situations apart.

Not all health professionals know these thoughts equally well, and some mothers have already been misunderstood. If you are afraid of this, use the words "intrusive thoughts" and ask to see a professional who specialises in perinatal mental health. Speaking about these thoughts is acting as a parent who is seeking help.

7. What research says, and what it does not establish

Psychological suffering is taken seriously

In France, the national confidential enquiry into maternal deaths is a system in which experts examine, anonymously, every death of a woman during pregnancy or in the year that follows. Its seventh report, published in 2024, shows that suicide and other psychiatric causes are the leading cause of maternal death when the whole year after pregnancy is considered: 17% of the deaths that occurred between 2016 and 2018. This figure is not here to frighten you. It says that asking for help after a birth is never excessive.

Psychological treatments work

Psychotherapies are treatments based on talking and on exercises, carried out in sessions with a trained professional. A meta-analysis of forty-three studies and more than six thousand participants concludes that they are probably effective against depression during pregnancy and after the birth, with effects lasting at least six to twelve months, even though the results vary a great deal from one study to another.

Two approaches have been particularly well studied. Interpersonal therapy, a brief therapy that links mood to relationships and to changes in life, was tested in a hundred and twenty depressed mothers, half of whom, drawn by lot, were waiting to start treatment: after twelve weeks, those who had received it had recovered clearly more often. Cognitive behavioural therapy, which works on what you do and what you tell yourself, is effective according to a review of forty trials, for treatment as well as for prevention.

These treatments do not always require a specialist. In villages in Pakistan, a programme based on cognitive behavioural therapy was entrusted to community health workers, trained for the purpose without being mental health specialists. Six months after the birth, 23% of the mothers who had received it were still depressed, compared with 53% of those who had received ordinary visits.

Prevention works too

A Cochrane review, named after an international network that evaluates treatments independently, brought together twenty-eight trials, that is, studies that compare groups drawn by lot, and nearly seventeen thousand women: psychological help and support, such as repeated home visits by a midwife or a nurse, reduce the number of depressions after the birth. In the United States, the public body responsible for prevention recommendations advises referring women at risk, for example those who have already had depression, to psychotherapy from pregnancy onwards.

What research does not establish

That treatment changes everything in the long term. In a British trial, three brief psychotherapies improved mood more than usual care from the doctor did, when the baby was four and a half months old. At nine months, this lead had disappeared, because many of the women followed only by their doctor were better too, and the treatment did not prevent new episodes afterwards. The benefit that has been demonstrated is therefore getting better sooner, during your child's first months; and the length of a depression matters for the child, as we will see below.

That treating the depression is enough to heal the bond. In an American trial, interpersonal therapy improved the mothers' mood, but the relationship with the baby did not improve of its own accord. That is why section 15 is devoted to it.

That a parent's depression necessarily harms their child. A large international review concludes that parents' mental disorders increase the risk of difficulties in the child, but that these difficulties are not inevitable. What shapes them can be changed: the quality of everyday care, the support of the partner and of family and friends, and how long the disorder lasts. That is a reason to get treatment early, not to feel guilty.

8. What keeps depression going after a birth

With a newborn, depression keeps itself going through a sequence that many parents recognise.

1. Broken nights exhaust you, and exhaustion lowers your mood.
2. Low mood makes everything harder, including looking after the baby.
3. Every difficulty is read as proof: the baby is crying, so I am doing it wrong.
4. Guilt pushes you to do more and to ask for nothing.
5. Exhaustion increases, and the cycle starts again, a little tighter.

Each step seems reasonable. Taken together, they make everything worse. On top of this come withdrawal, when the baby becomes the only activity of the day and friends drift away; the demand to be a "good mother" who is always available and happy, the kind social media shows in its best light; and secrecy, which prevents you both from receiving help and from hearing someone contradict the judgements you make about yourself.

This cycle can be broken at several points, and the following sections tackle them one by one: the nights (section 10), the days (section 11), the demands (section 12) and asking for help (section 14).

9. Taking stock: a week of observation

Before changing anything, look at where you are. For seven days, in the evening, write a single line: your mood from 0 to 10, your hours of sleep and the longest stretch of sleep in one go, the hardest moment of the day, and a moment that was a little better. Two minutes is enough. For example: "Tuesday. Mood 3. Five hours of sleep, two in a row at best. The worst: 6 p.m., the crying, alone. A little better: coffee in the sun with Léa."

This record often brings out the link between nights and mood, and it shows that your mood is less flat than it seems when you look back from memory. It will also give the professional a precise picture, far more telling than "I am not doing well".

Three questions to sort things out

"When I manage to sleep, does the pleasure come back a little?" If so, exhaustion is weighing heavily, and the night plan can change a great deal. If nothing comes back, even after a good night, think of depression.

"When someone is watching over the baby, do I sleep?" Being unable to because of thoughts going round points towards anxiety or depression. No longer sleeping at all, without tiredness, is an emergency (section 4).

"What frightens me most, and what do I do so as not to think about it?" If the answer includes avoidance and checking, sections 6 and 13 concern you.

The questionnaire you may be offered

Your midwife or your doctor may offer you the Edinburgh Postnatal Depression Scale: ten questions about the last seven days, completed in about five minutes. A high score is not a diagnosis; it is a reason to talk things through at greater length. In France, the early postnatal interview (entretien postnatal précoce), a compulsory appointment devoted to your emotional wellbeing and your needs, takes place between the fourth and the eighth week after the birth with a midwife or a doctor: bring your record to it. Elsewhere, the check-up after the birth often plays this role.

10. Sleep first: the night plan

Why start there

Lack of sleep lowers mood, increases anxiety and irritability, and makes everything else this guide suggests harder. In a Norwegian study of nearly three thousand mothers, poor sleep was associated with depression even after taking the other risk factors into account, without explaining everything. It is also one of the few things that can change within a week. In people who have bipolar disorder, lack of sleep can moreover trigger a phase of elation, as many participants in a large British study reported: for them, protecting the nights is a preventive measure in its own right.

"Sleep when the baby sleeps" does not work when your mind is racing. You need a written plan, and someone to stick to it with you.

The plan, step by step

1. Reconstruct the last three nights, hour by hour: when the baby woke, who got up, what stopped you getting back to sleep. This exact picture shows the moments when someone could take over.
2. Name the people who can take over: your partner first, then a parent, a friend, a home help, a family support service. For each one, ask yourself what is holding you back from asking them.
3. Write down a protected block of several hours in a row, at least three nights a week, during which someone else looks after the baby and you cannot hear the baby: another room, the door closed, earplugs. During this time, the baby sleeps in their own cot, on their back, in the room where the person watching over them is sleeping. For example: "Friday and Sunday, Thomas takes the wake-ups from 10 p.m. to 3 a.m., with the crib next to him; I sleep in the study."
4. Arrange feeding as you choose: milk expressed in advance, a bottle, or a single breastfeed during the block, with the person taking over bringing the baby to you and then taking the baby back. The plan adapts to the way you feed your child, not the other way round. If you are breastfeeding and want to continue, talk to your midwife about the plan: in the first weeks, night feeds help to establish your milk supply, and bottles of formula can reduce it. She will help you find a balance, for example by expressing your milk once during the block.
5. Postpone rumination, those thoughts that go round in a loop without resolving anything. If you lie awake going over things, jot down in a few words what is going round, and come back to it the next day, at a time chosen in advance, when your mind is clearer.
6. Add a daytime break: an hour when someone takes the baby and you rest. It is often easier to get than a whole night.

The obstacles

"The baby only settles with me." That is a prediction, and it can be tested: hand the baby over for one night, then two, and look at what actually happened. "If I sleep, something will happen to the baby." That is anxiety talking, and it can be worked on (section 13). "My partner works." The plan must protect his sleep too: take turns, use weekend nights, look for a second person to take over. "I am ashamed to sleep while someone else looks after the baby." A parent who rests is not abandoning their child: they are putting themselves in a state to look after them.

Two precautions

The usual methods for insomnia do not apply as they stand to the parent of a newborn. One of them, restricting time in bed, consists of deliberately reducing that time in order to consolidate sleep; the researchers who used it during this period adapted it, by counting the time spent looking after the baby at night. Do not try it on your own. Our programme Getting your sleep back: the Psychotip® programme will be more useful later, if insomnia persists once the baby is sleeping through the night.

And never fall asleep with the baby on a sofa or in an armchair: the American Academy of Pediatrics considers them extremely dangerous for the baby. If you are likely to fall asleep while feeding, feed the baby in your bed instead, with no pillows or covers near the baby, then put the baby back in their own cot: falling asleep with the baby is still advised against, but it is less dangerous than a sofa. The danger increases when the adult is exhausted, has drunk alcohol or has taken a medicine that causes drowsiness, such as some antidepressants. These rules also apply to the person who takes over. They are set out in detail in Children's and teenagers' sleep: a guide for parents.

11. Getting back on your feet during the day

In depression, desire is the first thing to go. If you wait until you feel like going out before you go out, you will wait a long time. The method called behavioural activation, one of the techniques of cognitive behavioural therapy, reverses the order: you do a very small amount, at a fixed time, without waiting to feel like it, and you look at what it changes in your mood.

1. Make a list of what has disappeared since the pregnancy: the people you used to see, outings, movement, and whatever made you feel like yourself, such as reading, singing or swimming.
2. Choose three activities for the week, small, precise and with a date, at least one of them with another adult. Some can be done with the baby, others require leaving the baby with someone, and both count. For example: a walk with the pram to the park on Tuesday morning, a call to a friend on Thursday at 2 p.m., twenty minutes alone in a café on Saturday while your partner looks after the baby.
3. Plan a reduced version: if the baby has not slept, the walk becomes ten minutes on the pavement. It avoids all or nothing, which turns every unexpected event into a failure.
4. After each activity, note down how much pleasure you took in it and how far you felt you had achieved something, from 0 to 10. This figure, written down in the moment, corrects the grey impression of the week that low mood leaves behind.

Parent and baby drop-in centres and new parents' groups offer contact with people who are going through the same thing. In France, the maternal and child protection centres, known as PMI (protection maternelle et infantile), free public prevention services for families and young children, can tell you about those in your area. It is not an obligation: a call to a friend counts just as much.

An activity you did not do is not a failure: it was too big. Divide it by three, and reschedule it. Our programme Behavioural activation: fighting depression sets out this method in detail.

12. The "good mother": examining your own rules

Many depressed parents live under a set of rules they have never written down. Write them down, so that you can question them.

1. Note down your sentences, word for word, when you feel guilty: "a good mother doesn't complain", "if I ask for help, it means I can't cope", "I should be happy". Note how much you believe each one, from 0 to 100.
2. Look for where they come from: a mother who never complained, photos of radiant parents, a remark on the maternity ward. This is not about blaming anyone, but about seeing that these rules were learnt, and can therefore be re-examined.
3. Examine the heaviest one. Who, among the parents you really know, lives by it? What does it cost you? And what would you say to your best friend if she described exactly your week to you?
4. Distinguish responsibility from guilt. Being responsible for your child means meeting their needs as best you can. Feeling guilty about everything that happens to them, a cold, a restless night, crying, is something else: it only pushes you to do more and to ask for nothing.
5. Write a fairer rule, one that you can believe: "a baby needs a parent who is there enough, not a perfect parent". A modest sentence that you half believe is better than a generous statement that you reject.
6. Test it. This week, do one thing that the old rule forbids: ask for help, turn down a visit, leave the baby safely in their cot while you have a shower. Note what actually happens.

Parents who seem to be managing, especially on screens, show only what can be photographed. Breastfeeding, for its part, is often at the heart of guilt, whatever the choice. Whether or not to breastfeed is your decision, and it measures neither your love nor your worth.

Fathers have their rules too, such as "I have to hold it together, she's the one who gave birth". They can be worked on in the same way, and Perfectionism: high standards without burning out can help you go further.

13. The thoughts that frighten you: what helps

Before anything else

First talk to a professional, who can confirm that these are intrusive thoughts, and only start the exercises below once you have that opinion. If these thoughts come with sleeplessness without tiredness or with confusion, or if they do not horrify you, this is not the time for an exercise: seek medical help the same day.

The principle

Treatment consists of gradually stopping avoiding, checking and asking to be reassured, so that your brain sees for itself that the thought has no power. This approach is called exposure: facing, gradually and safely, what you avoid. It is at the heart of cognitive behavioural therapy for OCD.

Step by step

1. Name the thought when it comes: "this is an intrusive thought; it horrifies me because I care about my baby". Do not try to drive it away: wanting to get rid of it forces you to keep watch for it, and what you watch for comes back.
2. Make a list of your avoidances and your checking: the bath you no longer give, the knives stored up high, the internet searches, the "are you sure?" put to your partner.
3. Rank them from the easiest to the hardest to take up again. For example: giving the bath with your partner in the next room, then alone; cooking with the baby in their bouncer; staying alone with the baby for an hour, then for an afternoon.
4. Take up the first rung several times during the week, letting the thought come without trying to cancel it out. Note your fear at the beginning and at the end, from 0 to 10.
5. Move on to the next rung when the fear has clearly gone down, or when you have seen that what you dreaded did not happen.
6. Reduce reassurance with your partner's agreement: he answers once, gently, then no longer answers the same question. This is not coldness; it is part of the treatment.

You expose yourself only to ordinary care, the kind a parent without these thoughts would give quite naturally, never to anything that would be dangerous for the baby. When the distress remains mild, the British guidelines on OCD provide for this step-by-step work, with self-help materials and a few sessions with a professional: stay in touch with the professional who saw you. If the thoughts take up several hours a day, or if you are not making progress, ask for cognitive behavioural therapy with exposure: in a British trial, an intensive form of this therapy clearly reduced the symptoms of mothers with OCD after a birth. Our programme OCD: the eight-step exposure programme describes the method in detail.

14. What has changed, and the help to ask for

A transition, with its losses

Interpersonal therapy speaks of role transition, that is, the move from one place in life to another: a birth brings a great deal, and it also takes things away, whole nights of sleep, time for yourself, a place at work, time as a couple, a body you recognised. Ignoring these losses because the event is a happy one feeds guilt. You are allowed to miss your old life and to love your child.

Take a sheet of paper. Write down what you have lost, without playing it down. Write down what you have gained, including the skills you no longer notice: recognising your baby's hungry cry, soothing them, getting through a day on little sleep. Then choose one thing to take up again in another form, and give it a date: a friendship kept up by a message, the swimming pool every other Saturday.

Asking, precisely

"Help me more" changes nothing. "Can you take the baby on Saturday from 2 p.m. to 5 p.m.?" changes a Saturday. A precise request says what, when and for how long; it is easier to accept, and harder to forget. With your partner, write down together who does what, and when: the nights, the meals, the shopping. If the arguments are multiplying, Arguing less, talking better offers a method.

You can ask visitors to come for less time and more often, to bring a meal rather than a present, or to look after the baby while you sleep. When you are given advice you did not ask for, you can say thank you and do nothing with it. If saying no is hard for you, Saying no: standing up for yourself can help.

15. The bond with the baby

If you do not feel what you expected, you are neither alone nor abnormal. The bond is built through care and exchanges, and depression can numb it for a while. Your baby does not need a parent who feels love at every moment. Your baby needs to be responded to, and you are probably already doing that.

1. Watch your baby rather than yourself. Instead of asking yourself whether you are doing it right, look at what the baby is doing: what they stare at, how they react when you talk to them, how they show they have had enough, by turning their head away.
2. Note the moments that are already going well, even brief ones: a look during a feed, a smile at a nappy change, a moment when the baby calmed down in your arms. Depression wipes them from memory; write one down every evening.
3. Plan two shared moments a day, short and with no goal: singing, talking face to face, bath time. You follow what the baby is looking at and doing, instead of suggesting activities.
4. Read the crying differently. A depressed parent hears it as a reproach. A crying baby is communicating, not judging. A meta-analysis of studies in which parents recorded their baby's crying and fussing every day shows that it is at its peak in the first six weeks, around two hours a day on average, and that it decreases markedly at around two to three months. At this age, a lot of crying is therefore the norm, and not proof that you are doing it wrong.

If you feel persistent rejection or anger towards your baby, or if the relationship does not improve along with your mood, talk about it. There are forms of support centred on the parent-baby relationship which sometimes use short videos of a shared moment, watched afterwards with a professional to spot what the baby is expressing and what is already working. In a Canadian trial, three sessions of this kind, guided by a nurse, improved the quality of the exchanges between depressed mothers and their babies. Turning to this kind of help is not a failure; it is one more form of support.

16. When the birth was difficult

For some women, the birth stays stuck. The images come back without warning, and so do the nightmares. You avoid walking past the maternity unit, you change the subject when it comes up, you jump at the slightest noise. This is post-traumatic stress disorder, which can follow any event experienced as a threat to your own life or to the life of someone close to you. It affects about 4% of women after a birth, and nearly one in five in at-risk groups.

A meta-analysis has shown that, during the birth, what is most strongly linked to this disorder is the way the birth was experienced, even more than interventions such as a caesarean or forceps; lack of support also counts. A birth that is straightforward from a medical point of view can therefore be traumatic, and the British guidelines say so explicitly. This disorder also very often comes with depression.

Recounting the birth in detail in a single session to "get it out" has not shown a preventive effect, and the British guidelines advise against it. What helps first is understanding: you can ask the maternity unit to go over with you what happened, why an emergency caesarean was decided on, why the baby was taken away. If post-traumatic stress has set in, it is treated with trauma-focused cognitive behavioural therapy, which goes back over the memory step by step with the therapist, or with EMDR, a therapy that combines recalling the memory with eye movements guided by the therapist. Our programme Understanding trauma and the window of tolerance explains these mechanisms.

The partner who witnessed the scene sometimes believed they were about to lose the mother or the child: they too may be left with traces of it.

17. Fathers and co-parents

A meta-analysis of forty-three studies estimates that about 10% of fathers have depression between the start of pregnancy and the end of the first year, with higher rates between three and six months after the birth. One parent's depression is associated with the other's: when the mother is unwell, ask how the father is doing too, and vice versa.

In men, depression is hard to see. In a large American survey of men in general, men reported anger, risk-taking and the use of alcohol or drugs more often than women did. The survey was not about new fathers, and it is not known whether their depression often takes this form; it simply invites us not to wait for tears before becoming concerned. A father who becomes irritable, comes home later and later, drinks more in the evening or withdraws into a silence that his partner takes for indifference deserves to be asked how he is. The Edinburgh scale has been validated in fathers, with a lower alert threshold than in mothers.

Co-parents are the adults who bring up the child without having carried them, such as the mother who did not give birth in a couple of two women, or a parent who adopts. Like the parent who brings up a child alone, they go through the same transition, sometimes with less recognition, and they have been little studied. An American study found depressive symptoms in adoptive mothers comparable to those of mothers who had just given birth, and bringing up a child alone is among the risk factors retained by the American recommendation: these parents are not immune.

If you are the partner, take your share of the nights, but protect your own as well, for example by taking turns on night duty rather than both getting up. Tell someone how you yourself are doing, too: the method in this guide applies to you as well. And if you are both unwell, call on other adults so that the baby is well looked after while you get treatment.

18. Treatments: psychotherapies, medication, breastfeeding

Psychotherapies

They are most often offered first in mild to moderate forms. Cognitive behavioural therapy, with its exercises between sessions, inspired sections 10 to 13; interpersonal therapy, which works on the transition, conflicts and support, inspired section 14. For less intense forms there is also guided self-help: working materials accompanied by a few short exchanges with a professional.

You can ask whether you may bring your baby, which many professionals accept, and some offer remote sessions. The British guidelines ask that psychotherapy begin within a month of the assessment, because the child is growing while you wait.

Medication

This guide prescribes nothing and recommends no particular drug. A few landmarks will help you talk about it with the doctor.

The decision is the doctor's, ideally a psychiatrist who knows the perinatal period, working with the midwife, the obstetrician, who is the doctor responsible for the pregnancy and the birth, and the paediatrician. Good-quality studies of medication during pregnancy and breastfeeding remain few, and every decision rests on weighing things up for the individual.

Not treating is not a risk-free option. Severe untreated depression has its own consequences, for the mother as for the child, and this is often the half of the balance that is missing from parents' minds.

Some antidepressants are used during pregnancy and breastfeeding. In moderate to severe forms, the British guidelines propose psychotherapy, a medicine, or the two combined when one is not enough. In recent years, medicines designed specifically for postnatal depression have also been authorised in some countries, including the European Union in 2025. They are not available everywhere, the one authorised by the European Union is not recommended during breastfeeding, and their place is discussed with the psychiatrist.

Never stop a treatment abruptly on discovering a pregnancy: stopping abruptly can cause withdrawal symptoms and a relapse. Call your doctor: if a decision is made to stop, it is done gradually.

Breastfeeding

Psychotherapies are entirely compatible with breastfeeding, and where medication is concerned, the doctor knows the compatible options. Breastfeeding should be neither a reason to give up a treatment you need, nor a reason to stop breastfeeding if you want to continue.

19. Thoughts of death

They are spoken about, the same day

Thinking that it would be simpler not to be here any more, that the child would be better off without you: these thoughts are part of many depressions. They do not mean that an act is imminent, but that the suffering is intense, and that you must not stay alone with them. Say them the same day to your doctor, your midwife, someone close to you, or a suicide prevention line. These lines are often free and can be reached at any hour: look up the one in your country now, so that you have it to hand. In immediate danger, call the emergency services.

If these thoughts include your baby, if you think the baby could not live without you or that you should go together, this is an absolute emergency: call the emergency services now, and do not stay alone with the baby while you wait.

What protects

Do not stay alone at the most difficult times, especially at night. Give someone else anything that could be used to harm yourself, including medicines, keeping only small quantities of them yourself: putting these means out of reach is among the best-supported prevention measures, because it puts time between an impulse and an act. And write a safety plan, preferably with a professional: a sheet kept on your phone, read in order when the crisis builds.

1. I write down my warning signs, what I think, feel or do when the crisis is approaching.
2. I write down what I can do on my own to bring the pressure down.
3. I note the people and places that take my mind off things.
4. I note the people I can tell that I am not all right, with their numbers.
5. I note the professionals and the emergency numbers.
6. I note what has been put out of reach at home, and who is keeping it.

In an American study, this plan, combined with a few follow-up calls, was linked to a clear reduction in suicidal behaviour.

Talking about it does no harm

The fear of "putting ideas into someone's head" holds many people back. A review of studies concludes that asking about suicide does not increase suicidal thoughts, and might even reduce them. If you are worried about a new parent around you, When someone close talks about dying: ask, make safe, stay sets out what to do.

20. For family and friends

What helps is concrete and dated: "I'll come by on Tuesday at 10, I'll look after the baby for two hours and you sleep." Take a night or a morning, bring a meal, do the shopping without waiting to be asked. Listen without advising or comparing, come for less time and more often, and say simply that you can see she is doing her best.

What does not help are phrases such as "make the most of it, it goes so fast" or "you have a beautiful healthy baby, that's what matters", and remarks about breastfeeding, weight or the birth. Even said with affection, they add the guilt of not being happy to a suffering that is already overflowing.

To open the conversation, choose a calm moment, and talk about what you observe: "You've seemed exhausted and sad for several weeks. It happens to a lot of parents, and it can be treated. Shall we talk to the midwife about it together?" Offer to make the appointment, and to go with her. Our programme Helping someone close who is depressed develops this approach.

A mother who no longer sleeps at all without being tired, who says strange or confused things, who talks about dying or about taking the baby with her: in these situations, do not wait for her to agree to see someone, call the emergency services.

21. Particular situations

A premature or hospitalised baby. Fear for the baby's life, separation, a bond built through an incubator are added to the broken nights, for both parents. Talk to the neonatal team, the service that cares for sick or premature newborns, and ask whether a psychologist can see you.

A perinatal loss. A miscarriage, a termination of pregnancy for medical reasons, the death of a baby before or shortly after birth: these losses are often minimised by those around. Grief is not depression, even if it can come with it. When the baby has died before or shortly after the birth, the British guidelines ask that the possibility of seeing the baby, holding the baby, or keeping a photo and mementos be discussed with the parents, without anything being imposed. Our programme Grief: understanding it, getting through it, and knowing when to ask for help can accompany this path.

Violence in the relationship. Your safety and your child's come before everything else. Talk to your midwife or your doctor about it, one to one, and find out about the specialist helplines in your country. Coercive control: recognising it and getting free will help you see things clearly.

A birth after a long wait. After assisted reproduction, that is, fertility treatment such as in vitro fertilisation, some parents tell themselves they have no right to complain. This rule can be worked on like those in section 12. And twins make the night plan very hard to keep to without outside help: organise that help during the pregnancy.

Far from home. Exile and a family that has stayed far away deprive you of the usual people who would take over: look early for others, such as a parents' group or an association. If you do not speak the language of the country well, ask for a professional interpreter rather than your spouse or someone close to you, as the British guidelines recommend: you will be able to speak freely.

Alcohol and cannabis. Drinking or smoking in the evening to unwind soothes in the moment, treats nothing, and makes nights with the baby less safe. Drinking less, or stopping offers a method.

22. When to seek help, and from whom

When

• The tears, low spirits or anxiety have lasted more than two weeks, or are getting worse.
• Nothing gives you pleasure any more, or you have felt empty towards your baby for weeks.
• You cannot sleep when you have the opportunity.
• Worry, checking or frightening thoughts take up your days or make you avoid ordinary care.
• You are thinking about dying: talk about it the same day.
• A mother around you shows the signs described in section 4: she must be seen in the emergency department the same day.

Who to turn to

The midwife knows this period better than anyone. Your GP can assess you, prescribe if necessary and refer you on; your GP can also check for anaemia, that is, a lack of red blood cells, or a thyroid disorder, both of which cause fatigue and low spirits: according to a meta-analysis, about one woman in twelve has a thyroid abnormality after giving birth. The doctor who looks after your baby sees parents regularly, and can hear what you say about yourself. A psychologist trained in cognitive behavioural therapy or interpersonal therapy can support you. A psychiatrist, a doctor who specialises in mental disorders, is essential in cases of severe depression, bipolar disorder, a history of psychosis or questions about medication. In France, the PMI centres also see parents; elsewhere, the maternity unit will tell you about the maternal and child health services in your area.

What you can say

"Since the birth, I have not been able to enjoy anything, and I feel like a bad mother all the time. I would like to know whether this is depression."

"I have horrible thoughts about my baby, and they frighten me. I have never dared talk about them."

Bring your record from section 9: ten written lines are worth half an hour of hesitant explanations.

23. Six weeks, step by step

This plan is not a treatment, but a framework for the coming weeks, on your own or alongside professional care. Each task refers to the section where the exercise is explained. If it is too much, do only the first task that applies to you each week. The safety rules of week 1 apply throughout the six weeks. The plan is written for mothers, but fathers and co-parents follow it in the same way (section 17).

Week 1 — Observing and talking

Before changing anything, you look at where you are, and you stop carrying this alone. The evening record often brings out the link between nights and mood, and it will give the professional a far more telling picture than "I am not doing well" (section 9). The last three tasks are not exercises: they are the safety rules for the whole plan.

• Every evening, write a single line with your mood from 0 to 10, your hours of sleep and the longest stretch of sleep in one go, the hardest moment of the day and a moment that was a little better: two minutes is enough, and you will keep this record going for the six weeks (section 9).
• Tell someone you trust what you are going through, your partner, a friend or a relative: secrecy prevents you both from receiving help and from hearing someone contradict the judgements you make about yourself (section 8).
• Talk about it to a professional too, your midwife, your doctor or the doctor who looks after your baby, showing them your record; if words fail you, simply say: "Since the birth, I have not been able to enjoy anything, and I feel like a bad mother all the time. I would like to know whether this is depression." (section 22).
• If you are thinking about dying, say so the same day to your doctor, your midwife, someone close to you or a suicide prevention line; if these thoughts include your baby, call the emergency services in your country now, and do not stay alone with the baby while you wait (section 19).
• Call the emergency services the same day, or have someone close to you call them, if you are no longer sleeping at all without feeling tired, if you feel confused, elated or very agitated, or if an idea about the baby seems right to you instead of horrifying you (sections 4 and 6).
• If the crying becomes unbearable and anger rises, put the baby down on their back in their cot, go out of the room, close the door and calm down for about ten minutes while calling someone before coming back: a baby must never be shaken (section 6).

Week 2 — The nights

Lack of sleep lowers mood and increases anxiety, and it is one of the few things that can change within a week. "Sleep when the baby sleeps" does not work when your mind is racing: you need a written plan, and someone to stick to it with you (section 10). The aim of the week is to get three nights with a protected block, which your evening record will show.

• With the person who will take over, reconstruct the last three nights, hour by hour: when the baby woke, who got up, and what stopped you getting back to sleep, because this picture shows the moments when someone could take over (section 10).
• Using this picture, write down your protected blocks together: at least three nights a week, several hours in a row during which the person taking over looks after the baby and you sleep without hearing the baby, in another room, with the door closed. For example: "Friday and Sunday, Thomas takes the wake-ups from 10 p.m. to 3 a.m.; I sleep in the study." (section 10).
• If your partner cannot take everything on, name other people who can take over, such as a parent, a friend, a home help or a family support service, and for each one ask yourself what is holding you back from asking them (section 10).
• Decide how the baby will be fed during the block, as you choose: milk expressed in advance, a bottle, or a single breastfeed for which the person taking over brings the baby to you and then takes the baby back; if you are breastfeeding and want to continue, talk to your midwife about the plan (section 10).
• During the block, the baby sleeps on their back in their own cot, in the room of the person watching over them, and no one ever falls asleep with the baby on a sofa or in an armchair: if you are likely to fall asleep during a feed, feed the baby in your bed, with no pillows or covers near the baby, then put the baby back in their cot (section 10).

Week 3 — The days

In depression, desire is the first thing to go: if you wait until you feel like going out before you go out, you will wait a long time. The method, called behavioural activation, reverses the order: you do a very small amount, at a fixed time, without waiting to feel like it, and you look at what it changes in your mood (section 11).

• Choose three small activities for the week, precise and with a date, at least one of them with another adult, from among what has disappeared since the pregnancy, such as the people you used to see, outings, movement or whatever made you feel like yourself. For example: a walk with the pram to the park on Tuesday morning, a call to a friend on Thursday at 2 p.m. (section 11).
• Plan a reduced version of each one, for when the baby has not slept: the walk becomes ten minutes on the pavement, which avoids the all or nothing that turns every unexpected event into a failure (section 11).
• After each activity, note from 0 to 10 how much pleasure you took in it and how far you felt you had achieved something, because this figure, written down in the moment, corrects the grey impression of the week that low mood leaves behind (section 11).
• If an activity was not done, do not count it as a failure: it was too big, so divide it by three and reschedule it for another day (section 11).

Week 4 — The rules of the "good mother"

Many depressed parents live under a set of rules they have never written down. This week, you write them down so that you can question them, then you put a fairer rule to the test of the facts (section 12).

• When you feel guilty, note down word for word the sentence that comes to you, such as "a good mother doesn't complain", "if I ask for help, it means I can't cope" or, for a father, "I have to hold it together, she's the one who gave birth", and note how much you believe it, from 0 to 100 (section 12).
• Examine the heaviest sentence with three questions: who, among the parents you really know, lives by it? What does it cost you? What would you say to your best friend if she described exactly your week to you? (section 12).
• In its place, write a fairer rule that you can believe, for example "a baby needs a parent who is there enough, not a perfect parent": a modest sentence that you half believe is better than a generous statement that you reject (section 12).
• Test this new rule by doing one thing this week that the old one forbids, such as asking for help, turning down a visit or leaving the baby safely in their cot while you have a shower, then note what actually happened (section 12).

Week 5 — Fears and requests

This week has two paths. If intrusive thoughts about the baby are taking up your time, that is, thoughts or images that spring up without your looking for them, go against what you want and horrify you for that very reason (section 6), do the first four tasks: you move on to the next rung when the fear has clearly gone down, or when you have seen that what you dreaded did not happen (section 13). If not, do the last two, which come from section 14.

• Before any exercise on these thoughts, have a professional confirm that they really are intrusive thoughts, and only begin with their agreement; if they come with sleeplessness without tiredness or with confusion, or if they do not horrify you, this is not the time for an exercise: seek medical help the same day (section 13).
• With their agreement, make a list of what you avoid and check, such as the bath you no longer give, the knives stored up high or the "are you sure?" put to your partner, then rank these actions from the easiest to the hardest to take up again (section 13).
• Take up the first rung several times during the week, letting the thought come without trying to cancel it out, and note your fear at the beginning and at the end, from 0 to 10; you only take up ordinary care, never anything that would be dangerous for the baby (section 13).
• With your partner's agreement, reduce reassurance: when you ask yet again "are you sure I would never do that?", they answer once, gently, then no longer answer the same question; this is not coldness, it is part of the treatment (section 13).
• Do the "A transition, with its losses" exercise: on a sheet of paper, write down what the birth has made you lose, without playing it down, then what it has made you gain, including skills such as soothing your baby, and choose one thing to take up again in another form, on a set date (section 14).
• Make two precise requests, which say what, when and for how long, for example "Can you take the baby on Saturday from 2 p.m. to 5 p.m.?", because "help me more" changes nothing (section 14).

Week 6 — The bond and taking stock

Your baby does not need a parent who feels love at every moment: your baby needs to be responded to, and you are probably already doing that (section 15). The end of the week is for measuring how far you have come and preparing for what comes next.

• Plan two shared moments a day with your baby, short and with no goal, such as singing, talking face to face or bath time, following what the baby is looking at and doing instead of suggesting activities (section 15).
• Reread your evening records since week 1 and look at what has shifted: your mood, the longest stretch of sleep in one go, the moments that were a little better (section 9).
• If your mood has not clearly lifted since week 1, make an appointment with your doctor or your midwife and bring your records: this is not a personal failure, it is the information that makes it possible to check the diagnosis and discuss treatments (sections 18 and 22).
• If you have started the ladder from week 5, keep taking up each rung several times during the week and move on to the next one when the fear has clearly gone down; if the thoughts take up several hours a day or if you are not making progress, ask for cognitive behavioural therapy with exposure (section 13).
• Write down your personal warning signs in the order in which they came, for example sleep getting worse, then withdrawal, then guilt, and note next to each one what you will do if it comes back.
• If you feel persistent rejection or anger towards your baby, or if the relationship does not improve along with your mood, talk to a professional about it: there are forms of support centred on the parent-baby relationship, and turning to them is not a failure (section 15).

After the six weeks

If nothing has shifted, that is not a personal failure; it is information to bring to your appointment, together with your records: the doctor will check the diagnosis, look for a physical cause and discuss treatments with you.

Finally, an episode after a birth increases the risk in a later pregnancy, without making it certain. Tell your midwife or your doctor at the very start of the pregnancy, and arrange the people who will take over before the birth.

24. Frequently asked questions

Can the baby blues turn into depression? Most often they pass within a few days, but they are among the factors that increase the risk of depression afterwards. If the sadness, anxiety or emptiness persists beyond two weeks, or gets worse, it is no longer the baby blues: talk about it. It is better to seek help for nothing than to let a depression settle in.

I did not feel love for my baby straight away. Is that serious? No. Many mothers remember feeling indifferent at the first contact, and for most of them affection came in the days that followed. If this emptiness lasts for weeks, it may be part of a depression, and it can be treated.

Can you get postnatal depression several months after the birth? Yes. Professionals consider the whole of the first year, and some depressions even begin during pregnancy. In fathers, rates are highest between three and six months after the birth. And if, as the months go by, it is mostly the exhaustion of being a parent that sets in, our guide Parental burnout: when being a parent wears you out explains how to tell it apart from depression, and how to rebalance what drains you and what helps you.

I have images of harming my baby. Am I dangerous? Thoughts that horrify you and that you try to avoid are almost universal among new parents, and studies do not show that they lead people to act on them. Talk to a professional, who will check that these really are intrusive thoughts. An idea that does not horrify you, or that seems right to you, is on the other hand an emergency.

If I say what I am feeling, will my child be taken away from me? Depression or intrusive thoughts are not, in themselves, a reason to separate you from your child, and perinatal mental health professionals know that they are common. Their questions are there to understand what is going on. Even when a hospital admission is necessary, mother and baby units make it possible, in several countries, to treat the mother together with her child.

Do I have to stop breastfeeding to get treatment? No, not necessarily. Psychotherapies are compatible with breastfeeding, and so are some medicines: the doctor knows the options.

Does postnatal depression come from hormones? Nobody fully knows. Birth comes with hormonal upheavals, but the best-established factors are a history of depression or anxiety, lack of support, conflict in the couple and stressful events.

My partner is irritable, comes home late and drinks more than before. Could he be depressed? It is possible. About one father in ten has depression around the time of the birth, and in men depression can show itself through anger, withdrawal or alcohol rather than through tears. Suggest that he talk to his doctor about it.

Will my baby suffer because of my depression? It increases the risk of difficulties in the child, but these difficulties are not inevitable. What counts, and what can be changed, is getting treatment, having support around you, and not letting the disorder drag on.

Will it happen again in my next pregnancy? The risk is higher after a first episode, but nothing is set in stone, and it can be prepared for. If there is bipolar disorder or a history of postpartum psychosis, the plan is written with the psychiatrist, before conception if possible.

25. Key points

• The baby blues are very common, appear in the first days and generally pass within two weeks.
• Sadness, anxiety or emptiness that lasts beyond two weeks, or gets worse, deserves to be mentioned to a professional.
• Depression after a birth affects about one mother in eight and one father in ten; it says nothing about the love you have for your child.
• Postpartum psychosis is rare and sudden: a mother who no longer sleeps at all without being tired, who is confused or has strange ideas, must be seen in the emergency department the same day.
• Frightening thoughts about the baby, experienced with horror, are almost universal and are not a danger; avoiding them and seeking reassurance keep them going.
• Sleep is protected by a written plan, with named people to take over, adapted to the way you feed your baby; the baby sleeps on their back in their own cot, never on a sofa with an adult.
• You do not wait until you feel like it before acting: you schedule three small activities with a date each week, one of them with another adult.
• The rules of the "good mother" can be questioned, and the bond with the baby is built, without guilt.
• Psychotherapies have proved themselves during this period; medication is decided with the doctor, and breastfeeding does not stop you getting treatment.
• Thoughts of death are spoken about the same day; if they include the baby, it is an absolute emergency.

26. Sources and foundations

This guide is an original text written for Psychotip. It draws on published work, without reproducing the material of any proprietary programme. It reproduces no list of diagnostic criteria, names no medicine and describes no means of self-harm.

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Content last reviewed: 2026.