When Iza Thiago-Munoz brought her first baby home, she instituted a rule: She was the only person allowed to carry the baby upstairs. At the time, she lived in a narrow Philadelphia rowhouse with a steep staircase. If anyone else—including her husband—wanted to take the baby up, they had to buckle the infant into a car seat first.
Her husband occasionally tried to reason with her. He could hold the baby tightly, he pointed out. “But what if you fall down the stairs?” she would reply.
She didn’t know it at the time, but Thiago-Munoz was struggling with postpartum depression and anxiety, which amplified her lifelong tendency to imagine the worst-case scenario. She also felt enormous pressure to be a perfect mother. “I thought I had to do everything,” she says. Otherwise, she worried, “people would just think that I wasn’t good enough.” Asking for help felt like admitting that they were right.
Thiago-Munoz is now a lactation consultant, postpartum doula, and founder of Clementina Health, a postpartum and lactation telehealth company. Her work is informed by what she experienced after giving birth—and by what she wishes the people around her had understood. “I just didn’t feel joy in anything,” she says. “I felt like I was supposed to be happy because, wow, this major thing just happened. And I was happy, but I wasn’t joyful.”
Supporting someone with postpartum depression starts with knowing how it can show up, even when it doesn’t match the image you have in your head.
Both the “baby blues” and postpartum depression can cause sadness, tearfulness, irritability, and feeling overwhelmed after giving birth, says Dr. Kelli Burroughs, an ob-gyn and vice chair of clinical affairs and patient experience at the University of Texas Medical School in Houston. But the baby blues are generally mild, begin within the first week after delivery, and improve within about two weeks. Postpartum depression lasts longer and interferes more significantly with daily life.
Signs can include a persistently depressed mood; losing interest in things that usually bring joy; withdrawing from other people; difficulty eating, concentrating, or sleeping even when the baby is asleep; extreme fatigue; and feeling disconnected from the baby. Postpartum depression can also begin months after giving birth—not only during those first blurry weeks at home.
It doesn’t always look the way people expect, either. Sometimes, the moms who are suffering the most appear to have everything under control, says Jayme Scarfo, a licensed professional counselor in Surprise, Ariz., who specializes in working with pregnant and postpartum women. They’re showering, cooking, going to the gym, and insisting: “It’s hard, but don’t worry. I’ve got it.”
You don’t need to decide whether someone meets the diagnostic criteria before checking in. Describe what you’ve noticed without labeling her, Scarfo suggests: “I know this is a huge adjustment, and you haven’t seemed like yourself lately. How are you really doing?” Or: “You seem much more anxious than usual, and I’m worried about you. Can we talk about it?”
Consider who should initiate that conversation, too. “The best person to ask those hard questions is often going to be whoever she feels the least pressure to perform for,” Scarfo says. That might be a sister, best friend, therapist, or fellow mom—not necessarily her partner or mother.
Burroughs also likes asking questions that are harder to brush off with a reflexive “I’m fine.” For example: “Are you having more good days or bad days?” It’s also helpful to ask when she last slept for more than two hours or ate a real meal sitting down. Those answers can help you understand where she’s struggling—and how you might lighten the load.
When someone declares they’re a “terrible mother,” your instinct might be to disagree. Of course you’re not! You’re doing an amazing job. But depression and anxiety symptoms can start to feel like part of someone’s identity, says Emma Basch, a clinical psychologist in Washington who specializes in perinatal mental health. Trying to prove her wrong might leave her feeling even more misunderstood.
Instead of correcting her, acknowledge how much she’s hurting: “It must be so painful to feel that way. I’m here for you.” Burroughs likes: “I’m glad you told me. I’m glad you feel comfortable confiding in me.” That signals that you can handle the truth, and that your friend doesn’t need to resume pretending everything is fine.
Skip the sunny reassurances, like “Enjoy every moment,” “They’re only this little once,” and especially “You just had a baby—you should be happy.” Those comments suggest she can simply choose her way out of what she’s experiencing. “Postpartum depression is a true medical condition,” Burroughs says. “This is not a sign of weakness. This is out of the control of the new mom.”
Loved ones should try to remain calm if a new mom shares an intrusive thought, Scarfo says. A frightening flash like “What if I drop the baby?” isn’t the same as wanting it to happen. An alarmed reaction—or immediately suggesting an intervention like hospitalization—could make her less likely to confide in you again.
