Mental Health 101: "Baby Blues"
What are the baby blues? Are they different from postpartum depression?
In this new, ongoing series, I will spend each newsletter tackling a mental health concern that is common throughout pregnancy or early parenthood. I’ll try to cover the basics of each topic as well as summarize findings from an interesting study or two.
For this first edition, I wanted to better understand what people mean when they talk about “the baby blues,” how we can differentiate it from other postpartum mental health concerns, and discuss the findings from a study that compared common negative thoughts about childbirth and being a mother from depressed versus nondepressed moms.
The sixth night after my baby was born was, in a word, hard. I was in physical pain, deep in labor recovery and still getting cramps whenever my baby cried. My breasts were sore and my nipples were raw from breastfeeding. I was lucky if I could get three hour stretches of sleep at a time. Lying in bed, my cat jumped on my stomach, wanting to cuddle. It was uncomfortable (like it had been when I was pregnant), so I pushed him off. That’s when I lost it. Not being able to cuddle with my cat was apparently the last straw - it all of a sudden represented everything that had changed in my life after having a baby. “Why did we do this to ourselves?” I asked my husband, sobbing, resentfully staring at the sleeping infant next to our bed.
What are “the baby blues?”
Postpartum hormonal changes, sleep deprivation, stress, adoption of an entirely new role as a parent… with all of this happening at once, it would be weirder if there weren’t massive mood swings in new parents. The somewhat-condescending phrase “the baby blues” originated in the 1950s and is used as a catch-all for these to-be-expected emotional changes. Also referred to as postpartum or maternity blues, there is no formal medical definition for this condition, though it is commonly understood to include experiences like sadness, anxiety, crying for no reason, fatigue, irritability, and sudden mood shifts. Sources like the National Institute of Mental Health and the American Pregnancy Association note that these experiences are very common, usually begin a few days after birth, and go away on their own within a week or two. One recent systematic review of 26 studies found that the prevalence of the baby blues ranged from 14%-76% in a given study. However, this is most likely an underestimation, since most new parents aren’t officially screened for the baby blues and (I’m assuming like I was) are just told to expect some big mood changes. While the focus in the medical community is almost exclusively on the experiences of birth mothers, fathers and adoptive mothers experience these big changes, too.
Common negative thoughts after childbirth
While not technically about the baby blues, a study by Hall and Wittkowski (2006)1 helps us better understand some common negative thoughts that new birth moms can experience. The researchers wanted to understand whether the types of negative thoughts that depressed mothers experience are qualitatively different than those of nondepressed mothers after childbirth. First, they extensively interviewed ten mothers with postpartum depression about the types of negative thoughts they experienced. Next, they analyzed the interviews and developed a questionnaire that included 51 different negative thoughts that these mothers reported experiencing. Then, they recruited an additional 153 mothers who did not meet criteria for postpartum depression to (anonymously) fill out the questionnaire by stating whether or not they had ever experienced one of the thoughts since having their baby. These mothers had babies that ranged in ages from 6 weeks to 7 months.
They found that nondepressed mothers experienced a range of negative thoughts that were almost exactly the same as the thoughts that mothers with postpartum depression experienced2. The researchers did not find differences in answers to the questionnaire between younger (under 30) versus older (over 30) moms, or between first-time moms versus those with more than one child. Examining statements that were endorsed by more than 25% of the nondepressed mothers, the researchers grouped these thoughts into themes, including:
The need to be perfect (e.g., “I must show everyone that I’m coping”)
Negative judgment by others (“People are critical of me as a mother”)
A sense of responsibility (“Everything in my life should revolve around my child”)
Not being understood (“It’s impossible to explain how I feel”)
Expectations of motherhood (“Having a baby is not fantastic like I expected”)
Safety of their baby (“I don’t trust anyone with my baby”)
Death or impending doom (“My baby could die”)
Negative appraisals of their current situation (“I’m trapped”)
The three specific thoughts that were most frequently endorsed included: “Everything in my life should revolve around my child” (63.9% of nondepressed moms); “My baby could die” (62.4%); and “I must show everyone that I’m coping” (61.8%).
It should be noted that this study took place in England and the sample was not diverse; for example, all but five of these mothers were white and only 14 were single or divorced. Even considering these limitations, I still like this study because it analyzed real mothers’ own experiences to understand the range of different types of negative thoughts one might experience. I also found it incredibly validating to see such a variety of negative thoughts - it can be hard to share how negative you can feel about being a parent, especially in the newborn stage. In fact, the authors suggest that most likely these thoughts are even more common than what they found because, even though they collected these responses anonymously, it can still feel shameful for moms to report negative thoughts about their children.
Baby blues versus postpartum depression
So when do “normal” negative thoughts veer into the territory of depression or another, more serious mental health concern? Indeed, experiencing the baby blues is associated with an elevated risk of developing postpartum depression. However, like most mental health challenges, there is no clear line that separates the baby blues from postpartum depression or other diagnoses. New mothers are often asked the very serious questions of whether or not they have thoughts of harming themselves or their baby as one marker of postpartum depression. But just because you have these thoughts doesn’t automatically mean you’re depressed - just like the aforementioned study showed - and not every parent who has postpartum depression experiences these specific thoughts. Generally, the difference between the baby blues and something like postpartum depression comes down to severity and duration: If your symptoms don’t get better after two weeks or more, or become severe to the point that it’s extremely difficult to take care of yourself or your baby, you might be experiencing something more serious than the baby blues and talking to a doctor would be helpful. If you’re ever unsure, it’s a good idea to reach out for help. Even without the baby blues, having a newborn is HARD, and it doesn’t hurt to get some extra support.
There is an expectation that being a parent (especially a mother) is the most fulfilling, joyous experience there is, and when women are ambivalent about this role, they tend to be punished or perceived as pathological. Normalizing that motherhood in particular is difficult and you aren’t going to be thrilled about the experience at all times - in fact, you might hate it sometimes - can help with unrealistic expectations. From personal experience, it’s difficult to understand how intense the baby blues can feel, even when a doctor talks with you about them, until they happen. It can be incredibly startling to feel out of control about your emotions, or to have negative thoughts about your child, especially during as sensitive a time period as right after childbirth. It’s easy to wonder if you’re experiencing something more serious than what up to 80% of women report experiencing.
The same night that my cat caused my existential crisis about my baby, maybe four hours later, I was crying again, but for a different reason: I was staring at my son after feeding him, thinking that he was the most beautiful thing I had ever seen. I think about that night often as a microcosm of parenting in general. I guess the rollercoaster never really ends, does it?
Further Reading and Resources
A recent New York Times article discussed research on the postpartum mental health concerns in fathers.
For a historical account of the baby blues and postpartum depression, including more discussion about the societal idealization of motherhood, check out: Held, L., & Rutherford, A. (2012). Can't a mother sing the blues? Postpartum depression and the construction of motherhood in late 20th-century America. History of psychology, 15(2), 107–123. https://doi.org/10.1037/a0026219
The March of Dimes has a nice overview of tips for dealing with the baby blues, including a list of postpartum mental health resources.
Hall, P. L., & Wittkowski, A. (2006). An exploration of negative thoughts as a normal phenomenon after childbirth. Journal of midwifery & women's health, 51(5), 321-330. https://doi.org/10.1016/j.jmwh.2006.03.007
The only negative thought that was not endorsed by any nondepressed mother was: “Others think that I could sexually abuse my child.”