Postnatal Depression
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Becoming a parent is one of life's most demanding transitions, reshaping relationships, identity, body, and future plans, often while the new parent is expected to adapt with ease and constant positivity. Around 90% of pregnant people experience some emotional disturbance, anxiety, or depression in the days, weeks, and months following childbirth, a pattern identified in research as postnatal depression. Its exact cause remains unclear, but it is generally understood as a combination of physical, emotional, genetic, and social factors, and it can affect both parents.
Common emotional experiences include guilt, shame, unworthiness, emptiness, numbness, and low self esteem, alongside behaviours such as withdrawing socially, insomnia, fatigue, and struggling to care for oneself or the baby. Symptoms typically begin between two weeks and a month after delivery, though onset can also follow a miscarriage, and both parents can experience symptoms three to six months after birth.
Challenging the Myth of Natural Motherhood
Much of the difficulty in recognising postnatal depression stems from an idealised, almost mythical image of parenthood. Ann Oakley's research found that new mothers were often shocked by how much caregiving responsibility fell to them, describing motherhood combined with marriage as feeling like a kind of confinement rather than pure fulfilment. Paula Nicholson similarly questioned why the difficulties of parenthood are rarely passed down honestly between generations of women. With time, adjustment, and support, parenthood can also bring genuine joy and meaning, but the initial shock and pressure to appear perfect can tip into real unhappiness.
Feminist scholars such as Jane Ussher have argued that pregnancy and childbirth have long been treated as medical problems to be managed by (historically male) experts, with the birthing person positioned as a passive patient rather than an active participant. This framing, they argue, makes it harder to see postnatal depression as a reasonable response to major life upheaval rather than as individual failure.
Physical and Biological Factors
Hormonal changes in late pregnancy come to an abrupt end at birth and through the start of breastfeeding. As early as 1858, physician Louis Victor Marce documented rates of depression across pregnancy and the postpartum period. Oestrogen and progesterone levels fall to pre-pregnancy levels within about 24 hours of birth, a dramatic shift some researchers believe is closely tied to mood changes. Brain imaging studies have also found reduced activity and connectivity between the amygdala and hippocampus in people experiencing postnatal depression, suggesting a genuine neurological component.
Difficult birth experiences, including caesarean delivery or other medical interventions, have been linked to higher rates of postnatal anxiety and depression, and some researchers argue that hospital births carry greater risk than home births. Recovery from physical trauma, such as an episiotomy wound or breastfeeding related discomfort, compounds the hormonal disruption during this period.
Risk can also be inherited or linked to existing conditions such as fibromyalgia or IBS, hormone irregularities, and the administration of synthetic oxytocin during labour.
A Global and Historical Pattern
Postnatal depression is especially underrecognised in developing countries. A 2020 study at a hospital in Bharatpur, Nepal, found symptoms in about one fifth of the pregnant people studied, linked to factors including pressure to conceive, age, and delivery complications, and found smoking was associated with a fivefold increase in risk. Around 13.5% of participants reported feeling overwhelmed by the pressures of parenthood to the point of suicidal thoughts.
Severe cases, including postpartum psychosis, remain rare but serious, affecting roughly one to two in every thousand births, and postpartum depression is a leading contributor to infant mortality linked to parental mental illness in the United States. Historical accounts stretch back centuries. Fifteenth century writer Margery Kempe described what modern historians consider a postnatal psychosis, and in the nineteenth century gynaecologists frequently blamed "puerperal insanity" on women's reproductive organs, accounting for roughly 10% of asylum admissions of the era. Treatment approaches shifted through the twentieth century from physical interventions toward a broader psychiatric understanding, and today includes medications such as sertraline alongside emerging evidence supporting hormone based therapies, always with care taken around breastfeeding.
Research during the Covid-19 pandemic found postnatal depression rates increased alongside other stressors: reduced social support, family conflict, job loss, relocation, and the burden of caring for other children while isolated. Financial resources also strongly affect outcomes, with people who have fewer resources reporting higher stress and depression.
Much of this distress stems from unrealistic ideals of motherhood as inherently selfless and fulfilling, ideals that make it harder for struggling parents to ask for help or speak honestly about their experience. A 2013 Cochrane review found that psychosocial support after childbirth, including home visits, peer support, and psychotherapy, meaningfully reduced the risk of postnatal depression. Notably, much of this effective support has come not from specialist counsellors but from midwives and nurses without formal mental health training.
No two experiences of postnatal depression are the same, and its causes are rarely singular. What is clear is that new parents need real time, support, and honest information to adjust to a profound life change, and that centuries of silence around this experience mean far more awareness, research, and open conversation are still needed.to share with the world. Whatever it is, the way you tell your story online can make all the difference.
By Julie Faye Evans
