Pregnancy and childbirth are portrayed as some of the most magical moments in a woman’s life. But what if those magic moments don’t turn out as planned? Amid the sleep deprivation and fatigue, how can you tell if you have something more than the “baby blues"?

Approximately 14% of women, or 1 in 7, experience significant depression following childbirth, according to the Centers for Disease Control and Prevention and the American Psychological Association.

More bad days than good

Formal medical criteria from the American Psychiatric Association for perinatal or postpartum depression includes a depressed mood for two weeks or longer, as well as symptoms of guilt, low energy, sleep and appetite disturbances, difficulty concentrating, lack of enjoyment and fatigue, among others.

But how to find the fine line between normal “baby blues” (mood swings and weepiness during the first two to three weeks after birth that affect about 80% of women) and something more serious?

Postpartum baby blues typically lasts the first couple of weeks and can largely be attributed to fatigue. Postpartum depression is more a day-to-day problem that does not resolve quickly.

That definition resonated with new mom Carrie Lock. “I was told to pay attention to whether I was having more bad days than good. And that it doesn’t have to be that way,” she said. “That really resonated with me. It’s hard because your hormones are so crazy and sleep deprivation makes everything so much harder. It’s important to know that you shouldn’t worry if you’re still scared or anxious after the baby’s born and it’s not purely the magical moment you’re expecting.”


Symptoms can start anytime during pregnancy or up to a year after a woman gives birth. According to the National Institute of Mental Health, symptoms can include:

  • Feeling sad, hopeless, empty or overwhelmed.
  • Crying more often than usual or for no apparent reason.
  • Worrying or feeling overly anxious.
  • Feeling moody, irritable or restless.
  • Oversleeping or being unable to sleep, even when the baby is sleeping.
  • Having trouble concentrating, remembering details and making decisions.
  • Experiencing anger or rage.
  • Losing interest in activities that are usually enjoyable.
  • Suffering from physical aches and pains, including frequent headaches, stomach problems and muscle pain.
  • Eating too little or too much.
  • Withdrawing from or avoiding friends and family.
  • Having trouble bonding or forming an emotional attachment with the baby.
  • Persistently doubting the ability to care for your baby.
  • Thoughts about harming yourself, the baby or others.

When some doctors are talking to patients who are worried they may have perinatal or postpartum depression (PPD), they try to simplify the medical criteria for it into a few basic things. For instance, are they doing the basic functions they need to every day? Eating, sleeping, exercising and playing – all things that are definitely more difficult for a new mom to do.

Poor appetite or overeating can be a sign of depression. Every new mom is sleep deprived, but if you’re riddled with anxiety and worry and are unable to sleep, that can also be a sign.

And when it comes to exercise and play, doctors will ask new moms if they’re enjoying their baby and the things that matter to them in their lives. Most moms’ lives are radically changed when their baby is born. And they're already at risk for postpartum depression because they’re bogged down in the day-to-day of taking care of their baby and aren’t necessarily taking care of themselves.

Causes and risk factors

There is no definitive cause of perinatal or postpartum depression, though women who have a personal or family history of depression, anxiety or PPD are at a much higher risk of experiencing it. One finding: If women discontinue their depression medication during their pregnancy, they have up to a 68 percent chance of a recurrence of depression during pregnancy or postpartum.

The physiological changes that women experience during and after pregnancy also can contribute. The fluctuation in hormones combined with extreme sleep deprivation, difficulty breast-feeding or a colicky baby can be the perfect storm for some women, experts agree.

Other women who may be at a higher risk for perinatal or postpartum depression include women who:

  • Experience premenstrual dysphoric disorder (PMDD or PMS).
  • Have inadequate support in caring for the baby.
  • Have financial or marital stress.
  • Experience pregnancy, birth or breast-feeding complications.
  • Have experienced a recent major life events, such as a loss, house move or job loss.
  • Are mothers of multiples.
  • Have infants in the Neonatal Intensive Care Unit (NICU).
  • Have undergone fertility treatments.
  • Have a thyroid imbalance.
  • Have any form of diabetes (type 1, type 2 or gestational).

Overcoming the stigma, reaching out

Although significant strides have been made around acknowledging mental health struggles, there still a stigma related to depression. Some women will stop taking their depression medications during pregnancy because they think it is something they can control and something that makes them weak. When, in fact, stopping the medication can cause a lot more harm than good.

And many people may not be aware of how common it is and how it can be treated effectively. Treatment can include counseling or antidepressant medications or both in combination.

More than anything, doctors agree, it’s important to tell someone how you feel. Whether it's your doctor, family or a friend, women need to tell someone if they think they’re experiencing perinatal or postpartum depression. Reaching out for help is the key first step.

Novant Health offers free, confidential postpartum depression support groups and online resources for new parents, like a Postpartum 101 Virtual Class. For more information and to register, email

If you have thoughts of harming yourself, your baby or others, seek medical attention immediately.

For more information about maternity services offered by Novant Health, call toll-free 1-855-251-8808.