Postpartum Mental Health P3

Series: Beyond the Baby Blues: A Postpartum Mental Health Series

Intro to series:

At BESST Transitions, we explore the turning points that shape health and wellbeing. Few transitions are as profound as the shift into parenthood.  This post is part of Beyond the Baby Blues: A Postpartum Mental Health Series, which explores the emotional realities of the “fourth trimester.” This is a time of immense physical, emotional, and social change. In this series on postpartum mental health, we’ll follow this journey through its many layers: from the early adjustment beyond the baby blues, to the realities of anxiety and depression, to strategies for support and advocacy. Each post is an invitation to recognize the challenges of this transition, and to imagine more supportive pathways forward. Two other series will follow.  These will explore postpartum mental health across the lifespan and postpartum mental health in marginalized communities.

Posts in this Series:

1. Postpartum Mental Health: Beyond the Baby Blues

2. Postpartum Anxiety: The Silent Partner of New Motherhood

3. Postpartum Depression: Understanding the Shadows Beyond the Smile

4. Partners & Family: The Ripple Effects of Postpartum Mental Health

5. Self-Care and Coping Strategies for New Parents

6. Navigating Professional Support: From Pregnancy to Postpartum as a First-Time Parent

7. From Advocacy to Action: Canada Joins the Global Push for Perinatal Mental Health

Postpartum Depression:

Understanding the Shadows Beyond the Smile

The Smile as a Mask

When we picture new motherhood, we often imagine joy spilling over; a radiant woman beaming down at her baby, exhausted but glowing, blissfully wrapped in the magic of new life. The expectation is that you should be happy, ecstatic, even. After all, you have what you wanted, what so many women long for: a beautiful new baby. And if you’ve waited years for that baby, through education, career-building, or late-in-life partnership, the pressure to feel only gratitude can be crushing.

I know this firsthand. My pregnancy at 43 was considered “geriatric,” a word that does nothing to ease a new mother’s anxiety. Because we had difficulty conceiving for several months, we were considered to have fertility issues and sought guidance from a fertility clinic to explore the best path forward. When we received our test results, we were told there was no clear medical reason why I couldn’t conceive, other than that my ova were likely few, making it more difficult. We were even told to consider the possibility of using someone else’s eggs, though I could probably carry a pregnancy.

That day, I felt a profound sadness. I knew there were many ways to become parents, but I couldn’t help grieving the reproductive years I had “wasted” with a partner who was not right for me, someone I didn’t feel would make a good parent. And now that I was ready for children, I faced the possibility I could not have my own, while he could.

Yet life surprised me. Five days later, I had been late for my period and took a urine pregnancy test, as I had done many times in the previous months. It was positive. The baby was deeply wanted, carefully planned, and profoundly hoped for. And yet, the very fact that this pregnancy was so longed-for added layers of emotional complexity, pressure, fear, and vulnerability, that I had not anticipated.

I had spent years defining myself through my career, independence, and the life I had built with my partner, my “powerSerge,” the person I wanted to share a family with. When our son arrived, I believed I should be over the moon. And on the surface, I was. I wore the smile, told myself I should feel only joy. But beneath that smile lived shadows, doubts, exhaustion, guilt, and a weight I hadn’t anticipated. This was also heavily compounded by work tensions and the early arrival of my bundle of joy. That opposition between what I was supposed to feel and what I actually felt became part of my postpartum journey, one I later realized wasn’t uncommon at all.

What Postpartum Depression Really Is

Postpartum depression (PPD) is not just “feeling sad” after having a baby. It’s a complex, sometimes overwhelming condition that can appear in the weeks or months after birth. Unlike the “baby blues”, those short-lived dips in mood that affect up to 80% of new mothers, PPD is more intense, longer lasting, and can interfere with daily functioning and bonding with the baby.

The preferred diagnostic manual in North America (DSM-5-TR) does not define PPD but rather categorizes it as an episode of major depressive disorder with peripartum onset, defined as beginning during pregnancy up to four weeks postpartum (APA, 2022).  However, it has become clear that the range for postpartum onset must be extended to at least one year (Radoš et al, 2024).

It doesn’t always look like depression in the stereotypical sense. Some women feel hopeless and weepy. Others feel numb, detached, or irritable. For many, it hides behind a smile, surfacing only in private moments when the mask slips.

The Weight of Expectations

Motherhood comes with powerful cultural scripts: You should love every moment. You should be grateful. You should never complain. For mothers who waited a long time to have a child, or who made a deliberate decision later in life, these expectations can be even heavier.

When your reality doesn’t match the script, guilt and shame creep in. You wonder: What’s wrong with me? Why can’t I just be happy? These thoughts can deepen the shadows of postpartum depression, making it even harder to reach out for help.

Why Motherhood Can Feel So Isolating

The transition to motherhood begins in pregnancy, but for many women it doesn’t fully take hold until the baby arrives. During pregnancy, you may still be working, socializing, or moving through your familiar routines, with motherhood taking shape only in glimpses, such as with doctor’s visits, the growing anticipation, and the occasional kick reminding you of the life within. However, once the baby is born, the reality is suddenly all-consuming. The rhythms of feeding, rocking, soothing, and sleepless nights can shrink your world to a cycle of survival, often leaving little space for the other parts of your identity.

For me, becoming a mother at 43 intensified this disorientation. I had spent years defining myself through my career, my independence, and the life I had built with my partner. When our son arrived, that self was suddenly eclipsed by the single role of “mother.” I loved him fiercely, but the narrowing of my world felt overwhelming and, at times, lonely.

This was surprising even to me, because I am more introverted by nature. I’ve always been comfortable with quiet, with time to myself. But the solitude of early motherhood was not restorative. It wasn’t chosen; it was imposed, filled not with stillness but with the relentless demands of caregiving. The very thing that usually replenished me, time alone, was replaced by an isolation that drained me.

Of course, not every woman feels this way. Some find the transition to motherhood a natural extension of themselves, even liberating in its clarity of purpose. The experience can also differ depending on whether it’s a first or subsequent child. With a first baby, the learning curve is steep, and the sense of identity shift may be sharper. With later children, some mothers find themselves less disoriented, already accustomed to the rhythms of caregiving. Others, however, may feel an even greater loss of self as responsibilities multiply and time for personal identity shrinks further.

The truth is that there is no single story of motherhood. But when the reality doesn’t match the cultural script of pure joy and fulfillment, mothers may feel they must hide their struggle, wearing a smile to mask the isolation that sits beneath.

Signs & Symptoms to Watch For

(Centre for Addiction and Mental Health, n.d.)

While PPD looks different for everyone, common signs include:

• Persistent sadness, hopelessness, or emptiness

• Irritability, anger, or feeling on edge

• Loss of interest or pleasure in activities once enjoyed

• Difficulty bonding with the baby

• Changes in sleep or appetite (beyond the normal demands of caring for a newborn)

• Overwhelming guilt or feelings of worthlessness

• Intrusive or frightening thoughts

  
  

Not every mother experiences all of these symptoms, but if several resonate and persist beyond two weeks, it may be PPD rather than “just the baby blues.”

Risk Factors & Triggers

PPD arises from a mix of biological, psychological, and social factors. Hormonal changes, sleep deprivation, and physical recovery intersect with stress, previous mental health history, and the availability (or lack) of support (Agrawal et al., 2022).

As I wrote in my post on postpartum anxiety, being an older mother added another layer of complexity for me. I carried the weight of medical labels, the pressures of career and motherhood colliding, and the vulnerability of starting this chapter later in life. Each woman’s story is unique, but what’s shared is how isolating these struggles can feel.

Pathways to Healing

The good news is that postpartum depression is treatable. Healing often requires a combination of approaches:

• Professional support: Therapy (such as cognitive-behavioral therapy or interpersonal therapy) and, when indicated, medication can make a profound difference (Fitelson et al., 2010). Studies have also examined the safety of many commonly used antidepressants during breastfeeding, finding that the amount passed through breast milk into infant plasma is often very low, and adverse effects are rare when the mother is monitored (Berle and Spigset, 2011; Den Besten-Bertholee et al., 2024).

  
  

• Community support: Talking openly with friends, family, or peer groups can lessen the shame and isolation.

  
  

• Self-compassion: Allowing space for imperfection, rejecting the myth of the “perfect mother,” and recognizing that struggling does not mean failing.

  
  

• Technology: Apps, online support groups, and virtual therapy are becoming increasingly valuable lifelines (Novik et al., 2022), a topic I’ll explore more deeply in a future post in this series.

Light Beyond the Shadows

Behind every smile, there can be unseen struggles. Postpartum depression does not define you, and it does not have to be faced in silence. Seeking support, whether through loved ones, professionals, or community, is a courageous way to honor both yourself and your child. Even in the quiet, shadowed moments, there is hope, and with care, guidance, and connection, you can rediscover balance, joy, and the deep bond with your child.

Because sometimes the bravest thing you can do is let the mask slip and say: I’m not okay…but I want to be.

-- Anne TM Konkle, PhD 

References

Agrawal I, Mehendale AM, Malhotra R. Risk Factors of Postpartum Depression. Cureus. 2022 Oct 31;14(10):e30898. doi: 10.7759/cureus.30898.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.

Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Current Womens Health Reviews. 2011 Feb;7(1):28-34. doi: 10.2174/157340411794474784.

Centre for Addiction and Mental Health. (n.d.). Postpartum depression. CAMH. Retrieved September 24, 2025, from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/postpartum-depression

Den Besten-Bertholee D, Touw DJ, Damer EA, Mian P, Ter Horst PGJ. Sertraline, citalopram and paroxetine in lactation: passage into breastmilk and infant exposure. Frontiers in Pharmacology. 2024 May 22;15:1414677. doi: 10.3389/fphar.2024.1414677.

Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. International Journal of Womens Health. 2010 Dec 30;3:1-14. doi: 10.2147/IJWH.S6938.

Novick AM, Kwitowski M, Dempsey J, Cooke DL, Dempsey AG. Technology-Based Approaches for Supporting Perinatal Mental Health. Current Psychiatry Reports. 2022 Sep;24(9):419-429. doi: 10.1007/s11920-022-01349-w. Epub 2022 Jul 23.

Radoš SN, Akik BK, Žutić M, Rodriguez-Muñoz MF, Uriko K, Motrico E, Moreno-Peral P, Apter G, den Berg ML. Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD. Comprehensive Psychiatry. 2024 Apr;130:152456. doi: 10.1016/j.comppsych.2024.152456. Epub 2024 Jan 29.