Baby Blues, Postpartum Depression, Postpartum Anxiety, Postpartum OCD, and Postpartum Psychosis: Understanding the Differences
Written by Dr. Colleen Reichmann, owner and clinical director of Wildflower Therapy
You spent months preparing for your baby’s arrival. You researched strollers, packed a hospital bag-you’ve read basically every article you could find about labor and feeding. Hell the Birth Hour podcast has been on a constant loop during your morning walks for months at this point.
And maybe you’ve even read about navigating postpartum mood and anxiety shifts. emotionally after birth. But if you are like so many mothers, it’s hard to know how to fully plan for navigating the “what ifs” when it comes to your own postpartum mental health.
If you feel uncertain about what’s to come- or if you are currently smack dab in the postpartum period and have been wondering whether something is wrong or if these big emotions and that steady drumbeat of anxiety are just a normal part of the process- please know you’re so not alone.
One of the biggest misconceptions about maternal mental health is that every emotional struggle after birth is “postpartum depression.” Or, worse yet, every emotional struggle is just referred to overall as simply “postpartum.” In reality, several different conditions can occur during the postpartum period, and very clearly understanding the differences can help you recognize when it’s time to reach out for support.
So What Are the Baby Blues?
The baby blues are incredibly common. In fact, the vast majority of new mothers experience them.
So what do they feel like? How do you know if you have them? Well, during the first few days after delivery, hormone levels shift dramatically. Now add in sleep deprivation, various physical recovery, learning to care for a newborn, and one of the biggest, most indescribable life transitions imaginable-and, well. Yes. It’s beyond understandable that emotions can feel all over the place.
If you have the baby blues, you might notice:
• Crying easily
• Feeling unusually emotional
• Mood swings
• Irritability
• Feeling overwhelmed
• Difficulty concentrating
But what is the most important takeaway here is that, although the baby blues can feel intense, they typically begin within a few days after birth and improve on their own within two weeks.
So please remember- that is actually a very short period of time. If your symptoms continue beyond those first couple of weeks, it’s so important to pay attention (and potentially connect with a perinatal therapist for further assessment)
What Is Postpartum Depression?
Postpartum depression is much more than feeling sad. It affects approximately 1 in 7 mothers and can develop anytime during the first year after giving birth. And some people notice symptoms immediately, while others don’t begin struggling until months after their baby is born. And neither experience is more correlated with the depression being more severe. (IE It’s important to really notice and also track any depression that arises anytime with that first year)
Common symptoms include:
• Persistent sadness
• Loss of interest in things you used to enjoy
• Feeling disconnected from your baby
• Guilt or shame
• Hopelessness
• Difficulty sleeping even when your baby is asleep
• Changes in appetite
• Feeling like you’re failing as a parent
• Thoughts that your family would be better off without you
Many parents with postpartum depression describe feeling like they’re simply “going through the motions.” Or they describe feeling underwater. Or like everything is grey. Others talk about a persistent numbness. They love their baby deeply, but they don’t feel like themselves anymore.
(Please please hear me when I remind you of what you probably already know: This isn’t a character flaw, and it doesn’t mean you’re a bad mother. It’s a medical with hormonal and neurochemical underpinnings- one that can strike any of us- and it’s a condition that deserves compassionate treatment.
What Is Postpartum Anxiety?
While postpartum depression receives much of the attention, postpartum anxiety may actually be just as common. It’s actually one of the top struggles that clients of our therapy practice cope with during the postpartum period.
Instead of the sadness more traditionally associated with postpartum mental health struggles, rumination, worries, and fears take center stage in post partum anxiety.
Mothers often describe their brain as feeling like it can never turn off. The worries feel chronic, persistent, and nearly impossible to disconnect from. Mothers with postpartum anxiety frequently report constantly worrying something bad will happen to their babies, googling symptoms for hours, feeling unable to relax, needing constant reassurance. They often also talk about experiencing racing thoughts, feeling physically tense, having panic attacks, and even avoiding situations all together because they feel unsafe
Many parents assume this level of worry is simply part of becoming a mother. And while worrying is very normal, worries to this extent- that are continuous, outside of the bell curve in strength, and feel consuming- are not.
Caring deeply about your child is normal. Feeling trapped in relentless anxiety is not.
Therapy can help you learn to distinguish between protective parenting instincts and anxiety that has begun taking over your life.
Intrusive Thoughts and Postpartum OCD
One experience that often surprises new parents is intrusive thoughts. These are unwanted, distressing thoughts or mental images that seem to appear out of nowhere.
They might sound like:
“What if I accidentally dropped the baby?”
“What if I fell down the stairs while holding them?”
“What if something terrible happened?”
These thoughts can be frightening, especially if you’ve never experienced anxiety before but they are very common in the first few months of the postpartum period. And they do not automatically mean there is Obsessive-Compulsive Disorder (OCD) present…
So when do these intrusive thoughts indicate an actual diagnosis of postpartum OCD? Well, what separates these thoughts from postpartum obsessive-compulsive disorder (postpartum OCD) isn't really the content of the thoughts, it's more about the brain response to them. With postpartum OCD, intrusive thoughts become frequent, distressing, and difficult to dismiss. Mothers can find themselves spending more and more time seeking reassurance, mentally replaying events, avoiding certain situations, or performing rituals to keep their baby safe. For example, a parent might repeatedly check that the baby is breathing, so the point where they are becoming sleep deprived in part due to this practice. Or they may avoid carrying the baby down the stairs for fear of dropping them, refuse to use knives while cooking, or constantly ask a partner, "Do you think I'm a bad mom?"
The hallmark of postpartum OCD, however, is that the thoughts are ego-dystonic, meaning they feel completely inconsistent with who you are and what you want. Parents with postpartum OCD are often terrified by their thoughts and go to great lengths to protect their baby. (This is one of the most important distinctions between postpartum OCD and postpartum psychosis.) In postpartum OCD, parents recognize that the thoughts are unwanted and irrational, remain grounded in reality, and are deeply distressed by them.
What Is Postpartum Psychosis?
Postpartum psychosis affects approximately 1 to 2 out of every 1,000 births.
Unlike postpartum anxiety or depression, postpartum psychosis is a psychiatric emergency requiring immediate medical evaluation.
Symptoms may include:
• Hallucinations (seeing or hearing things others don’t)
• Delusional beliefs
• Severe confusion
• Rapid mood changes
• Disorganized thinking
• Not sleeping for extended periods without feeling tired
• Losing touch with reality
People experiencing postpartum psychosis often do not recognize when they have slipped into psychosis. However, symptoms like depression, sleep disturbances, and paranoia are often present prior to the onset of the psychosis. This is why it is so important to tell you support system and ideally also a therapist, psychiatrist, and medical doctor about these kinds of symptoms as soon as you notice them, so that you have support in tracking them, and people monitoring you in the scenario that they turn into postpartum psychosis.
If you believe you or someone you love may be experiencing postpartum psychosis, seek emergency medical care immediately. Early treatment is highly effective, prompt intervention can make a significant difference.
How Do I Know If I Need Therapy?
Many mothers understandably wait until they’re completely overwhelmed before asking for help (after all, it’s a season of life when putting another human’s needs before your own can feel almost necessary at times. So putting off appointments, or brushing away concerns with the thought “I don’t even have time to think about it” can feel automatic.)
So I want to be one voice urging you not to wait. Don’t wait until you are overwhelmed- don’t even wait until you are struggling if you can help it! Consider working with a therapist when you find out you are pregnant and developing a postpartum mental health plan with a qualified provider.
You matter here. You are the person going through the immense hormonal, psychological, and emotional shifts. Your body is living through one of the biggest seasons of tax and upheaval that a human body can. You deserve attention and support right now too.
Consider reaching out if:
• Your emotions feel harder to manage than you expected.
• Anxiety is making it difficult to enjoy your baby.
• You’re avoiding activities because of fear.
• You’re crying most days.
• You don’t feel like yourself anymore.
• You’re constantly worrying you’re a “bad mom.”
• You experienced a stillbirth or neonatal loss.
• You’re struggling with infertility grief, birth trauma, or pregnancy after loss.
• You’re functioning, but everything feels incredibly hard.
Therapy Can Help You Feel Like Yourself Again
At Wildflower Therapy, one of the areas that we specialize in is maternal mental health. We know how complex this season of life can be. Whether you’re adjusting to your first baby, navigating postpartum anxiety, grieving the birth experience you hoped for, coping with infertility, coping with loss, or trying to reconnect with yourself after becoming a parent, you do NOT have to figure it out alone.
Our therapists provide evidence-based, compassionate care that helps parents move from surviving to feeling grounded, confident, and connected again. We offer postpartum therapy in our Philadelphia and Devon offices, as well as virtual therapy throughout Pennsylvania, making it easier to access support during the busy postpartum season.
You Don’t Have to Wait Until Things Get Worse
One of the biggest myths about postpartum mental health is that you have to be in crisis before therapy is appropriate. But the truth is, earlier support often leads to a smoother recovery. If you’ve been wondering whether what you’re experiencing is “normal,” that question alone is worth bringing into therapy.
Looking for a postpartum therapist in Philadelphia, Devon, or the Main Line?
Wildflower Therapy specializes in postpartum depression, postpartum anxiety, infertility, pregnancy after loss, birth trauma, eating disorders, and maternal mental health. We offer both in-person therapy in Philadelphia and Devon and virtual therapy across Pennsylvania.
If you’re ready to feel more like yourself again, we’d be honored to help. Please reach out today to schedule your free consultation call.
