Postpartum Depression: Breaking Through Shame and Stigma

Note: Sarah is a composite of stories shared by mothers experiencing postpartum depression. Identifying details have been altered for confidentiality.

Sarah just had a baby. But she was not feeling very…well, happy. Yes, she felt overpowering love for her new baby. But she also felt irritable, depressed, nauseous and she was crying alot. Even worse, she started having nightmares.

Scary nightmares that she dared not talk to anyone else about. They were, well, just plain disturbing. They centered around things that she imagined could just happen to her baby that were outside of her control. She was trying to hide behind a veil of smiles and perky laughter.

Untreated depression can also strain intimate relationships during an already vulnerable time.

Sarah felt very scared and very, very, ashamed of herself. She wondered why she wasn’t happy. She didn’t want to admit she was depressed. After all, she couldn’t possibly have a mental illness! She wondered if being depressed meant she was weak or somehow failing at motherhood. Why couldn’t she simply think her way out of these feelings?

The first twelve weeks after birth — often called the fourth trimester — are a neurologically and emotionally sensitive period.

Patrick W. Corrigan, Psy.D., Professor of Psychology at the Illinois Institute of Technology has conducted extensive research about stigma and mental illness. He’s found that the public stigma about persons with mental illness is that they are incompetent, lazy, and won’t help themselves. The negative public perceptions and attitudes about mental illness is internalized in individuals. The consequences for internalized stigma is shame, low self-esteem and feelings of worthlessness.

Yes, Sarah felt bad about herself.

One day Sarah happened to see Beth, her birth doula, in the supermarket parking lot. Beth hugged Sarah hello, asked how she was doing and cooed over the baby. Sarah automatically answered “Fine.” Beth looked kindly into her eyes and said, “Well, sometimes it’s not so easy …”

Sarah made a snap decision at this opening of empathy from an understanding soul. With tears starting to fall, she said, “I’m not doing so well, I feel so mixed up! I don’t know what is happening to me! I keep crying! I’m not happy! ”

Beth listened and told her that it was ok to feel the way she felt, that she was not “crazy ” and there was help available. Beth normalized Sarah’s feelings. Beth told her about a support group for new moms she knew about and also about some therapists who she might want to talk with. Beth promised to call her and give her this information as soon as she got back home.

Sarah felt very relieved. At least there might be some end to these bad feelings! She could get help! She shared her experience with her husband. He urged her to hire some help and to ask her mother for some help as well so she could get to see a therapist. He was very supportive.

Sarah’s experience is not uncommon. Postpartum Support International says that 15 – 20% of women experience significant depression or anxiety after childbirth. But there is stigma and shame associated with mental illness and many don’t seek help.

As Suzanne Swanson, Ph.D. , clinical psychologist and owner of Mothers Matter in St. Paul, Minnesota, says :

“I have definitely found that women are ashamed to define what they are experiencing as a mental illness or even as anything they might need help with. They don’t seek treatment, or they come to therapy but are very hesitant to talk about the depth and breadth of what they are experiencing. They suffer in their relationships — with a partner, with parents, with other children. They get depleted physically, too, trying to prove they can do all they think they are supposed to do (and do it with a smile).”

Sarah was fortunate as her community was informed and concerned. Her doula and her husband responded in a compassionate and supportive manner.

For some mothers, unresolved birth trauma can intensify symptoms of postpartum depression and anxiety.

Education, openness, and compassionate conversations about perinatal mental health reduce stigma and make it safer for women to seek help.

Karen Kleiman, LCSW, Founder & Director of the Postpartum Stress Center, LLC in Rosemont, Pennsylvania, and author of numerous books on the subject of perinatal mental illness, has these suggestions about how to respond to a woman who is struggling with mental health issues:

“The best response to a woman who is struggling with perinatal anxiety or depression is to put words to it and not dance around the subject. We want women to know that this anxiety and depression during pregnancy and the postpartum period is real, it has a name, and it is very treatable. We want to tell a new mother that negative feelings are common during this vulnerable time, due to hormonal/genetic/biologic factors, social/environmental influences, and relational stressors. We want them to know that seeking help from a healthcare provider who is familiar with perinatal distress will validate their experience and reduce symptoms. And perhaps most importantly, we want them to know that these are symptoms, they are not a reflection of who they are or what kind of mother they are, and they will not always feel this way.”

Sarah’s mothering story had a successful ending. She reached out and was received with consideration and care and this lead to appropriate treatment. It's not all in your head.

Perinatal mental health is deeply shaped by how the nervous system adapts to pregnancy, birth, and the postpartum transition.

Perinatal mood and anxiety disorders are not character flaws. They are medical conditions influenced by hormonal shifts, nervous system changes, sleep disruption, and psychosocial stress. With proper support, they are highly treatable.

For Support

For immediate support and resources,

contact the Postpartum Support International HelpLine at

1-800-944-4773 (EN/ES)

or visit postpartum.net.