What really happens after childbirth? Experts explain how postpartum depression can look like

Postpartum depression, experts say, is much more complicated than what one believes, with some women reporting intense irritability and anger, especially toward husbands and in-laws.

Sudden outbursts of anger, frequent crying and an abrupt shift in episodes of sadness and happiness. What does this remind you of? May be, you'll call it anxiety.

But this is the reality of many new mothers. And it is not an one-off instance, it is a part of their daily routines. What is this, you ask?

This is what postpartum depression looks like. There's more. Lack of attachment with the baby, poor appetite, lack of self love, and in extreme cases suicidal thoughts and even thoughts of hurting the new born.

So, to just brush it off as mere 'baby-blues' doesn't feel right. While postpartum depression is common, it is not something one should ignore.

The sensitive topic has been discussed a lot lately, but no one knows what really happens after childbirth. And believe it or not, for some it is still an alienated concept.

So, first of all, what causes it?

"Postpartum depression occurs after childbirth because the body experiences sudden hormonal changes which lead to decreased estrogen and progesterone levels," said Dr Gayathri Kamath, Additional Director, Obstetrics & Gynaecology, Fortis Hospital, Bannerghatta Road, Bengaluru.

Think of it as a plane crash landing. Why such horrific analogy, you ask? Because estrogen and progestrone levels crash by 90 per cent or more within the first 24 hours to a few days after childbirth. Imagine, what will happen when hormones in your body take a nosedive.

Postpartum depression feels like an overwhelming fog of dread, helplessness, and numbness, where joy evaporates and even one’s baby feels distant. Women often describe unbearable loneliness amid family, an inability to feel love or happiness and a guilt for not bonding as expected

Anusha G S, Consultant Psychologist, Maarga Mind Care, Bangalore

The rapid shifts from laughing to crying, Anusha said, stem from hormonal crashes post-delivery. Since estrogen and progesterone plummet sharply within 24 hours, it disrupts serotonin, the "feel-good" chemical, triggering emotional turbulence.

"The tendency to handle emotional dysregulation is low in new mothers hence the shift in mood is extreme," she explained.

Some women also report intense irritability and anger, especially toward husbands and in-laws during post-partum.

Extreme negative thoughts like 'my in-laws are my enemies' or 'everyone is taunting me' are also reported in some women with severe post-partum depression.

"I gave birth to a baby in 2024. That has to be the worst period of my life. Not because I don't love my baby, but because how the following days looked like. The morning after my C-section I felt this sudden emotion that 'my in-laws are going to take my baby away from me'. That thought continued to haunt me for one whole year where I tried my best to become the sole caregiver to my baby and to keep him safe," a 30-year-old Sakshi (name changed), said.

"In the process, I ended up compromising on my physical and mental health due to extreme exhaustion. But those thoughts were too strong for me to think of anything else at that time," she added.

The root cause for such situations, Anusha said, is extreme stress.

"It arises from overwhelming stress, unmet expectations for support, and family disputes in high-pressure households exacerbated by hormonal changes, fatigue, cultural role strains like childcare burdens and anxiousness which leads to thinking “what if this happens” situations," Anusha explained.

Representative image of a couple fighting

Not only this, PPD also plays a role in strained marriages, and there are several reasons behind it.

"PPD significantly strains marriages, with up to 20% of cases linked to increased conflicts from unequal workloads, intimacy loss, and emotional withdrawal, expectations not being met from each other and managing household chores often leading to dissatisfaction/conflict of interest," Anusha added.

As per Postpartum Depression.org couples commonly face marital problems during the first year after welcoming a new child into the world.

"After my delivery, I had become more irritable. Even simple suggestions by my husband felt like taunts. I had developed so much hate for him that it was difficult to spend together. And the hate only came from the fact that he gets to enjoy with his friends till late night while I had to stay back with a 2-month-old who cries his lungs out. Now, I am trying to rebuild that connection with my husband but I don't know how long will it take me," a 33-year-old woman, who had given birth six months ago and wish to stay anonymous, said.

While controversial, several studies also suggest that women who gave birth via C-section are at a higher risk of suffering from PPD.

A study published in NIH's National Library of Medicine suggest that PPD risk may rise in the presence of CS. In particular, the risk was increased by 20% in the EMCS group, and the risk of PPD within one to six months postpartum after CS increases by 6% compared to that at six months postpartum. However, it suggests that more rational designs and in-depth studies are needed to obtain more accurate information.

But Kamath believes that postpartum depression can occur after both vaginal and C-section deliveries. However, C-section delivery results in increased physical discomfort for some women because they experience extended recovery periods and impaired movement abilities and complications that lead to higher emotional stress levels.

"That said, the type of delivery alone does not cause depression, factors like support system, previous mental health history, and overall recovery play a bigger role," Kamath said.

And in case you were wondering if exclusive breastfeeding put you at a higher risk of developing PPD, it is not the case. But challenges like sleep deprivation, constant fatigue, or breastfeeding difficulties can increase stress.

She added that another important aspect that is commonly observed is the sudden shift of attention to the newborn after delivery.

"Naturally, family members, including the husband, tend to focus more on the baby’s needs, and the mother may sometimes feel emotionally neglected or left out at a time when she herself is physically and mentally vulnerable. This feeling, though often unintentional from the family’s side, can increase the risk of low mood, irritability, or emotional withdrawal," Kamath explained, adding that this is why partner support plays a very important role in the postpartum period.

Representative image 

PPD does not only affect the mother, it indirectly affects the newborn as well.

"Mothers with diagnosed or undiagnosed PPD provide less responsive care, raising infants’ risks of socio-emotional delays, language issues, and which leads to childhood trauma or insecure attachment style for the child if PPD is not treated," Anusha explained.

As to whether the woman actually ever comes out of PPD, the answer is a bit complicated.

"Even after treatment, many women carry emotional scars like guilt, fear of recurrence, and eroded self-worth, though therapy helps most rebuild fully, outcomes improve with early intervention and positive identity recollection," Anusha emphasized.

She added that PPD history doubles chronic depression risk years later, heightens illness vulnerability, and sharply raises recurrence odds in future pregnancies making vigilant monitoring and preconception counselling necessary.

PPD has become so common that Siddhi N Yadav, Consultant, Psychologist, Motherhood Hospitals, Kharghar, Navi Mumbai, said that they see 3-4 new mothers aged 25-35 visit with postpartum depression in a month.

However, not all cases of anger and irritation can be attributed to PPD. In some cases, it is just postpartum anxiety. But some people end up mixing the two. And while awareness about postpartum depression is increasing, discussions about maternal mental health are still limited and not detailed enough.

"Because of this, many people assume that all emotional difficulties after childbirth are postpartum depression. But in reality, conditions like postpartum anxiety and postpartum depression have different symptoms but they are often misunderstood or overlooked. Increasing open conversations and education can help mothers and families recognize these differences and seek timely support," Yadav said.

And contrary to the popular belief that PPD only happens soon after childbirth, Yadav clarified, that it can develop anytime within the first year after childbirth, including six months after delivery.

(Disclaimer: This content is for informational purposes only. Always seek the advice of a qualified medical practitioner with any questions about a medical condition. If you know someone who is suffering postpartum depression or any other mental health disorder, reach out to a psychologist immediately).