The baby is here.

And it should be the most magical time of your life.

You’ve waited 9 months or longer for this.

But, instead of joy, you may feel -

Vulnerable. Anxious. Grief. Sadness, or even rage.

For most mothers, the fourth trimester (the first 12 weeks after childbirth) can be an emotionally difficult adjustment period. With hormonal fluctuations, a lack of support, the mental load of motherhood and its’ expectations, this time can be incredibly taxing on a new mother. From baby blues to anxiety and even psychosis, the postpartum period can affect a mother’s mental health in many ways. Described below are a few maternal mental health conditions:

Postpartum (Baby) blues – Affects 1 in 4 mothers and is usually temporary. Symptoms include feeling tearful and irritable with mood swings. It begins a few days after delivery and should resolve within 2 weeks. It is managed with reassurance and supportive measures.

Postpartum depression – Symptoms include persistent sadness, loss of interest, fatigue and feelings of guilt, that can also affect daily functioning and relationships. It lasts longer than 2 weeks. It is managed through counselling and may also require medication.

Postpartum anxiety – Extremely common and symptoms include excessive worrying, intrusive thoughts, palpitations and constantly checking on the baby due to fear “something bad will happen”. It is managed with counselling and supportive measures.

Postpartum rage – Symptoms include anger, irritability and surges of frustration that can affect relationships.

Postpartum psychosis – An emergency affecting about 1-2 mothers per 1000 births and causes hallucinations, delusions and extreme agitations. It can result in self-harm and even harm to the baby. Needs immediate psychiatric intervention which requires a hospital stay in a mother-baby unit.

It is often believed that treatment for maternal mental health conditions requires the separation of mother and baby, but in fact it is encouraged that both mother and baby are kept together if there is no intent to harm the baby (even during postpartum psychosis), as this improves maternal and child bonding. Treatment is often a combination of psychological therapy and medication. Mothers are often at home when treated, and do not need to be relocated to new spaces.

Cultural stigma surrounding mental health and the societal expectations of mothers, often prevents new mothers from seeking medical help, due to the fear of judgement and criticism. This results in most mothers suffering silently, affecting not only their own wellbeing, but also the wellbeing of their baby and family.

Even though maternal mental health remains significantly overlooked in Sri Lanka, with gaps in early detection and referral, there are strategies that can help improve maternal mental health. These include:

1. Practicing self-care – prioritising rest, sleep, eating and taking a few minutes each day for yourself, is important for your mental health.

2. Finding your support networks – families and friends can be an important asset to help with childcare, reduce isolation and support you. Having practical and realistic discussions when pregnant or early in your postpartum journey about who can help you will help ease the mental load.

3. Ensure you and your partner are both aware of postpartum mental health signs and symptoms, so conditions can be identified and treated sooner.

4. Seeking professional help – Timely intervention is essential to effectively manage maternal mental health conditions. Speaking to a trained healthcare professional, even whilst still pregnant, can help you develop coping strategies and establish support pathways.

If you or someone you know is finding it difficult to navigate the fourth trimester, please get in touch with the following services:

• Public Health Midwives – midwives are now trained to assess perinatal mental health when visiting new mothers for their postpartum checks at home

• General practitioners can often be a first point of contact; they can refer if needed to psychologists/psychiatrists.

• Alokaya Counselling Centre at The Family Planning Association of Sri Lanka (+94112555455, 077 989 5252, No. 37/27, Bullers Lane, Colombo-07).