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Mental health changes after childbirth: how can the family help?

Alanoud AlturkiMedical review: Tatmeen team11 min read
امرأة تحمل رضيعًا وتضع يدها على جبينها، وخلفها ظلال نساء وسحب داكنة يسارًا وزهور وضوء يمينًا.
Article contents
  1. When to seek urgent assessment
  2. Who stays with the mother, and who cares for the baby?
  3. What about sadness, anxiety and unwanted thoughts?
  4. What should you tell the doctor?
  5. Questions about treatment and the baby’s care
  6. Support you can sustain
  7. Frequently Asked Questions
  8. Sources and references
  9. Writer and reviewer

Your first observation may be, “She doesn’t seem like herself.” She cries often, cannot settle, or speaks and behaves differently. Listen to how she feels, then tell the doctor what has changed and when it began. The help she needs depends on the severity of the change and whether she can eat, drink and care for herself and her baby. You do not need to know the name of a condition before seeking care.

When to seek urgent assessment

Sudden confusion or a severe change in reality awareness or activity

If she suddenly becomes confused or disoriented, go to the emergency department now. Someone else should drive and a safe, capable person should accompany her; if you cannot keep everyone safe or get there safely, call an ambulance on 997 in Saudi Arabia. Do not wait to work out whether the cause is psychiatric12.

Seek medical and mental health assessment immediately if, after childbirth, she hears or sees things that others do not, develops unusual fixed beliefs that do not fit reality, or becomes very active while sleeping very little and feeling she does not need sleep. These changes may be signs of postpartum psychosis1, a medical emergency that can worsen quickly5. Call her doctor or care team now to request an urgent assessment today2; if you cannot obtain one promptly, go to the emergency department. Do not wait for her to say she is unwell or intends to cause harm, or for her to have a previous diagnosis. A brief period of calm after these changes does not remove the need for urgent assessment.

Immediate danger, serious injury or poisoning

Call an ambulance on 997 in Saudi Arabia if the mother, baby or anyone else is in immediate danger, or if you cannot keep them safe or transport her safely. Also call an ambulance for any of the following that happened recently and has not yet been medically assessed: a suicide attempt7, an overdose or poisoning6, or a serious injury11 to the mother or baby. If you suspect that the mother or baby has swallowed an overdose or a harmful substance and has not been medically assessed, call an ambulance8. Do not wait to confirm what happened or for symptoms to appear.

Talk of death or self-harm

If she says she is thinking of ending her life now, go to the emergency department immediately, even without a plan. Stay with her if it is safe; call an ambulance on 9978 if there is immediate danger or you cannot reach care safely. A wish to die or not wake up, or other thoughts of self-harm, needs urgent professional assessment today13; if this is unavailable promptly, go to the emergency department. Do not use the absence of a plan or her saying she is fine as a reason to delay assessment.

Unable to care for herself or the baby

If her condition leaves her unable to meet basic needs, such as eating and drinking, or to care for her baby, seek urgent assessment today4 and arrange help with their care. Hallucinations or an intention to cause harm are not required. If assessment is unavailable promptly, go to the emergency department; call an ambulance8 if safety cannot be maintained.

When everyone is safe and you need guidance

In Saudi Arabia, when everyone is safe and you need medical advice or guidance on where to obtain care, you can call the Ministry of Health’s 937 service. Doctors provide medical consultations around the clock9. Do not delay emergency care to make this call.

Who stays with the mother, and who cares for the baby?

While arranging urgent assessment, if two safe, capable adults are available, one can care for the baby and the other stay with the mother, as long as it is safe. During confusion or a severe change, do not leave her with sole responsibility for the baby while she waits for help. If you are the only person helping, say so when you call: “I’m here alone with her and the baby. We need help with transport and care.” Tell the medical team who is looking after the baby and what you cannot provide. Do not wait to find a companion or help at home before seeking care. If safety or safe transport cannot be maintained, call an ambulance8.

If she can travel safely, someone else should drive and a person able to help her should accompany her. If she cannot take part in the conversation or refuses to go while showing the urgent changes described above, call the medical service3, explain what is happening and ask for help. Do not try to restrain her or transport her by force yourselves. If staying puts you in danger, move to a safe place and call emergency services. For threats or violence, you can call the security patrols8 on 999 in Saudi Arabia.

Speak calmly and keep the number of people gathered around her small. You might say, “I can see you’re frightened. I’m going to get medical help, and I’ll stay with you as long as it’s safe.” You do not need to settle whether everything she says is true or have a lengthy argument before seeking assessment1.

What about sadness, anxiety and unwanted thoughts?

Mild mood swings, crying or anxiety can appear in the first few days and improve within days. This is known as the baby blues. Help her rest, eat and share the baby’s care, and listen to how she feels. If the distress persists, worsens, becomes severe or disrupts her life, help her contact a doctor for assessment. Do not wait two weeks if symptoms are severe or getting worse. Persistent sadness, loss of pleasure2, hopelessness or overwhelming anxiety may need treatment; they are not a measure of her love for her baby or her ability as a mother.

She may have upsetting thoughts or images that she does not want, feel frightened by them, or avoid tasks because of them. An unwanted intrusive thought is not, by itself, a wish or intention to act on it. Such thoughts can occur with obsessive-compulsive disorder (OCD). Listen without blame to what she describes and what she does afterwards, and encourage her to tell the doctor. These details help the professional distinguish OCD from depression, psychosis4 and other conditions. Being upset by a thought is not enough on its own to establish safety or decide what care she needs. If there is an intention to cause harm, dangerous behaviour or an inability to maintain safety, seek urgent help as described above.

In non-emergency situations, ask what would help her obtain care: booking the appointment together, accompanying her if she wants, or caring for the baby during the appointment. Agree with her on who will take part in the conversation and what she wants to discuss. She can start with a primary care doctor or the doctor following her after childbirth, who can assess the situation and guide her towards appropriate care2.

What should you tell the doctor?

Describe what you have actually noticed, when it started and how it differs from her usual behaviour3. Listen to her account too. For example, say, “She couldn’t sleep even when we took care of the baby, and she’s speaking much faster than usual,” rather than simply, “She’s tired after giving birth.” If something is unclear, say that you do not know. Tell the team about current medicines, recent changes5 and any previous illness or treatment you know about.

You can copy this short note for a call or appointment. Write only what you know; do not delay asking for help to complete it:

Note for the medical team

  • Date the baby was born, baby’s age, and when the change began:
  • What we have noticed, and the mother’s own account:
  • Sleep when rest is possible, eating, drinking and self-care:
  • Medicines or recent changes, and any treatment history we know:
  • Mother’s and baby’s safety now, who is caring for the baby, and what we cannot provide safely:
  • Any previous assessment, and what has changed since then:

If she has already been assessed but then gets worse or develops new symptoms, ask for reassessment5 rather than relying on earlier reassurance. Explain what has changed. Use emergency care when the urgent situations at the start of this article arise.

Questions about treatment and the baby’s care

Postpartum psychosis is usually treated in hospital1. Ask the team about the actual plan for the mother and baby and who you can contact. Do not assume that accommodation or arrangements for the baby’s care are the same in every hospital. Treatment for depression2 or OCD depends on the assessment and may include psychological therapy, medicine or both4.

Together with her, you can ask:

  • What treatment is proposed, and what effects should we watch for? Who should we contact if she gets worse?
  • How can we arrange the baby’s care, sleep and follow-up? What help will be needed when she comes home?
  • Is this particular medicine suitable for breastfeeding and this baby’s health? Could it affect her alertness or ability to care for the baby?
  • If breastfeeding is not possible or she chooses another feeding method, how can we arrange the baby’s feeds and support her?
  • When is the next review, and how can she take part in decisions3 and ask questions when she is able to?

Some medicines can be used while breastfeeding2, but the decision is individual5 and made with the doctor, taking the medicine and the mother’s and baby’s health into account. Do not stop or change her medicine yourselves. Breastfeeding should not be a condition for receiving treatment4 or a test of whether she is a good mother.

Support you can sustain

Offer specific help you can sustain: preparing a meal, looking after the baby at an agreed time, taking her to follow-up, or arranging visits so she can rest1. “I can prepare dinner this evening. Would that help?” is easier to act on than “Ask us for anything.” Check what she prefers, agree who will take responsibility, and review the arrangement as she improves. Everyday support makes rest and access to care possible, but it does not replace assessment and treatment2.

Recovery is possible1, and she may need time and support after the severe symptoms settle. Share the responsibility and seek support for yourselves3 if worry or lack of sleep is wearing you down. One person does not have to carry the mother’s and baby’s care all the time.

Frequently Asked Questions

Is it normal to cry and feel anxious in the first days after giving birth?

Mild mood swings, crying or anxiety can appear in the first few days and improve within days; this is known as the baby blues. Help her rest, eat and share the baby’s care, and listen to how she feels. If the distress persists, worsens, becomes severe or disrupts her life, help her contact a doctor for assessment. Do not wait two weeks if symptoms are severe or getting worse.

What are the signs of postpartum psychosis?

Signs may include hearing or seeing things that others do not, unusual fixed beliefs that do not fit reality, or becoming very active while sleeping very little and feeling no need for sleep. Postpartum psychosis is a medical emergency that can worsen quickly. Call her doctor or care team now to request an urgent assessment today; if you cannot obtain one promptly, go to the emergency department. Do not wait for her to say she is unwell or intends harm, or for a previous diagnosis. A brief calm does not remove the need for urgent assessment.

Meanwhile, do not leave her solely responsible for the baby. Someone else should drive, with a capable companion; call an ambulance on 997 if safety or safe transport cannot be maintained.

What should we do if a new mother talks about ending her life?

If she says she is thinking of ending her life now, go to the emergency department immediately, even without a plan. Stay with her if it is safe, and call an ambulance on 997 if there is immediate danger or you cannot reach care safely. If she can travel safely, someone else should drive and a capable person should accompany her. A wish to die or not wake up, or other thoughts of self-harm, needs urgent professional assessment today; if this is unavailable promptly, go to the emergency department. Do not let the absence of a plan, or her saying she is fine, delay assessment.

Do unwanted thoughts after birth mean a mother wants to act on them?

An unwanted intrusive thought is not, by itself, a wish or intention to act on it, and such thoughts can occur with OCD. Listen without blame to what she describes and does afterwards, and encourage her to tell the doctor; these details help distinguish OCD from depression, psychosis and other conditions. Being upset by a thought is not enough on its own to establish safety. If there is an intention to cause harm, dangerous behaviour or an inability to maintain safety, seek urgent help.

How can family support a mother's mental health after childbirth?

Offer specific help you can sustain: preparing a meal, looking after the baby at an agreed time, taking her to follow-up, or arranging visits so she can rest. Check what she prefers, agree who will take responsibility, and review the arrangement as she improves. In non-emergency situations, you can help her obtain care by booking the appointment together or accompanying her if she wants. Everyday support makes rest possible, but it does not replace assessment and treatment.

Writing and article review

Alanoud AlturkiWritten byAlanoud Alturki

Content writer and researcher at Tatmeen, writing in Arabic and English on mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

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