Who can say exactly where we derive our expectations for pregnancy? Maybe from our mothers, who talk about the first time they felt us kick in the womb; from our girlfriends, who complain about morning sickness and laugh over bizarre cravings; from the movies and magazines and Instagram posts that show mothers emerging from the pain of childbirth glowing and head over heels in love with their tiny new bundle of life.

However subconsciously, these stories and anecdotes influence our expectations for our own pregnancy and postpartum experiences. So much so, that when normal symptoms like hormonal shifts, swelling, bleeding gums, hemorrhoids and other less “polite” health issues occur, we think that there is something wrong with us.

Nowhere are these expectations more pervasive than in the postpartum time. The showers are over, the delivery is behind you, friends and family return to their own lives and leave you to enjoy what you’ve been conditioned to expect will be the happiest time of your life. And then suddenly, it isn’t.

Loneliness and desperation set in, and dark thoughts begin to swirl:

“I am hating every second of this, but I can’t tell anyone — they’ll think I’m crazy. I am crazy.”

“Isn’t this the baby I’ve always wanted? How can I complain now after trying so long for this?”

“Cleary, I am a terrible mother and I should never have become one in the first place.”

We haven’t heard this part of the story. If there is one thing that our society needs to address more openly, it is that motherhood is not all about the glow — not all sunshine and rainbows. It is filled with moments of self-doubt, worry, and stress. These are very real aspects of motherhood: they are not abnormal, and they are certainly not shameful.

In the first 24 hours after childbirth the body’s level of estrogen, which radically increases in pregnancy and is tied to serotonin production (the feel-good neurotransmitter in the brain), rapidly drops back down to its normal levels. This is similar to the smaller shifts in hormones affecting a woman’s moods before she gets her menstrual period. There is a dramatic shift in the amount of serotonin the new mother has in her brain, which leads to mood swings and other emotional stresses.

The single most important thing you can do at this time is to realize you are not alone. Find one trusted confidant. Someone who will hold your hand, listen while you rant, and embrace you as you cry. A friend, sibling, or another mother in the preschool pick-up line. You’ll know them by the following traits: they’re a good listener, non-judgmental, and most likely, if a mother themself, has felt this way at some point in the past too. Their promise to you: they know you for who you really are, they have your back, and if you need more help than they can offer, they will advocate to get you the help you need.

Another key part of handling this scary period of parenthood is managing expectations: know what is normal and what is not in the postpartum period.

Baby Blues

Many new mothers experience mood swings and weepiness during the first 2 weeks after giving birth. Mood swings are generally mild, and weepiness can come from joy as well as sadness. Symptoms might include:

  • Anxiety

  • Crying spells

  • Irritability

  • Loneliness

  • Loss of appetite

  • Restlessness

  • Sadness

  • Sudden mood swings

If symptoms last longer than 2 weeks, then an evaluation with your care provider is recommended to rule out a more serious mood disorder.

Postpartum Depression/Anxiety

Postpartum depression (PPD) is often mistaken for baby blues, but the signs and symptoms are more intense and last longer, eventually interfering with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin later, up to six months to one year after childbirth. About 10-15% of women report experiencing significant depression following childbirth, but these numbers only include reported incidents. Symptoms might include:

  • Anger or irritability

  • Anxiety/panic attacks

  • Appetite and sleep disturbance

  • Crying and sadness

  • Feelings of guilt, shame, or hopelessness

  • Lack of interest in the baby

  • Loss of interest, joy, or pleasure in things you used to enjoy

  • Possible thoughts of harming the baby or self

The Edinburgh Postnatal Depression Scale is a 10-item questionnaire that is used for self-assessment, to help identify women who have PPD. On this scale, a score of 12 or greater raises concern and indicates a need for more thorough evaluation by a healthcare professional. An affirmative answer on question 10 (presence of suicidal thoughts), requires immediate attention by your healthcare provider or by calling the National Suicide Prevention Hotline at 1-800-273-8255.

Postpartum Psychosis

This very rare condition occurs after 1-2 out of every 1000 of births (.1-.2%). The onset is usually sudden, most often within the first 4 weeks postpartum. Symptoms include:

  • Decreased need for or inability to sleep

  • Delusions or strange beliefs

  • Difficulty communicating at times

  • Intense irritation

  • Hallucinations (seeing or hearing things that aren’t there)

  • Hyperactivity

  • Obsessive thoughts about the baby

  • Paranoia and suspiciousness

  • Rapid mood swings

In order to keep you and your baby safe, these symptoms require an immediate call for help.

In an emergency dial 9-1-1 (in the U.S.) or call the National Suicide Prevention Hotline: 1-800-273-8255, available 24 hours every day.