It was 1991, and I was a young postgraduate trainee in Obstetrics and Gynaecology at Sree Avittom Thirunal (SAT) Hospital in Thiruvananthapuram — a place that anyone who has trained there will remember for its sheer, overwhelming volume. SAT was (and still is) one of India’s busiest maternity hospitals, a tertiary referral centre where nearly 14,000 babies are born each year. That meant 35 to 40 births every single day, managed by a handful of junior doctors, a few postgraduate trainees like me, and a small team of senior clinicians doing their best to hold the system together. It was a place where you learned extraordinary clinical and surgical skills, but also a place where patient safety could feel frighteningly fragile.
One morning, after a long night shift, I walked back towards the maternity building to start my day's duty. The old building had wide windows without doors on the first floor, opening directly onto a narrow parapet. As I approached, something unusual caught my eye: a woman in a saree climbing out of one of those windows.
From the ground, I could see her clearly. She stood on the parapet, motionless, for a few seconds that felt strangely suspended in time but was probably only a few seconds. Confusion turned quickly into dread. Before I could react, she stepped forward and vanished from sight.
For your daily dose of medical news and updates, visit: HEALTH
I ran. A fall from that height can be fatal, and my mind raced ahead of my feet. Construction work was underway outside, and a large mound of soil blocked my view of where she had landed. When I reached her, I realised — with overwhelming relief — that she had fallen onto a smaller heap of loose soil. She was alive. Apart from a fractured leg and a few abrasions, she had survived what should have been a deadly jump.
She had delivered her baby just 36 hours earlier. In the fog of exhaustion and emotional upheaval, she had slipped into severe postnatal depression — and in that moment, saw no way out — a condition that, even today, remains under‑recognised and under‑discussed.
Postnatal depression affects far more women than we acknowledge, yet it remains wrapped in silence, stigma and misunderstanding. This article explores why it happens, how to recognise it, and why early support can change the trajectory for both mother and baby.
Amazing experience of childbirth – Not for all
The early weeks after childbirth are often idealised as a time of joy, bonding and celebration. For many families, this is true. But for a significant number of women, the postpartum period is a complex mix of wonder, exhaustion, physical recovery and emotional upheaval. The body is healing, sleep is disrupted, and the responsibility of caring for a newborn can feel overwhelming.
Across cultures, postpartum care varies widely — from structured confinement practices to almost no support at all. Yet one truth is universal: every woman’s emotional journey after birth is deeply individual. Despite the expectation that motherhood should feel instantly blissful, up to one in five women experience depression or anxiety during pregnancy or in the first year after birth.
The emotional rollercoaster
Hormonal shifts in the first few days after delivery can trigger the “baby blues,” affecting around 80% of new mothers. Mood swings, tearfulness, irritability and anxiety typically peak between days three and five and settle within two weeks.
When symptoms persist or intensify, they may signal something more serious
Birth does not always unfold as planned. A difficult labour, emergency interventions or feeling unheard during the birthing process can leave emotional scars. For some women, this leads to birth‑related trauma, which can contribute to postnatal depression, anxiety or even post‑traumatic stress symptoms. “Birth trauma” has become a hot topic in both the Australian and British media, with much of the public debate centred on finger‑pointing at care providers, particularly obstetricians.
Admitting that motherhood feels overwhelming can be difficult. Many women fear judgement or worry they will be seen as “failing.” Yet seeking help early is one of the most protective steps a woman can take for herself and her baby.
What is postnatal depression?
Depression is more than sadness or tiredness. It is a medical condition that can range from mild to severe and can affect a woman’s ability to care for herself and her child. Symptoms lasting more than two weeks may include persistent sadness, loss of interest, irritability, difficulty concentrating, low motivation, changes in sleep or appetite, low energy and reduced bonding with the baby.
Risk factors include a history of depression, inadequate support, major life stresses, family violence or unresolved trauma. Medical conditions such as thyroid disorders or anaemia can also contribute, making professional assessment important.
A very small number of women may develop postpartum psychosis — a rare but serious condition involving hallucinations, delusions or severe confusion — requiring urgent medical attention.
What about anxiety?
Anxiety is equally common and often co‑exists with depression. It may present as constant worry about the baby, intrusive thoughts, panic attacks or compulsive checking. Women with a history of anxiety may be particularly vulnerable.
How is a diagnosis made
Healthcare professionals may use tools such as the Edinburgh Postnatal Depression Scale (EPDS). Assessment includes discussing emotional well-being, reviewing symptoms, exploring personal or family history, assessing support systems and performing relevant physical checks or blood tests.
How to treat depression?
Treatment depends on severity. Mild symptoms may improve with increased support, rest and lifestyle adjustments. Psychological therapies such as Cognitive Behavioural Therapy (CBT) or Interpersonal Therapy (IPT) are highly effective. Medication may be recommended in some cases, with careful discussion about risks and benefits during pregnancy or breastfeeding. For many women, the risk of untreated depression is greater than the risk of appropriate medication.
Culturally sensitive care is essential, ensuring support aligns with a woman’s values, family structure and community context.
Will it happen again?
Women who have had postnatal depression once have about a 50% chance of recurrence in a future pregnancy. However, awareness, early planning and proactive support can significantly reduce this risk.
Postnatal depression is not a sign of weakness, failure or poor parenting. It is a medical condition — common, treatable and deserving compassion. The most important step is reaching out. When women feel seen, heard and supported, recovery becomes not only possible but likely. And in supporting mothers, we support the well-being of the entire family.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
