Could My Wife Have Postpartum Depression? What Dads Can Do to Support Their Partner
Nearly 20% of women suffer from postpartum depression (PPD), a mental health condition that affects the whole family. In my clinic I see many new fathers whose primary concern is the mental health of their partner. They want to better understand and support their partner, as well as address their own stress and concerns. Dads who have a partner with PPD are also at an increased risk of experiencing their own depressive symptoms or a depressive episode. When dads are equipped with information about PPD, they are more effective in looking after their family.
What is Postpartum Depression?
Major Depressive Disorder (MDD) is a mental health condition with recurring episodes of depression that meets specific criteria. People can experience brief periods of sadness or “depressed mood” without having MDD, in the same way you might experience an occasional headache without having a migraine disorder. An episode of MDD affects the brain and body in many ways. In addition to not feeling in control of our emotions, reducing our frustration tolerance and experiencing less pleasure in life, there are also changes to our sleep, appetite, energy level, concentration, and our thoughts about ourselves and our future. Postpartum Depression is defined as having an episode of MDD that begins within the first 4-weeks after having a baby.*
*The term Perinatal Depression is now more commonly used which refers to the onset of depression anytime during pregnancy and up to 1-year after delivery.
How does Postpartum Depression develop?
Research shows that up to 1 in 5 women experience postpartum depression; with 40% of these women being diagnosed with MDD for the first time after birth. There are several biological, psychological, and social changes and stressors that increase the risk of developing depression. Changes in brain biology include hormonal changes and metabolic shifts from pregnancy to the postpartum state, as well as sleep deprivation and energy depletion. Psychologically, one experiences change in identity, the formation of new relationships with one’s child and with one’s partner now as co-parents, and several emotions including but not limited to joy, fear, worry and even grief with the loss of our pre-parent life.
Socially, one becomes responsible for a new person, while also continuing to manage other stressors including family, friends, home, finances and perhaps a later return to work. As stress levels go up, the time, energy and opportunity to cope with this stress goes down. Other risk factors include history of a mental health condition, a difficult marital relationship, and other demographic factors.
Even in the absence of these risk factors or stressors a woman can be diagnosed and suffer with Postpartum Depression (PPD). As with most medical conditions, PPD can also spontaneously occur even when everything around us seems to be going well. And at the same time, mothers can be under a lot of change and stress and not develop PPD.
How long does an episode of Postpartum Depression last?
Following the onset of PPD, the average length of an episode is 2 to 6 months however, for some it can last more than a year. The length of an episode can depend on several factors including recognition that one is suffering from PPD, the time it takes to seek support and help, the ability to make changes to reduce stress and improve self care, and the ability to follow through with a doctor’s recommendations and treatment. Another important factor that often gets overlooked but has been shown to be associated with prolonged PPD in mothers is untreated depression in their partners, us dads.
What is the impact of Postpartum Depression on the family?
Postpartum Depression affects the whole family. It causes suffering in mothers, and it can cause strain on their relationships with their partner and their child. All mental health conditions affect our brain biology and the way our brain functions: our emotions, thoughts and behaviours. This has an impact on our relationships and the way we interact with our environment. If PPD causes someone to have reduced appetite, poor sleep, impaired concentration and lower energy; makes them feel sad, irritable, with limited moments of pleasure, and leads to more negative thoughts and increased avoidance, then you can see how that might affect their relationships. Depression in either parent has been associated with increased risk of mental health, behavioural, cognitive and social concerns in children as they develop. Treating and recovering from PPD; however, has been shown to reverse the potential negative impact of PPD and contribute to greater understanding of each other, improved relationships and overall resiliency. Therefore it is important to be aware of the PPD, especially given how prevalent it is, to take it seriously, and to ask for help. It is also important that in the case of PPD, the whole family is supported.
What are the early signs of Postpartum Depression?
Given the high prevalence of PPD and the reality that pregnancy and parenting change our brain biology, I think it is important to be aware in advance that this period in our lives will be stressful. How we manage the stress as parents and as a co-parent team will depend on several individual and relationship factors. As mentioned above, if someone has a history of a mental health condition such as Major Depressive Disorder prior to delivery, then they have an increased risk of experiencing symptoms or a relapse in the postpartum period. If a person identifies as having maladaptive coping strategies such as avoidance, blaming or substance use, then this may be exacerbated under future stressful periods. The quality of the relationship as partners including level of satisfaction, communication skills and time spent together can also predict the nature of the relationship as co-parents.
Given that the postpartum period and parenting changes our brain biology we are likely to experience changes in how we think, feel and behave. Not everyone will experience changes that lead to postpartum depression. Many mothers continue to feel in control of their emotions, and can adapt to these biological changes to preserve their health. Some women will identify with what is called “Baby Blues”, a postpartum experience associated with mild and transient symptoms of emotional lability that usually starts in the first few days after birth and resolves spontaneously within 2 weeks. Typical features of Baby Blues are tearfulness, mood swings, emotional sensitivity, anxiety and feeling overwhelmed. Baby Blues differ from PPD because the Blues are mild, transient and don’t cause functional impairment. If the Baby Blues progress or last more than 2 weeks, then PPD should be considered.
PPD requires 5 or more symptoms of a Major Depressive Episode. Not all 5 symptoms may begin at once. Early signs of PPD include the development of some of these symptoms which could present in a number of ways.
It is also quite possible that a partner or family member notices changes in mom’s behaviour before the mother notices changes in her thoughts and feelings. She may seem out of character from her usual self. The presence of early signs does not mean that PPD will absolutely develop; however, it is an indication to discuss your concerns and provide support.
Early signs can include:
She seems more irritable or short-tempered than usual — snapping at her partner, older children, or family over small things.
She is unusually anxious or hypervigilant about the baby — repeatedly checking breathing, feeding, temperature, sleep, or needing constant reassurance.
She cannot relax even when someone else is caring for the baby.
She is exhausted but still cannot sleep when given the opportunity.
She starts withdrawing — stops answering texts, declines visitors, avoids friends, or no longer wants to leave the house.
She stops enjoying things she normally likes, even briefly.
She becomes unusually self-critical: “I’m doing everything wrong,” “I’m a bad mother,” “Everyone else seems better at this.”
Small decisions become overwhelming — what to feed the baby, whether to go out, what to wear, when to shower.
She seems emotionally flat or “not herself.” A partner may describe her as distant, robotic, disconnected, or simply different.
She cries much more easily, sometimes without being able to explain why.
She becomes more controlling or perfectionistic around routines, feeding, sleep, cleaning, or visitors.
She neglects herself — not eating, showering, changing clothes, taking medications, or attending appointments.
She talks about wanting to escape, wanting to be alone, wishing she could “just disappear,” or saying motherhood feels like a mistake.
One particularly useful observation from partners is: “She technically can do everything, but everything seems to take enormous effort.” Many women with early postpartum depression remain highly functional externally, so the change may initially be visible only to someone who knows them quite well.
Partners also sometimes notice anger before sadness. Postpartum depression can present as irritability, resentment, agitation, or rage rather than stereotypical tearfulness.
WHAT DADS CAN DO TO SUPPORT THEIR PARTNER
There are many ways to support your partner; here are some that I often emphasize especially in the context of co-parenting and when your partner may be suffering from postpartum depression.
Learn about changes in the brain that occur in the postpartum period.
Take a moment to read and reflect on some of the brain changes that occur in how we think, feel and behave once we become parents. Even more changes occur in the brains of mothers than they do for fathers; as our brain changes as well (Darby Saxbe, Dad Brain). Understanding that so much is going on inside our heads can help us appreciate that behaviour and “personality” changes we see in our partners are in response to these changes (hormonal, new and complicated feelings, relational, etc).
Unfortunately, no mother is immune to postpartum depression and to know that this is a possibility for every family makes it easier to talk about it and respond in the event of early warning signs.
Be present.
As much as possible, be present. Be there to observe and witness how your partner is adjusting and responding to parenthood. Notice them during vulnerable periods like breastfeeding, putting the child to sleep, tending to the child in the middle of the night, and soothing the child when unconsolable. It may feel redundant to have two parents present when there are so many other tasks to do and she is the primary parent in that moment, but being present and observant helps you better understand and appreciate how the brain changes and all that she is doing.
Be curious and ask how she is doing.
Be curious and open to the possibility that your partner may be experiencing stress as a parent. Ask them how they are feeling and what changes they have noticed in their own emotions, thoughts and behaviours since becoming a parent. Ask them how they are coping with any stress.
“I’ve learned that so much changes in the brain when we become parents, how have your thoughts and feelings changed since giving birth? What parts do you find very stressful? How have you coped with this stress?”
Express gratitude, love and appreciation.
Parenting is hard work. So is going to work and providing family income, but it is worth repeating: parenting is hard work. Any work is tough if we are unsure if we are doing it right, if the person we spend the day with doesn’t seem to be listening, talking back, or acknowledging what we are doing, and when progress is very slow. It is a basic human need to feel like we matter and to be appreciated. It can be
difficult to express appreciation to our partner if we don’t feel appreciated by them. It can also feel a bit unnatural to thank our partner for fundamental parenting tasks such as (breast)feeding and caring for our child. All that being said, without our partners looking after our child, we would be stuck with continuous and very difficult work. Therefore, I strongly encourage dads to openly express their appreciation and love to their partner for all that they do in raising their child. Someone has to begin to fill the gratitude bucket of the other and I believe that the parent who works outside the home is responsible to initiate this task.
Help but don’t ask, “What can I do?”
Of course it is ok to periodically ask the question, “How can I help? What would you like me to do?” but in many ways, being helpful is noticing what needs to be done and doing it. Offering to help and asking what needs to be done is putting your partner in the role of manager and being responsible of keeping track and delegating tasks. This can be exhausting and is one component of what is often referred to as “cognitive” or “invisible” labour.
At the same time, just doing things and doing them your way can cause some temporary friction especially if your partner prioritizes tasks in their mind in a different order or prefers to do things a certain way. This type of friction is inevitable; however, don’t let it erode your confidence and competence in doing things. Taking a moment to communicate what you notice needs to be done and how you are going to do it can be reassuring or an opportunity to clarify each other's expectations and ultimately be most helpful in the long run. It is often easier to edit something than to begin from scratch so let her edit your plans rather than tell you what to do. For example, which of these do you think would be most helpful to say to your partner while they are rocking your child to sleep?
(A) “Hey, what would you like me to do?”
Or
(B) “Hey, I noticed that there are pump supplies and bottles next to the sink, as well as nothing really interesting to eat for supper. I was going to wash this stuff and then run out to grab us something to eat, how does that sound?
Parent.
Defining dad's role as a parent starts with our own childhood experience up to the expectations of today. There is a great degree of variability in the role of father involvement based on culture and family needs. I do believe that spending time with our children as a supportive or primary parent is what ultimately leads to the beneficial change within ourselves as fathers.
In the context of being supportive to our partner especially if they are struggling with postpartum depression, dads need to play a larger role as a primary parent.
Dads have proven time and time again, to be great adapters when it comes to parenting and stepping up when it matters most. Dads are capable of taking on all of the tasks of parenting and being a primary parent on their own or as a co-parent team with their partner. If their partner is struggling with postpartum depression, fathers may experience some challenging interactions with their partner however they must not avoid the situation nor parenting, and rather face parenting head on to ultimately support their family.
Provide opportunities for her to focus on self-care (and don’t get upset when she declines).
As more and more dads take on all aspects of parenting and feel confident and comfortable being completely alone with their child, there are more opportunities for moms to step away and focus on themselves. When dads have an opportunity to leave the house to go to work, run an errand, or exercise, it is often easier for them to turn the parenting dial down and transition to a self-focused task. Moms on the other hand, may have more difficulty leaving the house even when they trust their partner will be fine. It is important to create opportunities for moms to focus on themselves without getting too caught up on how mom spends that time. Perhaps initially she won’t want to leave the room or go upstairs, or won’t follow your suggestion to take a nap, go outside, or return to her yoga. Maybe you will find her folding laundry or scrolling on her phone and you wish she was doing something else with her time. I would suggest resisting the urge to comment or suggest what she does, and rather just focus on continuing to create these opportunities even if she doesn’t make the most of them, initially. Of course, if you become concerned about a particular pattern and are worried about her, you can explore this with her and discuss further.
Ensure she gets sufficient sleep, nutrition and movement.
Some of the ingredients for maintaining or reestablishing mental wellness are adequate sleep, healthy nutrition and physical movement. Helping your partner achieve this may include purchasing and preparing the right food, taking on tasks during the day or in the middle of the night, and going for walks together. The possibilities are endless and some may be unique to your family’s circumstance. I encourage dads to speak to their partner about how these three elements have changed for her since birth and discuss strategies to work together to improve any one of these areas. For some mothers with postpartum depression it is essential that they sleep through the night. This can be disruptive to what your family may have imagined in terms of plans for infant feeding. Discuss this together and with your doctor, if needed.
Do some things “her way” and some things “your way”.
A baby often arrives when there are many other things going on in a couple's life. Not only that, but stressors that may have been previously avoided, such as financial concerns, issues with in-laws and future planning, now become more prominent. All that being said, there is much less time to deal with sorting out life at this moment. Given this challenge, when partners parent differently, it can be particularly straining. Differences can be with values, attitude, approach, or the sequence of events to get something done. Inevitably, she may want to do it one way, and you may want to do things another way. There are likely many different ways to dress a baby, for instance. As long as it is done safely (i.e. clothing appropriate for the temperature) it is probably good for the baby to have two parents who are confident and competent in what they’re doing, as opposed to one being competent and the other feeling criticized. Team parenting is ideal. To minimize stress I encourage dads to understand and approach some aspects the way their partner would, and to also find other tasks that they can do their way.
“I know this is how you do this and that this approach works well. I can do that too. I also want to try doing this my way. We can both learn from our mistakes. In the end it will be good for the baby, for me and for you if I am able to figure out what works best for me.”
Validate. Don’t jump to problem solving.
In an ideal world, communication between two people would start with letting the other person know what you expect from them in response to what you are about to say. Two of the most common requests are (1) just to listen and (2) provide me with a solution. Without being reminded that our partner wants us just to listen and understand what they are feeling/thinking (1), most of us have a tendency to jump to fixing the problem (2). This approach can sometimes backfire, especially when we assume too quickly what the problem is. More often the problem is not that a person is upset, sad or anxious, or what may have contributed to them feeling this way, but rather that they feel alone with these thoughts or feelings. By simply listening and responding in a way that makes them feel understood, they begin to feel less alone, and ironically we will have achieved both (1) and (2).
It’s Okay to be “Wrong”.
It takes both courage and curiosity to get perspective sharing right. When two people sit down (or stand) and exchange their differing perspectives, someone has to be the first person to be curious about the other’s perspective. This can be challenging when the other person’s perspective includes accusations about something we did or didn’t do that upset them. Naturally, we want to explain or defend ourselves when we hear this - we want to jump in and share our perspective. We want to clarify where we think we are right, not wrong. If we start to share our perspective without fully hearing and understanding the perspective of our partner then the goal of understanding perspectives is overridden by the goal of trying to be right, not wrong. It’s ok to be wrong. It’s ok to listen to the perspective of another person which includes their thoughts and feelings about what happened. Even if those thoughts are inaccurate based on your perspective or even what a third-party may have noticed, what is most critical and accurate is your partner’s feelings about the situation. She may be focused on the impact of what has happened to her, even if your previous actions were intended for something else. Understanding the impact is what matters most. Being wrong is totally okay.
The magic with perspective sharing is that once a person feels that their perspective is understood by someone else, they too become much more curious in now understanding the other’s perspective. If we can avoid defending ourselves and focus on understanding the other person as much as possible, we will eventually have our chance to share our perspective to someone who is also curious about what we think and feel.
In the context of Postpartum Depression I encourage Dads to be listeners first and perspective sharers second. Also, be mindful that the capacity for our partner to be curious and capable to understand our perspective may be compromised due to the depression and to take this into consideration and be patient.
Ask others for direct help.
When a nuclear family is created I encourage couples to examine the direction of support and be open to more support coming in rather than going out. Many of us who look out for others in our lives intend to continue doing so even after becoming parents. We want to remain helpful to our extended family, friends and colleagues. New parents are permitted to put a pause on helping others and rather request help for themselves. Acknowledging this can be difficult, even when many offer support. When moms suffer from postpartum depression extra help may be required. I encourage dads to share or take on this responsibility in requesting help. Dads can call their own parents or their in-laws and request their presence. You can ask a friend to bring over supper, you can explore getting some part-time paid help for household cleaning. It might be helpful just to have some company for our partners not to be home all day alone with our child.
Dads might also need help from their employer, for example, permission to be more flexible in working hours or to work from home.
Sometimes, extra help means asking for money to assist with managing or reducing the stress of this vulnerable period. At a time when we expect to manage everything on our own and yet potentially feel most self-critical, asking our family for financial support can feel incredibly burdensome and shameful; however, in the end, this type of assistance has made all the difference for some families.
Have a difficult conversation about her mental health.
For some couples, it can be difficult to talk about mental health, whether it is concerns about your own wellbeing or that of your partners. Hopefully for many couples, they have a shared understanding that mental health is a major component of overall health and that we are all vulnerable to feeling unwell at times. Ideally we are also aware that our mental health affects our behaviour and our relationships and that sometimes our partner will notice changes in our character before we fully appreciate it and are open to talking about them. For other couples, this can be a difficult conversation, especially if we are vulnerable to feeling guilty about our behaviour or shame about ourselves, if we have done something we perceive as wrong.
When dads begin to notice a departure in the mental wellbeing of their partner it can be important to discuss this concern. I suggest preparing for this conversation by collecting your thoughts and writing them down if necessary. Think of an ideal time to have this conversation and ask your partner if it is okay to share with her some of your concerns before speaking about them. Feel free to examine and share some of your own thoughts and feelings and invite her to share what they may have noticed change in you. If you have noticed behavioural change speak about it in the context of underlying emotional changes. For instance:
“I’ve noticed a change in your behaviour, that you have been more withdrawn…or more irritable…or haven’t been able to look after yourself the way you normally do…and I’m wondering if you’re feeling more upset, sad or anxious?...Given that this has been going on now for over a few weeks do you think it’s possible you might have postpartum depression?”
Remember to be curious about their perspective and to address the possibility of her feeling alone with her thoughts and feelings before trying to solve other problems. Once loneliness is addressed other clear problems (such as not sleeping well) may arise and solutions can be explored.
Sometimes the conversation leads to involving others to get additional help, support or mental health care. Ideally, both of you recognize this next step and are in agreement to involving others, which sometimes requires sharing these mental health concerns with family or a primary care provider. It is a trickier situation when only one of you want to inform and involve others and the other person does not. Further thought and conversation has to be done here especially if the wellbeing and safety of the entire family is concerned.
Seek professional mental health support.
Knowing for sure whether or not your partner is suffering from postpartum depression, an adjustment disorder, or another mental health condition, requires an assessment by a primary care provider or a mental health clinician. Nurse Practitioners, Family Doctors, Psychiatrists along with some psychotherapists, have been trained to screen and assess for postpartum depression. Even obstetricians and paediatricians may inquire about mom’s mental health during routine physical appointments. It is important to be honest when asked questions about your mental health. Some health professionals may not be equipped to treat postpartum depression but they can all refer your family to someone who can.
Self-screening using online tools and websites may validate or highlight some of your concerns, but one should err on the side of caution and seek medical attention to address mental health concerns more accurately.
In some cases dads are invited to participate in mom’s mental health care, such as joining for part of the assessment, providing collateral information or being part of the treatment plan. I encourage couples whenever possible to both participate in such meetings.
Seek urgent or emergent medical attention.
In some cases, postpartum depression requires urgent or emergent medical attention. It can be difficult to find urgent care (I would start by calling a current member of your health care team) and therefore both urgent and emergent situations may end up in a hospital emergency room. That’s okay. Emergency phone numbers available at anytime include 9-8-8 (suicide help line) and 9-1-1.
An episode of depression can become more acute and serious based on a number of red warning signs, such as, but not limited to the following:
Ongoing deterioration and worsening of symptoms
Functional impairment
Not getting better despite following a treatment plan
Sudden change in symptoms
Not feeling in control of one’s mind or thoughts
Distortion in reality and having disturbances (hallucinations, ideas) that others do not view as real
Worsening thoughts including thoughts of hopelessness, worthlessness, death or suicide
Thoughts and/or urges of self harm, suicide, or harm to others including children
Dads have a protective instinct within them and sometimes this means addressing mental health concerns promptly in order to help their partner feel better and ensure everyone is safe. For some, seeking medical attention can feel uncomfortable, inconvenient, embarrassing, and even dreadful; however, it will offer a clear understanding of what is going on, and personalized treatment options to feel better and more in control sooner.
Consider taking time off work.
More and more dads take a period of parental leave during their child’s first year of life. The typical intention is to be the primary parent or co-parent during this time in order to enrich one’s bonding experience and continue care of the infant at home.
In some cases of postpartum depression it may be worth considering taking an unplanned parental or caregiver leave from work in order to fully support and look after your family during a critical time. You may want to explore this option with your partner, your doctor and your employer.
Take care of yourself.
Finally, be sure to take care of yourself. As the adage states, “be sure to put on your own oxygen mask before assisting another person with theirs.” It can be difficult for dads to prioritize their health at the best of times (hence why I’ve created this website); however, maintaining your health is essential to being the supportive partner you want to be. I will continue to write about all the various ways to maintain our health, but will highlight a few here:
Make note of your own brain changes and what you are thinking and feeling
It is okay to share these thoughts and feelings with your partner. People often fear that sharing difficult thoughts and feelings will make another person feel worse; however, more commonly both partners are feeling similarly and knowing just that, will make both people feel less alone
When you have a moment to yourself consider doing the activity that refuels you. Passive activities such as scrolling on your phone may feel like a good distraction, however, may not be the best activity to fuel you up. 20-minutes of exercise such as a walk or calisthenics at home could do the trick.
Jennifer Wallace, author of Never Enough, stated that it is not about putting your mask on first, but rather having a friend who can be there to help you with your mask. I wish for every dad to have someone they can lean on, especially when extra support is needed for these important times.
