It is really important to think about Postpartum mental health as a spectrum. Depression is on that spectrum, but so are anxiety and obsessive compulsive disorder (OCD). Depression can leave mothers with an intense feeling of sadness, despondency and emptiness. A deep fatigue can set in, which is made all the worse by the natural disruption of sleep that comes from caring for a newborn. The lack of sleep becomes a significant risk factor for the mental health worsening.
There is also Postpartum anxiety and OCD. The anxiety leaves mothers with uncontrollable worry for their baby. These mothers feel the need to check on their baby every few minutes. They worry about Sudden Infant Death Syndrome, and cannot sleep for fear of their baby dying. They worry about their babies' health, and growth and development. Postpartum OCD can be very frightening for new mothers, as it can include intrusive thoughts of baby harm. It is as though the worse possible scenarios (dropping a baby, maybe even on purpose etc) intrusively flood into the mother's thought stream. Mothers with OCD would never do these things, but even the thought of the possibility is so disturbing and distressing that the mother incredibly suffers--and often suffers in silence because she worries that if she tells anyone that the baby will be taken away from her. This form of OCD occurs in 3-5% of new mothers.
One of the most important ways to help new mothers is to educate them in advance about the possibility of experiencing these symptoms. Many physicians and midwives will talk about depression and anxiety--but they may leave out OCD for fear of unnecessarily distressing an expectant mother. However, if new mothers do not realize that these symptoms may occur, during the chaotic days of caring for a new baby for the first time, they will be terribly (and perhaps even overwhelmingly) frightened and distressed if these do symptoms occur. So, talking about these symptoms before and after birth is very important. We MUST destigmatize mental health challenges of all forms--and especially the forms that can occur after childbirth.
New mothers, and especially new mothers who are experiencing these feelings, should be encouraged to talk about their emotional state with others, and those listening to new mothers, should continually reassure them that these feelings are nothing to be ashamed of. Becoming a new mother is one of the most vulnerable times in a women's life, and it is important for family, friends, and community to rally around her. She needs people to be with her, especially if she is feeling symptoms of OCD. She needs sleep during the day, and she needs help with feedings, baby care, family meals & chores and school drop offs/pick ups of older siblings. She needs cups of tea and gifts of body lotion and bubble baths. She needs to feel acceptance of her changing and healing body. Husbands and partners need to give her ample time to find her sexual self again.
If a new mother expresses concern about her feelings/mental state, that is time to seek help. If a new mother is not sleeping, not eating or behaving in any kind of strange way, that is time to seek help. Talk to the midwife, doctor, or doula. Together with these postpartum experts, you can make the call as to whether or not a mental health expert is required. If you are not sure, book a consult with a mental health expert (like a Registered Psychologist or Licensed Clinical Counsellor) to discuss your fears.