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Are you plagued by feelings of guilt after you have had a baby? You may have postpartum depression.

The signs of postpartum depression most of us are likely to be familiar with are a depressed mood, which means feeling sad, empty, and hopeless, a loss of interest or enjoyment in activities one previously found meaningful, fatigue and low energy, and possible thoughts about death, suicide, or harming one's baby. In addition to these symptoms, postpartum depression can also be accompanied by appetite changes and weight fluctuations, insomnia or excessive sleepiness, changes in physical behavior such as slowed speech and movement, and an inability to concentrate. Persistent feelings of guilt and worthlessness are, however, another integral part of the diagnostic picture of major depression, including postpartum depression. [1]

Are you a new mother who is plagued by intrusive feelings of guilt? Understanding this unpleasant emotion in the context of other postpartum depression symptoms, and examining how severe your feelings of guilt are, can help you decide what actions to take next. 

The Hamilton Rating Scale for Depression rates feelings of guilt on a scale of 0 to 4. A rating of 0 represents a complete absence of feelings of guilt, while a rating of 1 means that you experience a degree of self-blame and self-criticism, and feelings that you have let people down. People whose feelings of guilt begin to dominate their thoughts would score 2, while those scoring 3 are struggling with delusional feelings of guilt, believing, for example, that their present situation is a punishment for past misdeeds. At the extreme end of the guilt spectrum, those scoring 4, you have guilt-related auditory or visual hallucinations. [2]

In postpartum mothers, these feelings could manifest as:

  • Feeling guilty for bringing a baby you currently believe you are not well-equipped to care for into the world. 
  • Feeling guilty for not being able to focus on your baby's needs fully 24 hours a day. 
  • Guilt over actions not taken or taken: about being unable to breastfeed, having had a cesarean section, or having to go back to work, for example. 
  • Guilt over experiencing feelings of guilt and other related postpartum depression symptoms, such as not bonding with your baby well. 

These feelings can, in short, be summed up as feeling that you are a bad mother. 

Such feelings of guilt are closely associated with other negative emotions experienced by mothers suffering from postpartum depression — sadness, frustration and anger, disgust, regret, disappointment, and even boredom. [3] All these emotions can, in turn, serve to exacerbate pre-existing feelings of shame and guilt. 

Societal Stigma And Feeling Alone: Contributors To Feelings Of Postpartum Guilt?

Pregnancy, childbirth and the postpartum period represent a time of profound change in a woman's life. This period of life is one of extreme emotional, hormonal, physical and biological transition, all of which affect the central nervous system. [4] It is hardly surprising that many mothers feel vulnerable during this time of sleep deprivation, physical soreness, and adjustment to a new role in life. 

Yet during this inherently vulnerable and turbulent existential transition, society, rather than supporting them through these tremendous changes, sends new mothers a rather different message — they are faced with enormous pressure to not only be "perfect mothers", but to be perfectly happy.

The combination of quite natural negative emotions and societal expectations to be positively jubilant can collide to create feelings of guilt, even in mothers who are not depressed, one study found. Informing postpartum mothers about the fact that negative post-baby emotions are quite normal, the study authors concluded, could help alleviate feelings of guilt. [5, 6]

Do You Need Help For Your Feelings Of Postpartum Guilt?

SteadyHealth would like to reassure you that it is quite normal not to be floating around on a pink cloud of happiness all the time after you have had a baby. Such feelings do not mean you are a bad mother and there is no need to feel guilty about occasional negative emotions — nor are these feelings, as we have seen, necessarily pathological.

Should your feelings of shame and guilt be so intrusive that they don't just nag at you sometimes but have rather taken over your life, however, it is indeed quite possible that you are struggling with postpartum depression. 

On the milder end of the spectrum, you have the so-called Baby Blues, which could be described as a "mini depression" that strikes many new mothers within the first few weeks after giving birth and that then subsides within a week or two. Symptoms include feeling weepy, fatigued, irritable, confused, and guilty. [7] While the Baby Blues should certainly be taken seriously, and can be alleviated with the help of a supportive social network, they do not require psychotherapy or antidepressant medication. 

Should the postpartum depression signs described above be familiar to you, and should you have been experiencing most of these symptoms for a large portion of the day on most days, for at least two weeks, you are more likely to be dealing with full-blown postpartum depression than with normal negative feelings many new mothers experience, or with the Baby Blues. In this case, know that postpartum depression is a common occurrence [8] and nothing to be ashamed of.

Help is available. Research shows that receiving treatment as early as possible leads to the best outcomes, with talk therapy (cognitive behavioral therapy and interpersonal therapy) being a highly effective approach to alleviating your symptoms. Where necessary, talk therapy can be augmented with antidepressant medication. [9]

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