Maybe you experienced postpartum depression when you had your own children, or you’ve heard stories from fellow grandparent friends about their children dealing with mental health issues after welcoming a baby. Navigating the delicate nuances of postpartum mental health – especially in your role as a grandparent – can feel intimidating, but learning how to spot red flags now can help you feel more confident about knowing what to look for. 

Know that perinatal mood and anxiety disorders, or PMADs, can affect parents who give birth as well as those who don’t. That means that dads may experience symptoms, as well as adoptive parents. Symptoms can also begin during pregnancy and pop up anytime within the first year after baby joins the family. 

In our work supporting expecting and new parents – and as moms ourselves (we have five kids ages 11 and under between us) – we’ve noticed a pattern. While our culture is more open about mental health issues than it once was, parents often still struggle to identify their own mental health challenges and to get help quickly. Many new parents still think they need to wait until the six-week postpartum appointment to talk about their mental health concerns; however, there’s no need for them to suffer if they’re already feeling that something is “off”. Conversely, symptoms may not emerge until a few months into parenthood. 

There is also still a huge stigma that prevents partners from identifying mental health challenges, as they often think that only people who give birth face things like postpartum depression. Dads in particular may not realize why they’re struggling and neglect to get help. 

It’s useful for loved ones, who often know new parents best, to have a plan for what to do if they’re concerned something is going on. The first step is to be able to differentiate between different PMADS, including what’s commonly known as “the baby blues”, postpartum depression, postpartum anxiety, postpartum OCD, and postpartum psychosis. While no one expects you to be able to identify and diagnose these conditions, many times grandparents are the “first line of defense” in being able to identify potential perinatal mood disorders. 

Here are some ways that each is different - although often, more than one PMAD manifests together in new parents:

1. The “Baby Blues”

• Occurs in the first few days to weeks after childbirth.

• Common symptoms include mood swings, crying spells, irritability, and mild anxiety.

• Typically resolves on its own within a few weeks without treatment.

2. Postpartum Depression (sometimes referred to as PPD or often just called “postpartum”), can also be perinatal (begins during pregnancy through the first year)

• Develops within the first year after childbirth, but usually within the first few months.

• Symptoms may include persistent feelings of sadness, hopelessness, worthlessness, fatigue, changes in appetite or sleep patterns, and difficulty bonding with the baby.

• Can interfere with daily functioning and requires treatment, such as therapy, medication, or support groups.

3. Postpartum Anxiety (PPA)

• Characterized by excessive worry, fear, and nervousness related to the baby's well-being or other aspects of life.

• Symptoms may include racing thoughts, restlessness, irritability, difficulty concentrating, and physical symptoms like dizziness or palpitations.

• Can coexist with or be a separate condition from postpartum depression and requires proper diagnosis and treatment.

 4. Postpartum Obsessive-Compulsive Disorder (PPOCD)

• Involves intrusive, repetitive thoughts* or obsessions, often related to the baby's safety or well-being.

• These thoughts lead to compulsive behaviors or rituals, such as excessive cleaning, checking, or arranging items.

• Can cause significant distress and impairment in daily functioning and requires specialized treatment, including therapy and sometimes medication.

*Postpartum intrusive thoughts are unwanted and distressing thoughts or mental images that intrude into the mind of a new parent following childbirth. These thoughts typically involve fears or worries related to harm coming to the baby, oneself, or others. Examples may include imagining accidental harm to the baby, thoughts of accidents or tragedies, or intrusive images of violent or disturbing scenarios. It's important to note that experiencing intrusive thoughts does not mean a person intends to act on them, but they can cause significant distress and anxiety.

5. Postpartum Psychosis

• A rare but severe condition that typically develops within the first few weeks after childbirth.

• Symptoms may include hallucinations, delusions, extreme mood swings, confusion, agitation, and thoughts of harming oneself or the baby.

• Requires immediate medical attention and often involves hospitalization for safety and intensive treatment, including medication and therapy.

We know that simply observing some of these symptoms can be scary for family members. They’re scary for the new parents to experience! But identifying and discussing mental health concerns, while it can be hard, is much safer for your loved ones (including your grandchild!) than pretending they don’t exist or hoping they’ll resolve themselves. 

If you’re able to, having a discussion with your child and/or their partner before baby arrives can be really effective. A great conversation starter is something like:

"Hey, I've been reading up on postpartum depression lately, and I know how common it can be for new parents. I want you to know that if you ever feel overwhelmed or notice any changes in your mood or behavior after the baby arrives, you can always talk to me about it. I'm here to support you, and we can figure out what steps to take together if needed."

If your child or in-law seems open to it, you can even ask, “If I notice that you’re not feeling well, how would you like me to approach that conversation? Is there something specific I can do or say that would feel supportive?”

If baby is already here look for things like:

• Persistent sadness or mood swings

• Withdrawal from social activities

• Changes in appetite or sleep patterns

• Difficulty bonding with the baby

• Physical symptoms: headaches, stomach problems, or unexplained aches and pains

• The parent(s) saying things like, “I’m not sure I’m cut out for this” or “I can’t handle this” consistently,

If you see any of these symptoms, you may want to start by addressing the non-affected partner, if possible. You can simply share your observations and ask if they’re noticed the same things. Together, you can come up with a plan to support the parent who is struggling.

If that’s not an option, you can certainly address the affected parent directly. The first thing to know is that every parent is different in how they want loved ones to bring up potential mental health issues. Your level of closeness with your child or in-law may have no bearing on their openness to hearing your concerns, and that’s okay. Nothing about their response (be it gracious, defensive, or somewhere in between) when you identify a potential issue is about you or an indication about the quality of your bond. 

However, there are ways you bring up your concerns that might help your adult child (or in-law) be more receptive to your observations. A few things that our new parent clients say feel most supportive:

• Emphasizing the parent’s health and well-being, rather than your concern about the baby

• Sharing your personal experiences (if you struggled with postpartum mental health) without making specific comparisons

• Reinforcing that you know they’re the best possible parent for your grandchild

• Offering tactical help, and financial support if possible, to make it possible for them to pursue mental health care

• Reminding them to speak to the care providers they’re already in contact with

As difficult as it is to identify that they’re struggling mentally, the second hardest thing for most new parents to do is find help that is accessible and affordable. We often help clients identify potential mental health resources (virtual and in-person therapists, support groups, etc.) before they welcome their baby, as well as afterwards. Having an objective third party assist with this can be incredibly helpful. Whether you suggest resources like ours, or simply remind your loved one to talk to their doctor, doula or lactation consultant, new parents often find that triangulating in outside help to be useful. 

Supporting new parents starts before the baby comes. We designed New Grandparent Essentials to make sure you are ready to give your family the help and encouragement they need. Learn more about our exclusive resource for new grandparents.

Candy Baracat-Donovan, CLC, and Tiffany Miller are two real-life sisters who use their training as a lactation professional and postpartum doula to support expecting and new parents through their company, Like A Sister. Their Postpartum Planning Toolkit is an e-Book and workbook that guides parents through the creation of a customized postpartum plan. They also offer on-demand parent prep and baby feeding classes as well as a monthly membership where expecting parents can find education and support. Their 1:1 postpartum support services give new parents a place to ask questions and get help. All their Like A Sister offerings make great baby shower gifts and can be found atwww.likeasistersupport.com.