There is no straightforward answer. There are many theories, and some understanding of ’causes’ is often linked to what you call it eg. a post-traumatic response, relationship difficulties, grief and loss, anxiety or depression, or even the ups and downs of a relatively normal adjustment to the life-change of parenting. In general though, most forms of post-natal distress arise from different contributing factors, which coincide and interact with each other, leading inevitably to secondary effects on esteem, relationships, and sense of wellbeing, if they continue for long enough.

One of the important keys to recovery is to make some personal sense of it all, which can be rather like putting a jigsaw puzzle together of your life. The ‘puzzle’ is usually made up of different predisposing factors (your family and life experiences up to that point, and the sort of person you are), precipitating factors (more recent events affecting your experience of pregnancy, labour and delivery, and parenting), perpetuating factors (things which keep it going or make it worse), and the all-important protective factors (the skills and strengths and resources which will get you through).

Here are some of the most commonly proposed contributing (predisposing, precipitating, and perpetuating) factors:

 

+Physical/biological
  • Hormonal and biochemical changes (including thyroid dysfunction)
  • Sleep deprivation and physical exhaustion
  • Pregnancy or post-natal recovery complicated by health issues such as hyper-emesis, gestational diabetes, pre-eclampsia, post-partum haemorrhage
+Reproductive
  • Difficulty conceiving
  • History of miscarriage, adoption, death, or other ‘loss’ of a child (eg. health issues)
  • Birth trauma — physical and emotional (sometimes this triggers memories of earlier experiences of abuse/abandonment, even though the trigger itself can seem relatively minor to others)
+Emotional
  • Unresolved issues (eg. related to identity, independence, self-worth, control, competence and achievement) from earlier experiences
  • Unresolved grief for loss of valued relationships, places, roles, status, health, hopes, lifestyle
  • History of trauma and abuse – physical, sexual, emotional – which is unresolved – whether recent, or many years ago
+Personal/psychological
  • Previous or existing mental health issues – including eating disorders, alcohol or drug abuse, depression
  • Not feeling ready/wanting to be a mother
  • A big negative difference between expectations (of pregnancy, labour and delivery, the baby and parenting) and reality – resulting in a sense of incompetence, dissatisfaction, unwelcome dependence, and loss of control
+Family/relational
  • Family history of mental health issues
  • Unsatisfactory relationship with own mother/father/caregivers – as a child, and/or now
  • Current relationship difficulties (with partner, children, family and friends)
  • Difficult ‘fit’ with the baby eg. hard to feed, predict, or comfort; health problems; not liking the baby, or feeling as if the baby doesn’t like you
  • No-one to co nfide in or share with
+Practical/environmental
  • Lack of practical and emotional support (from people you feel OK accepting this from)
  • Lack of experience with babies/feeling helpless and hopeless as a consequence – especially if there are no parenting models around who you trust and respect
  • Feeling as if you don’t have the resources available to meet the demands on you (eg. time and energy, support, money, skills and knowledge) – whether actual or perceived
  • Stressful life events/circumstances with negative consequences
+Societal
  • A society that devalues and disempowers mothers in many ways, but also seems to expect them to be able to manage everything – often in the absence of sufficient support
  • Pressure to ‘achieve’ as a parent
  • Conflicts between mothering and other roles (eg. work)
  • Stigma about expressing difficulty or dissatisfaction with mothering
  • Cultural differences which result in isolation and disadvantage eg. minority group, refugee, and immigrant experiences