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Postpartum Disorder Is not Always Obvious

7 EMOTIONAL SIGNS EVERY DOULA SHOULD KNOW

woman with a solemn look holding a flower in front of her face

As a doula, you are often one of the first people a new mother trusts. But when it comes to postpartum disorders, the signs may not be the ones you expect. The transition to motherhood is emotionally complex, and for women, especially those over thirty-five and into their forties the red flags are not always loud or clinical. They are quiet, subtle, and easy to dismiss as “just adjusting.”

In this article, we will walk through seven emotional postpartum disorder warning signs that doulas must recognize. By doing so, you will strengthen your ability to offer compassionate, informed care and ensure your clients are not navigating mental health struggles alone.

Before we start, if you or someone you know is experiencing symptoms of postpartum depression, anxiety, or any mental health condition, please seek support from a qualified healthcare provider.

Fertile Optimism does not claim to diagnose, treat, or prevent any condition. Always follow your professional scope of practice and refer clients to appropriate care when and as needed.

EMOTIONAL CUES CAN BE EARLY POSTPARTUM DISORDER WARNINGS

Postpartum mental health concerns affect up to 1 in 5 women, with these women experiencing symptoms that go undetected or unreported [1]. However, while physical symptoms like sleep disruption or appetite changes are often discussed between doula and client, emotional warning signs, especially in women trying to appear “put together” are easy to miss.

For doulas, knowing what to look for can mean the difference between a client silently struggling or guided to care and support.

The 7 Postpartum Disorder WARNING SIGNS

Postpartum Disorder Checklist

Free Postpartum Disorder Checklist for Doulas and Birth Professionals

Patterns of Guilt, Disconnection, and Irritability

  1. Persistent Feelings of Guilt or Shame

If a client repeatedly says, “I’m a bad mom,” or fixates on perceived failures, this could be more than insecurity, it may signal deep internal distress. Guilt is a hallmark of postpartum depression, sometimes linked to intrusive thoughts or self-blame.

For example, as a doula, offer empathy and take note if the guilt seems chronic, harsh, or disconnected from reality.

  1. Flatness or Numbness in Emotion

Rather than crying, clients may report feeling “nothing at all.” This emotional numbness can be a red flag, especially if the mother describes a disconnect from her baby, her husband, or herself.

This is especially common in high-functioning individuals who may seem “fine” externally.

  1. Unusual Irritability or Rage

Anger is one of the most underrecognized symptoms of postpartum mood disorders[2]. Sudden frustration, snapping at loved ones, or intense irritability may signal an underlying mental health concern.

Encourage journaling or reflection and gently suggest a check-in with a therapist or care provider if rage becomes frequent.

  1. Difficulty Experiencing Joy or Bonding

When the expected joy of motherhood does not show up, or feels overshadowed by dread, it is not necessarily a personal flaw. It may be a sign of postpartum depression or anxiety.

Ask open-ended questions: “How are you feeling about your time with baby right now?”

Signs of Withdrawal, Anxiety, and Instability

  1. Excessive Worry or Racing Thoughts

While worry is normal, especially for new mothers, rumination and catastrophizing can indicate postpartum anxiety or obsessive-compulsive tendencies. These thoughts may revolve around a baby’s safety, personal inadequacy, or fear of harm.

Encourage grounding techniques and note if the thoughts interfere with daily functioning.

  1. Sudden Withdrawal from Support

If your client starts canceling check-ins, stops texting back, or says things like “I’m fine, I just need space,” it may be a sign of emotional overload rather than autonomy.

Watch for withdrawal that feels abrupt, isolating, or defensive.

  1. Emotional Whiplash or Mood Swings

Hormonal shifts are normal; however, rapid cycling between sadness, irritability, and despair may indicate something more. Therefore, if your client seems emotionally unstable or overwhelmed by her reactions, she may need further support. In such cases, normalize the experience while offering resources and validation.

Postpartum Disorder Checklist

Free Postpartum Disorder Checklist for Doulas and Birth Professionals

HOW DOULAS CAN HELP: POSTPARTUM DISORDERS

Doulas are not therapists. However, you are, in most situations, in the first line of compassionate support. Your ability to:

  • Listen without judgment!
  • Gently reflect on what you observe.
  • Offer resources and normalize seeking help.

Truly, your actions can make a life-saving difference.

At Fertile Optimism, we recommend every doula complete a course like our Postpartum Warning Signs: A Course for Birth Professionals, or for a more in-depth discussion on this subject you are encouraged to take our Doula Business Fundamentals course, a certified doula business course that offers in-depth training on emotional, behavioral, and physical signs of postpartum distress, and designed for doulas supporting women of advanced reproductive years. 

FINAL THOUGHT: POSTPARTUM DISORDERS

Postpartum depression does not always come wrapped in tears. Sometimes, it comes as silence. Anger. Irritability. Numbness. As a doula, your presence and preparation matter.

Remain informed. Stay present and keep steady through this delicate storm, because emotional support is as essential as physical support.

References

[1] Shorey, Shefaly, and Shih-Wen Chan. 2016. “Paternal Mental Health during the Perinatal Period: A Qualitative Systematic Review.” Journal of Advanced Nursing 72 (9): 2055–70. https://doi.org/10.1111/jan.12931

[2] Postpartum Support International. 2024. “Understanding Postpartum Rage.” https://www.postpartum.net/learn-more/postpartum-rage/

Further Reading & Evidence-Based Resources
General Overviews on Postpartum Depression
Emotional Symptoms and Screening Tools
Anger, Guilt, and Emotional Numbness in PPD
PPD in Women Over 35 and 40 and High-Risk Populations
Resources for Doulas and Providers
Disclaimer

The information provided in this article is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. This content is designed to support doulas and birth professionals in expanding their awareness of emotional and behavioral signs that may indicate postpartum distress. It does not replace the guidance of licensed medical or mental health professionals.

Doula, Education, Health & Wellness, Postpartum Disorder, Pregnancy

July 12, 2025

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