For some mothers, having a baby brings a joy that is difficult to describe. For others, the early months of motherhood can also bring exhaustion, anxiety, sadness and a sense of isolation that they may struggle to explain. For Marie Louise Uwase, becoming a mother was a dream she had cherished for years. Having grown up in a family of two children, she had always imagined raising a large family of her own—perhaps six children and even twins. Her first pregnancy went smoothly. But things changed during her second pregnancy, when she developed hyperemesis gravidarum, a severe condition characterised by persistent nausea and vomiting. After giving birth, Uwase began experiencing severe anxiety, emotional distress and persistent headaches. She often felt sad, cried unexpectedly and questioned whether she was a good mother. “I started blaming myself, thinking I wasn’t a good mother. I couldn’t tell what was really happening to me,” she said. As the distress continued, she and her husband sought help from a psychologist. Following an assessment, she learned that her symptoms could be linked to postpartum depression. ALSO READ: Postnatal depression: When baby blues take a toll on new mothers The experience helped her understand that emotional difficulties after childbirth are not necessarily a sign of failure. Exhaustion, lack of sleep and difficulties with breastfeeding can all add to the strain of adjusting to life with a newborn. A significant burden The experience is not unique. A study published in May 2026 in BMC Pregnancy and Childbirth found that 24.5 per cent of pregnant women and mothers of children under two in Rwanda’s Burera District experienced symptoms of perinatal depression. The cross-sectional study involved 1,464 participants across four sectors of the rural district and examined social and structural factors associated with maternal mental health. The figure does not mean that all of the women had a clinical diagnosis of postpartum depression. Rather, it points to the scale of depressive symptoms among women during pregnancy and the period following childbirth. Marie Providence Umuziga, a mental health nurse, researcher and lecturer at the University of Rwanda who works with the Rwanda Biomedical Centre on maternal mental health programmes, says postpartum depression should be distinguished from the temporary emotional changes many women experience after childbirth. ALSO READ: Not just baby blues: Understanding postpartum mood disorders Families should be concerned when symptoms persist, particularly when they last for two weeks or more, significantly interfere with a mother’s daily functioning, or affect her ability to care for herself or her baby, she says. Common signs include persistent sadness, frequent crying, loss of interest in activities previously enjoyed, excessive worry or anxiety, hopelessness, feelings of worthlessness, irritability, difficulty concentrating and withdrawal from family and friends. Some mothers may also experience overwhelming guilt or feel inadequate in their new role. Changes in sleep or appetite beyond what would normally be expected when caring for a newborn, as well as difficulty bonding with the baby, can also be warning signs. Dr Patrick Rwagatare, a clinical psychologist, says the effects of postpartum depression can extend beyond the mother herself. “This depressive state profoundly affects the physical and emotional well-being of both the mother and her child, as she may have difficulty taking care of herself, let alone her newborn,” he says. Because newborns depend heavily on their mothers or other caregivers, Rwagatare says the condition can also affect a child’s psychosocial and emotional development, particularly during the first year of life. When exhaustion becomes overwhelming For Jackie Umutoniwase, the difficulties began about three months after giving birth. Her baby slept during the day but was often awake at night, leaving her severely sleep-deprived as she balanced work, household responsibilities and childcare. With her husband out of the country on a work trip, Umutoniwase had to manage everything on her own while also returning to work. The baby’s frequent crying and disrupted sleep left her exhausted and increasingly overwhelmed. “I was exhausted, and I didn’t know what else to do. I feared that people would think I didn’t love my baby. Everyone expected me to be happy because I had just become a mother, but what I really needed was someone to ask me if I was okay,” she said. ALSO READ: Postpartum and baby blues: What to expect She rarely talked about what she was experiencing because she feared being judged. Like many new mothers, she felt pressure to live up to the expectation that becoming a mother should be a purely happy experience. Rwagatare says psychological wellbeing and stress can influence a mother’s vulnerability to postpartum depression, particularly among women with a history of mental health difficulties. “Psychological factors that may help prevent postpartum depression include, among others, effective stress management in all its forms,” he says. He notes that previous mental health difficulties may also increase the risk of postpartum depression. When breastfeeding becomes a source of anxiety Abigail Mahoro faced a different challenge. Visitors would come with gifts for her baby and compliments about how cute and beautiful the child was. Behind the smiles, however, Mahoro was struggling with anxiety because she could not breastfeed as she had hoped. Her milk supply was low. She bought an electric breast pump, but it did not help her produce enough milk. She had hoped to breastfeed exclusively for at least nine months. “I thought I wasn’t eating or drinking enough, so I tried everything to increase my milk supply. Still, I couldn’t produce enough for my baby, so I had to supplement with formula,” she said. At the time, Mahoro did not realise that persistent sadness, anxiety, guilt and feeling overwhelmed could be signs of postpartum depression. ALSO READ: Postpartum depression and difficulty breast-feeding may go hand in hand She constantly worried about her baby and found it difficult to relax, even when the child was asleep. Some days, she wondered why motherhood seemed easier for everyone else. Her experience shows how emotional distress can remain hidden behind smiles, family visits and the expectation that a new mother should be happy. Fathers may miss the signs too John Mugabo, a father of two, reflects on his family’s experience after the birth of their first child. The couple had prepared for pregnancy and childbirth and expected the usual changes. What they did not anticipate was the emotional strain that could follow childbirth. “At first, we thought the baby’s colic and frequent crying were the main challenges. Then my wife became increasingly sad and agitated. We assumed it was simply the exhaustion of caring for a newborn, but later realised there was more to it,” Mugabo said. His wife often cried, worried constantly about the baby and struggled to relax, even when the baby was asleep. She compared herself with other mothers and wondered why she was struggling. Their experience reflects a broader challenge surrounding perinatal and postpartum depression: distinguishing normal exhaustion from symptoms that require attention can be difficult for both mothers and their loved ones. Beyond the ‘baby blues’ The emotional changes that come with childbirth are not always easy to distinguish from the ordinary demands of caring for a newborn. Sleepless nights, changes in routine, breastfeeding difficulties and the pressure of adjusting to a new role can all take a toll. The “baby blues” are generally short-lived and relatively mild, lasting from a few days to about two weeks. Postpartum depression is different in its intensity and duration. Symptoms that persist for more than two weeks and begin to interfere with a mother’s daily life or ability to care for herself or her baby warrant professional attention. Umuziga says families should look out for persistent sadness, anxiety, irritability, guilt, withdrawal and changes in sleep or appetite. Difficulty bonding with the baby can also occur. ALSO READ: Postnatal depression: A traumatic experience for new moms “Particular attention should be given to any thoughts of self-harm, suicide, or harming the baby, as these require urgent professional assessment and support,” she says. Rwagatare says the period after childbirth can bring a range of emotions, but persistent and disabling symptoms should not be dismissed as an inevitable part of motherhood. Stress and conflict during pregnancy and within families can also contribute to psychological difficulties during the perinatal period. Why some mothers suffer silently For some women, recognising that they need help is only the first hurdle. Umuziga says limited awareness remains an important barrier. A mother or her family may interpret symptoms as normal tiredness, personal weakness, family problems or something she simply needs to overcome. Stigma can make the situation worse. Mothers may fear being judged as weak, incapable or “a bad mother”, leading some to suffer silently rather than disclose how they are feeling. Other barriers include limited partner or social support, financial difficulties, competing responsibilities at home and limited access to specialised mental health services. Another problem is that attention after childbirth often centres almost entirely on the baby, while the mother’s own emotional and psychological wellbeing receives less attention. ALSO READ: Life after birth: How mothers should cope with postpartum depression Rwagatare says psychoeducation can help families recognise postpartum depression and understand how to support affected mothers. “It is important to avoid conflict between couples and within extended families, as such conflicts during pregnancy may contribute to the development of postpartum depression,” he says. From a socio-cultural perspective, he says couples and their families should understand that postpartum depression is a recognised and treatable mental health condition. “This can help prevent misinterpretation of the situation and, consequently, the use of inappropriate responses or solutions,” he noted. Rwagatare says families should provide support without becoming intrusive. Where a mother is struggling significantly to care for the newborn, another family member can temporarily take responsibility for the baby’s care while ensuring that the mother is supported rather than replaced. Asking if she is okay For Uwase, seeking professional support gave her a better understanding of the emotions that had initially left her confused and blaming herself. The expectation that mothers should naturally know what to do, remain strong and enjoy every moment can make it harder for them to admit when they are struggling. Seeking help does not mean that a woman has failed as a mother. In Rwanda, Umuziga says women can begin by seeking support from their nearest health centre or hospital, particularly through maternal and child health services. Healthcare providers can assess the mother and refer her for additional mental health support when necessary. Community health workers can also help identify difficulties and connect mothers with appropriate services. ALSO READ: Can public–private partnerships bridge gap in maternal mental health? If a mother expresses thoughts of suicide, self-harm or harming her baby, or appears severely confused or disconnected from reality, families should treat the situation as an emergency and seek immediate professional medical care. For Umutoniwase, the question she needed was a simple one: “Are you okay?” Sometimes, that question can be the beginning of getting help. Yet in many societies, the emotional struggles of new mothers are still not treated as a serious concern, leaving women to carry the burden alone.
