Postnatal Depression Isn't a Six-Week Problem. So Why Do We Only Check Once?

Most of us grow up with the same rough idea of postnatal depression. It hits some new mothers, it's hard for a while, and then, somewhere around the six-week mark or a few months in, it lifts. The health system is largely built around that idea too. One screening questionnaire, usually around six weeks after birth, and if you pass it, you're considered fine.

Having spent years looking at how maternal mental health actually unfolds, I don't think that picture holds up. What I see, in the research and in real mothers' lives, looks less like a passing phase and more like a chronic condition. The kind that flares, settles, and can come back, in the same way high blood pressure or diabetes does. And if that's true, checking in once isn't enough.

Why "it'll pass by six weeks" doesn't match the evidence

Some mothers do feel steadier by six weeks. Plenty don't. Symptoms like poor sleep, irritability, intrusive worries, and a flat, joyless feeling often continue well past the early weeks, especially when a baby has feeding or health issues, childcare is unstable, or things are tense at home. And for mothers who've had depression or anxiety once, the odds of it returning in a later pregnancy or another major life change are meaningfully higher, not lower.

That pattern, symptoms that persist, fade, and can resurface, is exactly how we talk about chronic conditions elsewhere in medicine. Nobody expects a single blood pressure reading in week six to tell them everything about someone's cardiovascular health for the rest of the year. Yet that's essentially what we do with maternal mental health.

The single check-in misses the moments that matter most

Here's where the timing problem really shows up. Many mothers feel relatively okay in the first few weeks, when they're still on leave and have extra help at home. Things can shift later: when maternity leave ends, when a baby's sleep gets worse instead of better, when the initial adrenaline of new parenthood wears off and the tiredness catches up. A questionnaire filled in at six weeks simply isn't there to catch any of that.

The standard screening tool, the Edinburgh Postnatal Depression Scale, was also built mainly to pick up depressive symptoms. Anxiety, which shows up at least as often in new mothers, can slip through a tool that isn't really looking for it.

It isn't a lack of willpower

I think it's worth saying plainly: struggling to act on what you know you need, more sleep, more support, professional help, isn't a character flaw. It's what happens when the practical ability, the opportunity, and the motivation to do something all have to line up, and for a lot of mothers, they don't.

Sleep deprivation alone makes it harder to think clearly or manage emotions, so the capacity to cope is already reduced before anything else is factored in. Then there's opportunity: if getting to an appointment means losing income, finding childcare, or explaining an absence to an unsympathetic workplace, the option to seek help barely exists in practice, even for a mother who wants it. And motivation gets worn down by shame and the quiet fear of being judged as not coping, not grateful, not a good enough mother. Put those three together, and it becomes much easier to understand why so many women wait, minimise their symptoms, or don't seek help at all, not because they don't know something is wrong.

What treating this as a chronic condition could look like

A chronic-care approach doesn't mean every mother needs long-term therapy. It means building in the kind of ongoing attention we'd expect for any long-term health issue, rather than one clinical checkpoint and then silence.

In practice, that could mean checking in at more than one point, antenatally, in the early weeks, and again around the time many mothers return to work, rather than relying on a single screen. It could mean normalising the emotional side of new motherhood as thoroughly as we currently cover breastfeeding technique, so that struggling doesn't automatically feel like failing. It could mean bringing partners into the conversation, since a mother's ability to cope often depends heavily on whether the people around her share the load. And it means workplaces and policies that don't quietly punish a mother for needing flexibility while she's still finding her footing.

None of this requires abandoning what already works well in Singapore. It means not assuming that once the early weeks are over, the job is done.

If you've been managing postnatal anxiety or low mood for longer than anyone told you to expect, or if it's come back after feeling better for a while, that doesn't mean something is uniquely wrong with you. It's a fairly well understood pattern, and there's support available for it. You're welcome to get in touch if it would help to talk through what that could look like.

About the author

Pamela Vanessa Lim is a Health Psychologist in research and Integrative Nutrition & Movement Therapist, focused on maternal and child health in Singapore. Read more about her work here.

Sources

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Quah, S. H., Lee, R. C., Chong, Y. C., Ng, C. T., & Tan, P. L. (2025). Maternal psychological outcomes in Singapore: Findings from a prospective perinatal cohort. Annals of the Academy of Medicine, Singapore, 54(1), 35-48. Singapore-specific antenatal and postnatal prevalence data.

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