Ibtisam Aghfir
Benghazi — Postpartum depression is considered one of the most common psychological disorders following childbirth. It is a condition that goes beyond fleeting sadness, transforming into a deep internal struggle that affects the mother, her child, and her family. During this stage, hormonal, psychological, and social factors intertwine, making the mother more vulnerable to anxiety, isolation, and feelings of guilt—highlighting the importance of family and community support and the need to break the silence surrounding it.

In recent months, news spread widely about a female gynecologist who allegedly committed suicide by throwing herself into the sea due to postpartum depression. Public sympathy was immense, and all of Libya rallied in solidarity with the doctor. The focus then shifted to discussing the dangers of postpartum depression. However, the true account of the doctor’s death later emerged: she had been deliberately killed by her family, in collusion with her husband, and her body was hidden in a sewage tank in their home.

Postpartum disorders are considered an important public health issue. Estimates by the World Health Organization indicate that around 10% of pregnant women and 13% of women after childbirth may suffer from mental disorders, with depression being the most common. In low- and middle-income countries, the rates may be higher (15.6% during pregnancy and 19.8% after childbirth). In severe cases, psychological suffering can be profound and may reach thoughts of self-harm or suicide among some women.

Postpartum depression is neither rare nor a temporary weakness; it is a psychological disorder whose effects may last for years if not detected early and if the mother is not provided with the necessary medical and family support. In this report, we shed light on postpartum depression through a personal experience and the perspectives of specialists in mental health, obstetrics and gynecology, and family counseling, in an attempt to gain a deeper understanding of this silent suffering.

 

Motherhood Burdened by Inner Conflict

Hanaa Boudbous describes postpartum depression as one of the harshest experiences she has gone through as a woman and a mother, affirming that society still does not fully accept or understand the nature of this condition. The prevailing view considers what a woman experiences after childbirth to be natural and easy, and that all women go through it as a transient feeling that does not warrant concern—whereas reality is entirely different.

She explains that the psychological effects of childbirth can be profoundly deep and may extend for years if a woman does not attend to her mental health and seek treatment in a timely manner. She notes that she has experienced postpartum depression twice: the first was seven years ago after the birth of her first daughter—a difficult and confusing experience—and the second she is currently experiencing after the birth of her new baby.

She describes this phase as an acute psychological struggle that becomes even more complex when depression follows the birth of a third or fourth child. At that point, a woman enters an internal tug-of-war between responsibilities toward children who already exist and a newborn. She says that what exhausted her most during this phase was the flood of conflicting thoughts that pushed her to reconsider every action and every feeling.

 

Symptoms Beyond Fleeting Sadness

Hanaa Boudbous speaks about a range of symptoms that accompanied her during this period, including extreme sensitivity, crying for the simplest reasons—and sometimes for no clear reason at all. She also refers to persistent overthinking, accompanied by a constant sense of guilt, especially toward the baby, feeling that she was falling short despite the efforts she made. She also suffered from sleep disturbances, overeating, and avoiding seeing or talking to others due to the harmful thoughts that might result.

She believes that when a woman feels these symptoms, she should surround herself with people who provide safety and support in order to overcome this phase with minimal harm. She notes that some women resort to medication, but she personally prefers, first and foremost, seeking psychological counseling or talking with trusted people who better understand the experience.

 

Breaking the Silence Is a Therapeutic Necessity

Hanaa Boudbous emphasizes that talking about what a woman feels during this phase is of great importance, and that fear of the idea “no one will understand me” only deepens feelings of loneliness and depression. She clarifies that she did not think about suicide or directly harming herself, but she sometimes resorted to excessive eating even without feeling hungry, or losing control of her nerves over trivial matters.

She adds that in her first experience, she found an outlet in therapeutic writing, which helped her emotionally release what she was going through. This time, however, she feels scattered and has lost the desire to write, and she is still searching for a means to help her emerge from the depressive state she is experiencing.

A Disorder with Levels and Risks

Aziza Al-Tabouli, a psychological specialist, defines postpartum depression as a psychological disorder linked specifically to a woman’s mental state after childbirth. She explains that this disorder is entirely different from “puerperal fever,” which is considered a physical condition, while depression is classified as a purely psychological symptom.

She notes that this illness was not widely recognized in the past within women’s circles, which is why there is no commonly used popular term for it in Libya. She describes the condition as one in which a woman feels distress and gloom, stemming mainly from hormonal fluctuations: hormone levels are at their peak during pregnancy and then drop noticeably after childbirth, which is a normal occurrence.

She explains that this change may lead to a clear disturbance in mental health, including anxiety, mood swings, and similar feelings, and stresses that this state should not last more than three days. If it exceeds this period, then other diagnoses and classifications come into play.

Aziza Al-Tabouli clarifies that the full picture of this disorder requires distinguishing between several levels. The first level is mood disturbance, a state of mood swings that affects a woman immediately after childbirth. If these fluctuations persist for more than three days, the condition progresses to depression or depressive disorder, where psychological signs begin to appear clearly, indicating that the woman is indeed going through this disorder. She notes that this phase may extend from two weeks after childbirth up to six months, and the woman may later enter a post-postpartum depression phase.

She indicates that postpartum depression may, in some cases, develop into a psychotic stage, which is classified into three types: schizophrenic psychosis, affective psychosis, and delusional psychosis. These stages are among the most dangerous. She emphasizes that once a woman enters the depressive stage, it becomes imperative to immediately consult a psychiatrist to prescribe appropriate treatment or undergo psychotherapy sessions to help control the disorder.

She warns that reaching the psychotic stage means losing the ability to perceive reality. This is a highly dangerous preliminary stage accompanied by disturbed behaviors, hearing voices, and feeling that others are conspiring against her, which may escalate to a strong desire to harm the child.

Regarding the most effective and socially acceptable treatment approaches, Aziza Al-Tabouli says that care for a woman should begin from the start of her married life and during pregnancy, especially if she is a first-time mother. She explains that during this stage, a woman faces multiple challenges—social and economic—along with the transition from her family home to her husband’s home and all the changes that accompany it.

She gives an example from what is observed in psychological clinics, where a large number of women present with psychological disorders due to delayed early detection and the lack of attention from those around them to what they were going through immediately after childbirth. She points out that society still fears the stigma associated with visiting psychological clinics or consulting a psychiatrist.

Aziza Al-Tabouli stresses the importance of breastfeeding, as it contributes to the secretion of hormones that help with relaxation, happiness, and psychological recovery. This emotional recovery positively reflects on both the woman and her child. She affirms that psychological disorders, like physical illnesses, require treatment and follow-up, and that society must become aware of this.

 

Hormones at the Heart of the Equation

For her part, Dr. Rasha Ahnid explains that the first days after childbirth (24–48 hours) witness sharp and rapid hormonal fluctuations, with some hormone levels dropping by as much as 90%. This sudden decline directly affects a woman’s mood and emotions, potentially leading to psychological disturbances that may later develop into postpartum depression.

She notes that women with thyroid disorders are more susceptible to postpartum depression, and that the hormone cortisol may cause psychological disturbances, while elevated prolactin increases a woman’s sensitivity and emotional reactivity without directly causing depression. She clarifies that these hormonal changes are natural for all women after childbirth, except for those with thyroid problems.

“Baby Blues”… Natural Mood Swings

Dr. Rasha Ahnid explains that “baby blues” are natural mood swings that affect 70–80% of mothers after childbirth. They appear in the form of mild anxiety, emotional disturbance, and light crying spells, and gradually disappear within two weeks. However, if these symptoms persist for more than two weeks and are accompanied by rejection of the baby, difficulty dealing with the child, and exaggerated reactions, this is considered an indication that the condition has developed into postpartum depression.

She clarifies that an obstetrician-gynecologist can notice indicators of a woman’s likelihood of developing postpartum depression, such as a previous medical history, a prior episode of postpartum depression, or a family history of depression. However, she emphasizes that diagnosis and treatment fall under the psychiatrist’s expertise, while the role of the obstetrician-gynecologist is limited to monitoring physical health.

She notes that referring a woman to a psychiatrist in cases of postpartum depression occurs infrequently, although psychiatrists are best equipped to prescribe medications that are safe for breastfeeding mothers. She adds that high-risk pregnancies—such as gestational diabetes, placental abruption, or preeclampsia—increase the likelihood of depression, highlighting the role of the obstetrician in providing psychological support. She also points out that unplanned pregnancies and difficult financial and social conditions are among the contributing factors to postpartum depression.

Family and Social Support… The First Line of Defense

For her part, educational and family counselor Fatima Al-Taib emphasizes that postpartum depression is often misinterpreted within the family and reduced to incorrect popular notions, while in reality it has clear psychological and behavioral symptoms, such as persistent crying, anxiety, isolation, loss of self-confidence, and disturbances in sleep and eating.

She believes that the absence of family support—especially for a woman giving birth to her first child—increases the likelihood of depression. She notes that postpartum depression does not only affect the mother, but extends its impact to the child and the family as a whole, through a weakened emotional bond, reduced care, and increased family tensions, which may threaten family stability in the long term