When someone you love is struggling after having a baby, it can be difficult to know what to do.

You might be watching your partner, sister, daughter or friend experience anxiety, low mood, intrusive memories, guilt, anger or a sense that they are simply not themselves. Perhaps the birth was frightening or traumatic. Perhaps pregnancy or early parenthood has brought difficulties that nobody expected.

Supporting someone through birth trauma or perinatal mental health difficulties isn't about having the perfect words. Often, the most helpful things are much simpler: understanding what may be happening, helping to reduce some of the pressures around them, and being alongside them without trying to immediately take their distress away.

First: understand what may be happening

Pregnancy, birth and becoming a parent involve enormous psychological as well as physical change.

For some people, this period can be accompanied by difficulties such as postnatal depression, anxiety, obsessive or intrusive thoughts, post-traumatic stress following birth, or difficulties adjusting to the transition to parenthood.

Following a traumatic birth, someone might experience:

• unwanted memories or images of the birth

• nightmares or flashbacks

• feeling panicky or physically on edge

• avoiding reminders of what happened

• repeatedly going over the birth and trying to understand it

• anger towards healthcare professionals, themselves or others

• guilt or self-blame

• feeling detached or numb

• difficulty trusting that they or their baby are safe

• distress about hospitals, medical appointments or future pregnancies.

Other perinatal mental health difficulties can look different. Someone might seem persistently worried, tearful, irritable, withdrawn or overwhelmed. They might struggle to enjoy things they expected to enjoy, doubt themselves constantly as a parent, or become caught in frightening thoughts about themselves or their baby. Please feel free to browse the 'Experiences’ section of the website to find out more about specific difficulties.

These reactions don't mean that someone is failing at parenthood. They tell us that their emotional system is struggling with something difficult.

A Compassion Focused Therapy way of understanding distress

One helpful way of thinking about this comes from Compassion Focused Therapy (CFT).

CFT describes three interacting emotional systems: the threat system, the drive system and the soothing system.

Our threat system evolved to detect danger. When it is activated, it can produce anxiety, fear, anger, hypervigilance and a powerful urge to protect ourselves or the people we love.

After a traumatic birth, that system can remain highly sensitised. Although the immediate danger has passed, the brain may continue behaving as though something terrible could happen again.

Perinatal anxiety can work similarly. A parent's brain has a very good evolutionary reason to become more alert to potential threats after having a baby. But sometimes that protective system becomes so sensitive that danger seems to be everywhere.

Then there is the drive system: the part of us concerned with doing, achieving and getting things right. In early parenthood this can easily become caught up with expectations:

I should be coping.

I should be enjoying this.

I should know what my baby needs.

Everyone else seems to be managing.

Meanwhile, the soothing system; associated with feelings of safeness, connection and being cared for, may be particularly difficult to access.

This gives loved ones an important clue about how to help.

You don't necessarily need to convince someone that their fears are irrational or solve the problem for them. Instead, think about how you can help create experiences of safety, warmth, connection and support while their own emotional system gradually settles.

Listen before trying to fix

When someone we love is distressed, the instinct to reassure them is incredibly strong.

We might say:

"Don't worry."

"But the baby is absolutely fine."

"At least you're both safe now."

"Try not to think about the birth."

These comments usually come from love. But they can inadvertently leave someone feeling that their emotional response doesn't make sense or that they need to stop talking about it.

Try listening first. You might say:

"That sounds as though it was really frightening."

"I can understand why that's still affecting you."

"You don't have to make this sound better for me."

"I'm here. You can tell me about it if you want to."

Compassion doesn't require you to agree with every fearful thought. It means taking the person's distress seriously.

Ask what kind of support they need

Don't assume that every difficult emotion requires a solution.

A surprisingly useful question is:

"Would it help more if I listened, helped you think through what to do, or took something practical off your plate?"

The answer may change from one day to the next: Sometimes someone needs to talk. Sometimes they need help finding professional support. And sometimes what they desperately need is for somebody to make dinner, hold the baby and put a load of washing on.

Remember that practical support is emotional support

When someone's threat system is already working overtime, ordinary demands can become surprisingly difficult.

There is also an enormous amount of invisible work involved in caring for a baby: remembering appointments, feeding, washing bottles or pump parts, researching symptoms, buying nappies, answering messages, planning meals and keeping track of what the baby needs next.

Rather than saying "Let me know if you need anything," try making your support concrete.

Offer to:

• bring or cook food

• do laundry or washing up

• take responsibility for shopping

• manage messages or visitors

• hold or care for the baby while they shower, eat or rest

• accompany them to appointments

• take responsibility for organising something that is weighing on them

• protect periods of rest or sleep where possible.

And try to take ownership of the whole task. Asking an overwhelmed person to identify, plan and delegate everything that needs doing can simply create another job.

Help create moments of safeness, not pressure to "relax"

If someone's nervous system is highly activated, being told to relax rarely works. Instead, think smaller.

What helps this person feel even 5% safer or more settled?

It might be sitting together with a cup of tea. Going outside for ten minutes. Having a shower while somebody trustworthy holds the baby. Watching something familiar. Eating something. Being hugged. Having someone quietly sit beside them.

In Compassion Focused Therapy, compassion isn't about forcing difficult feelings away. It is about noticing suffering and responding to it with warmth, wisdom and a commitment to help.

Small experiences of being cared for can matter.

Sometimes, we might need to be careful with reassurance

Reassurance is a natural part of relationships, and there is nothing wrong with comforting someone.

But if anxiety is prominent, repeated reassurance can sometimes become part of the anxiety cycle.

Someone might repeatedly ask:

"Do you think the baby is okay?"

"Do you think I'm a bad mum?"

"Do you think I'm going mad?"

A reassuring answer may bring enormous relief — but only temporarily. Soon the doubt returns, requiring reassurance again.

Rather than endlessly trying to provide certainty, combine warmth with confidence in the person's ability to tolerate uncertainty.

For example:

"I can hear how frightening that thought feels. I don't think answering it for the tenth time is actually helping you for very long. Can I stay with you while the anxiety comes down instead?"

If it’s tricky to know when, professional support can help you work out when reassurance is supportive and when it may unintentionally be maintaining anxiety.

Please do not force someone to talk about a traumatic birth

Talking about trauma can be helpful; but when, how and with whom matters. You don't need to encourage someone to repeatedly recount the birth if they don't want to. Instead, let them lead.

If they want to talk, listen without interrogating, correcting their memory or trying to find a positive interpretation. If they don't want to talk, let them know that the door remains open.

And if memories of the birth are significantly affecting everyday life, specialist psychological therapy can provide a safe, structured way of processing what happened.

If professional support is needed, try to discuss this without making them feel like the problem

You might notice that your loved one needs more support than friends and family can reasonably provide.

You could gently say:

"You've been carrying an enormous amount. I wonder whether it would help to have someone alongside you who understands this professionally. I can help you find somebody if you'd like."

Depending on their circumstances, support might come through their GP, health visitor, midwife, NHS Talking Therapies service, specialist perinatal mental health services, or a psychologist or therapist specialising in perinatal mental health and birth trauma.

You can also offer to make the process easier: finding contact details, sitting with them while they make a call, looking after the baby during an appointment or attending an appointment with them if appropriate.

Occasionally, the most helpful support might be couple’s or family therapy, in which case, a partner’s willingness can be really appreciated.

Look after yourself too

Supporting somebody you love through significant psychological distress can be difficult. Partners may be frightened themselves, particularly if they witnessed a traumatic birth. They may also be caring for a baby, managing practical responsibilities and trying to support someone they love while processing their own experience.

You are allowed to need support too. Importantly, getting support for yourself doesn't mean discussing your loved one's private experiences indiscriminately. It means recognising that you are part of this situation and that your wellbeing matters.

The Birth Trauma Association specifically supports partners as well as mothers affected by traumatic birth, including through peer support. PANDAS Foundation also provides support for parents, carers and the wider network of people affected by perinatal mental illness.

Where partners, friends and family can get support

Birth Trauma Association

The Birth Trauma Association provides peer support for people affected by traumatic birth, including partners. Its private Facebook community is open to mothers and partners, and its peer-support team includes support for dads and partners. You can contact the support team on 0203 621 6338 or support@birthtraumaassociation.org.uk.

www.birthtraumaassociation.org

www.birthtraumaassociation.org/fathers

PANDAS Foundation

PANDAS supports families and networks affected by perinatal mental illness — not only the person experiencing the symptoms. It offers a free callback service, WhatsApp support and support groups. Its WhatsApp service can be contacted on 07903 508334.

www.pandasfoundation.org.uk

Samaritans

If you are struggling yourself, or need somewhere confidential to talk, Samaritans can be contacted free on 116 123, 24 hours a day.

If you're worried about someone's immediate safety

Most people experiencing birth trauma, anxiety or depression do not require emergency intervention. But some symptoms need urgent assessment.

If someone is at immediate risk of harming themselves or somebody else, call 999 or attend A&E.

Seek urgent medical help if someone becomes extremely confused, severely agitated, unusually elated or "high", appears to be losing touch with reality, is hearing or seeing things that others cannot, develops unusual or strongly held beliefs, or is behaving in a way that is dramatically out of character, particularly in the first weeks after giving birth.

If you're unsure how urgently someone needs help, contact their GP or NHS 111.

Finally, remember, you don't have to say the perfect thing

When somebody you love is struggling, it's easy to become preoccupied with saying the right thing. Usually, what matters more is the relationship underneath it.

We’re just trying to communicate the general principles:

I believe that you're struggling.

You don't have to hide it from me.

I'm here with you through this.

We don't have to solve everything today.

Compassion isn't about removing every difficult emotion. It's about having the courage to turn towards suffering; our own and other people's, and responding in a way that is warm, wise and helpful.

Sometimes that might mean listening, sometimes it means making dinner, and sometimes it simply means staying beside them while things are difficult.