—J_art—Getty ImagesWhen Iza Thiago-Munoz brought her first baby home, she instituted a rule: She was the only person allowed to carry the baby upstairs. At the time, she lived in a narrow Philadelphia rowhouse with a steep staircase. If anyone else—including her husband—wanted to take the baby up, they had to buckle the infant into a car seat first.Her husband occasionally tried to reason with her. He could hold the baby tightly, he pointed out. “But what if you fall down the stairs?” she would reply.She didn’t know it at the time, but Thiago-Munoz was struggling with postpartum depression and anxiety, which amplified her lifelong tendency to imagine the worst-case scenario. She also felt enormous pressure to be a perfect mother. “I thought I had to do everything,” she says. Otherwise, she worried, “people would just think that I wasn’t good enough.” Asking for help felt like admitting that they were right.Thiago-Munoz is now a lactation consultant, postpartum doula, and founder of Clementina Health, a postpartum and lactation telehealth company. Her work is informed by what she experienced after giving birth—and by what she wishes the people around her had understood. “I just didn’t feel joy in anything,” she says. “I felt like I was supposed to be happy because, wow, this major thing just happened. And I was happy, but I wasn’t joyful.”Supporting someone with postpartum depression starts with knowing how it can show up, even when it doesn’t match the image you have in your head. Know the difference between “baby blues” and postpartum depressionBoth the “baby blues” and postpartum depression can cause sadness, tearfulness, irritability, and feeling overwhelmed after giving birth, says Dr. Kelli Burroughs, an ob-gyn and vice chair of clinical affairs and patient experience at the University of Texas Medical School in Houston. But the baby blues are generally mild, begin within the first week after delivery, and improve within about two weeks. Postpartum depression lasts longer and interferes more significantly with daily life.Signs can include a persistently depressed mood; losing interest in things that usually bring joy; withdrawing from other people; difficulty eating, concentrating, or sleeping even when the baby is asleep; extreme fatigue; and feeling disconnected from the baby. Postpartum depression can also begin months after giving birth—not only during those first blurry weeks at home.It doesn’t always look the way people expect, either. Sometimes, the moms who are suffering the most appear to have everything under control, says Jayme Scarfo, a licensed professional counselor in Surprise, Ariz., who specializes in working with pregnant and postpartum women. They’re showering, cooking, going to the gym, and insisting: “It’s hard, but don’t worry. I’ve got it.”You don’t need to decide whether someone meets the diagnostic criteria before checking in. Describe what you’ve noticed without labeling her, Scarfo suggests: “I know this is a huge adjustment, and you haven’t seemed like yourself lately. How are you really doing?” Or: “You seem much more anxious than usual, and I’m worried about you. Can we talk about it?”Consider who should initiate that conversation, too. “The best person to ask those hard questions is often going to be whoever she feels the least pressure to perform for,” Scarfo says. That might be a sister, best friend, therapist, or fellow mom—not necessarily her partner or mother. Burroughs also likes asking questions that are harder to brush off with a reflexive “I’m fine.” For example: “Are you having more good days or bad days?” It’s also helpful to ask when she last slept for more than two hours or ate a real meal sitting down. Those answers can help you understand where she’s struggling—and how you might lighten the load.Don’t argue with how she feelsWhen someone declares they’re a “terrible mother,” your instinct might be to disagree. Of course you’re not! You’re doing an amazing job. But depression and anxiety symptoms can start to feel like part of someone’s identity, says Emma Basch, a clinical psychologist in Washington who specializes in perinatal mental health. Trying to prove her wrong might leave her feeling even more misunderstood.Instead of correcting her, acknowledge how much she’s hurting: “It must be so painful to feel that way. I’m here for you.” Burroughs likes: “I’m glad you told me. I’m glad you feel comfortable confiding in me.” That signals that you can handle the truth, and that your friend doesn’t need to resume pretending everything is fine. Skip the sunny reassurances, like “Enjoy every moment,” “They’re only this little once,” and especially “You just had a baby—you should be happy.” Those comments suggest she can simply choose her way out of what she’s experiencing. “Postpartum depression is a true medical condition,” Burroughs says. “This is not a sign of weakness. This is out of the control of the new mom.” Listen without panickingLoved ones should try to remain calm if a new mom shares an intrusive thought, Scarfo says. A frightening flash like “What if I drop the baby?” isn’t the same as wanting it to happen. An alarmed reaction—or immediately suggesting an intervention like hospitalization—could make her less likely to confide in you again.Acknowledge that the thought sounds scary, and gently ask more: “How often are you having these thoughts?” “Do you feel like you might act on them?” “Do you feel safe right now?” “Who can we call together?”You don’t need to act like the thought is no big deal; it clearly feels like a very big deal to her. The goal is to become a safe place for her to say the things that aren’t picture-perfect, Scarfo says—and then help her figure out what she needs next.Know when it’s an emergencyTalking about suicide or harming the baby does require immediate intervention, Basch says. The same is true of signs of postpartum psychosis, which can include hallucinations, delusions, paranoia, confusion, or a decreased need for sleep accompanied by a surge of energy. “It’s not a layperson’s job to diagnose,” she says, “but it’s a layperson’s job to take action.” Anyone experiencing a mental-health crisis can call or text 988. The National Maternal Mental Health Hotline, available at 1-833-TLC-MAMA, also provides free, confidential support 24/7 to pregnant and postpartum women and their families.Make a concrete offer“Let me know if you need anything” might sound kind. But it puts the burden back on the person who’s already overwhelmed. She hears “ball’s in your court,” Scarfo says, and “a depressed mom is not picking up the ball. She has 17 other things to do.” Instead, tell your loved one exactly what you’d like to do, Basch advises. “I’m dropping off dinner tonight—does 6 p.m. work?” is much easier to answer than “Can I bring you something sometime?” She can still say no or suggest another time, but she doesn’t have to identify a need, invent a solution, and delegate it to you.Be careful not to turn helping into unwanted visits. Scarfo and her sister-in-law used to leave meals on each other’s porches and say: “I’m dropping off dinner at 6. I’m going to leave it on the porch, and I’ll text you when it’s there.” There was no expectation that the recipient would invite anyone inside or make conversation. “It doesn’t put that burden of gratitude on the new mom,” Scarfo says—“that burden of performing or hosting.” Take the legwork out of getting helpProfessional treatment might include therapy, medication, or both. Yet finding a provider, staying on top of insurance, making calls, and arranging child care can feel impossible when someone is already overwhelmed.Basch has seen loved ones do that legwork themselves and say: “I found a few therapists who specialize in postpartum mental health. I’d be happy to help you connect with one.” You might offer to make the call, accompany your loved one to an appointment, or watch the baby while she goes.If your partner keeps insisting that she’s fine but you remain concerned, Burroughs suggests contacting her ob-gyn, midwife, or other maternal-care provider yourself. Be specific about what you’ve observed: persistent sadness, repeated crying, withdrawal, difficulty bonding with the baby, or struggling to complete essential tasks. You might say: “I’m concerned about my partner’s emotional recovery after giving birth. These are the changes I’ve noticed at home.”The provider can then reach out to the patient without necessarily revealing who called, Burroughs says. They’ll usually open by saying: “I’m just calling to check on you. I want to see how your recovery is going.” Then, they’ll ask how the new mom feels emotionally on a scale of 1 to 10, whether she’s bonding with the baby, how often she feels sad, and whether she’s having more good days or bad ones. Those specific questions can make it harder for serious symptoms to disappear behind “I’m fine.”Keep showing upSupport tends to pour in immediately after a baby is born, when everyone wants to deliver a casserole and tickle the newborn’s toes. Then people return to their own lives, even though the need for support often outlasts that initial flurry of attention. Continue checking in without demanding a response: “Thinking of you today. No need to text back.” Keep offering specific help, even if your loved one turns you down the first time. Scarfo suggests making it clear that you’ll come over whether she wants to run an errand alone or lie down on the couch while somebody else handles the chaos around her.Thiago-Munoz still remembers the neighbor who noticed that she had stopped taking her dog on his usual 9 a.m. walk. If Thiago-Munoz hadn’t appeared by 9:15, her neighbor came over and walked him herself. “I honestly never would have asked her to take the dog for a walk,” she says. “I didn’t have the capacity to look for someone to do it. She knew my routine.”