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Objectives: To study severe postpartum blues and associated factors. Study design: One hundred and two women in two maternity units in the suburbs of Paris completed self-administered questionnaires, including Maternity Blues questionnaire, three days after giving birth. We defined severe blues as a score on the maternity blues scale above the 90th percentile of our sample distribution (cut-off point = 12/28). Results: Severe blues was associated with the mothers' unemployment but not with their socio-demographic characteristics. Women who breast-fed had a higher frequency of severe blues. Severe blues tended to be associated with women's expectation of little or no help with child care and with problematic relationship with their baby's father. It was strongly related to high state anxiety but not to high trait anxiety. Conclusion: These results suggest that both breast feeding and insecure psychological and social surrounding, such as unemployment, may be risk-factors for severe blues. [ABSTRACT FROM AUTHOR]