A Compassionate Look at Postpartum Depression
Watch my Postpartum Depression Interview on Inside Guelph
At least 12-16% of mothers experience postpartum depression. The true prevalence is probably even higher, since postpartum depression is under-diagnosed and under-reported by health care providers. It’s also not something that every mom is willing to discuss with her health practitioner or even her close friends and family. That’s because the feelings of shame and self-doubt, anxiety and isolation can be overwhelming, and make a mom feel super vulnerable especially in the age of Facebook and other media conveying only select (read: non-depressed) aspects of real life with a new baby. The isolation associated with postpartum depression only amplifies a woman’s feelings of failure and despair. Many women put extraordinary pressures on themselves to maintain their contribution to regular household functions or finances, to be the same kind of partner she was just months ago, to care for her other children and to strive for goals of perfection at being a mom…there are even pressures to “not be depressed”!. A new mom may have been led to believe that mothering is “instinctual” and that if she’s not getting everything just right, it means she is a failure or something is wrong with her. Moms may suffer from direct or implied family criticism or judgment about her choices and preferences as a parent. Or they may feel so ashamed of their feelings of indifference, lack of joy or bonding with baby that they keep all the difficult feelings inside and further isolate themselves.
Don’t Forget the Dads
Dads are at risk for postpartum depression, too. A 2014 study found that 11% of new dads experienced depression after their wives gave birth.
Where Does Postpartum Depression Come From, and What Can We Do About It?
Many factors may contribute to a parent’s risk of postpartum depression. If you think you may have postpartum depression or are having trouble coping, or know someone who’s in this situation, you/they should seek the help of a health care practitioner right away.
Here are some of the risk factors and what you can do about them:
- Stress vs. Support
For both moms and dads, a lack of social support and higher stress levels place them at risk for postpartum depression. It doesn’t matter whether the lack of support is actual or perceived. Women commonly feel like they have to do it all, and do it all perfectly. It is very natural that the skills of breastfeeding and caring for an infant need to be learned and practiced, and very realistic that a mom’s energy and time available for regular household duties or caring for older children can be severely limited. It’s also really common for a woman’s family circle to be a source of stress, rather than support, especially where family members attempt to control, advise or criticize her. In Guelph we have many opportunities for new moms to get out and interact with other new parents, get some support around breastfeeding or other issues that go along with the transition to motherhood, and we try to support mothers closely especially in the first few weeks and months of the baby’s life so that we can help make this the healthiest and happiest time possible.
- Delegate, De-Schedule and De-Stress
It’s not groundbreaking news: having a new baby involves stress. Stressors include sleep deprivation, financial worry, relationship strain, a health condition, and day to day responsibilities at work and home. To help overcome postpartum stress, practice letting go of and/or delegating some previous responsibilities to let you focus on caring for your new little one. Which activities can take a “pause” while you regain your energy and adapt to baby’s (ever changing) routine? Can you hire a postpartum doula, cleaning support, or a teen from your neighborhood to help you with cleaning or cooking once or twice per week? Is there a family member, friend or neighbour who could walk the dog or bring a homemade meal for the family? It’s not easy for new moms to ask for help, but it’s certainly a skill worth learning.
- Anti-Depressant Nutrition: Which Supplements Do We Need?
Three recent studies involving over 1000 pregnant women each reported that vitamin D deficiency during pregnancy or immediately after birth was a significant risk factor for postpartum depression.
Lower vitamin D levels have also been associated with negative impacts on fertility, as well as higher risk of gestational diabetes, preeclampsia and high blood pressure during pregnancy.
Omega 3 oils such as those found in fish may also be important in preventing and treating postpartum depression. Lower blood levels of omega 3’s have been correlated to increased risk of postpartum depression. The general recommendation for oily fish and fish oil intake during pregnancy is 2 servings of oily fish per week, or 200 mg of DHA daily during pregnancy. (DHA is crucial to your baby’s developing brain, and pregnancy and breastfeeding will pull your DHA stores to deliver them to baby). Most of us don’t get enough omega 3’s in our diets, especially when we’re wary of pollutants like mercury and pesticides and even plastic residues that are now showing up in fish. While the overall benefits of consuming fish in pregnancy seem to outweigh the risks, if you’re avoiding fish, take a fish oil supplement which has been purified of contaminants and supplies you with extra DHA and EPA for your baby’s brain while you’re breastfeeding and EPA to help treat and prevent postpartum depression.
Deficiency of b-vitamins, folic acid, calcium and iron may also influence postpartum depression. The typical Western diet commonly leaves pregnant women deficient in these nutrients. I recommend continuing your prenatal supplement (or a multi with iron and 400-1000 mcg folic acid) for as long as you’re breastfeeding, or as long as it takes for you to feel like “yourself” again. Moms need to eat three square meals each day providing quality protein, healthy fats and plenty of vegetables and fruits. Try a smoothie with some protein powder, dairy or non-dairy milk, fresh or frozen fruit, a few green leafies and 2-3 tsp hemp hearts, chia or ground flax seed.
It’s also very common for your iron stores to dip after having a baby. Your naturopathic doctor can order a blood test to see whether your levels are optimal for energy, mood and stamina.
- Check Your Thyroid
Pregnancy and childbirth can trigger a thyroid condition or reactivate a pre-existing one. Thyroid problems are among the most under-diagnosed conditions in general, and are frequently under-recognized in postpartum health visits. Simple blood tests can identify whether your thyroid is healthy or whether it may be contributing to symptoms of depression.
- Move to Your Groove
Exercise promotes healthy pregnancies, easier deliveries, prevents gestational diabetes and even promotes better brain development and intelligence in babies. Being in the habit of moving your body before pregnancy and birth is helpful, but not necessary to your success. Once your midwife or doctor has given you the go ahead to begin, find an activity you enjoy – walking together, dancing, squats or pushups at home, a 10-20 minute yoga video….start with 5-10 minute “exercise snacks” and work your way up to breaking a sweat and getting your heart rate up for 30 minutes a day. Exercise gives you a boost of happy hormones, busts through cortisol levels, helps you balance your blood sugars and increases your energy. When you feel depressed, it can feel insurmountable to even think about physical activity. The most important thing is to start, and pat yourself on the back for every little step forward.
Additional Risk Factors for Postpartum Depression
Having a more difficult labor and birth than expected is another risk factor for postpartum depression. One of the best ways women and couples can help prepare for an uncomplicated birth is to work with a doula and to do some in depth prenatal classes or hypnobirthing classes to help create a context for a less anxious, smoother and safer labor. The presence of a doula helps eliminate fear, which is a factor that tends to close down the labor process. Whether birthing at home or in hospital, a doula can be an advocate for the mother’s plans and decisions and empower her in the kind of birth experience that she is looking for.
Personal or Family History of Depression
We also know that women with a personal history of depression are more likely to experience postpartum depression and that includes women who experience depression during their pregnancy. It is very important to help women before they conceive and during pregnancy to address their depression to help them address some or all of their symptoms before the birth of their child, because introducing an infant can only add more pressure to mom’s sleep, nutrition and emotions and when a mother develops postnatal depression this can affect not only the mom but also the infant as well. There are so many challenges that a new parent faces that they may not have anticipated and that they may not be able to feel fully in control of. In our well baby and well mother program we help to screen women for postpartum depression in our first visits with mother and baby and we help to support women in addressing those feelings and symptoms as soon as possible in the baby’s life.
Natural & Complementary Treatment
If you have symptoms of postpartum depression, there’s no need to feel like you must choose an either/or approach when it comes to conventional and naturopathic treatment options. Natural medicine encompassing nutrition, sleep, counselling, meditation, acupuncture and other therapies are completely compatible with medication. In fact, these lifestyle choices may even help your conventional medication help you better. For example, when the supplement folic acid was added to the antidepressant medication fluoxetine, 94% of women experienced relief of depression symptoms compared to only 61% who took fluoxetine on its own. Natural medicine can also help you cope with medication side effects and can give you an individualized path to reducing your medication sooner if this is a priority for you.
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