Of course we want life with a newborn baby to be all sunshine and rainbows, but that’s not the reality for most new parents. The combination of increased responsibility and stress, along with lack of sleep, and changes to mom’s body can create the perfect environment for an emotional rollercoaster. Postpartum blues and more severely, postpartum depression can be very real. As a naturopath, I look at the body as a whole recognizing how vital mental health is in overall wellbeing - especially as a new parent.
Postpartum Blues vs Postpartum Depression
The postpartum or baby blues is common in the first week after delivery and usually starts to subside by the second week. Postpartum depression on the other hand may present in the 6 months after delivery and can be debilitating for many new moms. Being aware of the signs and symptoms of postpartum depression is important in recognizing when it’s time to ask for help.
Postpartum depression affects approximately 10-15% of new mothers (1).
Symptoms of Postpartum Depression (1)
Inability to sleep or sleeping a lot, even when baby is awake
Changes in appetite
Fear of harming, extreme concern and worry about baby
Sadness or excessive crying
Feeling of doubt, guilt, hopelessness
Difficulty concentrating and remembering
Loss of interest in hobbies and usual activities
Recurrent thoughts of death, which may include thinking about or even planning suicide
Many of these symptoms overlap with depressive disorders, and a history of depression or mental illness is a key risk factor in development of postpartum depression. However, postpartum depression may still present in those who have never experienced previous depressive episodes.
What is going on physiologically to contribute to this experience?
Changes in reproductive hormones, oxytocin, the HPA axis (which is responsible for stress hormones), and the immune system may all play a role in postpartum depression (2).
Estrogen and progesterone decline rapidly after giving birth and these changes have been presumed to contribute to postpartum depression due to their timing. However, those women who have lower amounts of reproductive hormones or experience a more rapid decline are not necessarily at higher risk of postpartum depression (2). This has lead to investigation of other possible causes.
Oxytocin, also known as the “love hormone" due to its role in social bonding, has been implicated in postpartum depression. A lower level of oxytocin during the third trimester is associated with increased depressive symptoms during pregnancy and immediately after birth (2). Oxytocin is also involved in breastfeeding and exclusive breastfeeding may reduce symptoms of depression postpartum (3).
The HPA axis is a hormonal cascade involving the end production of cortisol, one of the body’s main stress hormones. Increased activity of the HPA axis and increased cortisol production is associated with depressive symptoms (2). Cortisol levels increase substantially during pregnancy and drop 4 days after giving birth with normal functioning resuming around 12 weeks postpartum (2).
Immune system changes during pregnancy include dampening of the immune system so that mom’s body doesn’t accidentally mount an immune response against baby. This means that there is a decreased level of inflammatory compounds (2). After delivery, there is an abrupt shift to increased inflammatory compounds, which lasts for several weeks (2). Increased inflammation is speculated as a contributing factor to depression since those with depression tend to have higher levels of these inflammatory compounds (2).
The cause of postpartum mood changes appears to be multifactorial and may be specific to the individual. As a naturopath I use individualized care to better understand what each person’s contributing factors might be.
What can you do?
Some general approaches in addressing postpartum depression include:
Postpartum lab work: including a 3 month postpartum check of progesterone, and a 6 month postpartum check of iron stores, thyroid function, vitamin B12, and vitamin D. These particular markers commonly affect mood.
Breastfeeding: as mentioned above, breastfeeding promotes oxytocin production and exclusive breastfeeding may reduce symptoms of postpartum depression (3). However, this correlation may also be due to the immense pressure that is put on new moms to breastfeed, and a lack of breastfeeding may contribute to feelings of guilt. Knowing that breastfeeding isn’t the right option for every mom, and that baby can still get adequate nutrition from other sources may be helpful in relieving some of this pressure.
Self care: for mom this may include nutrition, sleep (as much as possible), exercise, acupuncture, and/or massage - listen to what your needs are and what leaves you feeling nourished.
Mental & emotional support: yes there are physiological factors that play into postpartum depression, yet the stress and mental aspect can be a huge piece. Psychotherapy is considered first-line treatment particularly for those with mild to moderate postpartum depression (1). Seeking emotional support from a friend, partner, or a professional can be a powerful tool during this time. Medications are preferably reserved as adjunct therapy for moderate to severe postpartum depression due to side effects and potential infant exposure through breast milk (1).
Mental health is so important in the postpartum period. For new moms it can often feel like survival mode is the only option. But what if you could truly be present and relish in these moments? Caring for yourself is crucial in order to best care for baby’s needs.
If you’re in need of postpartum support, please reach out. Start creating that support system and consider a visit at Juniper Family Health (778-265-8340) in Victoria, BC. Online booking available here.
1. Bailey, R., Ali, S., Jabeen, S., Barker, N. (2012). Postpartum depression: a review. Journal of Health Care for the Poor and Underserved, 23(2), 534-542.
2. Schiller, C., Meltzer-Brody, S., Rubinow, D. (2015). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48-59.
3. Figueiredo, B., Canario, C., Field, T. (2014). Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychological Medicine, 44, 927-936.