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Postnatal Depression
What is postnatal Depression?
Postnatal depression is a type of depression that many parents experience after having a baby.
It is a common experience, and affects more than 1 in every 10 women within a year of giving birth. It can also affect fathers and partners.
It's important to get help as soon as you think you might be depressed, so that you can seek treatment and start your journey through recovery, so that you can experience joy in your life again and enjoy your experience as a mum.
With the right support most people make a full recovery.
Symptoms of Postnatal Depression
In the first week or two after giving birth, many women can feel various emotions including feeling a bit down, tearful or anxious.
This is often called the "baby blues" and is so common that it's considered normal and comes about due to various factors including sleep deprivation, rapid withdrawal of placental hormones and adjustment to new parenting.
The "baby blues" typically does not last for more than 2 weeks after giving birth. If your symptoms last longer or start later, you could have postnatal depression.
Postnatal depression can start any time in the first year after giving birth.
If you are experiencing the following symptoms you may have postnatal depression:
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a persistent feeling of sadness and low mood
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a lack of enjoyment and loss of interest in the wider world
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lack of energy and feeling tired all the time
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trouble sleeping at night and feeling sleepy during the day
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finding it difficult to look after yourself and your baby
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withdrawal from contact with other people
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problems concentrating and making decisions
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frightening thoughts – for example, about hurting your baby or yourself.
Many women do not realise they have postnatal depression because it can develop gradually.
If you recognise these feelings in yourself or a partner or friend, know that treatment and recovery is possible. Seek support or encourage them to seek support from a health professional.
What is Postnatal Anxiety?
It is common for most new parents experience some worry. You want to be a great parent, and take the best care of your new baby.
Postpartum anxiety symptoms are more problematic for new parents and include:
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constant or near-constant worry that can’t be eased
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feelings of dread about things you fear will happen
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sleep disruption due to anxiety
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racing thoughts
Many women also experience physical symptoms of postpartum anxiety such as:
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fatigue
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heart palpitations
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hyperventilation or rapid breathing
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sweating
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nausea or vomiting
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shaking or trembling.
Causes of Postnatal Depression/Anxiety
The causes of postnatal depression or anxiety is individual and often multifactorial which is why postnatal care needs to take a bio-psycho-social-environmental approach.
There are a number of things that can make you more likely to have postnatal depression. These include:
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a history of mental health problems, particularly depression, earlier in life or during pregnancy
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pre-menstrual symptoms - indicating you could be more sensitive to the rapid hormonal changes that occur after birth.
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having no close family or friends to support you
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a difficult relationship with your partner
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recent stressful life events, such as moving cities, a significant loss or death of a family member
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physical or psychological trauma (current or historical), such as domestic violence or a difficult childhood.
Even if you do not have any of these contributing factors, having a baby is a life-changing event that can sometimes trigger depression.
It often takes time to adapt to becoming a new parent. Looking is after a baby changes your life, it can be stressful and exhausting.
Preventing Postnatal Depression
Women who have previous experience of postnatal depression, a family history of postnatal depression or pre-menstrual symptoms with periods are at increased risk for developing postnatal depression.
We encourage women to seek advice early during pregnancy to discuss options around supporting their mental health for the postnatal period.
An integrative assessment would take a bio-psycho-social-environmental approach.
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Biology: Review of bloodwork, stressors, family history and personal history of mental illness, PMS,
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Psychological: Exploration of concerns, worries around birth, mood, relationships.
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Social: Review of support systems and implementation of improved support systems where needed.
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Environmental: Growing a baby and giving birth is monumental physiological work for the body. We work with you to support your biology with foods, movement, sleep, stress management and nutraceuticals tp optimise to support your mental health during this exciting time of your life and to prepare you for a smoother fourth trimester.
Integrative Medicine for Postnatal Depression & Anxiety
Micronised progesterone
Progesterone is one of the major hormones produced by the placenta during pregnancy. It is metabolised to allopregnanolone and works as a calming neuro-steroid in the brain and has neurogenerative, neuroprotective, antidepressant, and anti-anxiety effects. Progesterone and therefore allopregnanolone levels drop sharply after birth due to delivery of the placenta.
Micronised progesterone (Utrogestan) is body identical progesterone and can be used to minimise the sudden decline in progesterone after birth by supporting maternal brain health and function. It can be used to prevent or treat postnatal depression. It is an affordable alternative to Brexanolone a synthetic progestin which is effective at reversing postnatal depression.
Nutrient dense whole food
Food provides energy and nourishment for healing and replenishing nutrients depleted during pregnancy and birth. This calls for energy dense and nutrient dense foods. Bone broth soups and stews with chicken, pork, fish or legumes are excellent sources of protein, calcium, minerals and collagen to support repair of tissues.
Eating diverse fruit and vegetables supply anti-oxidants and vitamins essential for supporting your recovery.
Fermented foods such as kefir, yogurt, sauerkraut and kimchi support the gut microbiome.
Sleep and Rest
It is normal to feel very tired for the first 2 weeks after birth as your body has gone through labor, delivery, and many physical changes and it needs extra rest for healing. Additionally caring for your newborn 24 hours a day puts new demands on your energy levels. Your sleep patterns will change to allow for at least 2 night feedings.
Resting lowers your metabolic rate and allows nutrients and oxygen to be diverted to healing instead of for activity. During your first 6 weeks be gentle with yourself and get as much rest as you can. Prioritise rest periods during the day. Take a nap or lie down and get off your feet for at least 30 minutes each day. Sleep when your baby sleeps, even during the day.
Use common sense about what must be done around the house and what can wait. Don’t try to be a hero. Ask your partner, family, or friends for help when you need it.
Mindful and wellbeing practices
Paying attention to what is your experience moment-to-moment without interpretation or judgment is the core aspect of mindfulness practice.
Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress.
Learning a variety of mindful practices means expanding your toolbox for dealing with stress. It also reduces anxiety, ease the pressure and stress of parenting as it reduces judgement and expectations and increase enjoyment of being a new parent.
Progressive Exercise
Pelvic floor and abdominal exercises support rehabilitation of the core and can be started from the first few days after the birth. Seeing a pelvic physiotherapist early on is helpful to support you to restrengthen your core.
Women who have experienced a birth injury such as prolapse, vaginal or labial tears can be assessed and lodge an ACC claim for birth injury.
As rest and recovery is the aim of the first 6 weeks of birth, gentle walking and core strengthen is the main exercise during this period. After this we can support you with gentle progressive exercise guidance to regain your pre-pregnancy strength and cardio-fitness in a way that honours your body.
Sex after birth - reconnecting with your partner/libido
When you do choose to begin having sex you may find your vagina is unusually dry if you are breastfeeding. This is hormonally related and lubricants can be a great help. Other women find using estrogen cream twice per week reduces the vaginal dryness and makes sex a lot more enjoyable. Remember contraception use is important when you do recommence having sex.
Difficulties with low desire/libido is common after birth, affecting approximately 35 percent of women. If your libido/sexual desire does not return as you would like, we can assess the physical, emotional, psychological factors and arousal problems affecting your low libido/ sex drive and help restore a healthy sexual relationship.
References
Lee YJ, Yi SW, Ju DH, et al. Correlation between postpartum depression and premenstrual dysphoric disorder: Single center study. Obstet Gynecol Sci. 2015 Sep;58(5):353-8. doi: 10.5468/ogs.2015.58.5.353. Epub 2015 Sep 22.
Barak Y, Glue P. Progesterone loading as a strategy for treating postpartum depression. Hum Psychopharmacol. 2020 May;35(3):e2731.