Prevention of Postpartum Mood Disorders

The question: Is there anything someone can do to prevent or lessen the chance of a postpartum mood disorder?

YES!  Read on:

Postpartum mood disorders are common, with literature quoting rates from 12-42% of all postpartum women affected. This fact gives postpartum depression the distinction of being the single biggest clinical risk that a birthing mother faces!  And, unfortunately, in the dizzying months of adjustment to a new baby, parents and care providers are typically poor at identifying mothers at risk.  It is confusing for mothers to assess what is “normal” postpartum adjustment baby blues and what is “abnormal.”  As a care provider, it can be challenging to identify mothers developing postpartum mood disorders.  And depending on where you live, resources for reproductive mental health like counselling and support groups are extremely limited–making it difficult to offer solutions other than prescription anti-depressants. 

Increased stress caused by sudden changes are known triggers for depression.  The stress from the profound changes of having a baby compounded by disruption in sleep, eating and exercise routines makes ALL women at risk for some postpartum mood disorders. However, women with personal or family histories of depression; who are struggling with anxiety/depression prenatally; or who lack support or are isolated from supports are at increased risk of postpartum depression.  Top this off with a disappointing birth or breastfeeding experience, and a woman can have a recipe for depression.

But it is not a guarantee–there are real opportunities to mitigate the risks to you and your baby by preparing for some of the physical and emotional challenges the postpartum period poses.  Think prevention. Prepare prenatally.

Here’s how:

Eat well.

Specifically, focusing on iron-rich foods can help avoid anaemia, which can dramatically decrease your energy levels.  Take your prenatal vitamins and consider an iron supplement if your levels are low.  Taking an additional B-complex can also help you deal with stress. 

Exercise! 

Regular exercise (such as walking for 30 minutes three times a week) is known to increase endorphins and is associated with reducing stress while improving mood.  Some studies have found exercise comparable in effectiveness to taking medication for people suffering from mild depression!

Choose a midwife and/or doula to support you throughout your pregnancy, labour and postpartum. 

Research demonstrates a reduction in the risk of interventions when a woman is supported throughout her birth experience.  Further, when a woman has a trusting relationship with a care provider and is supported to actively participate in the decisions around her birth she becomes the author of her story versus the victim of her experience. 

Give yourself the time to heal and change. 

Acknowledge and prepare for the profound impact of having a baby.   Adjust expectations.  Prepare meals ahead of time.  Eating regularly (aka. Snacking!) with easily accessible foods helps mood stability.  Take the time to surrender into your baby’s schedule and get to know one another. (See Into the storm blog).   

Gather support.

Learn to ask for and receive help.  Easier said than done – but so important!  North America’s increasingly nuclear families with women’s “I can do it all” attitudes are a set up for challenges.  We are one of the few cultures where birthing mothers are not fully supported in their postpartum period.  Challenge yourself to say “yes” to the willing neighbour asking if you need anything or the friend at your child’s preschool willing to pick up or drop off.  Family and friends are generally happy to contribute and can be a wealth of support.

Find other mothers! 

One of the most important recommendations for prevention of postpartum mood disorders is peer support. It is such a relief to find other mothers experiencing the same challenges and finding solutions!  Local mothers’ groups are often hosted through health units, schools, community centres and churches.  Find your own fit, and be mindful that you don’t have to connect to them all! 

Seek out resources prior to the birth. 

If you have known risk factors for depression, find the resources when you are well.  Ask your care provider, health unit or mental health agencies what is available locally.  Ask if there are support groups or reproductive mental health specialists. If you find your local community lacking, find support groups online.  An incredible resource in BC is the Pacific Postpartum Support Society who have a provincial mandate providing support by telephone to women across our province!  www.postpartum.org 

Create a care plan with your midwife and family doctor.

Seek a counselor that you trust prenatally so you have someone to check in with if you are feeling unwell or are concerned about your mental health.  Discuss when further interventions such as medication would be recommended or agreeable to you.  We know postpartum depressions are harder to recover from the longer a mother has been depressed.  Early recognition and support is key.   

After the birth, focus on getting enough sleep. 

I like to remind women that “Sleep deprivation is used as a form of torture!”   Getting enough sleep is imperative to our ability to function as it is the “emotional glue” that holds us together.  Interrupted sleep takes time to get used to and poses the biggest risk to mothers.   I tell women to aim for a minimum of 7 hours of sleep in a 24-hour period and that if they are not getting this level of sleep, they should access some increased support to come up with strategies to get more rest.   

Supplements and Remedies

The disruption in daily routines inherent in the postpartum period can make it difficult to maintain a balanced, nutritious diet.  Supplemental vitamins can make a difference to our moods.  It is recommended that all postpartum mothers keep taking their prenatal vitamins until breastfeeding is completed to replenish some of the vitamin and minerals that are in increased demand during pregnancy and breastfeeding.  Some women benefit from additional B vitamins, folic acid, calcium and magnesium. Research has shown taking increased doses of omega 3 fatty acids such as those found in fish oil supplements decreases the risk of postpartum mood disorders.  There is also some evidence for the use of the herb St John’s Wort in treating mild postpartum depression.  A naturopathic doctor can be super helpful in providing information on doses and the safety of using herbs while pregnant or breastfeeding. 

If you are feeling depressed, consider other physical changes that could cause you to be feeling this way. Ask you midwife or doctor to do some blood work to review your general health and particularly check your iron, B12 and thyroid hormone levels.  These can be treated with medications and supplementation.

If you feel these options are not helping and you are continuing to suffer or worsen, take advantage of the leg work you did prenatally in creating a care plan and reach out to a reproductive mental health specialist. They will lead you through the discussion about when to consider medications so you can be supported through the transition to motherhood this way.

Matraea has developed a line of special teas just for pregnant and postpartum women. These certified organic, caffeine free herbal teas provide a natural and tasty alternative to pills and other chemical based supplements. View our teas here.

Sarah Cosman

Cosman & Webb Townships Organic, Bury, Quebec, Canada