The face of postpartum mental health is changing. What we once referred to as Postpartum Depression no longer encapsulates the breadth of challenges that a woman may experience after birth.
Although depression is the more commonly known postpartum disorder, the struggle is frequently manifested as an anxiety rather than a mood disorder It can also start during the pregnancy and continue postnatally. To better reflect these elements, we now use the contemporary term Perinatal Mood and Anxiety Disorders or PMAD.
A review of the literature suggests that there are three types of postpartum mood states:
1) the maternity blues (a fairly common, transient disorder)
2) postpartum affective psychosis (relatively rare)
3) post partum anxiety
4) post partum OCD
5) postpartum depression (as many as 20% of postpartum women may develop mild to moderate depression).
For the scope of this article, we'll be talking about postpartum depression (PPD)
PPD impacts not only the mother but the baby as well, putting them at risk for future behavioral, social, emotional and cognitive difficulties. Untreated PPD has been correlated with depression and anxiety in toddlers, learning and behavioral difficulties in school-aged children and predispose kids to mood disorders later in life. PMAD have been identified as the number one reason for lack of school readiness in children.
You are not alone. The reported rate of women affected by PPD varies, with estimates as high as 22% (Gaynes et al., 2005).
Less than 50% of women are actually screened for PPD (Kelly et al., 2001); therefore the actual incidence is likely to be significantly higher than what's documented.
There are things we can do to mitigate or eliminate PPD.
1) Take charge of your birth.
Medical complications during pregnancy and birth can affect a woman's postpartum adjustment.
What is the connection between birth and postpartum mental health?
""One thing we know about anxiety and depression is that they correlate significantly with people's sense
of control or lack of control over their own lives. People who believe that they are in charge of their own fate are less likely to become anxious or depressed than those who believe that they are victims of circumstances beyond their control." (Hopkins, Marcus, & Campbell, American Psychological Association, 1984)
A traumatic birth experience can (and does) affect our mood after birth. Women often report feeling that medical intervention was the catalyst in feeling out of control in the birth setting. And as research demonstrates, when women don't feel like they are in control of their fate, they are more likely to experience anxiety, depression and other mood disorders.
As such, it is important that women stay involved in the decision making in birth. When non-emergency interventions are suggested, women are encouraged to ask questions, and be given the necessary time and space to process what and why an intervention is being recommended. This can facilitate a woman's ability to maintain a sense of control over a birth that deviates from her original plan, thereby improving her postpartum emotional outcome.
2) Shhh…no talking zone.
My first baby was born in a hospital and my doula was keenly aware of my intention to have a 'No Talking Zone' following the birth. This wasn't easy (as is often the case in hospitals) as it directly conflicted with the medical staff's intention of what caring for me entailed; birthing the placenta as quickly as possible, administering post-labor Pitocin and possibly stitching (which thankfully was not needed).
I was fortunate to deliver my second baby at home, which was a more conducive environment for my desires to be respected and a 'No Talking Zone' to be ensured.
Whatever environment you choose to birth your baby, give some thought to what you would like the first few moments of your baby's life to entail. Perhaps you would like to create your own 'No Talking Zone' or request all talk be limited to care of you and your baby. Know that it is for you to decide.
3) Skin to Skin all the Way
Despite mounting evidence of harmful effects of separation of mother and baby immediately after birth, it is still common practice to do so.
Some providers are now are recognizing the important research that has been done enumerating the harmful effects of separating mom and baby, including:
Benefits of Skin-to-skin contact between a mother and her baby at birth are invaluable:
Skin To Skin Contact is important to ensure a continuous flow of oxytocin (and serotonin) between mama and baby. According to mammalian neuroscience, the intimate contact between mom and baby sparks neuro-behaviors leading to fulfillment of basic biological needs, so whenever possible let's keep mom and baby together.
4) No hats or blankets, please.
It's standard practice. Baby is born. Baby is swaddled in a blanket and head is adorned by a hat. But did you know that 'hatting' or clothing a baby disrupts the natural flow of scents?
The time directly after birth, is a critical time for mother and baby to 'reconnect' outside the womb. It's essential for mother and baby to absorb the breathing, smells and the aura of one another.
Mama smell baby's head and it initiates an increased flow of oxytocin, which circles back to the baby. Love and happiness abound. This is one of the many ways the mother and baby "fall in love" with one another. It's all a perfect part of the very delicate chemistry post-birth.
Let's honor this sacred practice.
5) No washing, bathing or cleaning baby or mama!
Ok, before you stop reading, let me explain this really important step in the reconnection process between mother and newborn.
I recently spent two inspiring days enjoying Ina May Gaskin's company at her home in Tennessee. I remember so much from our long and wonderful conversations.
One thing that really stood out for me was when she started talking about the pitfalls of mother and baby separation. Of specific interest, she mentioned avoiding showers and deodorant.
Yes, you read right – no artificial scents, perfumes, deodorants or bathing for mom and baby.
She made some jokes and we had a good time talking about this idea. But in all seriousness, it's a very important step.
Just like we don't want blankets and hats blocking the bonding through natural scents, we don't want artificial scents or premature bathing to interfere either.
Baby and mother need to 'identify' one another through smells. The baby especially will recognize the smell of the amniotic fluid that spread out and around mom's breasts and even armpits, etc. This produces an incredible amount of oxytocin.
Encouraging the natural flow of smells will promote bonding, facilitate breastfeeding, increase oxytocin and reduce cortisol.
In addition, the exchange of smells:
This process brings comfort to the baby and mother and ultimately reduces the risks of PMAD.
And it continues to flow, full circles from mother to baby and back.
6) Breastfeeding: Unlimited and Uninterrupted
Skin to skin contact increases success in breastfeeding. Successful breastfeeding also contributes to decrease in PMAD. Need I say more? Let's be kind and support our new moms. Remind them that although breastfeeding is 'natural' it takes time to develop comfort and mastery over this new skill. For some moms it takes 6-8 weeks before they feel like they fully get the hang of it. Encourage mom and people around mom to be patient and supportive…the rest will flow on its own.
7) Nourishing foods and thoughts.
It is becoming more known that what we eat can affect our mood. And even our mental health. Toxic foods can lead to a toxic body. It's especially important to avoid artificial colours and flavours. By the same token, we should eat nourishing foods High in good fat, vitamins and minerals. Some herbs have been studied and thought to increase serotonin levels.
Thoughts. During this time especially, it's important to surround ourselves with positivity. If that means turning off the news, so be it. If that means spending less time with certain people, it's what needs to be done. Just think of your baby and yourself. Having the best healthy possible (mentally and physically) will ultimately decrease our chances of PPD.
8) Resurrect "The Village"
Back in the day, our ancestors, neighbors, wise women and family members all took part in raising a baby.
Mothers had an entire team of people who felt her pain, cried and laughed with her and were there for her. No questions asked.
Today, we've lost the "Village.". Modern society is so far removed from how human beings originally lived;and continued to live for thousands of years. We, mothers are left to fend for ourselves. Not only are we expected to care for new baby, but there is also pressure to maintain a tidy home, not falter with nutritious home cooked meals and possibly even contribute to the household income. All while recovering from what might be the most physical and strenuous workout of our lives. Birth.
This isn't anything new. Low levels of social support are commonplace and often cited as one of the most common reasons for the rise in PMAD.
If and when the emotional needs of babies and mothers are met and understood, our world could experience a gradual decrease in disease, mental illness and even the general problems faced today.