How to prevent postpartum depression is a frequent topic that comes up when I am talking to patients and other providers. To help squash some of the myths out there on the internet, and to provide some evidence-based education, I have put together a list of the top 5 natural ways to prevent postpartum depression. Keep in mind though, if someone has a history of two or more periods of depression in their past or has a history of bipolar disorder, the risk of those symptoms coming up again during pregnancy or postpartum is greater than 60% (higher for bipolar disorder) if they are no longer on medication. Because mental illness symptoms in pregnancy and postpartum have significant risks for baby, it is important to take the necessary steps to prevent mental illness from coming up during this important time. For some people, the safest option might be to continue their medication. For everyone, though, using these 5 natural tools to prevent mental illness will help keep both mom and baby healthier!
1. Support Network
Postpartum depression rates have increased over the decades, and one likely culprit is the change in our society structure. Women are more present in the workforce, and are working until they are older. This likely means a woman doesn’t live near other family, and that other family and friends also have jobs that take them away from helping when baby comes.
As humans, we have evolved as very social creatures though. We depend on social and emotional connections to thrive. This dependency on connection is even more imperative around the time of pregnancy and postpartum, as a woman’s brain is changing in many ways to prepare her for motherhood. Multiple studies have shown the importance of a woman’s support network during the postpartum period, and this makes sense logistically. If a woman has help with cooking, cleaning, working, and taking care of her other children, she is bound to have less stress, and, therefore, is less at risk for postpartum mental illness. Similarly, if she has someone to confide in about her struggles or fears, or someone to give her some time away from her newborn to rest, she is also going to fair better mentally and physically than a woman who does not have those opportunities. There was also a recent study that showed a baby’s IQ was directly correlated with the number of people in the mom’s support network. This isn’t surprising though. Many studies confirm that if mom does better mentally, then baby also thrives more in developing mentally and physically.
Take time to plan your postpartum period. Utilize the people who offer to help. Decide who will bring which meals, who can help out with other children, who can clean, and who can give mom and dad a needed break. Consider hiring a postpartum doula or a night nanny if friends or family are scarce. There are so many resources out there to help you plan for this time, including this Postpartum Workbook. PPHA is a local Austin organization that offers a doula voucher program so that families who would not otherwise be able to afford a doula, can. Visit pphatx.org to learn how to apply.
2. Food
Food and exercise are two lifestyle modifications that frequently show up as prevention tools for illnesses. It is no different with mental illness. Let’s not forget that the brain is an organ in our body, just like our heart, liver, kidneys, etc. And just as other organs benefit from a healthy lifestyle, so does our brain.
Eating a diet high in sugar and other processed ingredients increases the amount of oxidative stress on neurons, or the cells that make up our brain. Oxidative stress is a term that refers to chemicals our body makes in response to certain environments that harm the cells in our body. This makes it much more difficult for our neurons to function optimally, which increases our risk of developing mental illness. Eating a diet with a lot of vegetables, fruits, legumes, beans, and fish has shown to decrease this oxidative stress. Given this information, it is no surprise that The Mediterranean Diet has specifically been studied for its health benefits, and has shown to improve mood in some people. Overall, it serves as a great guideline for healthier eating habits. There are also psychiatrists who specialize in Nutritional Psychiatry, which studies how foods impact mental health. Dr. Drew Ramsey is one of the well-known psychiatrist in this field, and has published several books to help people eat foods that better brain health.
3. Exercise
Exercise is another tool to help prevent mental illness. There are several ways this possibly helps our brain to be healthier, but we still have not completely figured out why exercise decreases our risk of mental illness. We know exercise has many benefits on our body that impact mental health such as improving deep sleep quality, regulating stress hormones, increasing endorphins, and improving access to oxygen throughout the body. There is evidence showing that moderate exercise for 30 minutes a day, 5 days a week can improve depression, and that yoga is an effective adjunct treatment for anxiety.
Women have come up with some pretty creative ways to exercise with a baby, and you can find many of these exercise regimens on YouTube. There are even stroller meet up groups and yoga classes with baby here in Austin!
4. Sleep
There is a lot of research about sleep and its impact on the body, especially on the brain. As many people know from personal experience, a night of bad sleep can really change your mood or make you feel more anxious the next day. Even small amounts of sleep deprivation can add up over time to impact how the brain functions, making it more prone to mood instability and anxiety. Sleep problems in pregnancy have shown to increase the risk for postpartum mental illness, and those with more severe sleep deprivation postpartum, are also more likely to develop postpartum depression or anxiety. It is so important for the brain to get a minimum of 4 to 5 hours of uninterrupted sleep each night, but this can be impossible when you’re the only one caring for an infant at night.
Some strategies to help improve sleep after baby comes include, dividing up night duties with your partner (one person takes the first half of the night, and the other person takes the second half), hiring a night nanny for a few nights a week, sleeping in a different room than baby as (s)he gets older, using sound machines or ear plugs, and keeping it as dark as possible at night (this will help baby sleep too). It is very important to practice “sleep hygiene” techniques as well.
If you find that you are having trouble sleeping at night - whether it’s falling asleep or staying asleep - it is important to talk to a psychiatrist or therapist about this. The most validated way to improve sleep is by using a technique called CBT-I, or cognitive behavioral therapy for insomnia. This is the first-line approach to insomnia, and is much safer and more effective than medication. There are online programs for CBT-I for those who cannot afford therapy or cannot find a therapist who offers it. One such program is Slumber Camp. If you notice you are having trouble sleeping when baby is asleep, this is also a red flag that you may be suffering with postpartum mental illness.
5. Therapy
It can seem unrealistic to some, but going to therapy weekly can actually be as effective as medication at improving mild depression and anxiety symptoms. Weekly therapy has also been shown to help prevent postpartum mental illness in some studies. There are two types of therapy that specifically show evidence in postpartum mental illness treatment: cognitive behavioral therapy and interpersonal therapy. To find a therapist near you, check out psychologytoday.com.
When Mother's Day HurtsWhen Mother’s Day Hurts“There is, I am convinced, no picture that conveys in all itsdreadfulness, a vision of sorrow, despairing, remediless, supreme.If I could paint such a picture, the canvas would show onlya woman looking down at her empty arms.”-Charlotte BronteAs Mother’s Day approaches, I’ve been speaking with several of my clients who’ve struggled to become mothers and/or have lost a child in utero about what this day means to them and how they feel. I’d like to share some of the themes that have emerged through our discussions. Unfair. For many women, the veneration of mothers on this day is deeply painful. Feelings of anger, irritation, envy, and confusion arise. Why me? Why haven’t I become a mother after so much effort? Why did I lose this much sought-after pregnancy? The women I see in my practice have typically spent months, sometimes years, trying to birth a healthy baby. They may have sacrificed tremendous time, energy, and spent the reserves of their emotional and financial resources to try to conceive. They may have given birth and held a dead baby in their arms. The legacy of their losses becomes their new reality, and they must learn to navigate the world with the constant presence of someone’s absence. This, my friends, is unfair. Isolation. Infertility and/or pregnancy loss is often a silent struggle. Research reports that women who are struggling to become mothers experience increased feelings of anxiety, depression, isolation, shame, guilt, and loss of control. Depression levels in people with infertility have even been compared with patients who have been diagnosed with cancer, and couples tend to report that infertility or pregnancy loss have been the “most difficult” events in their lives thus far. This silent sorority of women is estimated to affect 1 in 8 couples (or 12% of married) who struggle to get pregnant or sustain a pregnancy (Rooney & Domar, 2018). That’s roughly the size California, folks! And yet, we don’t talk about it enough, and that’s especially true for men. Sadly, when these discussions do come up, well intended yet uninformed family, friends, or coworkers can say thoughtless, hurtful comments. This can further the cycle of silence. Grief/Loss. If you wonder what that constant tension is in your body, that heavy feeling that sits on your chest – it’s grief. Feelings of anger, depression, anxiety, fear – all different colors of grief expressed. Loss is ever present in the stories of those struggling to create their families, and it doesn’t just disappear when a baby arrives. For some of my clients, the losses can be layered, so let’s take a look at some of them:What’s been lost?Loss of the experience of pregnancy and birth – you feel you are missing out on one of the most miraculous events of lifeLoss of sense of belonging – you don’t quite fit amongst your friends, family, or society at largeLoss of being in control – of your body – of your life. This wasn’t how it was supposed to beLoss of feeling healthy and normal – your identity shifts from “healthy person” to “infertility patient”Loss of feeling competent – you feel you can no longer achieve what you set out to doLoss of sexual intimacy, identity, and privacy – what had been the most private and intimate acts is now publicThe Eagles band has a song titled “Hole in the World” and I think it certainly applies here - -There's a hole in the world tonightThere's a cloud of fear and sorrowThere's a hole in the world tonightDon't let there be a hole in the world tomorrowIdentity Disruption. Talking with a client who had experienced three recurrent pregnancy losses in the recent past, she noted how her relationship to mother’s day had not transitioned the way she expected, from honoring your mother figure to honoring yourself as a mother. She further described feeling excluded from parenthood and being relegated to still sit at the “kid’s table.” For so many women, they had constructed (whether conscious or unconscious) a reproductive narrative, a story of the family they would have one day and the role they would play in that family. And this story can be largely influenced by the dominant cultural narrative regarding becoming an adult – separating from your parents, establishing your own residence, taking responsibility for your life, and creating your own family. Being denied these important rites of passage and roles can be experienced as an existential crisis. Who am I? Where do I belong?Heroism. The people that I’ve had the privilege to work with during their parenting journey are nothing short of courageous as they attempt to create life against the odds. Some of those people came home with a baby, while others made the heartbreaking decision to be childless due to financial constraints and/or unwillingness to undergo fertility treatments. Some of them only have pictures of the child that never breathed air. As Dr. Ilona Laszlo Higgins expressed in her book “Creating Life Against the Odds,”The struggle of these individuals to create and nurture children goes well beyond the desire to produce a new generation in one’s own image, or to have a living repository for one’s inheritance. It is about the sense of completion that comes from the conscious commitment to be responsible for the well being of another. It is the wisdom that comes from the ashes of loss, translated into new life. (Intended) parents such as these set an example for all of us about the hard work of love. I couldn’t agree more. Society often pathologizes and judges the lengths these folks go to in order to become parents. I’ve had several clients exclaim, “I would never do that,” and then when faced with no other alternative, start down the path they said they would never go. To me, these individuals aren’t crazy, they’re heroes. They are willing to recreate their story and consider what could be versus what should have been. They grieve their losses and nurture their wounds, then carry on. On this day, it is my hope you can do the following for yourself:Practice being with grief, in whatever form it takes, unconditionally and nonjudgmentally. Be with your deeply wounded self.Acknowledge that there’s a missing piece to your life puzzle. A hole in your world.Take good care of yourself. Far from being selfish, self-care in grief is courageous.Forgive yourself. You did nothing wrong. Create a ritual to acknowledge what or who is missing. Write a letter, bury an object, say a prayer, light a candle, carry flowers, whatever honors the void. Ritual acts, whether private or public, are ways in which we give way to the feelings of love, pain, and connection. References/Recommended further readings:Cacciatore, J. (2017). Bearing the unbearable: love, loss, and the heartbreaking path of grief. Wisdom Publications, Somerville, MA. Fast Facts About Infertility. Available at: http://www.resolve.org/about/fast-facts-about-fertility.html. Resolve: The National Fertility Association. Higgins, I. L. (2006). Creating life against the odds: the journey from infertility to parenthood. Xlibris Corporation. Jaffe, J., Diamond, M., & Diamond, D. (2005). Unsung lullabies: understanding and coping with infertility. St. Martin’s Press, New York, NY. Rooney, K. & Domar, A. (2018). Dialogues Clin Neurosci. Mar; 20(1): 41–47.
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