Ideas for fighting depression before and after your baby arrives.
Barbara Higham
Women who have suffered from depression before, or have a history of depression in the family, are at a higher risk for postpartum depression (PPD) following the birth of a baby. Being aware of the possibility and having some tools to help combat depression if it occurs or returns can be a good idea for an at-risk pregnant mother.
Depression is an awful illness and very much more severe than the baby blues, which are fleeting.
Here are 10 tips to help in case you need to fight PPD.
➊ A traumatic birth experience can greatly increase the risk for depression. While there is no guarantee about the way birth happens, there are lots of ways you can prepare and be ready for different eventualities and how you want to approach them. High intervention births put mental health at risk. Rowlands & Redshaw, 2012 revealed that women who had unplanned cesareans or forceps deliveries had the highest rates of depression and anxiety and the most breastfeeding difficulties. This does not mean that medicalized births are always traumatic. An experience is traumatic when it is “sudden, dangerous and overwhelming” (Figley, 1986).
Care. Birthing women are at high risk for experiencing medically induced psychological trauma, so much so, that the World Health Organization, 2014 issued a statement calling for respectful care of women during labor and birth. Gentle care can make all the difference to how you feel as a new mother. How mothers are treated may set the stage for either breastfeeding success or failure. The high levels of a new mother’s hormone oxytocin aid bonding with her baby, but also increase her openness, which in turn heightens her vulnerability to harsh or indifferent care from postpartum providers (Kerstin Uvnas Moberg, in a personal communication with Kathleen Kendall-Tackett, July 16, 2017). It’s important to trust your birth attendants and to feel comfortable and safe in the environment where you will have your baby, so give some thought to your choices.
➋ Plan to breastfeed. Breastfeeding might well protect against negative moods and stress. Groër, 2005 found breastfeeding mothers had more positive moods, reported more positive events, and perceived less stress than formula-feeders. In Tatano Beck’s, 2010 study of women who experienced birth trauma, breastfeeding could either exacerbate the trauma mothers were experiencing—or help them heal. But the lactation care that many of the women in her sample received (e.g., grabbing their breasts or shoving babies on their breasts) added to their trauma. Stressful births can delay milk production by several days (Grajeda & Perez-Escamilla, 2002). When babies end up requiring supplements or even dehydrated and back in the hospital, their mothers are further traumatized. Finding out about how breastfeeding works in advance may well help you if it does not get off to an easy start.
It is also encouraging to know that exclusively breastfeeding mothers appear to get more sleep than their mixed- and exclusively formula-feeding counterparts (Kendall-Tackett, Cong, & Hale, 2011). Breastfeeding hormones can help you relax and encourage bonding, which can be a struggle if you are prone to depression. Be aware that many moms experience a depressed mood when they stop breastfeeding.
➌ Find help with breastfeeding BEFORE the baby arrives, so when you feel overwhelmed if things don’t fall into place, you know whom to turn to for support. Go along to a breastfeeding mothers’ group while you are pregnant and watch other moms breastfeeding. Draw up a list of lactation consultants and knowledgeable breastfeeding mothers that you or your partner can call upon if you need support. It will be much easier to reach out for help to people you have already met than to call up a complete stranger. Read up about breastfeeding while you are still pregnant.
➍ Try to ensure that your partner has an idea of what to expect with birth and breastfeeding by reading books and attending prenatal classes together. His support and that of your parents/friends/family is really important and if they are well prepared with good information, they will be less likely to say things that might undermine your confidence as a vulnerable new mother and will also be in a position to protect your birthing and postpartum environment from anyone who might undermine you. Supportive comments when you are feeling particularly tired or low can make all the difference when you are struggling to make breastfeeding work or to adjust to your new role and this in turn will help them to adjust to their new role as father/grandparent/guardian, etc.
➎ Make practical arrangements in advance:
- Cook freezer meals or tell friends and family you would like oven ready meals rather than baby gifts.
- Warn people that your husband/partner might not be able to continue with some commitments for a time because he will be taking care of you. You will want to stay in bed, or at least in your night clothes, for a minimum of ten days, even following a straightforward birth. My midwife told me that birth requires as much energy as running a marathon, so resting is absolutely in order and helps promote lots of skin-to-skin contact that is crucial for getting to know your baby unhurriedly, in a peaceful environment, i.e. your bed.
- If you have other children, plan for your partner, parents, friends or other trusted person to get involved with school runs, playdates trips to the park, etc, to give you more time to spend with your new baby and also to provide your children with some fun and slightly more independence from you. Obviously, you don’t want them to feel as though you are casting them aside in favor of the newcomer. Enlisting your older children’s help with little tasks and letting them cuddle up with you for stories may help you all stay happy.
- Mothers with good support in labor and postpartum have lower rates of depression. Some mothers employ a doula to attend their birth. Whether you had one for the birth or not, a doula can provide support postpartum by being there for you. She can help you tap into support networks. When necessary, she can make a referral to a mental health provider. She can encourage a mother to increase the time she spends in skin-to-skin contact with her baby, and she can offer a helping hand so all this is possible.
➏ Diet and exercise can help in combating depression. You won’t have time to do much cooking now you are caring for a new baby so ensuring you have some nutritious, pre-prepared meals—and not prepared by you, unless they are frozen before the baby arrives—can be really helpful. Ask your partner (or helper) to ensure you have a steady supply of avocados, bananas, oats, nuts and seeds, all of which are good sources of tryptophan, an amino acid that builds the happy hormone serotonin in the brain. Even better, if he will leave you a big healthy sandwich, a pan of soup, and a bowl of hummus and chopped veggies in the fridge before he goes to work, or any foods that you can grab and eat without having to put your baby down, that will really help you focus on the important work at hand, which is caring for your baby and yourself. A walk in the fresh air every day wearing your baby in a sling or wrap is a great habit to get into after your postpartum lying-in, and will help you build up your strength physically and mentally.
➐ It may reassure you to know that most antidepressants prescribed nowadays are compatible with breastfeeding, though not all those prescribing them are aware of this. Medications and Mothers’ Milk catalogs the medications which are compatible with breastfeeding, in the event that any need to be taken.
➑ Non pharmacologic treatments such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), a form of psychotherapy, are good talking therapies that can help if you are depressed. Mindfulness is also a useful tool.
➒ Know your triggers for depression and plan ways in which you might avoid them. Common triggers are isolation, a lack of support, the loss of identity that can come with giving up a career. Your triggers will be specific to you. Read Depression in new mothers, causes, consequences, and treatment alternatives, 2016 to help you pinpoint your triggers and examine ways to avoid or address them.
➓ Don’t be afraid to make known your needs. Ask people to be gentle with you.
Help for Very Fatigued New Mothers
High Intervention Birth and Mother’s Mood
References
Tatano Beck, C. (2010). A metaethnography of traumatic childbirth and its aftermath: amplifying causal looping. Qualitative Health Research, 21(3), 301–311. doi:10.1177/1049732310390698
Figley, C. R. (1986) Trauma and Its Wake: Traumatic Stress Theory, Research and Intervention. doi:10.4324/9781315803869
Grajeda, R., & Perez-Escamilla, R. (2002). Stress during labor and delivery is associated with delayed onset of lactation among urban Guatemalan women. Journal of Nutrition, 132, 3055–3060.
Groër, M. W. (2005). Differences between exclusive breastfeeders, formula-feeders, and controls: a study of stress, mood, and endocrine variables. Biological Research For Nursing, 7(2), 106–117. doi:10.1177/1099800405280936
Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22–26. doi:10.1891/215805311807011593
Rowlands, I. J., & Redshaw, M. (2012). Mode of birth and women’s psychological and physical wellbeing in the postnatal period. BMC Pregnancy and Childbirth, 12(1). doi:10.1186/1471-2393-12-138
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