Postpartum Depression and the Baby Blues

By: Sabrina Granniss, IBCLC

7 min

Overview

Who is at risk? Hormones and postpartum depression Postpartum depression and the gut health connection Labor and delivery Symptoms of baby blues Symptoms of postpartum depression Assessment of postpartum depression Treatment options Other Perinatal Mood disorders Support and Helplines

Having a baby is an exciting and happy time for expectant parents. Sometimes, the experience of bliss is replaced by feelings of anxiety, worry, and sadness. It can be surprising and confusing and interfere with daily life. Perinatal Mood and Anxiety Disorders (PMADs) include many different symptoms that can affect a person during pregnancy and postpartum. Learning what to look for in yourself or your partner can help identify if you need to reach out for help.

Depression, anxiety, and other mood disorders can occur during pregnancy or postpartum. Postpartum depression is considered to have an onset in the first year after giving birth.

Prenatal or antenatal - before birth.
Postpartum - after giving birth.
Peripartum - inclusive of both the prenatal and postnatal periods.

Who is at risk?

People with a history of depression or other mood disorders
Depression during pregnancy
People who experience chronic stress
Women of color are twice as likely to experience postpartum depression (6)
MTHFR gene mutation may increase the risk of postpartum depression (7)
Thyroid dysfunction (15)
Vitamin and nutrient deficiencies (16)
People who lack a support system
Parents whose baby was born prematurely
Current or past trauma
Marital status and satisfaction with your partner
Having baby blues

Hormones and postpartum depression

During pregnancy, hormones and the body are changing, and it can be a lot to adjust to. The hormonal changes affect our emotional state and how we feel physically. Hormones go through another significant shift after we give birth. These shifts can have a direct effect on our mood.

Human Chorionic Gonadotropin (HCG) rises and supports the placenta to grow. High levels of HCG are linked to more significant morning sickness. (1) Severe morning sickness can interfere with daily life and your sleep. Eating beans can help with nausea. The bean's soluble fiber absorbs the extra bile to help move it out of your system.
Progesterone increases in the first trimester. This pregnancy hormone supports the egg to implant on the uterine lining as well as maintain pregnancy. It helps smooth muscles relax, which can lower blood pressure and cause dizziness. Progesterone is necessary for the growth of ductal tissue in the chest. Progesterone drops significantly, and milk production increases. (2)
Estrogen increases throughout pregnancy to support the baby's growth and the development of our breasts. The breasts increase in size during pregnancy in preparation for lactation. Estrogen helps balance progesterone. After birth, estrogen levels drop.
Prolactin increases when the placenta is delivered. Prolactin is the primary hormone responsible for milk production.
Oxytocin is known as the feel-good hormone. It aids in the birth of the baby and the delivery of the placenta. Oxytocin is released during skin-to-skin contact with your baby. (3) It is responsible for milk release. Oxytocin helps manage stress. (4)
Cortisol is released when we experience stress. It is released and triggers the fight or flight response. This signals danger on a primal level, elevating the amount of energy available to us so we can run away from the potential threat of danger. Cortisol has been shown to transfer to the baby in a mom’s milk. (5)

Postpartum depression and the gut health connection

There is a connection between our gut health and depression. The gut and the brain communicate with one another, and information is passed from the gut to the brain as well as the brain to our gut. One way they are connected is by the Vagus nerve. An example of this connection most of us have experienced is nervousness, feeling it as a stomach ache or “butterflies in the stomach”. In the other direction, if we eat something that doesn’t make us feel good, we may begin to feel anxious.

Bacteria in our gut produce about 95% of our serotonin. (8) Serotonin is a hormone that makes us feel happy and balances our mood.

Decreased serotonin levels can result in symptoms of depression. It can impact our sleeping, mood, digestion, and bowel movements. Lowered serotonin can result in constipation. High levels of serotonin can cause us to have diarrhea. Improving gut health by boosting nutrition can play a major role in our symptoms of depression. Eating a whole-food diet and avoiding inflammatory foods can improve gut health, which can impact our mood.

Labor and delivery

Pitocin is synthetic oxytocin. Both stimulate contractions during the birth of the baby and the placenta. It also plays a role in controlling blood loss during delivery. Softening of the cervix as the baby is about to be delivered happens in conjunction with the release of oxytocin. When pitocin is used, it does not signal the softening of the cervix in the same way. (13) The amount of pitocin given during labor can lower the amount of natural oxytocin produced and affect the bonding between you and your baby. Sometimes, pitocin can help with labor that has stalled or other medically necessary situations. Using small doses is less likely to impact natural oxytocin production. (14)

When unexpected challenges or interventions occur during the birthing process or after the baby's birth, stress levels increase and can be a risk factor for depression. Emotional and physical stress increases when parents have a baby born prematurely or with other complications. Stress impacts our mood and sometimes our parenting abilities.

Symptoms of baby blues

sadness or crying for no reason
feeling anxious or restless
irritable and hard to concentrate
Feeling overwhelmed

Many new parents experience shifts in emotions after having their baby. The symptoms of the baby blues can happen a couple of days after birth and resolve by two weeks postpartum.

Getting outside for fresh air and sunshine and cuddling with your baby skin-to-skin can help elevate your mood during the blues. Get enough rest by taking naps when your baby naps, going to bed early if daytime naps are not an option, eating nutrient-dense foods, and drinking plenty of water. Share your thoughts and feelings with your support people and your healthcare team.

Symptoms of postpartum depression

Anger or mood swings
Anxiety
Feelings of guilt or hopelessness
Loss of appetite
Hard time bonding with the baby
Unwanted thoughts or fears
Insomnia
Panic attacks
Repetitive thoughts
Unable to make decisions
Unable to do daily tasks
Overly concerned about the baby
Lack of concern for the baby

Postpartum depression can interfere with bonding and feeding your baby, leading to weaning earlier than you wanted to. If symptoms of the baby blues are severe or do not resolve on their own, the result is postpartum depression. Postpartum depression does not go away on its own.

Assessment of postpartum depression

Our health during pregnancy and how we give birth can influence our risk of postpartum depression and other mood disorders. In healthcare, we still fall short when it comes to assessing depression during pregnancy. Talking with your midwife, doctors, IBCLC, and other care providers during your pregnancy about your health history and any risk factors you may have can ensure you get the care needed if depression arises.

The Edinburgh Postnatal Depression Scale is a questionnaire you can take at home while pregnant or after birth to help you determine if you may be experiencing more than the baby blues.
Assessment by your medical doctor
Blood tests to reveal any hormone imbalances, nutrient deficiencies, or genetic mutations like MTHFR
Diet and lifestyle assessment

Treatment options

Depression symptoms and treatments should be discussed with your healthcare team. Many options are available; finding the right one or combination of treatments can take some time and experimenting to know what works best for you.

Diet and gut health adjustments - discuss a gut healing diet, correcting nutrient depletions, and possible food allergies with a Naturopath or other functional medicine doctor
Talk therapy - this is one of the most common therapies and is helpful for many people
Vagus nerve therapy - this is starting to get more attention as a treatment and prevention (9)
Bodywork - massage, as well as chiropractic care, can improve depression
Homeopathy (10)
Antidepressant medication - most are considered safe while breastfeeding, but ask your IBCLC to be sure
Emotional Freedom Technique (EFT) (11 - learn EFT tapping techniques
Intranasal oxytocin (12) - this works differently than synthetic oxytocin given during labor and may help relieve postpartum depression symptoms

Other Perinatal Mood disorders

Anxiety
Depression
Panic disorder
Post-traumatic stress syndrome (PTSD)
Obsessive-compulsive disorder
psychosis

Support and Helplines

Postpartum Support International
Crisis text line
SAMHSA - Substance Abuse and Mental Health Services Administration helpline
Postpartum support for men

Some people are more at risk than others for Perinatal Mood Disorders, but they can happen to anyone, so knowing the signs and symptoms is important. Your personal history, nutrition, pregnancy, and birth experience all matter and can impact mood disorders. Hormones play a role, as does the health of our gut. Many preventative measures and treatments are available to support people experiencing postpartum depression or other mood disorders. Local support groups can be found by talking to your doctor or IBCLC. You deserve to feel good, and finding the right support can help the healing begin.