Having a baby is often exciting and a happy time for expectant parents. Sometimes the experience of bliss is replaced by feelings of anxiety, worry, and sadness. It can be surprising, confusing, and interfere with daily life. Perinatal Mood and Anxiety Disorders (PMADs) include many different symptoms that can affect a person during their pregnancy as well as the postpartum period. Learning what to look for in yourself or your partner can help identify if you need to reach out for help.
Peripartum depression can occur during pregnancy as well as anytime in the first year after giving birth.
- Prenatal or antenatal is before birth
- Postpartum is after giving birth
- Peripartum is inclusive of both the prenatal and postnatal period
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 with a lack a support system
- Parents whose baby was born prematurely
- Current or past trauma
- Marital status and satisfaction with your partner
- Having baby blues
There are many potential causes of peripartum depression. Sometimes hormonal, emotional, or physical reasons can put someone at risk of being affected by depression during pregnancy or after birth.
Hormones and postpartum depression
During pregnancy, hormones are changing, the body is changing and it can be a lot to adjust to. The hormonal changes affect our emotional state as well as how we can feel physically. Hormones go through another big 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 as well as your sleep. Eating beans can help with nausea. The soluble fiber in beans 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 to relax which can lower blood pressure and cause some 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 supporting the growth of the baby which is why our breasts get bigger 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 main 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 there is danger, on a primal level, elevating the amount of energy available to us so we can run away from it. Cortisol has been shown to transfer to the baby in a lactating parent’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 being nervous and 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 make us have diarrhea. Improving gut health by boosting nutrition can play a major role in our symptoms of depression. Eating a whole foods diet and avoiding inflammatory foods can improve gut health which in turn 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 can affect the bonding between you and your baby. There are times the use of 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 there are unexpected challenges or interventions during the birthing process or after the birth of the baby, stress levels increase and can be a risk factor for depression. Emotional and physical stress increases when parents have a baby who is born prematurely or who has other complications. Stress impacts our mood and sometimes our parenting abilities.
Symptoms of baby blues
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.
- sadness or crying for no reason
- feeling anxious or restless
- irritable and hard to concentrate
- Feeling overwhelmed
Getting outside for fresh air and sunshine and cuddling with your baby skin to skin can all help elevate your mood during the blues. Get enough rest by taking naps when your baby naps, go to bed early if daytime naps are not an option, eat nutrient-dense foods and drink plenty of water. Share your thoughts and feelings with your support people as well as your healthcare team.
Symptoms of postpartum depression
Postpartum depression can interfere with being able to bond with your baby and feeding your baby which can lead to weaning earlier than you wanted to. It does not go away on its own.
If symptoms of the baby blues are severe or do not resolve on their own, the result is postpartum depression.
- Anger or mood swings
- Feelings of guilt or hopelessness
- Loss of appetite
- Hard time bonding with the baby
- Unwanted thoughts or fears
- Panic attacks
- Repetitive thoughts
- Unable to make decisions
- Unable to do daily tasks
- Overly concerned about the baby
- Lack of concern for the baby
Assessment of postpartum depression
Our health during pregnancy and how we 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 help make sure 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
Depression symptoms and treatments should be discussed with your healthcare team. There are many options available and finding the right one or a 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 depletion 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
- 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
- Panic disorder
- Post-traumatic stress syndrome (PTSD)
- Obsessive-compulsive disorder
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. Our personal history, nutrition, pregnancy, and birth experience matter. Hormones play a role as does the health of our gut. There are many preventative measures and treatments 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.