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5 Ways to Prepare for the Postpartum

May 15, 2020
prepare postpartum naturopathic doctor toronto

When people are pregnant, they often think about what life will be like with baby. However, the immediate postpartum sometimes get overlooked. Today, I’m discussing 5 simple ways how you can prepare for the postpartum.

Create Your Nest

It’s likely that most of your time in the immediate postpartum will be feeding baby and getting rest. Many people believe they need to ‘get back to it’ days after birth – but the truth is that your body has done A LOT over the past 9 months, and some people liken birth to participating in a marathon.

In Traditional Chinese Medicine, there’s a huge emphasis on resting for the first 40 days after birth in order to replenish your energy stores. So, if you’re going to be recuperating in your home for the next little while, you may want to consider purchasing some items to cultivate some comfort.

This may include:

  • Comfortable chair that can glide back and forth
  • Side table to hold your water, phone, etc.

You essentially want to make your space as nice and cozy as possible so you can enjoy the immediate postpartum as much as you can.

Stock Your Pantry & Freezer

Oftentimes when you’re caring for a newborn, cooking isn’t top of mind. But eating well is important to you may want to replenish iron and blood, repair tissues and support hormones, enrich breastmilk and support mood.

When my clients begin maternity leave, they usually start preparing meals that can be frozen and easily warmed up when needed. Traditional Chinese Medicine emphasizes simple yet nourishing meals to support your body in the postpartum. This includes soups, stews, and broths (even during those warmer months!).

Soft and simple meals (read: easily digestible) are recommended because your digestive system was displaced during pregnancy and needs time to return to its original position and function. Eating a meal that takes a lot of energy to digest, may upset your system.

Ideally all your meals should contain some type of protein and fat to nourish your body and help with repair and recovery. Hydration is also quite important as you likely need to replenish fluids lost at birth. Moreover, if you choose to chest/breastfeed, water is needed for milk production.

Lastly, many wise people recommended adding gift cards your registry – specifically to grocery stores/local restaurants. Basically, if you’re able to purchase ready-made food, it will save you lots of time and energy (not to mention, washing dishes!).

Stock-up on Your Supplements

I often get questions from patients asking which (if any) supplements they should take in the postpartum. Obviously this depends person-to-person, but for the most part there are a few to consider having in your cabinet.

These include:

  • Prenatal Vitamin: You won’t be done with this one yet! If you’re chest/breastfeeding, your baby is getting many of their nutrients from you. So it’s necessary for you to continuously replenish that store for their needs as well as yours!
  • Fish oil with EPA and DHA: Fish oil in general is a great supplement to have on hand for your overall health and mood, and the DHA specifically will help with your baby’s neurological development.
  • Probiotics: If you ended up testing positive for Group B Strep, you will most likely get antibiotics during your birth. Supplementing with healthy bacteria will aid in replenishing your gut – which will not only benefit your immune system, but will support baby’s too. There are specific strains for the vaginal microbiome as well.
  • Vitamin D: Generally, most of us are low in vitamin D. Low levels have been shown to contribute to postpartum mood disorders. To determine how much you need (because this is one of those vitamins where dose does matter), a simple blood test can be done.
  • Iron: Low ferritin levels (the iron storage form), can also contribute to postpartum mood disorders. While iron is present in prenatal vitamins, sometimes more is needed. Again, a blood test would tell you how much is needed – test, don’t guess!
  • Lactation Herbs: There are tons of these – so speak to your ND before buying a particular brand. Goats Rue is an herb that works universally – supporting prolactin, milk production, insulin sensitivity, and the nervous system. But something to keep in mind is that if you’re experiencing milk production issues – it’s usually best to consult with a lactation consultant first before using herbs. Sometimes the latch is the issue!

When determining what exactly you’ll need in the postpartum, it’s important to work with someone who can provide you with the correct information, safe products and dosing.

Catch Your Zzzs

Your sleep quality and quantity may likely change in the postpartum. So if you have an opportunity, rest up before baby comes! Like I mentioned earlier, pregnancy can be like a marathon and preparing your body is important. Whether you’re taking naps throughout the day or going to bed a few hours early – every last bit counts.

When baby arrives and when it’s safe to do so (this article was written as we’re all physical distancing), don’t be afraid to ask for help! Whatever task that can be taken off your hands, and placed into the hands of family and friends will save you time and energy, ad hopefully allow you to get some rest.

Build Your Community

When people say it takes a village – it’s true! Your village doesn’t need to be made up of just family and friends though – healthcare providers can also provide support! The following are some professionals that you may want to seek out. Some clinics (like the one I work at) are tailored towards pregnancy and the postpartum, and usually have most of these services all under one roof (and many provide virtual visits as well).

  • Lactation Consultant (In person & virtual): A lactation consultant can be helpful for chest/breastfeeding support, especially promoting a flow and a healthy latch. Usually the first person you should talk to when it comes to feeding.
  • Postpartum Doula: A postpartum doula may be helpful at providing support for both you and your newborn. This may include chest/breastfeeding support, completing small tasks around your house (ie. laundry, tidying up), and providing a wealth of knowledge about the postpartum period.
  • Therapist (In person & virtual): Sometimes birth doesn’t as expected. You may want to consider adding a therapist to your postpartum team, to help process your delivery and your new role as a parent.
  • Pelvic Floor Physiotherapist (In person & virtual): It’s a common misconception that you don’t need to seek a pelvic floor physiotherapist if you’ve had a c-section. Your pelvic floor may still need support! Especially if you experience pelvic girdle pain and diastasis recti abdominus (DRA). Typically, you would see a pelvic floor physiotherapist around 6 weeks after birth.
  • Massage Therapist: A massage therapist can be helpful at helping to mobilize scar tissue, especially if there have been any adhesions.
  • Naturopathic Doctor (In person & virtual): A naturopathic doctor may be helpful for any postpartum depletion that you may be experiencing (diet-wise, energy/fatigue), and using acupuncture or herbs to help promote healing.
  • Acupuncturist: An acupuncturist may be helpful at promoting a general feeling of well being as well as helping with healing.
  • Chiropractor (In person & virtual): A chiropractic doctor may be helpful as reducing any aches and pains that you may be feeling, especially neck and pelvic pain.

Be sure to contact these specific healthcare providers to determine when would be the appropriate time to come and see them – especially if you’re noticing physical issues.

Final Thoughts

Now that you’ve gone through this list and hopefully picked up something new – you may consider checking in with a Naturopathic Doctor like myself to tailor some of these suggestions.

I’m offering virtual appointments during this time to support pregnant people throughout each trimester and the postpartum.

What is Postpartum Depression?

December 7, 2018
postpartum depression, PPD, postpartum naturopath, toronto naturopath, naturopathic doctor toronto

Happiness always follows after the birth of your baby, right?

Nope, not always. 

Postpartum depression (PPD) is a condition that between 7-20% women experience after delivery. Nowadays more light is being shed on PPD because it’s a serious public health issue that affects women, children, and families. Even though the defined postpartum period is between 2-6 weeks after birth, postpartum depression can happen anytime between 2 weeks to 1 year after birth. 

About 7% of women experience a major depressive episode within the first 3 months, but if you factor minor depressive episodes, about 20% of women experience those within the first 3 months. 

Within the 2 week to 1 year time period, women may experience major depressive episodes. And other common symptoms mainly experienced in PDD (when compared to major depressive disorder) are psychomotor agitation (ex. anxiety or nervous excitement) and lethargy. You may also notice exaggerated changes in mood and pre-occupation with your baby’s well-being. Anxiety, ruminative thoughts and panic may also happen too. 

PPD is a little different than postpartum blues and postpartum psychosis:  

  • Postpartum bluesmild dysphoria occurring in the first week after delivery

  • Postpartum psychosisa condition with a rapid onset associated with hallucinations or bizarre delusions, mood impairment swings, disorganized behaviour, and cognitive dominant symptoms, including extreme sadness and loss of interest or pleasure in things previously enjoyed. Usually occurs in conjunction with bipolar disorder. 

Risk Factors of Postpartum Depression

  • Depression or anxiety during pregnancy

  • Depression prior to pregnancy

  • Changes in hormone levels

  • Your age

  • Chronic health problems

  • Psychological stress

  • Lack of social support from friends and relatives

  • History of pregnancy loss

  • Unwanted pregnancy

  • Socioeconomic status

Symptoms of Postpartum Depression

  • Depressed mood or severe mood swings

  • Excessive crying

  • Difficulty bonding with your baby

  • Withdrawing from your family and friends

  • Loss of appetite or eating much more than usual

  • Inability to sleep (insomnia) or sleeping too much

  • Overwhelming fatigue or loss of energy

  • Reduced interest and pleasure in activities you used to enjoy

  • Intense irritability and anger

  • Fear that you’re not a good mother

  • Feelings of worthlessness, shame, guilt or inadequacy

  • Diminished ability to think clearly, concentrate or make decisions

  • Severe anxiety and panic attacks

  • Thoughts of harming yourself or your baby

  • Recurrent thoughts of death or suicide

Criteria for a Major Depressive Episode

At least five of the following nine symptoms in the same 2-week period:

  • Depressed mood

  • Loss of interest or pleasure

  • Change in weight or appetite

  • Insomnia or hypersomnia

  • Psychomotor retardation or agitation

  • Loss of energy or fatigue

  • Feeling worthlessness or guilt

  • Impaired concentration or indecisiveness

  • Recurrent thoughts of death and/or suicidal ideation or attempt 

And also have to meet this criteria:

  • These symptoms cause significant distress or impairment

  • The episode is not attributable to substance abuse or a medical condition

  • The episode is not better explained by a psychotic disorder

  • The patient has never experienced a manic or hypomanic episode

Next Steps

May moms are reluctant to seek help because they’re unable to recognize their own mental health symptoms and accessing care can be difficult. An easy screening tool that will help you determine is PPD is affecting you is the Edinburgh Postnatal Depression Scale. This scale is used by most health practitioners like myself. 

If not treated properly, PPD can affect your overall functioning. While untreated PPD may cause health and developmental problems in your baby – and even affect the whole family. Treatment does not always have to be simply holistic. It may involve medications, and that’s perfectly okay. The important thing is that you’re getting the support that you need and deserve. 

If you prefer to approach PPD from a holistic lens, be sure to check out postpartum depression and Naturopathic Medicine.

References

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Polmanteer, R., Keefe, R. and Brownstein-Evans, C. (2018). Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. Social Work in Health Care, pp.1-16.

Schiller, C., Meltzer-Brody, S. and Rubinow, D. (2014). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(01), pp.48-59.

Birth Control and Depression

birth control and depression, toronto naturopath, naturopathic doctor toronto

Over the last couple of years birth control and it’s affect on mood, most commonly depression, has been in the news. Many are left wondering if birth control is safe for women. I’ve assessed a couple of studies, looking at various groups of women to get a better idea of what the research is saying. 

What is depression?

Like most conditions, a person must experience a certain number of symptoms to be diagnosed with a major depressive episode. 

 Five or more of the following symptoms must be present on most days for at least 2 weeks

  • Depressed mood*

  • Diminished interest or pleasure*

  • Significant weight loss or weight gain

  • Insomnia or hypersomnia

  • Psychomotor agitation or impairment

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Decreased ability to think, concentrate, or ability to be decisive

  • Recurrent thoughts of death/suicide, or a suicide attempt

*One of these symptoms MUST be present

Select Populations & Birth Control

Adult Women 

A study conducted in Sweden (Zethraeus, 2017), looked at the effects of a combined pill (150 mg of levonorgestrel and 30 mg of ethinylestradiol) on general well being and depression in women aged 18-35. Compared to the placebo group, there was no difference in anxiety, depressed mood, general health. However, there WAS a significant reduction in in general well-being in women who used a levonorgestrel-containing OC, compared to women taking the placebo. 

Postpartum Women

A study by Horibe analyzed the connection between postpartum depression, drugs, and reported adverse events. They found that levonorgestrel was the top drug reported in connection with postpartum depression. This was followed by other progestins: etonogrestrol and drospirenone (further down in the list). The authors concluded that contraceptives or intrauterine devices with progestin might convey risk for postpartum depression.

With this in mind, I believe that postpartum women should be aware of the risk of depression with many of the pharmaceuticals they may taking during that first postpartum year. Moreover, it’s important to have these conversations with their doctors of what may happen, and what the next steps would be. Currently progestin-only contraception is considered first-line therapy for breastfeeding women. Estrogen-containing contraceptives are not started until breastfeeding is stopped as it may decrease milk supply. 

Adolescents

A groundbreaking study (looking at over a million women!) in 2016 by Skovlund, looked to investigate if hormonal contraception is associated with antidepressant use and a depression diagnosis. They ended up finding that adolescents (15 to 19 years) using hormonal contraception are more sensitive than older women (20 to 34 years old). when it came to getting a diagnosis of depression or using antidepressants. This effect was seen in both the combination pill as well as progestin-only pills (which was more predominant). The study also indicated that the incidence of depression and use of antidepressants decreased with age. 

For teens considering taking birth control, I would ask yourself why this might be. What is the outcome you are hoping to achieve? There are two conditions in which girls are given birth control as a treatment: endometriosis and acne (usually resulting from PCOS).

If you are experiencing heavy and painful periods (where you are unable on some days to go to school), talk to your medical doctor about endometriosis and if it’s a possibility. If you are experiencing acne, hair growth in places usually seen in males, and even irregular periods, talk to your doctor about PCOS as a possible explanation.  

Women with Bipolar Disorder and Depression

The study by Pagano aimed to look at the safety of contraception in women with depression and/or bipolar disorder. This was a meta analysis which looked at 6 studies that met their specific inclusion criteria. They found that oral contraception, levonorgestrel-releasing IUD and the depo shot, were not associated with worse clinical outcomes of depression or bipolar disorder in women who already had this condition. 

A couple things to note about this review: there was no 
standard definition or assessment of depressive and bipolar disorders or symptoms across studies, and the use of depression medication was unknown in three of the six studies. 

Final Thoughts on Birth Control and Depression

Overall, while there’s no clear cut answer on whether birth control causes depression – these studies still give you an idea of what the risk might be. Here are a couple of questions to think about if you’re considering taking birth control:

  • Why do you want to take birth control?

  • Are you considering birth control because of painful periods or ‘regulating’ your cycle?

  • Are you considering birth control because you want to prevent a pregnancy?

  • Are you willing to live with side effects (ie. a decreased quality of life)?

  • Are you an adolescent?

  • Have you given birth within the past year? 

While there isn’t a naturopathic alternative to birth control (I’m talking about supplements, not the fertility awareness method), it’s necessary to dive deeper into why you may be considering this option. This may also have you wondering what’s going on in your body and if you can help support it in other ways – perhaps with the assistance of Naturopathic Doctor as well!

If you found this information helpful, check out my handy chart of the nutritional deficiencies caused by the pill!

References

Zethraeus N, Dreber A, Ranehill E et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2017;107(5):1238-1245. doi:10.1016/j.fertnstert.2017.02.120.

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Pagano H, Zapata L, Berry-Bibee E, Nanda K, Curtis K. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016;94(6):641-649. doi:10.1016/j.contraception.2016.06.012.

Worly B, Gur T, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018. doi:10.1016/j.contraception.2018.01.010.

Skovlund C, Mørch L, Kessing L, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154. doi:10.1001/jamapsychiatry.2016.2387.