By Kate Kripke, LCSW
Is it possible to prevent postpartum depression?
I am asked this question a lot. Experts believe that because there is no definite way of knowing how a woman’s body will respond to childbirth, so we cannot say that there is a specific prevention, so to speak, for postpartum depression. However, I do believe that there is much a woman and her family can do during pregnancy that will lessen her chances of a postpartum mood and anxiety disorder like postpartum depression, or that may, at least, play a role in the reduction of symptoms.
I teach a class in “PPD Prevention” (yes, I call it that) at our local hospital, and I thought I would share some of the information that I give my families. This is not new information — Karen Kleiman writes about some of this in her book What Am I Thinking: Having a Baby After PPD, Deborah Sichel and Jeanne Watson Driscoll write about some of this in their phenomenal book Women’s Moods, and we have talked about many of these things in previous posts on this blog. I write this today as a way of giving some direction to some of you who may be thinking ahead about ways to increase the likelihood that you have an emotionally healthy postpartum experience. What we know is that the moms who meet the below criteria may reduce their risk of suffering from a perinatal mood or anxiety disorder like PPD.
Nutrition and Protein: Our brains need healthy nutrition and protein to function adequately. In fact, the “feel good hormone” serotonin is not naturally occurring in our bodies and therefore it requires important building blocks (amino acids/ tryptophan) that come from the food that we eat. A well-balanced diet with adequate protein intake is required for optimal emotional wellbeing.
Water: There is some research out there that suggests a connection between dehydration and anxiety. Moms who are pregnant, who deliver babies, and who breast feed are at an especially high risk for problems associated with inadequate water intake. Drink up.
Pampering and self-care: Yes, this is even important once your baby comes. Please remember that self-care is NOT selfish and that your baby needs you to be well. Nourish yourself all that you can with breaks when needed, baths, time with friends, and whatever else your brain and body need to feel grounded.
Adequate sleep: While having a newborn certainly does make it difficult to get the same quality/quantity of sleep than before you were a mama, sleep deprivation should be monitored. Studies have shown that quality of sleep is a higher predictor for postpartum depression and anxiety than the temperament of one’s baby, meaning a mom with a difficult baby who gets “enough” sleep is less likely to become depressed/anxious than a mom with an “easy baby” who is sleep-deprived, and so getting enough sleep can not be emphasized enough. For women with a prior mental health concern (especially bipolar disorder), adequate sleep can make the difference in preventing relapse. Consider aiming for at least one block of four hours of uninterrupted sleep a night (at a minimum). This block of sleep can occur at any point (hint: most healthy babies will give you a chunk of sleep sometime between 7pm and midnight).
Stay as active as possible: Women who get some form of mild to moderate exercise each day are generally less likely to become depressed or anxious than those who do not. This does not mean that you have to go to the gym. Or run a marathon. Or even get out to attend a yoga class. What we are referring to here is “movement and activity” as this helps the increase of endorphins and the decrease of stress hormones like Cortisol.
Create your village: Inadequate social support is one of the leading factors in developing depression or anxiety postpartum. Community allows for validation, emotional and logistical support, and company. Consider setting up a meal train in which friends, family, and colleagues can bring you food in the weeks after you bring your baby home (check out www.mealtrain.com as an example). If you have struggled with depression or anxiety in the past and know that you are at risk for PPD, connect with a therapist now. And if you are someone who has needed medicine to maintain emotional wellness before becoming pregnant, work with a trained reproductive psychiatrist so that you can continue this mental health need during your pregnancy if necessary. Connect with your village before the birth of your babe so that you know who is out there.
5. Understanding and Awareness
Of Self: Women who know their risk of postpartum depression are less likely to be hit unexpectedly with an episode of depression and anxiety and are more likely to put preventive measures into place. Understanding how your brain works, what your vulnerabilities and triggers are, and what you need most to feel well can make all the difference in your postpartum recovery. Please make sure that your expectations of yourself are realistic!
Of your partner: It has also been shown that couples who discuss their parenting hopes, expectations, fears, and roles prior to the birth of a baby are much more equipped to support each other along the way. The first postpartum year is a tough one for couples, and the more you communicate before your baby arrives, the more equipped you will be to manage the challenges.
6. Stress Reduction
Becoming a mother and having a new baby is simply stressful at times. There is no way around this one, and it is entirely normal to have moments of anxiety, irritability, and sadness along the way. What is important, however, is that moms have some tools for managing the emotions that come up when times get hard. Moms who have access to stress reduction strategies are less likely to become depressed and anxious than moms who do not.
Breath: When we are stressed or anxious, most of us are are not breathing adequately. When we breathe with our full lung capacity — all the way to the bottom of our lungs (diaphragmatic breathing) — we give our brains the amount of fresh oxygen that they need to function efficiently. Breathing effectively can literally change our bodies’ physiological response to stress.
Deep relaxation strategies: When we are stressed and anxious, we often forget what it feels like to be relaxed. Reminding your body that this is possible is important.
How to do this:
Progressive relaxation: In a lying-down or comfortable position, tense and relax each part of your body either from head-to-toe or from toe-to-head. Notice what it feels like to be tense (in your toes, foot, calf and onward) and then what it feels like to be completely relaxed. When you have gone through each body part in succession, tense and then release your entire body at once. This is often a great tool when having a hard time falling asleep.
Visualization: Think of or make up a place that gives you the sense of total relaxation. This can be some place that you have been before or a place that you have dreamed of. Close your eyes and see if you can bring yourself there: What do you see? What do you hear? What do you feel? What do you smell? What do you taste? While you do this, remember to practice your deep breathing. Notice, sense, and feel how your body reacts to this place. When you have reached a sense of calm and wellbeing, open your eyes. You can return to this place any time that you need it.
Grounding exercises: Often, anxiety (including panic) includes a sense of un-groundedness, floating, or ruminating about the past or future. Reminding yourself to be in the moment can decrease the symptoms that accompany the inability to be present.
How to do this: Notice, and say out loud, where you are in the moment. What do you see? What do you hear? What do you feel? What do you taste? What do you smell? This exercise can take as much or as little time as you have. The goal is to bring you back to the moment.
Please remember, folks, even women who do the above can suffer through a postpartum mood and anxiety disorder like PPD. Sometimes a mom’s symptoms will get in the way of accessing these strategies, and sometimes a mom’s depression and/or anxiety will be at a level that is distressing no matter what she “does.” Doing everything possible to take care of yourself isn’t a guarantee that you won’t have PPD. At the same time, it can feel incredibly empowering to do what you can to care for yourself. And if you are a mom who is recovering from postpartum depression, know that the above strategies may help you to thrive, one tiny baby step at a time.