Depression in Mothers
Over the past weekend I watched a webinar run by the Institute of Birth Healing on Depression in Mothers. It gave insight into the latest causes of depression and the simple thing women can do to help prevent and alleviate depression. Having had my own experience of prenatal anxiety and postnatal anxiety and depression (self diagnosed myself with PTSD following my daughters birth) I was very curious.
I don’t feel I got the level of understanding and support I needed post birth and unfortunately I felt pegged into the ‘depressed mother’ category by the Maternal Health Nurse I was assigned to and so didn’t accept the help that was offered. Possibly she didn’t give enough explanation as to why as I was feeling the way I was. And I felt so confused as I’d always thought I would feel this surge of love for my daughter that would bring me joy and happiness. I felt lost and alone.
How Common is Depression in Mothers
According to the PANDA website Australian and International research is showing around 15-22% of women experience depression during pregnancy and or following the birth of their baby. 1 in 5 women report anxiety symptoms during pregnancy and between 4-20% experience anxiety after giving birth. Between 4.2-9.3% of women will experience both anxiety and depression (5).
The perinatal period is associated with an increased risk of both mental health relapse, and newly diagnosed mental health disorders. Research suggests many women diagnosed with mental health disorders become parents, and it is of utmost importance that their ongoing mental health care needs are identified and treated.
What Causes Depression In Mothers?
Historically, it was thought that high levels of estrogen and progestorone in pregnancy prevented women from becoming depressed. Therefore the drop in these hormones after birth is what caused postnatal depression. However, there are women who suffer depression in pregnancy and those that do mostly experience it in their third trimester. So clearly the historical view is incorrect. But, what is happening in a woman’s body to cause the depression?
Health psychology research has shown any form of depression requires three factors to occur. The fight/flight response needs to be switched on, there is an imbalance in the HPA Axis leading to high levels of cortisol and there is high levels of inflammation in the body. Referred to as the 3 part stress system.
There are also other risk factors that increase the likelihood of depression. These include previous experiences of anxiety or depression before pregnancy (hands up for that), a lack of social support (also, hands up for that), trauma, chronic pain and chronic stress.
It is the discovery of the fact that inflammation leads to depression that is quite important as women with Postnatal Depression/Anxiety have high inflammatory factors in their bloods. If this information is known I wonder why they are not testing for inflammatory factors postpartum to help prevent depression in new mothers?
Inflammation molecules help to fight infection and support wound healing. Inflammation levels naturally rise in the last trimester of pregnancy as they help to ripen the cervix. If a mother has the other risk factors for depression the inflammation molecules can get pushed into a high range leading a woman to be susceptable to depression. For women who experience anxiety, depression, chronic stress or pain in pregnancy statistics show they are more likely to have a pre-term birth. The high levels of inflammatory molecules ripen to much putting the mother at risk of pre-term labour. Late pre-term babies are often notoriously bad sleepers which can impact a new mother’s ability to get adequate sleep. Lack of sleep also increases inflammation.
What Can Help Alleviate Depression in Mothers?
The first thing that needs to be done is to reduce the levels of inflammation in the mothers body. This can be done by taking the long chain fatty acid, DHA, found in fish oil (or synthesised versions for vegetarians/vegans). DHA has been shown to turn the inflammatory molecules off and limit depression.
Another long chain fatty acid, EPA, also found in fish oil has been shown to treat depression when taken at 1000mg a day.
Research has also shown anti-depressants are more effective when fish oil is added to them. So supplementing with 1000mg of fish oil a day may also improve the effectiveness of anti-depressants and reduce or limit depression.
Breastfeeding has also been shown to help with postpartum depression. This is because a small part of the brain within the hypothalamus controls the 3 part stress system and the oxytocin system. Oxytocin suppresses the stress system. As a baby feeds from a mother’s breast oxytocin is released. Unfortunately it also works in reverse. The stress system can suppress the oxytocin system so if the mother is highly stressed or breastfeeding is painful she may not be getting the levels of oxytocin required to reduce inflammation molecules.
Respectful touch also releases a lot of oxytocin. Massage during pregnancy and in the postpartum period (first 12 months post birth) can go a long way to reducing inflammation molecules.
Exercise is also another way to reduce inflammation as it helps the inflammation molecules move out of the blood plasma and go to where they are needed.
How Can Birth Impact Depression?
As you’ve just read, oxytoin suppresses the stress response. Everytime a baby’s head pushes on the cervix during labour a burst of oxytocin is released (the Ferguson Response). If a woman gets scared during labour then the stress response shuts down the oxytocin response and her birth is more likely to be traumatic and have medical intervention. She is then more at risk of postnatal depression as her inflammatory molecules are higher. If oxytocin bursts continue throughout labour a mother is more likely to be able to breastfeed and has a better mood as her inflammation molecules are lower
In one research study with women who had children aged 12 months or younger the women who had the highest levels of depression were those who had a planned cesearean. The 2nd highest levels were in women who had an emergency cesearean.
For women who have planned c-sections they do not get the bursts of oxytocin that come with labour. Oxytocin only begins to release once the baby is skin to skin with the mother. In Sweden they are trying to counteract this by giving a woman a small drip of synthetic oxytocin after the baby has been born to augment their response so they have higher levels of oxytocin and lower inflammation. So far it has shown to be successful in limiting depression in women who had planned ceseareans.
Women who experienced non-emergency, unplanned c-sections along with those who had non-traumatic births had some of the lowest levels of postatal depression. This is because they have the oxytocin response going prior to the birth of their baby. They also said they felt heard and part of the decision making process during their labour and birth.
A mother’s perception of birth along with the relationship to her birthing team is very important. If she feels safe and warm in her environment and trusts the people that are supporting her birth she is less likely to have a traumatic birth or one with medical intervention. Women who have doulas at birth generally have less c-sections and less epidurals.
How Do You Support a Mother with Postnatal Depression?
There are many online resources and organisations that provide information and support for women with depression and I encourage you to take advantage of them. I didn’t and was the worse for it. Pride and shame got in my way.
Make sure she is taking a good quality high strength fish oil that contains DHA and EPA at a 1000mg per day. Hopefully she has been taking 800-1000mg during pregnancy especially in her 3rd trimester. Vitamin D is also a beneficial supplement. And, she should still be taking her prenatal vitamins until she has stopped breastfeeding.
Get her out for a walk regularly with others. Motherhood can be a lonely place and a lack of social support is one of the risk factors for depression (covid has had a big impact on the level of depression in mothers). So organising regular catch ups with family members or friends is important. Don’t leave it to her to do it. She is doing enough just adjusting to her new baby.
Book her in for a postpartum massage. I offer a postpartum home shiatsu massage to all my pregnant clients that helps with supporting the body to heal postbirth, supports breastfeeding and nourishes the qi, blood and essence. Acupuncture and psychotherapy can also be very beneficial.
Help her with breastfeeding and to support her breastfeeding goals. Research shows mothers who exclusively breastfeed get the most sleep as breastfeeding has a protective effect and down regulates the stress response. They also get back to sleep sooner. So helping her to relax and whenever possible lie down on her side to breastfeed. If a mother can get an uninterrupted stretch of 4 hours sleep she is more likely to cope better with the lack of sleep a new baby brings.
Women who got up and sat in a chair to breastfeed at night increased the risk of SIDs by up to 67% in one study. Sitting in the chair requires a mother to be more awake and so over time they have the least amount of sleep and are the most tired.
Mothers need to spend time with other mothers especially more experienced mothers. It helps them to navigate the stressful times and also to learn. They see how other women react or deal with their babies/childrens behaviours and so their own responses become normalised.
Mothers groups can be wonderful but if the women in the group do not connect with one another then the value of them is limited. There are generally no community provided groups for 2nd or 3rd time mothers which is unfortunate as these women can more often than 1st time mothers find themselves isolated and lonely. With other children to attend to they have little time for social relationships.
I hope you find value in the information provided above. I still believe that motherhood, despite it’s challenges, should be a time filled with joy and love. We have the knowledge now to support women in the postpartum period and limit depression.
If you would like to know more on this subject the woman interviewed in the webinar was Kathleen A. Kendall-Tackett. She is a health psychologist and International Board Certified Lactation Consultant. She has a book titled Depression in New Mothers which she regularly reviews and edits with the latest research.