7 Ways to Decrease Perinatal Depression

By Dr. Alyssa Berlin and Margaux Khoury

Co-authored by Dr. Alyssa Berlin, a prenatal and postpartum clinical psychologist, childbirth educator and doula.

The face of postpartum mental health is changing. What we once referred to as Postpartum Depression no longer encapsulates the breadth of challenges that a woman may experience after birth. Although depression is the more commonly known postpartum disorder, the struggle is frequently manifested as an anxiety rather than a mood disorder It can also start during the pregnancy and continue postnatally. To better reflect these elements, we now use the contemporary term Perinatal Mood and Anxiety Disorders or PMAD.

A review of the literature suggests that there are three types of postpartum mood states:

1) the maternity blues (a fairly common, transient disorder) 2) postpartum affective psychosis (relatively rare) 3) post partum anxiety 4) post partum OCD 5) postpartum depression (as many as 20% of postpartum women may develop mild to moderate depression). For the scope of this article, we’ll be talking about postpartum depression (PPD)

PPD affect:

• the mother/child bond

• the child’s physical, behavioral and emotional health

• the entire family unit

Some Symptoms of PPD may include:

• sadness

• anxiety

• compulsive thinking

• fear

• feelings of inadequacy

• inability to bond well with baby

• inability to care for baby

• inability to connect with partner

• overwhelming feelings of worthlessness

Maternal depression during pregnancy has been related to:

• higher rate of preeclampsia

• an elevated risk of pre-term delivery (Kurki et al., 2000)

• low birth weight

Untreated PPD is associated with:

• anxiety and depression in infants and toddlers

• behavioral and learning disabilities in school-aged children

• mood disorders later in life (Zuckerman et al., 1990).

PPD impacts not only the mother but the baby as well, putting them at risk for future behavioral, social, emotional and cognitive difficulties. Untreated PPD has been correlated with depression and anxiety in toddlers, learning and behavioral difficulties in school-aged children and predispose kids to mood disorders later in life. PMAD have been identified as the number one reason for lack of school readiness in children.

You are not alone. The reported rate of women affected by PPD varies, with estimates as high as 22% (Gaynes et al., 2005).

Less than 50% of women are actually screened for PPD (Kelly et al., 2001); therefore the actual incidence is likely to be significantly higher than what’s documented.

There are things we can do to mitigate or eliminate PPD.

7 Ways To Reduce Perinatal Depression:

1) Take charge of your birth.

Medical complications during pregnancy and birth can affect a woman’s postpartum adjustment. What is the connection between birth and postpartum mental health? "One thing we know about anxiety and depression is that they correlate significantly with people's sense of control or lack of control over their own lives. People who believe that they are in charge of their own fate are less likely to become anxious or depressed than those who believe that they are victims of circumstances beyond their control." (Hopkins, Marcus, & Campbell, American Psychological Association, 1984) A traumatic birth experience can (and does) affect our mood after birth. Women often report feeling that medical intervention was the catalyst in feeling out of control in the birth setting. And as research demonstrates, when women don't feel like they are in control of their fate, they are more likely to experience anxiety, depression and other mood disorders.

As such, it is important that women stay involved in the decision making in birth. When non-emergency interventions are suggested, women are encouraged to ask questions, and be given the necessary time and space to process what and why an intervention is being recommended. This can facilitate a woman’s ability to maintain a sense of control over a birth that deviates from her original plan, thereby improving her postpartum emotional outcome. 2) Shhh…no talking zone. My first baby was born in a hospital and my doula was keenly aware of my intention to have a ‘No Talking Zone’ following the birth. This wasn’t easy (as is often the case in hospitals) as it directly conflicted with the medical staff’s intention of what caring for me entailed; birthing the placenta as quickly as possible, administering post-labor Pitocin and possibly stitching (which thankfully was not needed).

I was fortunate to deliver my second baby at home, which was a more conducive environment for my desires to be respected and a ‘No Talking Zone’ to be ensured.

Whatever environment you choose to birth your baby, give some thought to what you would like the first few moments of your baby’s life to entail. Perhaps you would like to create your own ‘No Talking Zone’ or request all talk be limited to care of you and your baby. Know that it is for you to decide.

3) Skin to Skin all the Way

Despite mounting evidence of harmful effects of separation of mother and baby immediately after birth, it is still common practice to do so. .

Some providers are now are recognizing the important research that has been done enumerating the harmful effects of separating mom and baby, including:

• difficulty breastfeeding

• Increased chances of baby going to NICU

• increased PMAD

Benefits of Skin-to-skin contact between a mother and her baby at birth are invaluable:

• reduced crying (for mom and baby),

• better sleep (for mom and baby)

• Which leads to reduce stress levels (contributing to lower risk of PMAD).

Skin To Skin Contact is important to ensure a continuous flow of oxytocin (and serotonin) between mama and baby. According to mammalian neuroscience, the intimate contact between mom and baby sparks neuro-behaviors leading to fulfillment of basic biological needs, so whenever possible let’s keep mom and baby together.

4) No hats or blankets, please. It's standard practice. Baby is born. Baby is swaddled in a blanket and head is adorned by a hat. But did you know that ‘hatting’ or clothing a baby disrupts the natural flow of scents?

The time directly after birth, is a critical time for mother and baby to 'reconnect' outside the womb. It’s essential for mother and baby to absorb the breathing, smells and the aura of one another.

Mama smell baby's head and it initiates an increased flow of oxytocin, which circles back to the baby. Love and happiness abound. This is one of the many ways the mother and baby "fall in love" with one another. It's all a perfect part of the very delicate chemistry post-birth.

Let’s honor this sacred practice.

5) No washing, bathing or cleaning baby or mama! Ok, before you stop reading, let me explain this really important step in the reconnection process between mother and newborn. I recently spent two inspiring days enjoying Ina May Gaskin's company at her home in Tennessee. I remember so much from our long and wonderful conversations.

One thing that really stood out for me was when she started talking about the pitfalls of mother and baby separation. Of specific interest, she mentioned avoiding showers and deodorant.

Yes, you read right – no artificial scents, perfumes, deodorants or bathing for mom and baby. She made some jokes and we had a good time talking about this idea. But in all seriousness, it's a very important step.

Just like we don’t want blankets and hats blocking the bonding through natural scents, we don’t want artificial scents or premature bathing to interfere either.

Baby and mother need to ‘identify’ one another through smells. The baby especially will recognize the smell of the amniotic fluid that spread out and around mom’s breasts and even armpits, etc. This produces an incredible amount of oxytocin.

Encouraging the natural flow of smells will promote bonding, facilitate breastfeeding, increase oxytocin and reduce cortisol.

In addition, the exchange of smells:

• promotes a cessation of post-birth bleeding

• helps get the uterus “back to normal” quicker

• facilitates the release of the placenta

This process brings comfort to the baby and mother and ultimately reduces the risks of PMAD.

And it continues to flow, full circles from mother to baby and back.

6) Breastfeeding: Unlimited and Uninterrupted Skin to skin contact increases success in breastfeeding. Successful breastfeeding also contributes to decrease in PMAD. Need I say more? Let’s be kind and support our new moms. Remind them that although breastfeeding is ‘natural’ it takes time to develop comfort and mastery over this new skill. For some moms it takes 6-8 weeks before they feel like they fully get the hang of it. Encourage mom and people around mom to be patient and supportive…the rest will flow on its own.

7) Nourishing foods and thoughts.

It is becoming more known that what we eat can affect our mood. And even our mental health. Toxic foods can lead to a toxic body. It’s especially important to avoid artificial colours and flavours. By the same token, we should eat nourishing foods High in good fat, vitamins and minerals. Some herbs have been studied and thought to increase serotonin levels.

Thoughts. During this time especially, it’s important to surround ourselves with positivity. If that means turning off the news, so be it. If that means spending less time with certain people, it’s what needs to be done. Just think of your baby and yourself. Having the best healthy possible (mentally and physically) will ultimately decrease our chances of PPD.

8) Resurrect "The Village"

Back in the day, our ancestors, neighbors, wise women and family members all took part in raising a baby.

Mothers had an entire team of people who felt her pain, cried and laughed with her and were there for her. No questions asked. Today, we've lost the "Village.". Modern society is so far removed from how human beings originally lived;and continued to live for thousands of years. We, mothers are left to fend for ourselves. Not only are we expected to care for new baby, but there is also pressure to maintain a tidy home, not falter with nutritious home cooked meals and possibly even contribute to the household income. All while recovering from what might be the most physical and strenuous workout of our lives. Birth. This isn't anything new. Low levels of social support are commonplace and often cited as one of the most common reasons for the rise in PMAD.

Here's How To Re-Create 'The Village':

• "Line up the troops". The best time to start is during pregnancy.

• Ask good friends and family if they are on board for helping around the house, preparing meals or doing other needed chores.

• Identify three people, maybe a sister, cousins, or friends that will lend a listening ear when you want to talk or share your thoughts and feelings about this new phase of life.

• Redefine the role of a visitor as someone who will come over daily or weekly to hold the baby so you can nurture yourself, take a shower, or whatever you need in that moment.

• Talk to your circle about "Mothering The Mother".

If and when the emotional needs of babies and mothers are met and understood, our world could experience a gradual decrease in disease, mental illness and even the general problems faced today. ~~~~~~

Dr. Alyssa Berlin, a prenatal and postpartum clinical psychologist, childbirth educator and doula. Dr. Berlin works specifically with women and their partners on issues such as anxiousness and emotional fluctuation during pregnancy, postpartum blues and depression, and the complex issues that can arise between and around new and expectant parents.

Dr. Berlin is a contributing expert for Birth.world, a community providing clarity for parents. She offers the internationally acclaimed Bringing Baby Home workshop. Along with her husband, Dr. Elliot Berlin, Dr. Alyssa teaches a one day childbirth education crash course once a month. Dr. Berlin is the creator of The AfterBirth Plan Workshop, a program that prepares couples for what to expect when the baby is born. She also sits on the Board of Advisors for International Cesarean Awareness Network (ICAN) and Pregnancy Awareness Month.

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Margaux is the CEO of one of the most popular organic, natural, cruelty-free deodorants, “The Best Deodorant In The World”, a company she started out of her kitchen. It can now be found in stores and online world-wide. Her passion is helping families understand the importance of eliminating toxins, living sustainably and using amazing, natural products that don’t harm our bodies, animals or planet.

Margaux consults with parents on how to start a company like hers from scratch, and how to create an income while staying home with their children. She is a compassionate, heart-centred entrepreneur who works with parents and company owners, both new and already established. Operating by two very simple philosophies: “People over profit” and “Profit With a Purpose”, she has been able to follow her heart and make an impact in her client’s lives. When she is not with her husband and 3 children, much of her time is spent with parenting experts, birth practitioners, medical professionals and natural living celebrities.

She has built close friendships with many of the world’s most accomplished and respected practitioners, authors, speakers, doctors, midwives, doulas, parenting experts and celebrities in the birth, parenting and entrepreneurial spaces.

Margaux just completed a book “Ultimate Guide To Organic Groceries” with Joanne Young, who is personal chef to Gisele Bundchen and Tom Brady.