Is postpartum depression a symptom or disease? This is a question that does not have a black and white answer, and it is a question that is as important for the society in which we live as it is for healthcare practitioners, families, friends and mothers. Why? Because in societies where women have the most support, i.e. paid leave and automatic postnatal health and household chore support, the incidence of PPD (Postpartum Depression) is significantly lower.
PPD and PPA (Postpartum Anxiety) are experienced by many women after child birth and yet it’s been little more than a decade that we have been talking about the problem. We give a lot of credit to Marie Osmond, who 12 years ago went on the Oprah show and talked about her experience with PPD and shed some light on the issue. Up until that point, PPD and PPA did not have a face. It was not something discussed in polite company. The myth of “happy motherhood and perfect baby” was the picture most of us carried around. And that picture made it even more difficult for mothers to come forward and get the help that they needed.
When asking the question of PPD as a symptom or disease, several things come to mind:
1. Exhaustion or Depression: No other normal physiologic body process is as demanding as pregnancy and birth. Many women go home with a new baby and have other small children and a husband to care for as well. New babies have intense needs day and night. They require nursing and feeding , lots of body contact and soothing. That means that mother probably won’t be sleeping through the night. Sleep deprivation contributes to negative mental states. Caring for a family and an infant can render mother exhausted. If a new mother has had a C-section, she is also recovering from surgery. Treatment for exhaustion is as important as treatment for depression, and it should be noted that exhaustion can mimic many of the symptoms of depression.
2. Nutritional Depletion: A baby’s body is made up entirely of nutrients that are donated by its mother’s body. The placenta is also made from nutrients donated by mother’s body. The placenta pulls nutrients from a mother’s bloodstream and gives it to the developing fetus. Nature has it wired that if one is going to do without; it will be the mother for the sake of new life. Some women lose a great deal of blood during childbirth and since blood is made from nutrients, this further depletes a mother’s nutritional reserves.
The research is clear that certain nutritional deficiencies, for example the DHA and EPA (as from fish oils) can cause depression and moods swings. So can a lack of certain B vitamins. All postpartum women can benefit from taking a good multiple vitamin and mineral, fish oils and supplementing calcium and magnesium. Many health care professionals now recommend that mothers stay on their prenatal vitamins for several months after the baby is born.
3.Community: In the past when extended families lived together or close by, a new mother would be able to have her needs met while she rested for a number of weeks to regain her strength. Women relatives and close neighbors would prepare her family’s meals and they would also help soothe her tender emotions while her body recovered. These days many women no longer have that kind of support. In the 1950s a woman who had just given birth stayed in the maternity ward for an average of 2 weeks, resting and bonding with her newborn. Now she is out of the hospital in 48 hours.
Today there are thousands of web sites started by women who have suffered and survived postpartum depression wanting to help other new mothers who are suffering. These are communities where women share their fears and stories and share what methods and treatments worked for them. Mothers who experience PPD and PPA need to know that they are not alone. These sites provide valuable support, community and information to both mother and her family.
4. Health overview: In contemplating the question of PPD as symptom or disease, a health overview is crucial. Hormone testing, adrenal stress index testing, thyroid testing provide information to the health care practitioner which can help decide the best course of treatment for a mother suffering from PPD or PPA.
5. Drug intervention: Though, we tend to be oriented toward natural remedies, we have always said that there is a time and a place for drugs. Mothers who are suffering from PPD and PPA may find it difficult to get the immediate relief necessary from natural therapies and will benefit greatly from medication which can get them over the toughest part of PPD and PPA. Women who suffer from postpartum psychosis often need to be medicated for life. No mother should have to suffer. If one is doing drug therapy for PPD and PPA , it is hopefully done as part of a holistic plan of diet, exercise, talk therapy and vitamin supplementation.
6. Meditation: Most new mothers will laugh at the idea that they would have even two minutes to sit and meditate! They would be right. That being said, we suggest a “portable meditation” in the form of deep belly breathing. If you are pushing a stroller, making dinner, sitting down to nurse, or shopping in the grocery store, you can do this. It is especially helpful when you start to feel anxious. Take a very deep breath in through the nose…as much air as you can take in…and then let it slowly out through the mouth. Ten of these deep, slow breaths will lower your blood pressure, slow your heart rate and reduce stress chemicals. Every new mother should have this technique in her tool box.
7. Exercise: The research is clear that for those who are able, mild to moderate exercise is a mood elevator. Walking with a stroller, yoga, and other beneficial forms of exercise can be very helpful.
So back to the question is PPD a symptom or a disease? Like we said, this question is worthy of contemplation, but it has no simple answer. In some ways PPD is a symptom of exhaustion and lack of physical and emotional support; in other ways PPD is a disease of depleted brain chemistry. In some ways PPD is a disease of the culture which still does not understand the PPD process and needs to become more aware of how women are treated in the postpartum phase of motherhood.
In a perfect world, we would wave a magic wand and all new mothers would stay in a birthing center for a few weeks after childbirth; where there were health care professionals to help them learn the coping skills needed to deal with the challenges and demands of motherhood; where mother could truly rest and recuperate; where nutrition dense meals were served ; where dietary supplements were part of the program; fresh air, sunshine and other mothers to talk with. In a perfect world just this kind of rest and replenishment could lower the incidence and the severity of PPD and PPA. In a perfect world. Until then, we need to keep shedding light on PPD and PPA and study methods of care that can best benefit the mother and the family