The appearance of mood and behavioral symptoms during pregnancy
and the postpartum (after childbirth) period has been extensively
reported. While there has been much speculation about possible
biologically based etiologies for postpartum disorders (PPD), none has
ever been confirmed.
Many women, having enthusiastically prepared for their new arrivals, are surprised by
the world awaiting them on the other side of childbirth. They are overwhelmed and unable
to find the time or space to tend to their own well-being - perhaps the greatest gift a
mother can give her children. Well cared for ourselves, we become physically and
psychologically equipped to care for our young, and to portray strong role models that
will inspire them to take good care of themselves in the years ahead.
According to current research, it takes about four to six weeks following an
uncomplicated vaginal birth, and six to eight weeks following a complicated vaginal birth
or cesarean, for a mother's body to complete the initial stage of recovery from
childbirth. Throughout this period of' time, the uterus contracts, involuting to its
prepregnancy size. Breastfeeding, which stimulates uterine contractions, assists in this
process.
To optimize your approach to the postpartum year, be sure to avoid any exercise that
places your joints at risk for injury, stresses your abdominals or lower back, or places
excessive caloric demands on your body. Safe forms of exercise include recovery exercise
classes that emphasize non- or low- impact aerobic activity for cardiovascular training,
swimming, walking on flat surfaces, stationary or mobile bike riding, and upper body
muscle conditioning with resistance bands rather than weights. Options that can adversely
affect your recovery include jogging, stair-climbing, step or bench aerobics, use of a
StairMaster or inclined treadmill, high-impact aerobics, heavy cross-training, cardio-fund,
and weight training. For as long as you continue lactating, your joints will remain
somewhat lax-probably until the return of regular periods--so avoid any form of exercise
that may stress your joints.
Time, patience, and the support of loved ones are all helpful during this time of
adjustment. Sometimes, however, women may still experience emotions that are bewildering,
unsettling, even frightening. These more confusing emotions can be classified in three
ways:
Postpartum depressions can range from transient "blues" following childbirth to severe,
incapacitating, psychotic depressions. Studies suggest that women who experience
depression after childbirth very often have had prior depressive episodes. However, for
most women, postpartum depressions are transient, with no adverse consequences.
The "blues" are extremely common during the first few days after delivery, usually
appearing suddenly on the third or fourth day. Postpartum "blues" are characterized by
some weeping, slight irritability, difficulty in sleeping, and loss of appetite - all
possibly linked to hormonal activity. Another contributing factor may be anxiety regarding
the care of a newborn child and the inevitable changes that must occur. The condition
usually improves by itself without medication or treatment. Family support is helpful in
dealing with it.
Postpartum depression is a serious disorder where the hormonal changes combined with
psychosocial stresses such as sleep deprivation may disable some women with an apparent
underlying vulnerability.
Women experience depression about twice as often as men. Many factors may contribute
to depression in women--particularly such factors as menstruation, pregnancy, miscarriage,
postpartum period, and menopause. Many women also face additional stresses such as
responsibilities both at work and home, single parenthood, and caring for children and for
aging parents.
Many women are also particularly vulnerable after the birth of a baby. The hormonal
and physical changes, as well as the added responsibility of a new life, can be factors
that lead to postpartum depression in some women. Treatment by a sympathetic physician
and the family's emotional support for the new mother are prime considerations in aiding
her to recover her physical and mental well-being and her ability to care for and enjoy
the infant.
The majority of people with postpartum depression are average people who are otherwise
responsible and capable. But depression makes them feel incapable and they have an
unrealistic view of their incapacity. The most common cases of postpartum blues don't
interfere significantly with the care of the child or household. If postpartum depression
gets to the point of being noticeable to the people around you, you probably have a more
serious problem.
Postpartum psychosis is the most severe disturbance. It is also quite rare, with about
one in one thousand woman suffering symptoms, usually within the first two weeks after
delivery. Symptoms are very exaggerated and may include insomnia, hallucinations,
agitation and bizarre feelings and behavior. Postpartum psychosis is a serious emergency
and requires immediate medical attention.
Women who breast-feed their infants produce lower levels of stress response hormones
than do women who bottle-feed, according to research conducted by the National Institute
of Mental Health (NIMH). The study is the first to explore the effects of lactation on
hormonal stress responses in humans.
The NIMH researchers, led by Margaret Altemus, M.D., theorize that lactation-induced
suppression of stress responses serves several purposes for both mother and baby.
First, it may help to conserve energy needed for production of breast milk. Second, it may
minimize the psychological stress associated with the demands of infant care, thus
enhancing milk release. Third, it may improve immune function during the postpartum
period.
The diet for lactation is important to provide nutrients for the quality and quantity
of breastmilk as well as to optimize the mother's postpartum nutritional status. Women who
are breast-feeding need more fluids, calories, protein, vitamins, and minerals. Women
should drink fluids (especially water) to satisfy their natural thirst. Drinking a glass
of water, milk, or juice each time the baby nurses is a convenient way to meet fluid
requirements. An extra 500 calories is recommended to meet the energy needs and usually
allows for a gradual loss (1 to 2 pounds, or 0.45 to 0.9 kilograms) of the weight they
gained during pregnancy.
A routine vitamin or mineral supplement is not needed by women who follow the Dietary
Guidelines. However, women who avoid fortified milk and have limited exposure to sunlight
may need a calcium and vitamin D supplement. Vegetarian women who avoid all animal
products need to take a supplement containing vitamin B12 and choose their diet carefully
to get adequate calcium and other nutrients.
With time, most cases of postpartum depression go away on their own. Until then, here
are some suggestions for fighting the after-the-baby-blues:
- Accept or ask for help from others.
- Rest or nap when the baby sleeps.
- Take a break and go out for dinner or a movie with your spouse...or enjoy a carry-out
meal at home. Meet a friend for lunch. - Lower your expectations of yourself.
- Talk about your feelings with your spouse, family or friends.
- Join a new mothers' group.
- Exercise (with doctor's permission)
- Take time for yourself when baby is asleep --- read, take a bath, watch a movie, or
pamper yourself in some other way. - Maintain a healthy diet.
