Coping with Postpartum Depression during a Global Pandemic

It is estimated that up to 1 in 5 women will suffer from maternal mental health disorders, such as depression or anxiety, during or post-pregnancy.  In fact, maternal mental health disorders, like postpartum depression, are the most common complication of childbirth.  This can emerge as either a new problem or a recurrence of a pre-existing mental health condition.

A surprising study showed that postpartum depression rates have almost tripled during COVID-19.  The study, which was conducted by the University of Alberta in Canada, showed that the number of women reporting symptoms of maternal depression has increased to 41% compared to 15% before the outbreak began.

Because of Covid-19, almost overnight our routines have been turned upside down.  The uncertainties of the situation and stay-at-home mandates have presented unique challenges.  Consider, humans are social by nature, and when we do not get regular social contact, our mental health suffers.

As a result, new moms are facing even more difficulty.

The transition into motherhood is a vulnerable one.  Research has found that women are more at risk of experiencing anxiety or depression during pregnancy than at any other time in their lives due to new challenges.  We know that as many as one out of five women will experience a postpartum mood disorder—and women who struggle with anxiety or depression may continue to experience symptoms throughout their life.

What Causes Postpartum Depression?

Childbirth is a miraculous feat of the female body, yet it is also physically and emotionally exhausting.  Most new moms report extreme fatigue in the days following labor and delivery.  Recovery from the physical trauma, hormonal changes, along with the pressure of caring for a new life all contribute to postpartum mood disorders.

Hormonal changes, for example, can trigger symptoms of postpartum depression.  When you are pregnant, levels of the female hormones estrogen and progesterone are the highest they’ll ever be.  The “glow” and added energy that shows up in the second half of pregnancy is a result of sky-high progesterone levels.

After the baby and the placenta are delivered, progesterone levels quickly drop back to nearly zero, and researchers think this sudden change in hormone levels may lead to depression.  Progesterone is a calming hormone that helps with sleep, and low progesterone is known to be associated with depression, anxiety, and mood disorders.  In our practice, we have found starting a low dose of progesterone in the days after giving birth can be helpful in curtailing or even avoiding postpartum mood issues.

Levels of thyroid hormones may also drop after giving birth.  The thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food, and low levels of thyroid hormones can cause symptoms of depression.  A simple blood test can tell whether this condition is causing your symptoms.  If so, your doctor can prescribe thyroid medicine.

Other feelings that may contribute to postpartum depression that many new mothers say they feel:

• Tired from a lack of sleep or broken sleep
• Overwhelmed with a new baby
• Doubts about their ability to be a good mother
• Stress from changes in work and home routines
• An unrealistic need to be a perfect mom

In the era of social distancing, the support systems that usually promote mental health during the vulnerable transition into motherhood, such as doulas in the delivery room, social support from family and friends, mommy and me groups, nannies, and mother’s helpers, are missing.  This makes new mothers even more at risk for mental health issues.

There are other factors that may contribute to increased rates of postpartum mood disorder during the COVID-19 pandemic, as well.  They include:

• Stay at home mandates, feeling alone and isolated
• Wondering when the pandemic will be over and when life can go back to normal
• Worrying about catching the virus or a loved one catching it
• Worrying about transmitting the virus to your baby
• Hospitals limiting birth support persons (perhaps you planned for your mom and spouse to be there)
• Worry about childcare availability
• Worry that your job will still be there (if you’re a working mom) or your spouse will still have a job in the wake of the economic turmoil

With all of these factors in place, it’s no wonder that women are at an increased risk of developing postpartum mood disorders right now.

But there are steps to take to protect yourself.

First, recognizing that you may be experiencing perinatal anxiety and depression will help you take control of your recovery.

The symptoms of anxiety and depression can include:

• Changes to your sleep
• Eating more or less than usual
• Irritability
• Constant fatigue
• Difficulty concentrating
• Losing interest in things that used to bring you joy
• Worrying about things you did not use to worry about
• Feeling sad or stressed often
• Feeling like you want to hurt yourself or others (please call 911 or go to an emergency room if this is the case)

To learn more about the symptoms of postpartum depression and anxiety, take the screening quiz by CLICKING HERE.

If you believe that you have a postpartum mood disorder, the first step is the reach out for help.  You can make a virtual appointment with a therapist where you can assess your symptoms together and come up with a plan to help you feel more like yourself.

In addition to therapy, there are some important lifestyle hacks that can help balance your postpartum hormones, nourish your adrenal glands, and provide the energy and balance you need to keep up with the demands of motherhood.

1. Enlist the help of your spouse, and one or two close friends or family members who have appropriately self-quarantined and social distanced to help provide household support, keep you company, and hold the baby so you can take a shower.
2. Prioritize Sleep.  I know it can be extremely difficult to get quality sleep with constant nighttime interruptions to feed and soothe the new baby.  Yet, sleep is important not only to the functioning of our bodies but also for our mental health as well.
   • To the extent that you can, try to establish bedtime rituals to relax and develop a sense of routine and calm.  And try to prioritize sleep.  If you have a partner or spouse, consider taking turns with nighttime feedings.  If possible, pump some milk so that your partner can lend a hand and let you get some much-needed sleep.
   • Nap when your baby naps.  Even if you are tempted to stay up to clean the house after your child has gone to bed, it is better to unwind and sleep.  Even if you can’t actually sleep, listening to a guided meditation can be equally soothing.
3. Get outside for walks with your baby.  Even with a stay at home mandates, it is still possible to get outside in some capacity—and doing so can be extremely therapeutic.  Studies have found that spending time outside can decrease the symptoms of depression and anxiety.  This is in part due to the benefits of vitamin D (which we get from the sun).  Walking with your baby in a stroller might be an easy way to get in some steps and breathe fresh air.  In a study published in Mental Health and Physical Activity, walking was found to be a statistically significant way to ease depression.
4. Limit your news intake.  Try not to watch the news right when you wake up or when you are about to go to bed and limit the amount of time that you spend each day listening to news reports.  Make use of reliable information sources that do not sensationalize the news.  If your province or state gives a daily update, that may be the one piece of trustworthy, non-sensationalized news to listen to.
5. Practice gratitude.  While you can’t control the coronavirus situation, and nervousness and concern are completely natural, you might be able to change some of the negative thoughts.  A good habit is to identify when you are focusing on worry and then flip it around to the point of gratitude; gratitude has been found to help relieve the symptoms of depression.  What are a few aspects of your situation that you can feel grateful for?  How about your baby’s laugh?
   • Forming a gratitude practice can be tough at first, but as you start to use new brain pathways, it will get easier.
6. Cuddle with Baby.  Holding and snuggling your new one is great for both baby and mom.  When you hold your baby, your body releases the hormone oxytocin, AKA “the love hormone”.  Oxytocin makes us feel better emotionally.
7. Eat a colorful nutrient-dense, whole foods diet.  Just as your nutrition during your pregnancy was important to grow a healthy baby, postpartum women also have increased nutrient demands for healing, recovery, and support breastfeeding.

Combating Postpartum Depletion With Nutrition

The good news is that there are simple ways to support your body’s increased nutrient needs during pregnancy and postpartum.  Being intentional about eating well can help your body replenish nutrient stores that may have been depleted during your motherhood journey.

Feeding your body optimally is not about restricting any foods or dieting but intentionally nourishing your body with foods that keep you replenished and that will help your body heal and recover.  

Eating adequately and including colorful nutrient-dense foods in your daily meals and snacks will help increase your intake of nutrients that are typically depleted during pregnancy, childbirth, and lactation.

Here are some steps you can take to optimize your nutrition to minimize risks of postpartum depression that may be associated with depleted nutrient stores:

Focus on Food Quality

This is not about trying to perfect the way you eat or not having flexibility and balance with food.  This is about aiming for variety and including foods in your diet that can support the increased nutrient needs that come during pregnancy and postpartum.

When it comes to your postpartum nutrition, think about foods you can include to support your physical and mental health, while not hyper-focusing or worrying about what you need to eliminate or exclude.  Sometimes, you will need to make food choices based on convenience, because that is real life in new motherhood, and that is OKAY.

Aiming for colorful nutrient-dense foods can be a way to get essential nutrients that are more easily depleted.

When putting together your meals and snacks, aim for a combination of nutrient-dense foods such as:

• Protein, for rebuilding tissues and muscles in the body, to stabilize blood sugar and support wound healing.  Foods high in protein include grass-fed beef, poultry, collagen, seafood, eggs, milk, yogurt, cheese, cottage cheese, legumes, nuts, and seeds.
• Complex Carbohydrates, to provide your body with energy, promote healthy digestion and regularity, and protect lean muscle mass in the body.  Foods that offer your body complex carbohydrates include whole grains (like quinoa, oats, and brown rice), fruits, non-starchy and starchy vegetables, and legumes are also great sources of complex carbohydrates. 
• Healthy fats and essential fatty acids are crucial for nutrient absorption, supporting brain health, stabilizing hormones, and balancing blood sugar. Foods that provide healthy and essential fats include extra virgin olive oil and olives, nuts and seeds, avocados, eggs, coconut, grass-fed butter, and fatty fish like salmon.

In the chaos that often comes with new motherhood, you might find it challenging to remember to eat.  Try not to go more than 3-4 hours without having a balanced meal or snack to prevent dips in your blood sugar and to stabilize your energy levels.

Going long periods without eating during the day can exacerbate physical and mental health challenges, making it more difficult for you to get adequate nutrition for your postpartum recovery.  Set reminders on your phone if needed to give you the gentle nudge to feed yourself enough throughout the day. 

Nutrients to Include in Your Postpartum Nutrition 

As mentioned earlier, there are certain nutrients that your body may need more of to help replenish nutrient stores that may have been depleted during pregnancy, childbirth, and breastfeeding (if you are nursing).

This includes trace minerals, B-vitamins, Vitamin D, and essential fatty acids.

Including foods in your postpartum diet that naturally offer these nutrients can help replenish your nutrient stores, as well as decrease your risk factors of postpartum depression that may be associated with poor nutrition.

Aim to include some of these nutrient-dense foods that can provide your body with crucial nutrients needed to support your physical recovery and mental health:

• • B-vitamins: These nutrients, including folate, B-6, and B-12, are crucial to many functions in the body, including energy and metabolism.  B-vitamins in the diet all directly impact breast milk concentration.  Foods to eat include: dark green leafy greens, eggs, nuts, whole grains, and red meat.
  • Iron: Iron-deficiency anemia can be a risk factor for postpartum depression, and many postpartum women struggle to replenish their iron stores. Research has specifically found that there is a strong association of iron-deficiency with depression, stress, and cognitive function in the postpartum period. Your iron needs are higher while breastfeeding and when resuming menstruation.  In addition, if you’ve lost a significant amount of blood during childbirth, this can also contribute to depleted iron stores.  Foods to eat include: Beef, liver, dark poultry meat, lamb, shrimp, dark leafy greens (like spinach), lentils, nuts, and whole grains.
  • Fatty Acids and DHA: The number of fatty acids in your diet will directly impact the fat composition of your breast milk.  Sufficient amounts of fatty acids support brain-development for your breastfeeding baby via your breastmilk.  Essential fatty acids are also critical for supporting your own brain health and overall mood.  Studies have found that a low intake of omega-3 fatty acids, such as DHA, is associated with an increased risk of maternal mental health conditions, including postpartum depression.  Foods to eat include: Seafood (especially salmon, sardines, and fattier fish), eggs, grass-fed beef, and grass-fed dairy (like butter).  Plant sources have a form of omega-3’s called ALA, and this can be found in nuts, like walnuts, or seeds, like flaxseeds, chia, etc. However, plant sources don’t convert as well in the body, so animal-based sources are preferred.
  • Vitamin D: Studies have found an association between lower vitamin D status and increased risk of depressive symptoms during and after pregnancy. Foods to eat include: Egg yolks, fatty fish (like salmon and tuna), and supplementation.
  • Probiotics: Recent studies have investigated the link between the gut and the brain, otherwise known as the “gut-brain axis”.  Studies have found that probiotics may be beneficial for mental health. By including fermented foods in your diet, you can naturally boost your intake of probiotics, which can support both digestive and mental health.  Foods to eat include: yogurt, kefir, fermented vegetables (like kimchi or sauerkraut), kombucha, or a probiotic supplement like Megasporebiotic.

To download my free 7 Day Postpartum Meal Plan, CLICK HERE

At the end of the day, you are and always will be the best expert on your body.  Your body is the best guide of what your body needs to feel well.

You might feel at odds with your body through the many transitions you’ve endured through pregnancy and postpartum.  However, the more you can align yourself with your body by listening to and honoring what your body needs, the better things will go for you: physically, mentally, and emotionally.

It’s important to understand that postpartum depression is a severe mental illness that often requires comprehensive help and professional treatment for recovery. Lifestyle and dietary changes alone are not cures for postpartum depression and maternal mental illness, but rather, should be an integral part of treatment and recovery.