What you need to know about postpartum mental health and hormones

Pregnancy, birth, and postpartum are marked by physical and hormonal changes, and women often feel like they are suddenly transformed into moms overnight.

The transition to motherhood is a unique experience that looks different for every mother. But there are, of course, shared experiences related to our reproductive abilities and physiology. Due to rapid hormone changes and the realities of caring for a newborn, many moms find that new motherhood isn’t so rosy.

We’ll be taking a closer look at why baby blues, postpartum depression, and postnatal depletion are so common. Read on to learn:

• What hormonal changes occur postpartum? How do fluctuations in prolactin, oxytocin, melatonin, cortisol, and our thyroid hormones play a role in postpartum mental health?
• What are the baby blues? Is it normal to feel sad and cry after having a baby?
• What are the causes and symptoms of postpartum depression and postpartum anxiety?
• What is postnatal depletion?
• How can I prevent postpartum depression, baby blues, and postnatal depletion through balancing hormones?

The immediate postpartum period

After nine long months of growing a human life (or more!), labor and delivery take place and your hormones begin to shift dramatically the moment you deliver the placenta.

There is an 80% clearance of placental steroids in the maternal circulation within the first forty-eight hours (1). From this time until breastmilk comes in, estrogen and progesterone levels drop very quickly and suddenly. This decrease in levels mimics that of a menopausal woman’s hormones (2). Prolactin levels rise to produce breastmilk, and oxytocin is released while nursing a baby. Oxytocin is also responsible for the contractions which brought on labor and shrink your uterus after delivery (and it’s also released during an orgasm). Don’t you love those connections? Essentially, oxytocin is a feel-good hormone that helps to balance out postpartum lows and allows for those nurturing feelings which help mom and baby bond.

Other important hormones that shift in this period include melatonin, cortisol, and thyroid hormone. We’ll take a closer look at how all of these hormones are at play when it comes to postpartum wellbeing and mental wellness.

Baby Blues: short-term fluctuations

Within those first forty-eight hours and up to about 2 weeks postpartum, the endorphins of birth start to dissipate and it is common to feel “ups and downs” or a variation in moods and emotions. This is called the “baby blues” (2).

New moms can experience a whirlwind of emotions precisely because of the sudden drop in pregnancy hormones and the rise in cortisol (3). However, over time, as oxytocin continues to be released as mom and baby form bonds, this hormone coupled with dopamine help to offset this hormonal storm (3). In fact, lower salivary oxytocin levels are found to be associated with baby blues in moms experiencing a bonding disorder (4).

During the early postpartum weeks, the primary focus tends to be on the baby. Even new moms are guilty of this, often neglecting their own self-care in the process. Unfortunately, this coping method is not sustainable and can take a toll on mothers’ wellbeing. New moms find that they need to slow down and tap into their network for support and extra resources. Depending on the mom’s relationship with self-care, they may find that they need to give themselves permission to heal.

What is postpartum depression, and what are its symptoms?

Moms who experience baby blues can have depressive feelings intermittently, but these emotions should come and go, and they should still be able to enjoy life. Meanwhile, depressive feelings that do not go away and get in the way of enjoying life, beyond two weeks after having a baby, can be classified as postpartum depression.

A depressed mom can be less aware of her down mood and how it’s affecting everyone else around her. Similarly, postpartum anxiety can occur when a new mom has frequent, and often, obtrusive thoughts and feelings, even in situations she would normally find enjoyable.

In prenatal practice, we use a scale during pregnancy and right after at your 2-6 week checkup to screen for postpartum depression (5). Moms who score 13 or higher out of 30 are likely experiencing depressive thoughts that would require a follow-up clinical assessment (5).

Typically, risk factors for postpartum depression include a past history of psychiatric illness, “low level of social support and domestic violence during pregnancy or after delivery” (6).

Iron deficiency is also linked with postpartum depression (7). Although iron deficiency and anemia are prevalent in pregnancy and postpartum women, due to the increased demand for iron and resulting blood loss, evidence points to a correlation between low iron levels and an increased risk of postpartum depression. Likewise, low ferritin levels in the postpartum period, but not during pregnancy, is associated with an increased risk of postpartum depression (7).

Additionally,  the sudden drop in pregnancy hormones estrogen and progesterone do not directly cause postpartum depression. Although there are women who may be more sensitive to hormonal fluctuations, and they may be at risk for PPD.

As mentioned earlier, oxytocin (which is released during breastfeeding) helps to counteract the negative feelings associated with a drop in sex hormones. So, yes: breastfeeding and cuddling your baby will lower stress. Although there is evidence that oxytocin levels are lower in depressed, actively breastfeeding mothers (8).

Moreover, shifts in the hypothalamic-pituitary-adrenal axis are associated with postpartum depression, especially extremely high cortisol, or extremely low cortisol levels (8). Nursing moms are found to have more suppressed HPA responses to stress as compared to non-nursing moms (8). All the more reason to breastfeed (if that is your choice)!

The other major player in the development of postpartum depression is the hormone cortisol. On the one hand, stress can diminish amino acids, such as tryptophan, needed to make feel-good neurotransmitters, such as serotonin (3). Even hunger and lack of sleep can alter cortisol levels and spike, leading to anxiety (3). Evidence demonstrates that very high levels of cortisol as associated with “transient” depressive states, while very low cortisol levels are linked with chronic postpartum depression (9).

An important hormone to pay attention to is the thyroid hormone, which can easily be assessed and treated. Studies show that women with anti-thyroid antibodies present in the postpartum period overlap with first-onset postpartum depression. This suggests that women should be evaluated for a thyroid condition prior to a clinical diagnosis of postpartum depression (10).

Postnatal depletion as a syndrome

Postnatal depletion is a syndrome defined by Dr. Oscar Serrallach as a “constellation of symptoms affecting all spheres of a mother’s life after she gives birth”.

Symptoms are due to hormonal changes, interruption of sleep, physiological recovery, along with mental and emotional experiences (3). Dr. Serrallach identifies three major factors: nutrients that were lost during pregnancy and birth, exhaustion, and change in mom’s new role.

Postnatal depletion can also look like “brain fog” and cognitive changes postpartum, such as forgetfulness, difficulty concentrating, or absentmindedness (1).

So, what is the difference between baby blues, postpartum depression, and postnatal depletion?

The main takeaway here is that the postpartum period is a time of rest, recovery, and nourishment.

There are many factors that can put new moms at risk for physical, mental, and emotional turbulence. As many as one in seven women experience postpartum depression (11). Whereas it’s quite common for new moms to experience postnatal depletion and baby blues.

The good news is that the latter are short term problems that can be solved with mostly simple interventions.

Preparing for a smooth transition into motherhood

In the same manner that expecting moms prepare for birth, planning ahead for the early postpartum period, a.k.a. “the fourth trimester” is essential.

Making a list of resources at hand is the first step. New moms should consult with loved ones who can be available to help them in the home and help care for the newborn in those early weeks. If not, there are excellent postpartum doulas and caregivers for hire who can help.

The reason why having extra help is so beneficial is because new moms need to take time to rest. This makes it easier for moms to sleep when the baby sleeps and avoid the exhaustion that can bring about a depleted state. One of the simplest interventions for restoring cortisol levels and calming the adrenal glands is through sleep (3).  

Another imperative reason for gathering extra support is to help around the home and help cook nourishing food. Some moms opt to batch cook nutritious meals and freeze ahead of the delivery, which is a brilliant idea for expecting moms who still have enough energy to do so late in pregnancy.

The goal with food is to replete lost nutrients, produce breastmilk, and support tissue repair. It’s best to eat regular meals and avoid fasting to prevent blood sugar drops, which may interfere with adrenal balance (3). Eating regularly and eating enough calories is also essential for breastfeeding moms. It is recommended to eat moderate to high levels of good fat (such as avocado, flaxseeds, salmon), along with moderate levels of protein (chicken, legumes), and smaller amounts of carbohydrates (potatoes, rice). A quick way to put meals together is by making salad bowls using healthy pantry items, such as olive oil, nuts and seeds, thrown together with fresh greens, roasted veggies, and leftover proteins.

One last thing, the biggest advice I have for postpartum moms is to drink lots of purified water. Hydration is not just necessary for breastfeeding moms, but it is key fo flushing out all the extra fluids from pregnancy, as well as intravenous fluids given during birth. It’s also the easiest intervention to implement! Working with a practitioner who specializes in postpartum nutrition is key to creating a care plan for success. There are specific nutrient needs for every individual, and supplement protocols must be individualized. One interesting study found that blueberry juice or extract given in conjunction with 2g of tryptophan and 10g of tyrosine almost completely eliminated the risk of a depressed mood during the peak period of postpartum blues (12).

Motherhood and beyond

Achieving hormonal “balance” in the postpartum period is certainly difficult for the aforementioned reasons, but following a wholesome protocol can help new moms readjust positively in a way that helps them thrive. Life beyond the first year post-birth is a time of discovery and transformation, and new moms choosing self-care and self-love will be more likely to achieve resilience and strength for years to come.

References

1. Henry JF, Sherwin BB. Hormones and cognitive functioning during late pregnancy and postpartum: a longitudinal study. Behav Neurosci. 2012;126(1):73-85. doi:10.1037/a0025540
2. Johnson, K. A. (2017). The fourth trimester: A postpartum guide to healing your body, balancing your emotions, and restoring your vitality. Boulder: Shambhala.
3. SERRALLACH, O. (2019). POSTNATAL DEPLETION CURE: A complete guide to rebuilding your health and reclaiming your ... energy for mothers of newborns, toddlers, and youn. Place of publication not identified: GRAND CENTRAL PUB.
4. Shishido, E., Shuo, T., Takahata, K., & Horiuchi, S. (2019). Changes in salivary oxytocin levels and bonding disorder in women from late pregnancy to early postpartum: A pilot study. PloS one, 14(9), e0221821. https://doi.org/10.1371/journal.pone.0221821
5. Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item. Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150: 782-786 https://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf
6. Šebela, A., Hanka, J., & Mohr, P. (2018). Etiology, risk factors, and methods of postpartum depression prevention. Etiologie, rizikové faktory a metody prevence poporodní deprese. Ceska gynekologie, 83(6), 468–473.
7. Wassef, A., Nguyen, Q. D., & St-André, M. (2019). Anaemia and depletion of iron stores as risk factors for postpartum depression: a literature review. Journal of psychosomatic obstetrics and gynaecology, 40(1), 19–28. https://doi.org/10.1080/0167482X.2018.1427725
8. Cox, E. Q., Stuebe, A., Pearson, B., Grewen, K., Rubinow, D., & Meltzer-Brody, S. (2015). Oxytocin and HPA stress axis reactivity in postpartum women. Psychoneuroendocrinology, 55, 164–172. https://doi.org/10.1016/j.psyneuen.2015.02.009
9. Seth, S., Lewis, A. J., & Galbally, M. (2016). Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review. BMC pregnancy and childbirth, 16(1), 124. https://doi.org/10.1186/s12884-016-0915-y
10. Wesseloo, R., Kamperman, A. M., Bergink, V., & Pop, V. (2018). Thyroid peroxidase antibodies during early gestation and the subsequent risk of first-onset postpartum depression: A prospective cohort study. Journal of affective disorders, 225, 399–403. https://doi.org/10.1016/j.jad.2017.08.058
11. Carberg, J. (2019) Postpartum Depression Statistics https://www.postpartumdepression.org/resources/statistics/
12. Dowlati, Y., Ravindran, A. V., Segal, Z. V., Stewart, D. E., Steiner, M., & Meyer, J. H. (2017). Selective dietary supplementation in early postpartum is associated with high resilience against depressed mood. Proceedings of the National Academy of Sciences of the United States of America, 114(13), 3509–3514. https://doi.org/10.1073/pnas.1611965114

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