Mind Body Medicine
Today we finish up the series presented by Kathy Morelli, LPC on hormones and mood disorders. Once again I’d like to thank Kathy for such a well written and informative series. I am also very grateful that she allowed me to share the series with Mamas on Bedrest.
The final installment of the series is Post Partum: How Women’s Brain Biology, Hormones and Mood Relate!
“After giving birth, a woman’s hormone levels drastically plummet. The literature says within one to five days after birth, estrogen levels drop to the level of a normal menstrual cycle. A woman’s body needs time to adapt to all of the physical changes. Remember that estrogen precedes serotonin, the mood stabilizer, in the brain. And a steep drop in progesterone has a depressive effect as well. There’s a big chance for dysregulation in the brain-gland feedback loop (Sichel and Driscoll, 1999).”
“Other hormones that come into play postpartum and have an effect on the HPA and mood are prolactin and oxytocin. Prolactin is produced in the pituitary gland and is the milk-producing hormone. Prolactin levels rise during pregnancy and while breastfeeding. Some studies indicate prolactin is protective of postpartum depression, but others indicate prolactin causes vigilance, appropriate to a protective mother, but this feeling can morph into anxiety and irritability. The presence of prolactin varies whether or not a woman chooses to breastfeed (Donaldson-Myers, 2012).”
“Oxytocin is another neuro-hormone with a big effect on mood and happiness. Oxytocin is synthesized in the hypothalamus and released by the pituitary gland. Oxytocin is secreted during breastfeeding. Research has shown that oxytocin induces feelings of calm and bonding (Donaldson-Myers, 2012). And the presence of oxytocin varies whether or not a woman chooses to breastfeed (Donaldson-Myers, 2012).”
Women’s hormonal levels go from such highs at the end of pregnancy and then plummet to such lows with labor and delivery it’s a wonder that not all women become depressed. Kathy shares that
“85% of women suffer from the baby blues and 20% suffer from a form of postpartum mood disorders”
so clearly these hormonal fluctuations are indeed significant. And let’s not forget that Mamas on Bedrest are at an even greater risk of perinatal mood disorders because of bed rest, so these numbers may not reflect the full scope of perinatal mood disorders.
So much more research is being done on hormones, mood disorders and the lifestages of women. When considering the mental health of post partum women, we also have to take into account their support system, their ability to take time to rest and recover from pregnancy (and bed rest!) labor and delivery, the family situation and interpersonal relationships. All these factors-along with the “pre-wiring” in a woman’s genetic make up will determine how well a woman fares emotionally after pregnancy. Mamas, Take this information, think it over and use it as a catalyst to take exquisite care of yourselves! A woman’s body is designed to do extraordinary things-not the least of which is create new life-but that feat is not without its consequences. In order to be able to successfully reproduce, mamas must take exceptional care of themselves-eat nurtritious meals, drink plenty of water, rest, regular exercise, safe secure home and financial security. Mamas, self care is not a luxury-IT IS A MUST if you want good health for yourself, your baby and your family!
I’m bringing you Part II of Kathy Morelli’s series on physical and hormonal influences on women’s mental health. In Part II she focuses on the changes that occur during pregnancy. Kathy breaks down the emotional responses to pregnancy this way:
Emotional. What if the pregnancy was unplanned? What if this pregnancy follows a stillbirth or miscarriage? What if her primary relationship with the baby’s father is not going well? There is also job stress, financial factors and a whole host of other life stressors that combined can make the news of a pregnancy hard to take and All of these emotional considerations require attention and adjustment. We clinicians and birth workers must be aware of these potential life stressors and be sure that we are as vigilant in addressing these emotional needs of the women that we serve as we are addressing their physical needs.
Physiologic/Hormonal. By the first six weeks of pregnancy, estrogen levels rise to three times more than during the menstrual cycle! Progesterone levels also rise quickly and Progesterone is also implicated in depressive moods. As the pregnancy progresses through the second and third trimester, along with elevated estrogen and progesterone levels, the hormones cortisol, prolactin and oxytocin rise. Cortisol is a strong player in the HPA feedback loop. High levels of cortisol are also associated with depression. And prolactin is also associated with anxiety, anger and irritability. Oxytocin is known as the bonding and happiness hormone. Natural oxytocin causes nutrition absorption, uterine contractions, pair-bonding, mother-infant bonding, pain amnesia, calmness and feelings of belonging and happiness. Now add in bed rest! Mamas on Bedrest are at increased risk of developing perinatal mood disorders because in addition to the normal hormonal fluctuations of pregnancy, the stress of being on bed rest and the unsurety of the pregnancy stimulate the “fight or flight” response, releasing additional cortisol and neurotransmitters that will affect Mamas’ mood.
During an uninterrupted birth, there is a surge of oxytocin, beta-endorphin, adrenaline, noradrenaline and prolactin. These hormones all combine to orchestrate the event of birth and positive emotional outcome. Oxytocin for uterine contractions, calmness, love. Beta-endorphins for a protective emotional high during a peak physical activity. Adrenaline rush for energy and the final push of the fetal ejection reflex. And high prolactin levels to consolidate breast milk production and breastfeeding. However, if there is medical intervention of any sort during labor and delivery; an epidural, episiotiomy, forceps/vacuum extraction or cesarean section, this natural hormonal protection and mood enhancement is disrupted and often lost resulting in birth trauma, post tramautic stress disorder and post partum depression. The extent of the trauma is different for every woman and typically correlates to the level of intervention. Researchers are just beginning to understand the delicate interaction between hormones, labor and deliver and a women’s mental health, and as more research is done, we will have better understanding of this complex interaction and how best to care for women during pregnancy labor and delivery to protect their mental and as much as possible, minimize negative emotional effects.
In Part III, Kathy looks at hormones and post partum!
I love Facebook.
Its a great way to connect and keep up with friends and family near and far. But sometimes there is stuff posted that makes me say, “What the F—?”
Case in point. I was reading a friend’s post and she was saying how she had had this interaction with another woman who was nasty to her and she didn’t understand why. Another friend replied with, “You drew her to you. You draw in what you yourself need to face within yourself. What is it that you need to learn?”
When I read such statements, I always bring them back to Mamas on Bedrest. So, if you are a Mama on Bedrest, you drew this situation in, and somehow made it manifest in your life? You wanted to be on bed rest? In the case of our fellow mama Amber, she drew in having pre-eclampsia so severe that she and her baby almost perished? Really???
I want to make one thing abundantly clear-AGAIN! Most (if not all) mamas DON’T CAUSE THEIR BED REST PRESCRIPTIONS! Mamas, you’ve done nothing wrong and BEING ON BED REST IS NOT YOUR FAULT! (of course there are mamas who have engaged in behaviors that are not in their best interests or the best interests of their babies, but the mamas I’ve encountered here do not fall in that category!)
That being said, I do believe in a higher power, God if you will. I do believe that there are forces at work that we can neither see nor readily perceive that are acting in/on the world. I don’t believe that we can necessarily control these forces (i.e. how can anyone control an earthquake, a tsunami, pre-term labor or other calamity?). But we can control how we respond to them and how we behave going forward once we are aware of certain occurrences.
In response to a question posed at a live presentation, Marianne Williamson gave what I think is an excellent response to those things seemingly out of control. The person in the audience asked, “If children are starving, did they somehow manifest their situation?”
Here is a paraphrase Ms. Williamson’s response,
It is a perversion on our part to somehow insinuate that poor children somehow caused their poverty and hunger. These children are the innocent victims of wars, government struggles and famines. However, there are enough resources on this planet such that every child should have food and shelter. The fact there are large numbers of poor, starving children is not so much an indication of the mind/heart of the children, but those of us who are aware of the problem and how we respond.
So how are you going to respond, Mamas?
I don’t believe that we create each and every situation that happens in our lives, most especially a complicated pregnancy requiring bed rest. But we can control how we respond to the situation. Are you going to get all wound up and make the situation worse? Or are you going to use the situation to learn to ask for help? Are you going to use the time to take exquisite care of yourselves and your babies or try and push yourself in unhealthy ways? The situation takes on a decidedly different meaning when we turn away from, “This has happened and there is nothing that I can do to change it” to “This has happened, now how am I going to work with it and use it to my advantage?”
Blame and self denegration is rarely if ever helpful. Even if you have done something wrong; whether it be during your pregnancy or in an interaction with another person, beating yourself up about the situation is not helpful. Rather, acknowledge what has happened, then do what you can to resolve the situation in the most positive way possible.