Post Partum Depression

Mamas on Bedrest: What is Placental Encapsulation?

April 17th, 2013

Hello Mamas, Here’s a question from Mama on Bedrest Josh asking,

“Doesn’t placental encapsulation help with Post Partum Depression symptoms?”

After doing a bit of checking, I found that there is not medical evidence that Placental Encapsulation has any medical benefit. That said, ingestion of the placenta in any form has been practiced for centuries in Traditional Chinese Medicine and in other tribal customs. Because it is high in hormones, it is porported that ingesting the placenta,

  • Helps balance a woman’s hormones post partum
  • Helps mitigate “the baby blues” a syndrome reportedly faced by up to 80% of women in the immediate post partum
  • Helps ward off post partum depression (this has not been proven)
  • Enhances milk production
  • May help balance hormones during perimenopause

The additional benefit touted is that because the placenta is actually an organ the woman herself produces, there is no toxicity or risk of adverse reaction. It’s is seen as similar to donating blood to oneself prior to surgery. And because the placent comes from the woman herself, it provides the ultimate “bio-identical hormones”.

While I don’t endorse or refute the practice, I recommend that women interested in placental encapsulation thoroughly research the process and find a trained, certified placental encapsulation specialist; someone trained in the proper preparation according to Traditional Chinese Medicine practices and OSHA trained so that the organ is properly handled and prepared. There are resources listed below.

If you have done placental encapsulation, know something about placental encapsulation or have an opinion, please share your comments in the comments section below. Thanks!!

If you have a question, send it to info@mamasonbedrest.com and we’ll answer it on an upcoming Wednesday Vlog.

Resources for further study:

Placenta Benefits.info

Vivante Midwifery & Women’s Health

Loving Beginning Birth Services

 

Mamas on Bedrest: Newborn “Cuddling” Good for Mamas and Babies

February 18th, 2013

Hi Mamas,

Did you know that it’s a really good thing to cuddle with your babies? Yeah, I know, a no brainer. Most of us may instinctively know this to be that case and find that it just feels so good we do it.  But research reported in the Journal of Obstetric, Gynecologic and Neonatal Nursing confirms that skin to skin contact comforts babies and helps them to sleep better and be less “fussy”, while also helping mamas ward off depressive symptoms and stress in the early post partum period.

Last week, I shared a link on the Mamas on Bedrest & Beyonds Facebook Page from The Post Partum Stress Center. The article entitled, “Skin-to-Skin Contact May Lower Risk for Postpartum Depression” reports findings from the aforementioned longitudinal study following mamas in the early post partum. Mamas in the study group were encouraged to hold their babies for approximately 5 hours daily in the initial week post partum and for at least 2 hours daily for the first month. Mamas’-whether or not they developed post partum depression- were followed for three months (at 1 week, 1 month, 2 months and three months), and completed depression questionnaires. The researchers reported the following results:

“Compared to mothers in the control group, mothers in the SSC group had lower scores on the depression scales when the infants were one week and marginally lower scores when the infants were one month; when the infants were age 2 and 3 months, there were no differences between groups in the mothers’ depression scores. Over their infants’ first month, mothers in the SSC group had a greater reduction in their salivary cortisol than mothers in the control group.”

I was following some of the comments on the Post Partum Stress Center’s page and was surprised that their moderator had the following comment,

“Conclusions from this kind of research makes me nervous. Too much room for misinterpretation and self-blame. What about moms who are practicing skin to skin contact and still get depressed? What about moms who are too sick to engage in skin to skin contact? What other variables are being considered when the moms in this study reported fewer depressive symptoms?”

As I said, this comment surprised me so I went and read the actual study myself.  The study indicated that there was a beneficial reduction in depressive symptoms from skin to skin contact between mama and newborn in the early post partum period and this reduction was measured via salivary cortisol levels. It wasn’t clear what specific questions were asked in the depressive questionnaire and as one person commented on The Post Partum Stress Center’s thread, it was not known in what other activities/interventions mamas who were reporting fewer depressive symptoms were engaging. The researchers go on to say that skin to skin contact may be a way to lessen depressive symptoms and enhance the mother/infant bond.

There are a couple of reasons that I am seeing a discrepancy. First, the citation on the Post Partum Stress Center facebook page is from an article reporting on the study. Whenever I see such an article I immediately track down the actual research publication so that I can “get the scoop from the source.” This proved to be important here because the article had a couple of minor mistakes. The actual study indicated that mamas held their babies for about 5 hours of daily skin to skin contact for the first month. The article reported the skin to skin contact to be 6 hours daily. The study also indicated, and this is what I feel is the biggest area of discrepancy, that skin to skin contact may be a way to lessen depressive symptoms. From what I saw, it did not say that it skin to skin contact was curative, nor did it say that by doing skin to skin contact a woman would not develop post partum depression.  Additionally, I did not read the study as the researchers saying that skin to skin contact could replace medication or cognitive behavioral (talk) therapy in depressed mothers, but seemed to see it as an adjunct to other treatments.

I completely see what the folks at the Post Partum Stress Center were talking about. Just reading the article, a “depressed” mama may be lead to believe that if she simply holds her baby, her depression will magically lift and, if she holds her baby she won’t get post partum depression at all. In my opinion, this is not the intended conclusion of the authors at all. Further, Post partum depression is a very complex and very serious medical condition. If a woman has symptoms of post partum stress, she should not try to “tough it out” nor should she try to self diagnose. She should be evaluated by a trained health care professional immediately, as untreated post partum depression can have serious negative effects on both mama and baby. And it is my firm belief that it is the job of the health care providers, the “trained professionals”, at each and every contact with a new mama to ask pointed questions about how mama is adjusting to motherhood. These questions should be both directed at the symptoms of post partum depression as well as open ended so that mama can elaborate on her particular situation and ask any questions she may be harboring.

With lots of open, direct communication and support, I believe that mamas can get the help and support that they need if they are suffering with post partum depressive symptoms. Mamas, post partum depression is nothing to play with. Seek help immediately if you feel that you have depressive symptoms.

my daughter getting in on the skin to skin action on her newborn brother.

my daughter getting in on the skin to skin action with her newborn brother.

 

 

Mamas on Bedrest: Biological Aspects of Post Partum Depression-Part II

December 17th, 2012

In our last post, we learned that there are specific physical changes that occur in pregnancy that put women at risk for Post Partum Depression (PPD). In most women, these changes self correct in the post partum period. However, for many women, re-regulation does not take place. And in women with susceptible anatomy, these changes put them at increased risk of developing Post Partum Depression. Below, we share information from a recent publication that discusses how the changes that occur as a natural course of pregnancy can contribute to a woman developing PPD.

Changes in Post Partum Depression

Endocrine

Low levels of estrogen and progesterone have been shown to be associated with PPD, but cannot be said to be causative as there have been studies in which participants had elevated levels of estrogen and/or progesterone and had PPD. However, estrogen therapy-in relatively large doses-does seem to improve PPD.

PPD being linked to suppression of the HPA has been substantiated in several studies. Women with PPD have markedly suppressed HPA and their HPA’s don’t return to their baseline regulation as does those of women not subject to PPD.

Oxytocin, the milk let down hormone, seems to have a positive mood altering effect. However, when women have difficulty with breastfeeding or stop breastfeeding, they often are at increased risk for developing PPD. This point remains controversial as some women, it seems, stop breastfeeding because they are depressed. Oxytocin does seem to have a suppressive effect on the HPA

As previously stated, Serotonin seems to play a prominent role in PPD.  Low levels of serotonin are indicative of depression and medications that increase serotonin levels (SSRI’s) successfully treat PPD. Other neurochemicals and neurogenetic predispositions that influence the serotonin levels, typically suppression of serotonin production and release, further put women with these chemical anomalies or genetic predispositions are at increased risk for developing PPD.

Seasonal/circadian Changes

Newer research in PPD shows that there are seasonal effects, i.e. PPD may in fact be more prevalent in the fall and winter months, as SAD.

High morning levels of Melatonin are associated with PPD. Melatonin is made from serotonin but when secreted in the morning, when one is to awaken instead of at night when one is trying to sleep, increases sleep deprivation and sleep deprivation is a hallmark of PPD. Unfortunately, sleep disturbances are also a hallmark of the early post partum period, so it is often hard to discern if the Melatonin levels are abnormal due to depression or due to post partum sleep disturbances. For now, studies suggest that high am blood levels of Melatonin are present in women with PPD. More work in this area is forthcoming.

Immunologic Changes

Inflammation plays a roll in PPD. As previously stated, cortisol levels are increased during pregnancy (due to the maternal/fetal interaction) and the feedback loop telling the adrenals that there is enough cortisol is shut down. Without the adrenals functioning, at delivery, cortisol levels drop and the inflammatory response is left unchecked. Increases in inflammation is the result of a prolonged inflammatory response which has been shown to be a way for PPD to develop.

Thyroid Disease

Abnormal thyroid function appears to be associated with increased psychiatric symptoms, with hyperthyroidism being related to anxiety, mania, restlessness, depression and cognitive deficits and hypothyroidism is associated with memory deficits, lack of concentration, psychomotor slowing and depression.

Pregnancy in and of itself challenges normal thyroid function, often resulting in the presence of thyroid antibodies. During pregnancy TSH levels fluctuate depending on the stage of pregnancy while levels of T3 and T4 remain relatively stable within normal limits. In the early post partum, TSH levels are decreased. Of note, thyroid hormone replacement in the post partum doesn’t seem to prevent or reduce PPD symptoms in the presence of thyroid antibodies.  Currently, these authors are only able to report that

Women with maternity blues have higher TSH levels  and women with higher, albeit still normal, TSH levels (measured 4 weeks after delivery) tended to have higher depression scores at 4-weeks postpartum.  In addition, the authors reported a positive association between subclinical hypothyroidism at delivery and the development of self-reported depressive symptoms at 6 months post partum.

Given this information, the best thing to do in a woman with PPD symptoms would be to test for thyroid function and treat accordingly.

Other Potential Factors in PPD

Vitamin D. It seems that Vitamin D is being found to affect everything from our moods to our weights and everything in between, so it’s no surprise that it has an effect on PPD. What is surprising is that fact that recent studies have reported associations between vitamin D deficiency, inflammatory response and mood disorders.

As it relates to PPD, the authors note that Vitamin D levels have been found in postpartum women compared with pregnant women, but there is  so far only one study in the literature, examining serum 25(OH)D levels postpartum in relation to Edinburgh Postpartum Depression Scale scores. That particular study shows a significant association over time between low 25(OH)D levels and high depression scores postpartum. Thus far, only one randomized clinical trial has evaluated treatment with high doses of vitamin D in depressed subjects with promising results.

Leptin

Although Leptin is most closely associated with satiety and obesity research, recent research has linked leptin with depression and reproductive function in women. Leptin is reported to rise during pregnancy, fall after delivery and subsequently increase during the first 6-months postpartum. A study by these authors showed that higher leptin levels at delivery provided protection against depressive symptoms at 5-days, 6-weeks and 6-months post partum. Several theories are suggested for the protection, but to date, there is no definitive explanation.

This is a very interesting and important article. This level of indepth research is much needed if we are ever to be able to effectively treat (and perhaps even prevent) PPD. As these authors showed, there are multiple mechanisms potentially responsible for post partum depression. It is no longer enough to “poo poo” it away as mood, fatigue, being a new mommy or to ignore the signs and symptoms all together. Each and every pregnant and post partum patient should be routinely asked if they have any signs or symptoms of mood changes, and prompt and aggressive evaluation and treatment should be undertaken to ensure that mamas in need, receive the help and care necessary.

Reference

Alkistis Skalkidou, Charlotte Hellgren, Erika Comasco, Sara Sylvén & Inger Sundström Poromaa. Biological aspects of postpartum depression. Women’s Health, November 2012, Vol. 8, No. 6, Pages 659-671.  DOI 10.2217/whe.12.55 (doi:10.2217/whe.12.55)