Navigating Postpartum Wellness: Understanding and Overcoming Postpartum Depression

The crucial postpartum phase, often referred to as the fourth trimester, includes the months following childbirth. In a recent Wednesday Wellness webinar, Obstetrician and Gynecologist (Ob/GYN), Dr. Crystal Zilo shared insights on navigating postpartum challenges, including understanding and overcoming postpartum depression.

Understanding the Postpartum Period

The postpartum period begins immediately after the newborn is delivered. While its end is less precisely defined, it typically spans up to 12 weeks post-delivery, according to the American College of Obstetrics and Gynecologists. This period is marked by significant physiological changes as the body recovers from childbirth.

What to Expect in the Hospital

• Rooming In: The baby stays in the room with the mother to promote bonding and breastfeeding, a practice endorsed by the World Health Organization and UNICEF.
• Maternal Monitoring: Frequent checks of vital signs and uterine massage are common to reduce postpartum bleeding.
• Lactation Support: Lactation specialists and nurses assist with breastfeeding.

Postpartum Changes

• Breast Engorgement: Fullness and tenderness in the breasts due to milk production, peaking around 3 to 5 days postpartum
• Abdominal Muscle Recovery: The abdominal wall regains most of its tone within the first few weeks, although diastasis recti (separation of the abdominal muscles) may persist longer.
• Skin Changes: Stretch marks may fade over time and loose skin on the belly gradually tightens.
• Hair Loss: A higher ratio of “resting hair” during the postpartum period can result in noticeable hair loss, typically returning to normal within 6 to 15 months.
• Hot Flashes: Likely due to hormonal changes; these typically resolve over time.

Return of Menstrual Cycle and Ovulation

For those who choose not to breastfeed, menstruation generally returns between 45 to 64 days postpartum, with ovulation occurring as early as 45 days.

There is considerable variability among women who breastfeed; some may not menstruate for up to six months or longer.

Addressing Mental Health in the Postpartum Period

While physical changes are expected and often discussed, mental health changes in the postpartum period are frequently overlooked. It's vital to address this "elephant in the room."

Normal Emotional Changes vs. Postpartum Depression

Baby Blues: Common in the first two weeks post-delivery, symptoms include mood swings, anxiety, sadness, and trouble sleeping. These usually resolve without treatment.

Postpartum Depression: More severe and long-lasting than baby blues, symptoms include feelings of sadness, anxiety, and hopelessness that interfere with daily activities.

Causes of and Risk Factors for Postpartum Depression

• Hormonal Changes: Significant drops in estrogen and progesterone post-delivery can trigger depression.
• Fatigue: Exhaustion from caring for a newborn can severely impact emotional health.
• Lifestyle Factors: Major life changes, lack of support and pre-existing depression increase risk.

Recognizing and Treating Postpartum Depression

Common symptoms include persistent sadness, loss of interest in activities, changes in appetite, sleep disturbances, and thoughts of self-harm or of harming the baby.

Health care providers often use screening tools like the Edinburgh Postnatal Depression Scale to identify those at risk.

Effective treatments include therapy (cognitive behavioral therapy and interpersonal therapy) and antidepressants, which are safe for use during breastfeeding.

Postpartum Psychosis

A rare but severe condition, postpartum psychosis requires immediate medical attention. Symptoms include confusion, hallucinations, and paranoia, typically developing within the first four weeks after delivery.

Supporting Someone with Postpartum Depression

• Be Present: Ask how they’re feeling and actively listen.
• Offer Practical Help: Assist with household chores, childcare, or accompany them to appointments.
• Avoid Unhelpful Comments: Refrain from minimizing their feelings or offering superficial reassurances.

Remember, mental health is as vital as physical health and support is available. If you or someone you know is struggling with postpartum depression, don’t hesitate to seek help.

Schedule an appointment with your health care provider, reach out to family and friends, and utilize available resources, such as postpartum.net.