Treatment of Depression During Pregnancy and the Postpartum Period

"Several adverse obstetric complications have been reported with untreated prenatal stress and depression, including pre-eclampsia, preterm delivery, low birth weight, miscarriage, small-for-gestational-age babies, low Apgar scores, and neonatal complications.7,8 In addition to being debilitating for the mother, postpartum depression affects maternal-infant interactions and some measures of infant development."

This is an excerpt from this article titled Treatment of Depression During Pregnancy and the Postpartum Period, published by the US Department of Health and Human Services.

While there is a fine line between normal hormonal changes and clinical depression and anxiety, any symptomatic woman in the perinatal period should seek clinical evaluation and possibly treatment.

Won't the Medications Cause Harm to Baby? 

It is a common concern for women with known depression to be wary of taking medication during pregnancy and/or breastfeeding. Quite frankly, for most pregnant women, there is some sense of fear of putting anything in their bodies. However, more and more is being published about the much GREATER risks of untreated depression in pregnant women. I spoke to an OB and a Pediatrician personally and asked for their opinion on the subject. To paraphrase, each physician emphasized how grateful they are when women come forward with these concerns so that they can be appropriately taken care of. Both of the doctors reiterated the vast research on the damage that untreated chemical imbalances can cause the mother AND the child. There are many safe antidepressant medications for pregnancy and breastfeeding.

There are Facebook support groups for women struggling with pregnancy and postpartum depression/anxiety with literally THOUSANDS of members. This is an epidemic that deserves more attention and less judgment. We are afraid to seek help for fear of looking weak or unfit as a parent.

As a society, we need to remove the stigma of mood disorders and mental illness. A mother who feels out of control of her emotions or feelings should not feel ashamed or like a bad mother. She should feel empowered to do the right thing for herself and her baby and seek the best treatment, as decided by her provider and herself.

Related articles:
Know The Symptoms Of Postpartum Anxiety And Depression
Embracing The Roller Coaster Of Motherhood
Nutrition Tips For Thriving During Postpartum
6 Comfort Tips For NOT Breastfeeding

Postpartum Expectations and Must-have Items

by Cynthya Dzialo, certified Hypnobabies hypno-doula and CBI birth doula, childbirth educator, and owner of The Happiest Doulas

In addition to filling your freezer with nutritious meals, lining up pet sitters, and daily help from family and friends, you'll want to stock up on postpartum supplies to have on hand upon your discharge from your birthing facility. Below are a dozen comfort suggestions to help you prepare for an easier postpartum time and a speedy recovery for both surgical and vaginal deliveries.

 

This post does NOT include any affiliate links for the below suggested items used for an easy postpartum recovery. We are sharing these links to help you prepare for parenthood. Also, here is our recommended gift registry for infant and breastfeeding gear that you may copy on Babylist to prepare for your baby showers. Happy Shopping!

After care items for a vaginal birth:

1. Epifoam
   If you receive stitches on your perineum, you'll likely receive a numbing spray called Epifoam while in the hospital. If you need more after your return home, ask your doctor if Dermaplast (over the counter) is an acceptable alternative.
   

2. Sitz baths
   This plastic tub is placed directly on the toilet rim (seat up) and you sit on it as it circulates warm water on your bottom via a tube connected to a bag you fill from the sink. This helps clean your bottom, may encourage urination, and will help with healing. Many women find it very comforting. Follow this with an ice pack! (Insert sigh of relief!) Your hospital may offer you a sitz bath or you can find this at your local pharmacy.
   

3. Peri-bottle
   Following the birth of your baby, you will be given a small plastic bottle filled with warm water. Use it to squirt on your bottom as much as necessary to help encourage urination and dilute the sting caused from urine. Once your bladder is empty, squirt your bottom again gently with as much water as necessary to help clean your bottom. Then PAT your bottom dry with hospital wash cloths or toilet paper. Take your bottle home with you or buy a few to keep in each of your bathrooms.
   

For both type of deliveries:

1. Doughnut-shaped pillow or wedge (V-shaped) cushion
   Called coccydynia or coccygodynia, tailbone pain usually goes away on its own within a few weeks or months after childbirth. To lessen pain while sitting, use a doughnut-shaped pillow or wedge (V-shaped) cushion. Try a dollar store pool tube!
   

2. Witch hazel or Tuck's pads
   Found at your local pharmacy, witch hazel is an over the counter astringent, which can be used to help shrink hemorrhoids. Most commercial bottles of witch hazel contain alcohol so it may sting with direct application. TJ Dickinson's is a brand that sells pure witch hazel. It may take you some time to locate TJ's unless you shop at Whole Foods. (You may want to try the wipes, Tuck's pads, or Preparation H.) If using the liquid, you can make a “padcicle” by soaking a pad with witch hazel and placing it in a clean Ziploc bag then freezing it. Once frozen, remove it and wear it as normal. Many women find this very comforting for their swollen, sore bottoms – especially after a vaginal delivery.
   

3. Senokot
   A gentle vegetable-based laxative called Senokot may be offered to you at the hospital. You can also find it over the counter at your local pharmacy. It is generally well-tolerated (doesn’t cause intestinal cramping) and takes effect within about 12 hours, so it’s usually taken in the evening.
   

4. Colace
   To help with those first few postpartum bowel movements, you may want to try Colace, a stool softener, during the first several days. Once you are eating/drinking somewhat “normally” and soreness has subsided, you may wish to stop taking these medications. Both can be taken on an as-needed basis in the future.
   

5. Maxi Pads (overnight/heavy flow with wings)
   Bleeding for the first 6-8 weeks following delivery is normal. It is called Lochia (LOW-kee-uh). It will begin as very heavy, bright red bleeding that will gradually diminish to a dark red, brown and then to a more yellowish color. During this time period, nothing at all should be introduced to the vagina. Only wear pads, cloth/reusable or disposable, no douching, and no sexual intercourse until the lochia flow has stopped and you have been cleared by your provider.
   

6. "Granny" or Mesh Panties
   At the hospital, you will use mesh panties to hold your pad and ice pack. Bring the mesh underwear home with you or have a pair or two at home. If you've had a c-section, try the C-Panty. Here’s a listing of postpartum panties to find the right type for you.
   

7. Ibuprofen Pain Reliever (Motrin/Advil)
   6-800mg of ibuprofen will be brought to you every 6 hours in the hospital, along with some crackers. This medicine will help with cramping, and will also help with inflammation “down below.” Most women find the ibuprofen is enough to manage their pain, but if you are still experiencing a lot of pain, ask your nurse for something else (usually taken in conjunction with the ibuprofen). You will be sent home with a prescription for the 800mg tabs of ibuprofen.
   

8. Nursing Pads
   When you nurse your baby, you will experience what is called a “let down”, which is simply the release of milk from your breasts at the same time. When you hear your baby cry, you may also leak milk and appreciate wearing nursing pads. Both reusable/washable and disposable pads are available for purchase. If you don't plan to breastfeed, you'll still need pads for a bit of time as well as a head of cabbage kept in your fridge.

9. Nipple Cream
   In the first few weeks breastfeeding, your nipples may get a bit sore. Nipple cream by Earth Mama Angel Baby or Motherlove will help soothe and heal the affected areas. Alternatively, you could try organic coconut oil.

It Takes A Village

You will need to build your village of support people. It’s important for BOTH parents to seek out support from other parents – not just friends, but other people who have kids and “get it.” Both men and women experience postpartum depression. Read this to be able to recognize the signs of postpartum anxiety and depression. 

Find a support group NOW so you know who/where to turn to for help. You can always call your doula or care provider if you need suggestions. We're here for you.

Finally, you may wish to arrange a lesson with an infant care specialist for hands-on guidance on newborn care. Doing so will help ease your transition to parenthood. Best wishes!

 

Doula Support

Related Articles:
Nutrition Tips for Thriving During Postpartum
Tips To Help Make Breastfeeding Easier
4 Things To Do Now For a Healthier Postpartum
Episiotomy, Tears, and Perineal Support

Tips To Help Make Breastfeeding Easier When Going Back To Work

Being a parent is a full time job and trying to breastfeed is a full time job. Now add going back to your “real” full time job while trying to balance being a mom/wife and trying to keep up with breastfeeding is one word: STRESSFULL!!

Breastfeeding is not the norm for much of the USA and it’s hard to get people to understand the amount of work it takes to be successful at it. To promote breastfeeding success while you are still pregnant keep these helpful tips handy.

• Register for an extra slow flow nipple like a preemie nipple for the bottles you choose. No need to size up unless they are sucking so hard they are collapsing the nipple. Our breasts rate of flow don’t change as babies grow, so the flow from the bottle doesn’t need to either.
  

• Don’t open/wash all the bottles you get. Most stores will let you exchange the bottles if they don’t agree with your baby.
  

• Get free bottles of various brands whenever you can. This way you will have lots to test out if they don’t like the one you registered for when it comes time to introduce a bottle to your baby. Once you find one that works for you and your baby, pay it forward and give the bottles to another pregnant person you may know.
  

• Buy a good hands-free pumping bra. I really liked the Simple Wishes Hands-Free Breastpump Bra. I have a large cup size and it held everything in place well.
  

• If you can afford it, have two pumps. One for work and one for home to reduce the amount of stuff you have to haul back and forth. Consignment sales are a great place to buy a closed system pumps (like the Spectra) that are safe to reuse from person to person.
  

• Order a pump through your insurance. A lot of the time they are free. You may need a prescription from your OB/Midwife for a pump before ordering one. I personally loved my Spectra S2.
  

• For more info on how to best prepare to breastfeed, see if this affiliate online course and other resources (some are free!) by Lactation Link are right for you.

“Your success of being a working, breastfeeding person is not measured in ounces in your freezer. It’s measured in the happiness of you and your baby.”

Before your return to work, follow these tips to promote healthy breastfeeding:

• Don’t worry about pumping for the first 4-6 weeks of baby’s life unless you have to return to work before 6 weeks. Just enjoy your baby and let your body regulate its milk supply before you start making it oversupply. That can cause a lot of other issues for you later on. If you do have to return earlier, start pumping two weeks before going back.
  

• You only need enough milk to fill the bottles the first day (1-1.5 oz. per hour when away from baby). You will replace those when you pump. Having a huge milk stash is not needed and it takes up so much space in your freezer. Your success of being a working, breastfeeding person is not measured in ounces in your freezer. It’s measured in the happiness of you and your baby.
  

• Introduce a bottle 1-2 times a week starting around 3-4 weeks old. At this time baby should have figured out latching pretty well, so there is no need to worry about nipple confusion. Have someone else feed the bottle as some babies don’t take a bottle well when the breast is nearby. You can also introduce a pacifier at this point as well.
  

• It doesn’t have to be a full feeding. It can just be a snack.
  

• Watch videos on pumping to see how to get the most milk out.
  

• Make sure you have the right size flanges. Nipples should not rub the sides and shouldn’t be sliding all the way down the flange.
  

Next up: Pumping and Breastfeeding Tips For Going Back To Work.

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Pumping and Breastfeeding Tips For Going Back To Work

Pumping and Breastfeeding Tips For Going Back To Work

Part 2 (read part 1: Tips To Help Make Breastfeeding Easier)
 

Part 2 (read part 1: Tips To Help Make Breastfeeding Easier)

After maternity leave is over, your first day back to work might be filled with lots of emotions. To ease back into the workplace, I suggest you make your first day back in the middle of the week to make the transition a little less chaotic.

I've listed below the things that have helped me continue breastfeeding and pumping after I returned to work, and while traveling. You'll need to guard your pump time! Block it out on your calendar and set appointment reminders on your phone. For all day meetings and events, remind people in advance that you will need to take breaks for pumping.

Know that your baby may have a transition period where they are refusing to drink from a bottle at daycare. This usually passes within two weeks. You might notice they start to cluster feed at night to make up for it. Expect your baby to want to be attached to you when you get home. It’s their way of saying they missed you.
 

To encourage breastfeeding success:

• Buy a door stopper and place it behind the door when you pump. For some reason people don’t stop and knock when a door is locked even when there is a sign that says that the room is in use. It will also allow you to use spaces that don’t have a lock with confidence that no one will walk in on you.

• Have lots of pictures and videos of your baby to look at while pumping. Ones of them crying are great to encourage a letdown.

• Pump for every missed for 30 minutes per session, or for 2-5 minutes after the last drops of milk.

• Remember that what you pump is NOT an indication of what baby gets when they are at the breast. Breasts are made for babies, NOT for cold plastic pumps.

• You don’t have to wash out your parts after every use. Store these in a gallon size Ziploc bag and put them in the refrigerator.

• Change out your membranes every couple of months or when you notice a decrease in supply.

• Keep a spare outfit for yourself in your office or car for the days you are leaky.

Items to store in your pump bag:

• extra membranes

• wash cloth to dry yourself off

• milk storage containers

• freezer packs

• gallon size ziploc bags

• nipple cream/coconut oil

• pump, pump power cord

• flanges and tubing

• breast pads

• clean bottles

• phone charger so you can look at pictures of your baby

• snacks and water

For the traveling, breastfeeding parent:

• Print the TSA guidelines for transporting breastmilk and keep them in your carry-on bag to show anyone who may need a reminder.

• Breastmilk does not need to follow the normal 3.4 oz. guideline.

• Your breastmilk does not need to go through the X-ray machine if you don’t want it to. Make sure to allow extra time for the required screenings, as well as a personal pat down by security.

• Ice packs, freezer packs, frozen gel packs and other accessories required to cool formula, breast milk are allowed in your carry-on.

• Some airports have pumping and breastfeeding pods called Mamava. Use their app to locate a pod closest to you. Mamava pods are pretty nice and are a great place if you don’t want to feed or pump in public.
  

“If pumping makes you unhappy, switching to other milk supplies, such as donor milk or formula, might be the healthiest choice for you, emotionally.”

If you don’t have enough time to pump because of the type of job you have, remember you don't have to feed all breastmilk, donor milk or formula. Consider using donor milk or formula for daytime bottle feedings and breastfeed your baby in the morning and night. Your body will adjust to your new schedule. If you decide to change your breastfeeding or pumping schedule, do so slowly. Weaning needs to be a gentle process for your body and your baby to adjust.

Keep in mind that if you find breastfeeding and pumping after your return to work is decreasing your quality of life, weigh the pros and cons. If pumping makes you unhappy, switching to other milk supplies, such as donor milk or formula, might be the healthiest choice for you, emotionally. Yes, breastmilk from you offers the most nutrition for your baby, but having a happy, well-balanced parent is important too.

Find your village at work that's made of people who understand you! It’s also great to have a “phone a friend” when you realize you left behind an essential piece of your pump at home. Meet new friends and gain support at your local La Leche League. Look at the directory to find a meeting close to you. 

Being a working parent is all about finding the right rhythm for you. You will live your life on a very tight schedule, but just remember, it’s only a season of your life. The days are long, but the years are short, my friend.

For more info on how to safely store breastmilk and maximize your milk expression, see if this affiliate online course and other resources (some are free!) by Lactation Link are right for you.

Related articles:
How to Comfortably NOT Breastfeed
Postpartum Expectations and Must-have Items
7 Key Ingredients to a Good Night’s Sleep for Your Newborn
Make Breastfeeding Easier When Going Back To Work

How Often You Should Feed Your Baby

Never wake a sleeping baby!!

You've heard people say this, right? I'm here to tell you it is a myth. Learn how to promote the best feeding and sleeping patterns by following these general feeding tips for newborns.

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