Naturopathic care for Postpartum Mood Issues June 3, 2009

Naturopathic doctors are trained to look for the root problem causing someone’s symptoms, rather than just making the symptoms go away.  If we address the underlying cause, we can allow the symptoms to recede for good.  This is no different for postpartum women, and there are a number of reasons WHY women develop postpartum mood disorders.  Naturopathic doctors, especially those trained in the art of midwifery or who have had special training in pregnancy and birth, are very well-equipped to figure out how to best help each woman on an individual basis.

Dr. Adriana Azacarate-Ferbel is a Portland area Naturopath who has studied Postpartum depression extensively.  I met with her last fall when I began researching this topic more myself.   She outlined the most common underlying reasons for development of Postpartum depression:

• Fatigue and Sleep Deprivation
• Hypothyroidism
• Hyperthyroidsim
• Immune system dysregulation
• Pain
• Low Cholesterol levels
• Hormone imbalance
• Neurotransmitter
• Insulin resistance

Sometimes, it may be a combination of one or more of these that can cause postpartum mood disorders to develop.  Because this is true for many women, the Naturopathic approach is multifactorial as well.  The earlier we can recognize the symptoms and determine what’s actually going on, the better.  In my office, a primary work-up to determine the underlying cause may include:

• Thyroid testing, followed by nutritional supplementation and/or medicine to balance the thyroid gland (if needed)
• Combination Hormone and Adrenal Saliva testing, followed by treatment with herbs and nutrients known to balance female hormones, DHEA, and/or cortisol (and are safe for breastfeeding).
• Lipid panel, to look at cholesterol levels, followed by nutritional counseling to ensure adequate levels.
• Comp. metabolic screen, Iron panel, and Complete blood count, to assess for blood sugar issues, anemia, and immune system problems
• Musculoskeletal assessment to determine sources of pain that may be adding to increased stress and fatigue, followed by massage, acupuncture, or other forms of physiotherapy
• In some cases, neurotransmitter testing will be done first.  This is especially true if someone has a marked history of depression, anxiety, or psychosis.

I could write pages and pages on this topic.  This is just a jumping-off point.  There is still a lot to learn about this realm of women’s health, but we have a very good grasp on how to make the transition to motherhood a happy and healthy time.

Be strong.  Live healthy!

Baby blues May 27, 2009

Did you know that about 80% of all new moms experience some form of postpartum mood flux?  There is a normal drop in mood, increase in anxiety and tearfulness that occurs in most women right after they have a baby.  In most of these women, it is hormonal.  The pregnant body is pumped full of estrogen, progesterone, relaxin, prolactin, and oxytocin.  When the baby is born, all these amounts shift—mostly dropping off like the cliffs of the Grand Canyon.

Having a baby opens women up in so many ways: physically, emotionally, and spiritually.  It is a very wonderful and overwhelming time in all regards.  It is also a very vulnerable time because the body is going through so many changes AND there is a tiny little being that must be tended to 24 hours a day.  “Baby blues” affect up to 80% of new moms within the first few days postpartum.   I’ve seen that days 4-6 postpartum tend to be the most difficult for women mood-wise.

About 10% of new moms will go on to develop postpartum depression.  The onset of postpartum depression actually tends to be anywhere from 6 weeks to 6 months after the birth.  The symptoms are similar to depression: low mood, sleep issues, appetite changes, panic, anxiety, disinterest–plus constant concerns about ability to care for the new baby, and possible fears of actually harming the baby.  If a mom has had issues with depression prior to pregnancy, she is at a higher risk for developing postpartum depression.  Sometimes, it can be due to underlying physiological issues like hypothyroidism (which can also develop in the postpartum period).  So it’s good to rule out root problems to best help with treating the symptoms.

Roughly 2% of new moms will suffer from postpartum psychosis.  This is a very serious condition that must be addressed immediately and is thought to also be due to the drop-off of hormones that occurs after the birth.  Symptoms of postpartum psychosis are seen within the first 2-3 weeks following the birth and include:

• insomnia (other than not being able to sleep because the baby is awake)
• mania
• flight of ideas
• self-harming
• constant thoughts of harming the new baby
• disinterest in the new baby
• complete shift of mental status (that friends and family easily notice)

Often, these women need in-patient help with stabilizing mood, but there is a lot that can be done naturopathically to support a woman in this situation.  With the right support, these women go on to embrace being a mother.

There is a whole slew of new research coming out on postpartum and antepartum mood disorders.  More prenatal care providers are broaching the subject with their patients as well.  One of the best tools we have is to educate the patient and her family about the signs and symptoms so early intervention can occur.

Next week, I’ll be writing about some of ways naturopathic doctors help women who may be at greater risk for developing postpartum depression, anxiety, or pychosis.  Until then, enjoy the days as we begin to welcome Summer this year!

Postpartum Nutrition May 20, 2009

Good Morning!  It looks to be another beautifully sunny morning here in Portland, Oregon.  Wow, we have really been blessed with some fantastic weather the past few weeks.  Our clinic garden is looking great as well as the garden my family and I are growing at home.  I’ll be taking some photos to show you all just what I mean!

Today I’d like to round out this series on Nutrition during pregnancy by providing some guidelines about postpartum dietary needs.  The postpartum period is defined as the time from the birth of the baby and placenta to 6 weeks afterwards.  I personally believe that this extends to 3 months after the birth at minimum, with the first 6 weeks being the time when the body makes most of it’s transition back to “normal”.

I put normal in quotations because it is very common for women to feel like they have a totally new body after having a baby.  To a certain extent, it’s true.  It’s not the same body.  It looks, acts, and feels different than before pregnancy.  Therefore, it has different needs.  This is especially the case if the new baby is breastfeeding. Let’s have a look at some guidelines for women in the postpartum period:

• During pregnancy, women need 200-300 extra calories per day to grow a baby.  During breastfeeding, women may need up to 500 extra calories per day to make enough milk to feed their new baby.
• Also needed for milk-making is WATER.  Most women will need between 2-3 LITERS of water a day to keep up with the demands of making milk.  I like to get the whole family involved in the process, stashing bottles full of water wherever mom might end up nursing the new baby.  Intense thirst universally follows feeding the new baby, and moms everywhere love having a big glass of water while they nurse.
• Many women need extra iron after having a baby.  Moms who had a lot of bleeding with childbirth are in a higher risk category for developing postpartum anemia.  To prevent severe anemia (which can lead to excessive fatigue and lowered mood):

1. Increase iron in the diet: red meat, eggs, enriched cereals, and blackstrap molasses are good ways to get iron.
2. Increase Vitamin C intake: Vitamin C helps you absorb more iron from your food.  Take with meals.  Do not exceed 3000mg/day unless being supervised by a health care practitioner.
3. No black tea: Tannins in the tea decrease iron absorption.
4. Cook with cast-iron pots and pans.  Believe it or not, you will get good doses of iron from doing so.

• Continue to take your prenatal vitamins through the end of breastfeeding.  You still need the nutrients.  Plus, the extra B vitamins will give you much-needed mental and physical stamina.
• Omega-3 fatty acids with a higher DHA:EPA ratio.  Studies show that infants benefit (neurodevelopmentally) from DHA supplementation in pregnancy and breastfeeding.  Moms also need these healthy fats to help heal and replenish the reproductive and nervous system.  DHA can be found in coldwater fish and algae most readily.  Taking an encapsulated form of DHA is a sure-fire way of getting enough.

Next week I’m going to address Postpartum depression, anxiety, and mood disorders.  It’s more common than you think, and there’s more that can be done to help prevent it from affecting you and the ones you love. 

Herbal Nutrition in Pregnancy May 13, 2009

Herbal Nutrition for Pregnancy

Red Raspberry Leaf (Rubus Idaeus): tones the uterus during pregnancy, prevents hemorrhage, provides excellent source of Vitamins C and E.  Also good source of Calcium and Iron.

Nettles (Urtica dioica): great tonic.  Has lots of Vitamins A, D, C, and K. Provides Calcium and Potassium as well.  The Vitamin K is instrumental in preventing hemorrhage during birth.  Also good for leg cramps and hemorrhoids.

Mint family (Mentha spp.): safe and helpful in pregnancy for digestive issues: morning sickness and indigestion.

Oatstraw (Avena sativa): good source of minerals for growing baby and for integrity of veins.  Oatstraw is calming and nourishing.  This herb is a personal favorite!

Specific issues during pregnancy*

Morning sickness:  1-2 cups Raspberry leaf tea, 1-2 spoonfuls of ginger root (Zingiber off.) decoction, peppermint of spearmint tea, alfalfa (Medicago sativa) tea for B vitamins

Varicose veins/Hemorrhoids: 1-2 cups daily of Oatstraw tea, 1-2 cups of nettles tea, raw parsley (Petroselinum sativum) in salads, witch hazel (topically)

Anemia: 1 TBS Yellow dock (Rumex Crispus) decoction per day.  Can also try teas of Dandelion root (Taraxacum off), Parsley, and Nettles.

Heartburn/Indigestion: Anise or Fennel seed tea for after meals, Papaya enzymes, raw almonds, Slippery Elm (Ulmus fulva)

Bladder Infections: unsweetened cranberry juice, Uva Ursi leaves infuse for 8 hours, then drink one cup every 12 hours.  Can add yarrow (Achillea millefoilium) if not clear with just Uva ursi.

Hypertension: garlic, cucumbers, Hops (humulus lupulus)—only during 3rd trimester, Passionflower tincture (15 drops per day), Skullcap (Scutellaria off.) 1-2 cups per day, Hawthorn berries (Crataegus off.)

Late Pregnancy uterine tonics: Black and Blue Cohosh (Cimicifuga racemosa and Caullophyllum thalictroides), Squawvine (Mitchella repens)

*Please consult a helath care practitioner before beginning any new herbal or nutritional regimen

Getting Pregnant: 101. April 22, 2009

Have you noticed all the babies lately?  You can’t go anywhere without seeing strollers, babies in slings, babies strapped on the fronts, backs and sides of mamas & dadas, or toddlers bopping around.  You can likely name at least 5 people who have given birth in the past year.  They’re calling it a baby Boomlet with 2007 being a record high for babies being born and 2008 not yet accounted for.

Baby making is in the air.

Health consciousness is in the air too.  I have a lot of women coming in these days saying, “I don’t want to get pregnant right now, but we’re thinking about having a baby in the next year or so.  What should I be doing in the meantime?”  I applaud these women for putting their baby’s health as a priority.  Giving your baby the best possible start in life is the gift that keeps giving.  Here are a few guidelines for having a healthy pregnancy and a healthy baby:

*Eat as though you are already pregnant: during pregnancy your caloric intake increases about 300 calories/day.  That’s not what I mean here.  I mean eat a whole foods diet.  Cut back on caffeine, sugar, and alcohol.  Make sure you’re getting 60-80 grams of protein per day.  Drink 2-3 Liters of water per day.

*Take your vitamins: 6-12 months prior to “starting” to get pregnant, begin taking Pre-natal Vitamins.  This will ensure appropriate amounts of things like Calcium, Folic Acid, Iron, Zinc, and Vitamin A (all are different amounts than regular vitamins).

*Detox: pregnancy, breastfeeding, and trying to get pregnant are not the times to do any sort of cleansing, fasting, or detoxing**.  Any time you’re going through this, you’re putting toxins and waste into the bloodstream which goes to the baby as well.  I think it’s a great idea to do a cleanse before or in between pregnancies.  If you’ve been thinking about doing any kind of detox, do it before you start trying or wait until you’re done breastfeeding.

Next week I’ll talk about nutrition during pregnancy.  So check back & have a great week!

**Any fasting, cleansing, or detox program should be supervised by a healthcare practitioner.

A little hiatus for a little reason. December 8, 2008

If you’ve been reading my natural health blog, you’ve noticed that I’ve taken a little hiatus. This year there have been 2 running jokes. I have been the pregnant midwife…and the pregnant obstetrics instructor. In early October, I stopped being both and started being Iris’s mama! She’s doing great, I’m doing great, and I’m back at work in my office, seeing patients with a new lens on life.