Tired of being tired.
“This is an illness that takes away a women’s ability to access joy, right at the time she needs it the most“
Dr. Katherine Wisner.
Postpartum psychiatric illness consists of a highly prevalent group of disorders that affect women during their childbearing years.
Despite the fact that effective non-pharmacologic and pharmacologic treatments are available and the multiple contact with medical professionals during the postpartum period, this condition is frequently overlooked and missed, and many women go without treatment.
Untreated postpartum mood illness places the mother and infant at risk. Therefore, appropriate screening for and prompt recognition and treatment of depression are essential for maternal and infant well-being, which can improve outcomes.
The American Academy of Pediatrician; AAP estimates that more than 400,000 infants are born each year to mothers who are depressed.
Mothers from all socioeconomic groups are affected.
Risk Factors for Postpartum Mood Disorders (PPDs).
Although predicting who is at risk for postpartum psychiatric illness is difficult, hormonal, psychosocial, and biologic factors are considered to be risk factors for PPDs.
- Hormonal factors:
Affected individuals may be abnormally sensitive to changes in the hormonal levels. Estrogen, progesterone and cortisol levels fall dramatically within 24 hours after delivery. - Psychosocial factors:
Women who have recent stressful life events, such as childcare, lack of social support, marital dispute, unintended pregnancy, and insurance status or a recent negative life events, such as a partner violence, death in the family, financial difficulties, or loss of employment, are more likely to experience postpartum depression.
Certain adverse perinatal outcomes may associate with increased symptoms of depression and postpartum depression.
Adolescents in the prenatal and puerperal period have higher rates of depressive symptoms and depression than their adult counterparts. - Biologic vulnerability:
Women with a previous history of depression (during pregnancy or not), a family history of a mood disorder, or depression during the current pregnancy are at increased risk for postpartum depression.
Screening for Postpartum Mood Disorders.
Too often, postpartum depression is dismissed as a normal or natural consequence of childbirth. Screening of all mothers during the antepartum and postpartum period for depressive symptoms is indicated to identify those women at higher risk for postpartum depression.
In Depth.
Postpartum Blues.
Up to 85% of women experience postpartum affective instability. Rapidly fluctuating mood, tearfulness, irritability, and anxiety are common symptoms.
Symptoms peak on the fourth or fifth day after delivery and last for several days, but they are generally time-limited and spontaneously remit within the first 2 postpartum weeks. Symptoms do not interfere with a mother's ability to function and to care for her child.
Management.
Postpartum blues are typically mild in severity and resolves spontaneously. No specific treatment is required, other than support and reassurance. However, further evaluation is necessary if symptoms persist longer than 2 weeks
Post-pregnancy Depression.
Postpartum depression is more persistent and debilitating than postpartum blues, often interfering with the mother's ability to care for herself or her child. The postpartum period is the most vulnerable time for a woman to develop psychiatric illness with postpartum depression occurring in 10-15% of women in general population. It develops most frequently in the first 4 months following delivery but can occur anytime in the first year. It is no different from depression that can occur at any other time in a woman's life.
Presentation.
Typically, the disorder develops insidiously over the first 3 postpartum months, although it may have a more acute onset.
Symptoms of major depression may include:
- depressed mood
- tearfulness
- anhedonia (inability to feel pleasure),
- insomnia
- fatigue
- appetite disturbance
- suicidal thoughts, and
- recurrent thoughts of death.
This interferes with the mother’s ability to function, causing risk of harm to the mother or infant.
Anxiety is prominent, including worries or obsessions about the infant's health and well-being. The mother may have ambivalent or negative feelings toward the infant. She may also have intrusive and unpleasant fears or thoughts about harming the infant.
Management overview.
Exclude medical causes for mood disturbance (e.g., thyroid dysfunction, anemia).Non-pharmacologic treatment strategies are useful for women with mild to moderate depressive symptoms. Individual or group psychotherapy (cognitive-behavioral and interpersonal therapy) are effective.
Psychoeducational or support groups may also be helpful. These modalities may be especially attractive to mothers who are nursing and who wish to avoid taking medications.
Pharmacologic strategies are indicated for moderate to severe depressive symptoms or when a woman’s condition does not respond to non-pharmacologic treatment. Medication may also be used in conjunction with non-pharmacologic therapies.
Inpatient hospitalization may be necessary for severe postpartum depression.
Sleep disturbances and insomnia have been associated with an increased risk of postpartum depression. A study recently demonstrated that treatment of insomnia in the third trimester of pregnancy reduces rates of postpartum depressive symptoms. These findings suggest that screening and treatment of sleep disturbances in pregnancy could reduce the incidence of postpartum depression.
Postpartum Psychosis.
Postpartum psychosis is the most severe form of postpartum psychiatric illness. The condition is rare, occurring in approximately 1-2 per 1000 women after childbirth. At highest risk are women with a personal history of bipolar disorder or a previous episode of postpartum psychosis.
Presentation.
Postpartum psychosis has a dramatic onset, emerging as early as the first 48-72 hours after delivery. In most women, symptoms develop within the first 2 postpartum weeks. The condition resembles a rapidly evolving manic or mixed episode, with symptoms such as restlessness and insomnia, irritability, rapidly shifting depressed or elated mood, and disorganized behavior.
The mother may have delusional beliefs that relate to the infant (e.g., the baby is defective or dying, the infant is Satan or God), or she may have auditory hallucinations that instruct her to harm herself or her infant. The risks for infanticide and suicide are high among women with untreated postpartum psychosis. Rates of infanticide in this population are as high as 4%.
Management.
Puerperal psychosis is a psychiatric emergency that typically requires inpatient treatment.
Breastfeeding and Psychotropic Medications.
Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into breast milk.
Impact of Postpartum Depression on Child Development.
“You don’t have to suffer in silence or feel ashamed, our babies need us to be healthy during a time when we are overwhelmed the most”
Brittany Willow Mayer.
A large body of literature suggests that a mother's attitude and behavior toward her infant significantly affects mother-infant bonding and infant well-being and development.
Mothers with postpartum depression are more likely to express negative attitudes about their infant and to view their infant as more demanding or difficult. Depressed mothers exhibit difficulties engaging the infant, either being more withdrawn or inappropriately intrusive, and more commonly exhibit negative facial interactions. In addition, mothers with symptoms of depression are more likely to discontinue breastfeeding earlier in the postpartum period. These early disruptions in mother-infant bonding may have a profound impact on child development.
These children are more likely than others to exhibit behavioral problems (e.g., sleep and eating difficulties, temper tantrums, hyperactivity), delays in cognitive development, emotional and social dysregulation, and early onset of depressive illness. Furthermore, children of depressed mothers have been shown to have slightly increased weight gain at 6 months of life, which may be predictive of increased risk of obesity later in life.
Prevention of Postpartum Psychiatric Illness.
- Women at high risk for postpartum illness should be identified before delivery. This includes women with a previous episode of postpartum illness and women with a history of either unipolar or bipolar depression.
- Women who experience depression during pregnancy should also be considered at high risk for postpartum illness.
- In addition to monitoring, women with a history of recurrent depression or a history of postpartum depression may benefit from prophylactic treatment with an antidepressant medication.
- If antidepressants are not used during pregnancy, they may be initiated shortly before or immediately after delivery to reduce the risk of recurrent illness. The prophylactic efficacy of non-pharmacologic interventions in this setting has not been fully assessed.
Motherhood can be rough, postpartum mood disorders are real. You aren’t the only woman who has felt this way, you aren’t now or ever alone in your feelings.
Everyone expects you to be nothing less than overjoyed, to be 100% grateful and over the moon, but the reality is many women end up in a dark, discouraging place.
Yes you have been blessed with motherhood when many never get the honor, so guilt clouds you when you feel depressed, hopeless, exhausted and barely hanging on, reach for help and talk about it, it needs to be.
“I gained a lot of weight during my pregnancy, and I think I did go through postpartum depression. I was trying to stay positive when it felt like my whole world had flipped upside down. Creating a human takes a toll on women’s bodies. Sometimes we don’t give ourselves enough love or patience about that.”
Danielle Brooks.
Now beautiful Mom, it’s time to fix your “worries”, give yourself 10 minutes a day and practice these 5 Pilates-modified exercises to feel connected and find balance in your life again.
You’re the super glue that hold a family together,
So remember self-love isn’t selfish, you can’t truly love and take-care of others until you know how to love and take-care of yourself.
The 5 simple but profoundly effective Pilates exercises:
1. Breathing exercise:
To relax, focus & reconnect.
In seated position, as close to neutral as possible (weight on top of sit-bones),lengthen spine, feet grounded, legs parallel & hips-distance apart, small ball between knees to engage inner thigh, shoulders wide & open in front & back.
Flex band around the lower aspect of the chest, its ends by hands & elbows in (activating Latissimus Dorsi muscle, your wings).
2. Inhale: through the nose, allow the rib-cage to move up & out, diaphragm contracts & moves down, giving enough space for the lungs to expand.
3. Exhale: through the mouth, rib-cage moves in & down, diaphragm relaxes & moves up, slightly squeeze the ball to connect inner thighs, deep pelvic floor muscles & TA muscle more.
4. In: allow the lungs to inflate like a balloon, feel the movement of the chest against the band (see the blue lines in both pictures).
5. Ex: through a pursed lips and deflate the lungs.
Do it for 5x. You can turn & tilt the head from side to side.
Free the belly, hug the belly:
Allows you to engage deep abdominal muscle (transversus abdominis, TA), bring awareness of the rib-cage & pelvis connection.
Standing, spine & pelvis neutral, equal weight underneath the feet, legs parallel & hips-distance apart.
Shoulders wide & open in front and back, eyes forward.
In: through the nose, allow the abs to stretch, relax and move out, more extension in the lower back as seen in the first picture.
Ex: through the mouth slowly, abs (mainly TA) will contract & move in, keep the abdomen flat with no bulging, which adds more support to the lumbo-pelvic area, extension of the lower back decreased.
Do it 5x. You can turn and tilt head.
Squat sit stretch:
A nice exercise to stretch the muscles of the low back and deep pelvic floor.
Standing with hands on Barre as an example for more stability, as close to neutral as possible, legs parallel or laterally rotated & slightly abducted, equal weight underneath feet, feet grounded down & the spine lengthened up (opposition, first picture), shoulders wide & open in front and back, eyes forward.
In: move your body away from the Barre, weight more on heels but feet still grounded, keep elbows in and down to connect the lats. (Latissimus Dorsi muscle, your wings), allow the ribs to open, lengthen the spine, eyes forward.
Ex: through the mouth, engage the TA muscle & bend the hips and the knees, keep the spine vertical & move all the way down, elbows in.
Stay, inhale & exhale slowly (do 3-5 breath cycle), feel the relaxation & contraction of the deep pelvic floor muscles, you can turn & tilt the head from side to side, you can shift the body from side to side or move it forward & backward, you can add spinal rotation to stretch the back muscles even more.
Last Ex: more weight on heels but feet still grounded, spine vertical, extend knees and hips with swift exhale, back to starting position.
Do it 5x. In each repetition add one variation as mentioned above.
Foot-work with spinal articulation on Stability Chair:
Use low tension 1 heavy low, 1 light top (1HL, 1LT) to focus more on the deep core muscles and spinal articulation.
Sit on the chair spine & pelvis neutral, sides of body equally long, balls of the feet on the pedals with heels up (ankles in plantarflexion), legs hips-distance apart parallel or laterally rotated, you can put a spacer between knees &/or ankles if legs are parallel, hands on the front sides or front edge of the chair.
In: stay, allow rib-cage to move up & out, diaphragm contracts & move down, deep pelvic floor muscles relax, expand & move down, keep eyes forward.
Ex: keep spine and pelvis neutral, keep lengthening & press the pedals down just above metal frame.
In: bend knees & hips to lift the pedals up with control, simultaneously keep pelvis neutral & flex the spine over.
Ex: press pedals down, keep pelvis neutral (weight on top of the sit-bones) & extend the mid-upper back.
Do it 5x – 10x. You can change the breath, inhale to extend the spine & exhale to flex over.
Mermaid in Reformer:
In seated position, spine & pelvis neutral, both sides of body equally long, your body centered between arms, cross legs, one hand on foot-bar slightly in front of shoulder, other arm on the front shoulder rest.
In: lengthen your spine, keep both sides equally long & lift arm on the shoulder rest overhead.
Ex: hug the belly (engage the TA), lengthen & flex the spine over the foot-bar (lateral flexion of the spine), keep arm overhead, simultaneously abduct other arm to move carriage out, keep opposite hip on carriage, weight on top of sit-bones, pelvis square forward.
In: lengthen spine back to vertical, arm still overhead, adduct other arm to move carriage in with control.
Ex: lower arm and place it over the shoulder rest back to starting position
In: arm on the foot-bar overhead.
Ex: lengthen and flex spine over away from foot-bar to balance.
In: move back to vertical, arm still overhead.
Ex: lower the arm, back to starting position.
Do it 2x – 3x then turn around and repeat.
“I don’t believe you will ever be ‘you’ again and that’s okay! You realize you are stronger than you ever thought, that you are capable of doing amazing things. So in my opinion, I’m a different new ‘me’, a stronger ‘me’.”
Dani Talerico
Teachers Bio:
Salma Abu-Farsakh (PPI Graduate - Perinatal Pilates Specialist) is a full certified Stott-Pilates Instructor and Pregnancy Pilates Impact graduate as a Perinatal Pilates Specialist. I have been working with pre and postnatal clients since 2018, aiming to help them grow safely during their pregnancy and heal safely in the postnatal period.
Email: [email protected]
Instagram: @salma_pilates_trainer
Facebook: Salma Abu Farsakh