POSTPARTUM MOOD DISORDER

Women-One in five.  Men-One in ten.   These are the numbers of new mothers and fathers who experience Post Partum Mood Disorder.  No longer described solely in terms of depression or anxiety, Post Partum Mood Disorder is a disorder that describes women and men who are not only depressed or anxious but also moms that experience scary, intrusive and obsessive thoughts and obsessive behaviors (Postpartum OCD), as well as moms that experience frequent panic attacks (Postpartum Panic Disorder).  Some moms experience difficulty managing their anger and feel intense feelings of rage.  Postpartum Mood Disorder also includes moms that experience symptoms in pregnancy  (Antenatal Mood Disorder) and moms that experience mood and anxiety problems related to traumatic births (Postpartum Post Traumatic Stress Disorder).  For a very small number of women, this illness can progress to Postpartum Psychosis which needs immediate medical and psychiatric attention.  The symptoms of PPMD can develop anytime in the first year after birth or after weaning from the breast.

There are many symptoms of Postpartum Mood Disorder and the website, Postpartum Progress, outlines these symptoms quite well.  http://www.postpartumprogress.com/the-symptoms-of-postpartum-depression-anxiety-in-plain-mama-english 

Many moms wonder how Postpartum Mood Disorder and breastfeeding interact with each other.   There is evidence to suggest that breastfeeding protects and/or lowers the risk of postpartum mood symptoms and that weaning early may not be in the mother’s best interests and may not reduce or clear her symptoms. http://www.sscnet.ucla.edu/comm/haselton/unify_uploads/files/Hahn-Holbrook,%20Haselton,%20Dunkel%20Schetter,%20Glynn%20Does%20breastfeeding%20offer%20protection%20against%20postpartum%20depression.pdf  However, early weaning due to PPMD is a personal decision and for some moms due to certain medications or conditions (such as complications from psychosis and medications to treat psychosis or suicidal ideation or behavior), it may be in the interest of her health and safety to wean.  Weaning early should not be taken lightly and should always be discussed with a doctor or IBCLC.

There are several natural ways a mother can help herself with her mood and anxiety symptoms.  A nutritious diet high in protein and sleep as well as any type of physical activity are important first steps.  Disrupted sleep is one of the biggest triggers for PPMD so it’s even more important to rest and find ways to get good sleep with a new baby.  The housework can wait, nap and cuddle with your baby.  Even a walk outside with or without your baby for 30 minutes a day can make a difference.  Deep breathing is the number one way to manage anxiety and progressive muscle relaxation and guided meditation are also very effective ways to treat depression and anxiety.  Practice these techniques before bedtime for 10-20 minutes.  Not only will you gain the practice to be able to use these techniques when you are feeling low but it will also help you fall asleep.  You can find several different scripts and ways to practice these techniques online and guided meditations are available online as well to download to your preferred media.  Journaling, asking for help for household chores and childcare, reducing your caffeine and sugar intake, a daily hot shower, taking care of your hair and body, reading, sex and masturbation (when you’re up to it, of course), yoga and other restorative exercises, and enjoying your interests and pleasurable activities are all great ways to help manage your feelings.   Take a break from childcare and put yourself in timeout.  It’s so important for your well-being and for the well-being of your children.  If you’re feeling overwhelmed or having a particularly bad day or, just pick one to do and it will make a difference.

Some mothers may need further assistance from their primary care physician to address their symptoms, especially if they are worsening or not improving with good lifestyle changes addressed above.  There are several medications that are considered safe for breastfeeding mothers.  Download Lactmed to your phone or call Infantrisk or Mother Risk with your doctor to find a safe option for you.  Medications take time to work (about 4-6 weeks for antidepressants) and sometimes it takes multiple trials of different medications for a mother to get relief because not all medications work for all people.  Some mothers also benefit from seeing a professional counsellor to talk about their feelings and find solutions.

As for dads, they can get postpartum mood disorder too.  Many dads have symptoms related to depression, anger management issues, feel an increase in stress about money or providing for the family, stress in supporting their partner with PPMD, difficulty or refusal to bond with the baby and low sex drive.  Sometimes when mom gets help and feels better, dad starts to suffer.  Look out for each other and keep communicating your needs and encourage dad to get help too.

Finally, remember you are not alone.   Postpartum Mood Disorder can be treated and managed.  You deserve the help and to feel well.   It is a brave mother to admit and seek help.  Check out the links below for further information and Google your state or city for local resources.

www.postpartumprogress.com

www.lifewithanewbaby.ca

http://www.postpartummen.com/

www.motherisk.org

www.infantrisk.com

http://www.ppdsupportpage.com/document.html

www.postpartumresource.com

http://postpartum.net/Default.aspx

www.meditainment.com  (to download guided meditations)

Foremilk Vs. Hindmilk

Many moms worry about the fat content of their milk. They hear from their friend that they had a foremilk hindmilk imbalance and that it caused issues. They pump and see only a super thin layer of “fat” atop the container and then see a picture of a woman with a huge fatty layer. The instant reaction is “oh my gosh, something is wrong!” 

First, lets clarify the terms. Foremilk is the milk your baby initial gets when they start feeding. This milk is usually low in fat. Hindmilk is the milk that the baby gets at the very end of the feeding, usually high in fat content. Why is there a difference in milk you ask?

Human breastmilk is actually all the same. The difference in milk comes from the fact that the fat globules in the milk stick together and collect further in the back of the breast. As the baby nurses and the milk moves from the back of the breast through the nipple the fatty globules move forward with it. 

This is also why the mistaken idea that longer time between feedings causes fattier breastmilk is NOT true. As your breasts refill the less fatty milk gets moved to the front while those fat globules get pushed back. Longer times between nursing means more foremilk and less fat. Shorter times between feedings means the baby is getting more of the fatty milk because those fat globules are closer to the nipple. 

IMPORTANT NOTE: YOU CAN NOT TELL FAT CONTENT OF MILK FROM PUMPING. The layer at the top of the milk is NOT an indicator of how much fat is in your milk. It is simply the milk separating into layers. Even foremilk which is less fatty will have a layer on top. Do not gauge your milks fat content by how pumped milk looks. The only way to do this is to have the milk professionally analyzed. 

Make sense? 
Many moms think that milk suddenly switched from foremilk to hindmilk. This however is just not the case! Kellymom describes the process as turning on a hot water faucet. “The first water you get out of the tap isn’t usually hot, but cold. As the water runs, it gradually gets warmer and warmer and warmer. This is what happens with the fat content in mom’s milk – moms’s milk gradually increases in fat content until the end of the feeding.” (http://kellymom.com/bf/got-milk/basics/foremilk-hindmilk/) 

Still not sure exactly what is being said. The blog the funny shaped women did an amazing job visually showing the difference between foremilk and hindmilk and the gradual progression that occurs! She pumped and took small samples at various points in her session and then had the samples analyzed for fat, calorie, carbohydrate, and protein content. The results show that over time slowly the milk increases in fat and calories, its not a sudden abrupt switch from foremilk to hindmilk.http://thefunnyshapedwoman.blogspot.com/2011/05/foremilk-and-hindmilk-in-quest-of.html

So what does all this mean to moms? 
When nursing your baby you want to let them finish the first breast first before switching. Many moms are still told to only nurse for X number of minutes per breast. Remember all moms produce milk different and produce milk with a different fat content. Also all babies nurse differently! While one baby may be satisfied by the first breast after 5 minutes another may want 10, 15, or even 20 minutes. If your baby pops off try burping and reoffering the same side. If your baby pops off again chances are they are done with that side. At this point most moms should offer the second side, even if your baby only nurses on that side for a few minutes. A large majority of babies nurse both sides per nursing session.http://www.llli.org/llleaderweb/lv/lvsepoct95p69a.html

There are situations however when women don’t want to offer both breasts. If your baby is constantly having frothy green poop then you may have too much milk and your baby may be getting too much of the less fatty foremilk and not enough hindmilk. There are other signs of oversupply as well, usually babies are gassy and fussy, tend to “chug” when nursing, pull away from the breast after letdown occurs (usually resulting in milk spraying everywhere!), and sometimes will actually have a shallow latch to help “slow down” the milk flow. At this point you may want to consider offering the same breast for 2 feedings in a row. This allows your baby to get more of the fatty milk out because your breast is not having as much time to refill between nursing sessions. This is called block or flex feeding. http://kellymom.com/bf/got-milk/supply-worries/fast-letdown/

Before jumping to the oversupply conclusion however ask yourself some questions: Does this happen all the time? Has anything changed recently? Did my baby just go through a growth spurt/has been nursing more frequently? Its normal for newborns to go through a growth spurt, nurse a lot, and end up taking in a bit too much foremilk. If you are not having all the symptoms listed above consistently then it may just be temporary. As I said, most moms offer both breasts per feeding. 

So what is the take home here? 
- Milk does NOT magically switch from foremilk to hindmilk!
- Watch your baby, not a clock! Let your baby nurse from the first side first, don’t rush them to move on! 
- Most moms should be offering both sides for each nursing session! 
- 99% of the time, you don’t have to worry about foremilk vs hindmilk. If your baby is nursing well and gaining well then everything is going great!