Preventing PPD 5: Taking care of yourself physically

This is Part 5 of my Preventing PPD series. Part 1 is here, Part 2 is here, Part 3 is here, and Part 4 is here.

Since depression is all about an imbalance of chemicals* inside your body, it makes sense that you're more prone to depression when your body isn't operating at full power. You're already behind, since you went through the delivery process. Any way it happens, it's a stress on your body. You're probably sleep-deprived before the baby's even on the outside, since the last few weeks of pregnancy are tough to sleep through (leg cramps, back pain, strange dreams, etc.). And that's not even considering how fatigued you are just from the pregnancy. Add on to that the fluids you lost during delivery and the sleep you're not getting now that the baby's here, and it's a real recipe for physical unwellness.

What that all means is that you have to be proactive about taking care of yourself physically. If at all possible, get your supplies and support all set up before you have the baby. If not, well, every little bit you can do helps.

Drink water. This is the single most important thing you can do for your health in the first few days post-partum. You need water to replenish yourself from the hard work of delivery and all the fluids you lost during the process. In addition, drinking lots of water will help flush out the pregnancy swelling, which will make it easier for you to get around and feel better about your body. (It won't do anything about the creepy feeling of all your organs going back into place, unfortunately.)

When I was leaving the hospital after having my first son, the doctor told me to drink a gallon of water a day for the first three weeks. He said it would help my body rid itself of toxins and get back to normal more quickly. Aiming for a gallon meant I'd get half a gallon, and if I drank a full gallon it wouldn't hurt me.

One stellar suggestion I've heard is to set up a few nursing/feeding stations around your living space. They should be comfortable places to sit and nurse or bottle-feed, and they should have all the things you'll need right within reach for you, including a bottle of water (plus a phone, remote control, magazine or book you can read one-handed, chapstick, etc.). Eery time you sit down to feed your baby, make sure you drink 8-12 ounces of water. By the end of the day, you'll have gotten what you need.

If you have a helper there, one great thing to occupy them is to put them in charge of keeping track of your water intake for the day and bringing you water when you need it.

Keep taking your prenatals. You probably need your prenatal vitamins more post-partum than you do during pregnancy to replace all the vitamins and minerals you lost with the baby and everything else. Vitamin deficiency can cause fatigue, problems sleeping, anxiety, depression, and all sorts of other things. So keep taking the prenates to ward off problems, especially since prescription prenatal vitamins can be cheaper through your health insurance plan than over-the-counter multivitamins are.

Keep taking your Omega 3s. I can't emphasize this enough. There's tons of research indicating the mental health benefits of taking Omega 3s. (The only problem right now is deciding whether to take fish oil or flax seed oil. I can't advise one way or the other at this point, since the research seems to be conflicting and muddled. I still take flax seed oil every day.) Omega 3s fill up your seratonin receptors to give you a feeling of wellness. If you don't have enough Omega 3 in your body, you'll crave sweets and carbs to hit those seratonin receptors, but that just starts a bad cycle. Because of the way we produce our food now (grain-fed farmed animals, for example) it's more difficult to get adequate levels of Omega 3s just from a healthy diet, so supplementation is critical, especially when you've just had a baby.

Lay off the diet products. Just as Omega 3s soothe your seratonin receptors, aspartame taxes your seratonin receptors, which makes you feel more hungry. Kind of a nasty trick, isn't it, that you've been drinking diet soda and it's just making you feel more hungry? People report headaches and irritability with consumption of aspartame, so if you're sensitive to it you could be feeling bad for no good reason. Since you're drinking at least half a gallon of water a day, you don't really need the extra fluids. If you need the caffeine, drink real coffee. If you need the fizz, mix your own "soda" with fruit juice and seltzer. (My favorite is white cranberry juice and seltzer. It's tart, and when you spill it down your shirt or on the baby's head it doesn't leave a stain.) If all else fails, drink a little bit of regular soda. The corn syrup in it is awful for you, but it's better than aspartame, and we have no idea what aspartame does through breastmilk to a baby.

Eat as well as you can. That doesn't mean truffles, Brie, and caviar, with a split of Cristal. That means 5 servings of vegetables a day, plus plenty of protein. Getting enough vegetables will keep your digestive system running smoothly, feed your cells, help you lose babyweight, and help you fight off illness. Protein is important to keep your energy level up. In addition, lack of protein sometimes masks itself as a craving for sugar. Sugar cravings can be just that, but often they indicate lack of liquids or protein. (So when you crave sugar, first drink a glass of water. Then eat some protein. If the craving is still there in 10 minutes, go ahead and eat the sweet thing.)

Having problems getting in the 5 servings of vegetables? Try doing green smoothies, with a huge handful of raw greens (spinach and kale are particularly great in this), some frozen fruit, and whatever liquid you want to thin it (fruit juice, water, milk, coconut milk, kefir, etc.), and blend until smooth. Extra bonus: You can drink it one-handed.

Get outside in the sunshine. It's that simple. If it's sunny, go outside for 15 minutes and expose some of your skin to the light, even if it's really cold. If you absolutely can't go outside, or there's no sun where you live (Hello to my Scandinavian and Alaskan readers!), consider investing in a light box to help keep your body stocked up on healthy light. If you're having insomnia or sleep schedule problems, you can also reset your system this way by going out in the sun first thing in the morning.

Do some exercise every day. Most women are cleared to go back to exercising at 6 weeks, but even before then you should be able to go outside and walk around slowly for 20 minutes at a time (listen to your body and don't overdo it!). Once 6 weeks hits, make sure you do some walking every day with your baby.

Another great mom-friendly exercise is T-Tapp, an exercise method you do at home with the DVD that takes 15 minutes a day and requires no special equipment except cross-training shoes. I do T-Tapp and find that it helps me sleep better, increases my mood and energy level, and gives me increased focus throughout the day. It's safe for people of all sizes and fitness levels (challenges even gym rats, but literally anyone can start it and feel benefits), and builds your muscular and lymphatic systems up from the inside. Here's a concise explanation of what T-Tapp does. If you're interested in starting out with T-Tapp but don't know how to start, Summer wrote the best getting-started primer I can imagine right here. (Summer's the one who got me started with T-Tapp, and I'll always be thankful to her for mentioning it on her blog.) T-Tapp also has mood-stabilizing properties if you do it several times a week or every day.

Maximize your sleep opportunities. You're not going to get 8 hours in a row when your baby is a few months old. You're just not, unless your baby is one of those apocryphal babies who sleeps through the night at a super-early age. It happens occasionally, but not to the majority of us. So that means you need to maximize the time your baby does let you sleep.

One plan is to ask your partner, if you have one, to do one feeding at night, so you can sleep through that waking. Of course, that only works if your partner won't wake you in the process of getting up with the baby. And if you're nursing and you have to get up and pump then anyway, it doesn't really make much sense as a strategy to get more sleep, since up pumping isn't sleeping through anything.

Another way to get more sleep, if you're nursing, is to ask someone to show you how to nurse lying on your side. Then decide to lie down every time you nurse during the day. You can latch the baby on and fall asleep (the nursing hormones will probably put you to sleep anyway if you're lying down), then sleep while the baby nurses, and if the baby sleeps after nursing you get that time to nap, too.

If you have helpers who are willing to come hold the baby for you, take advantage of that to nap. You may not be able to relax if the baby is in the same house or apartment with you, so let your helper take the baby out for a walk. The fresh air will be good for the baby, and you'll be able to sleep better without hearing baby noises.

If you find that you have the time to sleep, but can't sleep because of anxiety or stress, first make sure your Omega 3 intake is good. If it is, then consider adding a calcium and magnesium supplement. Take it 20 minutes before you go to bed, and see if that helps you relax any. If you're not already doing T-Tapp, it also helps people sleep better.

Keep your baby as close as you want to. You carried your baby for months inside you, never separate. All of a sudden, you are two entities instead of one. But you still need to be considered as a unit. If you're having feeding problems, it's a problem for both of you. The same with sleeping, bonding, and health problems. Hormonally, you're still connected, so most mothers without PPD feel better when their babies are close to them physically for the first several months, at least. (In my experience, I felt strange when my sons were away from me until right about the time that they could crawl away from me. I've heard the same thing from other mothers, and I don't think that's coincidence.)

All this is to say that you should hug and cuddle your baby as much as you want to. You know there's no way to "spoil" a baby by giving it too much physical closeness, but it will also help you physically and emotionally to keep your baby as close as you want to. If you're feeling stressed, you may want to get out of the house for a little bit without your baby, but it also may be helpful to strap your baby on with a sling, Bjorn, wrap, Ergo, etc., and go outside with your baby. Go walk around, wander the aisles of the grocery store, have a cup of coffee at a cafe, or go visit a friend. Getting a "break" from the normal routine doesn't necessarily mean separating from your baby, and if you're one of those women who feels discomfort at being separated from her baby, you're better off keeping your baby with you.

The newborn phase is so short in the scope of things, that there's no need to worry about independence issues (for either of you) at this point.

Get a massage whenever possible. If you have the financial ability to get a massage every so often, you can help maintain your health by getting one. Massage will help move toxins out of your body and stimulate the lymph and immune systems. It can also be an antidote, ironically enough, to the feeling of being "touched out" that many new mothers have. All day we're touched by our children, who want something from us, and then at night we're touched by our partners, who want something from us. It's surprisingly liberating to be touched by someone who doesn't want anything out of the touching except to increase our health and well-being.

If you can't afford a professional massage, your partner will probably be willing to give you one if you ask. Of course, this may make you feel even more "touched out," but if your partner does a good job the health benefits will be worth it.

Next installment: Taking care of yourself emotionally.

* After reading some of the comments, I realized that this is sloppy writing. Depression is a result of complex interactions that we don't understand completely yet, but we do know that there's an element of brain chemistry and/or hormones involved. Depression is sometimes an appropriate response to a crappy situation, but that doesn't mean it's good for you to be depressed, or for your baby to have a depressed mother.

 

Comments

[Christi]

I had ppd with both of my kids, and struggle with clinical depression generally...and I wish I'd seen this post postpartum with both of my kids. Excellent, excellent informative one with good suggestions and information.

[AmyinMotown]

Moxie--this is totally OT but I would like to ask a question and can't view your email off the link (my tech problem, not yours, I don't have my email program and my browser linked to each other). Can you email me with it? Would appreciate.

[hedra]

Fructose overload can also lead to depression/anxiety/ADHD-type-behavior.

The current American diet has more fructose than most people can tolerate. And even the normal amount (US RDA), only 2 in 3 people can tolerate.

Too much fructose causes a reduction in tryptophan levels.

Tryptophan (the 'happy mood' compound often mentioned around Thanksgiving because it is found in turkey), is also a building block of Seratonin.

Low tryptophan = low seratonin, and low seratonin = depression, among other things.

Fructose in combination with glucose is fine, if it is an even balance. So fruits like oranges may be fine. But overload on peaches, pears, apples, or juice, or things sweetened with juice, or dried fruit, and you can impact your mood for a few days.

Sugar alcohols (sweeteners that end in '-ol', like mannitol, sorbitol, etc.) also cause the same issues.

Other signs/symptoms that you might be getting more fructose than you can handle:

1) GI distress in ONLY HALF the population, and can sometimes be constipation (surprise!).

2) Osteoporosis or signs of low calcium/vitamin D levels (including growth delays in kids).

3) Easy bruising (due to malabsorption of other nutrients).

4) Sore head/eyes (some resources also indicate long bone pain).

5) fatigue/exhaustion/lethargy

6) Signs of IBS (though IBS may be the cause of the fructose issue, not the result, that's not yet clear from research).

Just one more thing to add to the list of 'things to be moderate about/with'...

[Ariella]

Moxie, I think all of the advice you've written here is excellent -- and I take the flax seed oil even with the conflicting reports on it.

I must, however, disagree with your bright line statement that depression is solely caused "an imbalance of chemicals inside your body." MAYBE, post-partum depression is caused somewhat by an imbalance of serotonin in your body, but there is no proof whatsoever that depression is ONLY caused by this imbalance. Moreover, I think there's an excellent argument that PPD could be defined as BOTH a chemically caused depression and/or a situationally caused depression.

In fact, all the things you mentioned within your article (traumatic experience (ie, birth), major changes in sleep/eating/drinking cycle, major life changes, huge amounts of stress, difficulty coping, feelings of inadequacy surrounding birth, breastfeeding, or both) are often the exact ingredients needed for situational depression to rear its ugly head.

It's funny because the things you're recommending people do are the things that are appropriate for situational depression, in any event. But I find it really sad that you made a bald statement about depression without any proof to back it up. I agree that sometimes medications are necessary, but I don't think I could ever take that risk with my kids.

[hedra]

Ariella, from what I know, 'situational' ('reactive' or 'exogenous') depression has as many physiological components as 'endogenous' (the 'caused by the imbalance without a triggering event' type). The current discussion in the field is how the imbalance or anomaly is caused/triggered by the situation, not WHETHER there is an imbalance in chemicals during depression.

Saying 'chemical imbalance' is definitely too simplistic if you're talking all the details of what is not 'balanced' in depression. Hormones, receptors, brain chemicals, nutrients, the amount of each varies, and can all play roles. Too much, too little, and a problem occurs. BUT, also, if a problem occurs, the body may respond by generating too much, or too little, or using up necessary nutrients at a faster pace, etc.

Just because depression is triggered by real events that are reasonably seen as 'challenging', does not mean that meds won't help. They often do, 'situational' or otherwise. The point Moxie makes is, IMHO, more that there really isn't much biological difference between depression of one sort or another, once it has set in. And in that, the research seems to be backing her up. Which exact 'imbalance' may vary, but keeping your body in good form, well fed, well hydrated, well rested, etc., is ideal for helping with both 'triggered' and 'not-triggered' depression forms. It may not be enough for either, once depression sets in. But it may be more than enough for either, too.

I've had low-grade depression for years. Maybe set off by experiences, maybe not, hard to say. But that's really immaterial. For me, finding that just keeping up with my rest and my fluids and my Omega-3's does 90% of the work, that's important. Considering the long-term neurological damage that depression-laden parenting can also cause our children, I'm on board with trying whatever will help. Having read rather a lot on the implications at the neurological level of staying depressed while parenting, I don't think that I could take the risk of NOT pursuing a variety of treatment avenues. Granted, I do start with the least invasive and most natural/dietary/lifestyle approaches first! That's a no-brainer. And it is exactly what Moxie is advising, IMHO.

[d. feldman]

Excellent advice--the previous installments helped me through the first few months of newborn bootcamp with only minimal craziness.

RE: PPD being situational and/or chemical, I've been re-reading Sarah Blaffer-Hrdy's "Mother Nature" and she makes an interesting point that it may related to lactational aggression. In other words, the same hormonal factors that in animals cause mothers to violently defend their nurslings could be at work in humans post-partum. It's an intriguing hypothesis, especially when one considers the cultural factors that often channel aggression and anger in women into self-doubt and self-destruction--not to mention the social isolation many new parents (mothers especially) endure.

You can't drive off a bad scenario with bared fangs, after all.

So whether PPD and related problems are hormonal, neurochemical or situational, anything that increases the physical, social and emotional support of a new parent can only help. Meds are simply another tool, good for some situations, not good for others.

RE: the post itself, I've had the GoLite for several years now to combat seasonal affective disorder, and I give it two thumbs way up. Going into this winter with a four month old, I've been extra vigilant about anything I can do to avoid a mental death spiral, and it's one of the big guns in my arsenal.

I've also found that with nursing, I need to make sure I eat enough fat or I crash fast because the kid's sucking it out of me to build her own brain. Sunflower and pumpkin seeds also have high omega-3 content, as do avocados, so you kill two birds with one stone there.

[Melinika]

Just to note - the link to Part 2 is missing from this post. It says "Part 2 is ,". Thanks!

[Mardougrrl]

As someone who is struggling with post-toddlerhood depression (I was fine for the first year of Madam's life, but now I am seriously struggling), I thank you for these. I just started taking my flax seed again.

I can't wait to read the second installment.

[Charisse]

"Mother Nature" is an amazing book--recommended to all moms and prospective moms. It's an academic but accessible look at the social and biological impact of motherhood by a senior primatologist/anthropologist. No how-tos or anything, just an exploration of the phenomenon from some very unorthodox perspectives.

But I was going to chime in to say that an exercise partner, if you can find one, is really helpful to keeping the regimen. If you live in anything resembling an urban neighborhood, figure out what coffee house the moms go to before the birth, if possible. If you know somebody whose baby is the same approximate age as yours, and they're nearby, it's very easy to go for walks together when the babies cooperate and do some kind of indoor physical thing when they don't.

No idea how I got so lucky, but I met 2 moms with babies within a few weeks of Mouse's age, who do the same form of yoga I do. Back when we were all on leave we'd get together at a very smushy start time, do a little practice...whoever needed to nurse would go ahead but we'd all encourage each other and help with each other's babies...and afterwards whoever's house we were at would make some scrambled eggs or a quesadilla or something. It really helped all of us--I'd never have stuck with it without them.

[Moxie]

Melinika, I fixed the link. Thanks for pointing it out.

Ariella, I consider hormones to be chemicals. What makes you think that situationally-caused depression doesn't have a hormonal element to it? All kinds of things affect our hormone levels in all sorts of ways, and we know for sure that lack of sleep, stress, the trauma of birth, and all sorts of other changes do just that. And, yes, sometimes depression is an appropriate bodily response, but that doesn't mean it's good for you to be depressed.

I also don't know if you'd decide against medications (which I didn't even mention in this post) if it meant you were having thoughts of killing your children or yourself. PPD is nothing to mess with, and I'd hope that we'd be willing to keep all our options open to keep ourselves healthy for our kids.

[lydia]

Thank you for this. I really struggled after the birth of my first, and the second is due in three months. I had a hard time with nursing pain and anxious insomnia. (BTW - postpartum or not, it is REALLY hard to keep emotions balanced when sleep is lacking). Most of the suggestions I got were to eliminate this or that thing (caffeine, dairy, TV, etc), but once you're in the thick of the PPD you feel so helpless.

Anyway, it's really refreshing to read a more proactive approach. Thank you again!

[Phc]

Thanks for mentioning the part about keeping your baby close to you. I think it's really important and it seemed like everyone thought I should be 'getting out' and 'doing things alone' during the first few months when that was the last thing in the world I felt like doing.

[SheilaC]

Once again, a terrific post Moxie. I wish I'd had all this advice when I was depressed after our kids were born. I'm sending the link to several new moms of multiples. The advice is excellent for all moms, whether feeling depressed or not.

[Rosemary Grace]

I suffer from depression, I found a really useful distinction is that it's sometimes appropriate to be SAD, but depression is never "ok". The difference is that depression involves some loss of self esteem or self worth, you feel bad about yourself because something bad happened, grief or sadness is feeling bad about the thing that happened. I think there's a tendency for people who are depressed to take a long time to realise it, because they think it's normal to feel that way due to something that they went through.

This was much better worded in the book I read, Feeling Good by David Burns, I'm mentioning it because it was a real relief to me to find that statement. I'd been convinced that the depression I was living with was just the normal response to my experiences, therefore nothing I could do about it.

[Jenn]

Is flaxseed oil ok to take while breastfeeding? I've tried looking it up and keep coming up with conflicting answers.

[rachel]

the only thing i would add is to ask/allow partner and helper to run the dishwasher, vaccuum the living room, do a load of laundry. also, to avoid any naysayers or people who are trying to push you to do somethign you don't feel comfortable with: leave your baby, give a bottle/formula, buck up and smile. i know my inlaws were not shy to give their opinions and it got old quick.

[Scotti]

Thank you Moxie for talking about PPD and offering such wonderful suggestions. I've been blessed with such great support systems and it's still been very difficult. I couldn't have made it through six weeks of breastfeeding hell without some amazing lactation consultants - and I couldn't have survived this long without an equally amazing therapist. I just wish more women were willing to be really honest about the challenges/frustrations/dramatic change in lifestyle and self-image of being a new mom.

And I second the GoLite recommendation. Costco carries them for a GREAT price -- $172.99 at www.costco.com (non-Costco members pay a 5% surcharge) includes shipping. Also available in their stores. I've used this light for a couple of years and it really helps. Plus it's small and portable!

[Moxie]

Jenn, I was told 4 years ago by an LC specifically to take flax seed oil to prevent both PPD and plugged ducts. But now the info seems to be conflicting, and I think we're in that nasty period before we can figure out conclusively what's really up with it. I can't in good faith tell anyone specifically to take it while breastfeeding, but I do take it myself.

[AinH]

I like the cafe/cake (Fruedian?) slip ;)

Ummmm...cake.

[VirginiaGal]

Moxie,
Thanks for your series. Found myself here from LaidOffDad, from DadGoneMad...as someone thinking to start trying in the next few months, this is very valuable information to have. I plan to print off and show my husband as well. Again, many, many, many, many, thanks.