Giving birth can be a magical time full of hope, joy, and love. But for many women and gender-diverse people, postpartum depression can make it difficult to enjoy this stage of life. Data from the Centers for Disease Control and Prevention (CDC) shows that approximately 1 in 8 women with a recent live birth experience symptoms of postpartum depression.1
In Canada, data from Statistics Canada shows that almost 25% of mothers who recently gave birth reported feelings consistent with either post-partum depression or an anxiety disorder.2
Quality of Life Impacts
To learn about the naturopathic approach to postpartum depression, as addressed through the Therapeutic OrderTM approach, we sat down with Dr. Kristin Wing, ND, in Oregon, and Dr. Samantha Klim, ND, in Washington.
Childbirth is arguably the most natural process in the world. But ‘it takes a village to raise a child’ is hard to implement in our increasingly busy and socially isolated world. New parents often struggle to get the care and attention they need to be fully present for their children and themselves. And when postpartum depression is a factor, that only adds to the burden. “Being a new parent is huge. You have a new role in life, and it can be lonely and isolating,” says Wing. “I think about building connections and getting social support so you don’t feel alone.”
“It’s hard to get your basic needs met when experiencing postpartum depression,” adds Klim. “It’s hard to eat nutritious food, stay hydrated, and recover on a physical level. There are many physical aspects of healing that happen postpartum. It’s hard to do [that healing] appropriately when struggling with depression. It impacts the quality of life in every single way.”
What is the most significant quality of life impact from postpartum that Klim sees in her patients? “New parents expect to love their baby unconditionally and be filled with joy. Then they experience a mental health condition that impacts their ability to feel those emotions and create that lifelong bond,” Klim explains. “They have a hard time enjoying the day-to-day experiences of early parenthood. I also see impacts years down the road, when parents feel guilt or shame about potential negative impacts on their baby’s development.”
Level 1: Establish the Foundation for Optimal Health
When establishing the foundations for optimal health for postpartum patients, naturopathic doctors explore several factors. Significant events like birth, illness, and the accompanying hormone shifts may trigger the onset of genetically susceptible conditions such as mental health conditions and autoimmune issues. Exploring family history makes the ND aware of which conditions should be monitored for changes.
Birth trauma is another aspect of patient history that NDs pay close attention to at this stage. “I look at the patient’s birth story. Pregnancy, preconception care, and birth experience are the foundation for a patient’s postpartum experience,” says Klim. “If we don’t address what happened leading up to the postpartum experience, then we miss key components.” Wing adds that emergency C-sections, blood transfusions, and other complications can add further trauma that people may not have the time or space to process. “In the conventional care system, postpartum patients typically only have one doctor’s visit six weeks after birth. Parents may have issues that a doctor couldn’t address in that 10-minute visit.”
Klim takes a big-picture view of what addressing the foundations of postpartum depression means in the larger cultural context. “We need to look at the culture we’re living in and ask how we care for postpartum people on a social, cultural, and economic level. The therapeutic order also includes removing obstacles to cure,” Klim notes. “The ultimate obstacle to cure is our lack of societal support. I view postpartum depression as a very natural response to the profound deficiencies in our culture.”
Wing asks detailed questions to assess their levels of support, then ‘triages their day’ by helping patients figure out what kinds of care and resources they may need. She also frequently recommends local and online parent communities such as “Swap and Play” and “Buy Nothing,” where patients can build friendships and have access to traded or donated baby and parent supplies. Klim takes a similar approach, asking questions to assess how well their basic needs are being met. Her questions commonly include asking whether the patient has access to the following:
- Security
- Shelter
- Nourishing food
- Enough water
- Adequate rest
Then, Klim asks whether they have a supportive partner or family who can care for them while they rest and recover. “The community aspect is one of the first things I ask about because it’s really hard to treat postpartum depression without adequate support,” Klim notes.
Research has found that social support in pregnancy can potentially reduce postpartum depression, especially for those not living with a partner.3
Evidence shows that consistent social support is vital in protecting mothers from postpartum depression and other perinatal mood and anxiety disorders. A 2022 study notes the importance of social support in light of increased isolation related to the COVID-19 pandemic.4
A 2023 study exploring the effects of the pandemic on postpartum women revealed that limited social support, social isolation, and fear of COVID-19 exposure or infection had worsened postpartum depression.5
In addition to assessing history, levels of social support, and ability to meet basic needs, NDs also explore several physical aspects of health. Wing commonly conducts physical exams and orders lab testing to assess metabolic markers like blood sugar, cholesterol, and protein and vitamins’ nutritional status. Wing pays particular attention to vitamin D as she finds her patients in Oregon are often deficient. Both NDs assess a patient’s iron status, as iron deficiency is common postpartum. “I also look at copper and zinc, which are common minerals that become imbalanced during pregnancy,” Klim adds.
Both NDs also point to the importance of properly assessing the thyroid gland. In conventional medicine, the health of the thyroid gland is typically not appropriately evaluated. “Thyroid function fluctuates profoundly during pregnancy and postpartum, and not just TSH [thyroid stimulating hormone],” explains Klim. “Many conventional doctors only look at TSH, which isn’t a great picture of overall thyroid function. I do a really comprehensive thyroid assessment.”
Levels 2 & 3: Stimulate Self-Healing and Support and Restore Weakened Systems
After a thorough assessment, NDs consider how to support the body’s natural self-healing abilities best and support organ systems for broad-spectrum healing.
For Klim, the best way to provide support is to leverage the naturopathic principle of prevention—working with people as soon as possible in the postpartum stage, presenting a vital healing opportunity. “Working with people during pregnancy and immediately postpartum is a good opportunity to prevent common postpartum ailments, both physical and emotional,” Klim explains. “Pregnancy and birth put the body and soul through so much transformation. If we support the physiological changes in the body and the spirit, we stimulate the self-healing mechanism. If we support weakened systems, self-healing happens without making a pit stop at disease.”
In her naturopathic practice, Klim values how other cultural healthcare frameworks view postpartum support. Many cultures have postpartum-specific foods, exercises, and practices. She points to the belief in Traditional Chinese Medicine (TCM) and Ayurvedic (Indian traditional medicine), where health in the first six weeks of the postpartum period informs future health status. “If you’re well cared for, and you recover with vitality, heal physical injuries, and have mental health support during that period, you set your pattern for lifelong health,” Klim notes. “If you have injuries or mental health concerns that aren’t addressed, that could set up a very different pattern.”
In other words, the lack of postpartum support is a missed opportunity to establish lifelong health. “The healing power of nature is so strong during that time. We need to give the body what it needs, and it will heal. The same goes for the emotional aspects like depression,” Klim observes. “We need to give new parents the celebration, honor, and acknowledgment of the transformation they’ve gone through. That in and of itself stimulates their self-healing power.”
Wing focuses on supporting the nervous system. “Some people have ‘wired and tired’ energy where they’re anxious (anxiety can be intermixed with depression). They feel irritable, frazzled, and may frequently wake at night,” explains Wing. “Other people feel apathetic, lack energy, and may have trouble getting out of bed. Some patients experience both ends of the spectrum.” She discusses the emotional experience in depth with each patient to decide which tools may be most effective.
Level 4: Address Physical Alignment
Addressing physical alignment in the postpartum period can help bring the body back into balance after birth and address birth-related injuries.
“I think about optimizing healing of the uterus, vaginal tissue, or wherever other birth injuries occurred. Then, it’s about addressing how much your body has shifted,” says Klim. “The hip bones, all ligaments, the spine, and organs are trying to get back into alignment. Sometimes this is impeded by birth injuries, posture, previous biomechanics issues, and scar tissue. Addressing all of these is important for returning to proper alignment. Understanding how the hormone Relaxin continues to impact the body is also very important for recovery.”
Klim points to essential links between addressing physical pain and postpartum depression, noting, “If they can’t go on walks because they are in pain, or they are experiencing incontinence or their perineal tears aren’t healing properly, that will contribute to depression because they can’t move through their daily life without pain and discomfort or move their bodies in a way that feels good to them” notes Klim. “Structural integrity is a huge thing in postpartum because so many people struggle with physical injuries and pain after birth, and the physical body transforms so much. There’s not a fantastic understanding of how to treat or prevent it in the conventional medical system.”
Klim feels that every person should receive physical therapy to rehabilitate their pelvic floor and core after birth. What types of physical therapies are most effective in addressing postpartum depression? Both Klim and Wing are strong supporters of holistic pelvic floor therapy. “It’s a potent area to treat,” Wing explains. “The pelvic floor can often store repressed emotions and trauma. Pelvic therapy can provide a sort of access point for deep nervous system healing and address common symptoms like pain with intercourse.”
“We store a lot of stories, trauma, and experiences in our pelvic bowls. Especially when people experience birth trauma, which influences their mental health state, it can be a powerful way to move through that,” adds Klim.
Klim provides pelvic floor care by making adjustments to realign the bones, release tight muscles, and strengthen loose muscles. She also addresses the core. “Many people experience diastasis recti postpartum, where the abdominal muscles separate during pregnancy. If you don’t have a functional core, it’s hard for the rest of your body to function appropriately. The core is the center of all,” Klim explains. “If you don’t have core stability, you’re more prone to injuries and back pain. Breathwork exercises and TCM practices like belly binding helps to knit those muscles together.” Both NDs regularly refer patients to Pelvic Floor Physical Therapists if they need additional support. Research shows pelvic floor muscle training can boost sexual function and quality of life postpartum.6
It can also speed the recovery of the postpartum vagina and pelvic floor muscles to prevent or treat postpartum vaginal prolapse and relaxation, urinary incontinence, and other pelvic floor disorders. Evidence shows that yoga can also significantly improve postpartum women’s physical and mental health.7
Level 5: Natural Symptom Control
When using natural substances to address postpartum depression, NDs often start with dietary changes to address nutrient deficiencies and ensure they eat enough. But that’s not always realistic in the postpartum period. Supplements can effectively fill the gap.
Regarding vitamins, both NDs prescribe vitamin D and iron to address the common deficiencies seen in the postpartum period.
In terms of minerals, Klim most often starts with magnesium. Wing prescribes magnesium for muscle tension, among other uses but will sometimes prescribe calcium and magnesium together. “Calcium paired with magnesium in a ratio like 2:1 is a great support for supporting the uterus returning to size post-partum and the cramping that occurs with this.”
Klim also prescribes antioxidant minerals like selenium to support thyroid function and zinc to balance out commonly disrupted zinc/copper ratios in the body. “Fish oils help to insulate our nerves but also improve mental health, energy, and dry skin,” Klim notes. Research shows that zinc supplementation in the postpartum period has a significant positive effect on postpartum depression. 8 Klim emphasizes that “all supplementation should be targeted and specific for each individual- there is no one size fits all approach, especially in postpartum.”
Herbal medicine is another powerful tool. While in the throes of postpartum depression, everything can feel overwhelming. Herbs can help make life more manageable so patients can address things more deeply.
Being mindful only to use herbs that are safe during breastfeeding, both NDs use herbs called adaptogens with their postpartum patients. Adaptogen herbs work holistically in the body, building our capacity to handle stress. Wing commonly prescribes the herb shatavari and medicinal mushrooms such as reishi and chaga. Klim often prescribes rhodiola, devil’s club, and eleuthero to address depression. If anxiety is also present, she turns to herbs, including Avena sativa (oats), passionflower, and lemon balm. Herbs also contain nutrients; she sometimes prescribes nettles and red raspberries to provide more minerals.
Wing also leverages bitter herbs to support the vagus nerve (our ‘rest and digest’ nerve), which improves mental health, heart issues like palpitations, or digestive concerns such as bloating, reflux, or low appetite. She often prescribes supplementation of bitters such as ginger and chamomile to be taken with meals.
Level 6: Synthetic Symptom Relief
When it comes to medications for postpartum depression, both NDs have prescribed anti-depressant medication, such as SSRIs (selective serotonin reuptake inhibitors). “About 95% of the serotonin we make is in the GI tract, associated with the vagus nerve,” explains Wing. “I think of serotonin as the embodiment neurotransmitter. SSRIs are used for both depression and anxiety and typically lead to feeling more calm and less overwhelmed.” Wing finds that patients who respond well to SSRIs feel more space between an experience and their emotional response. Most of her patients reliably report that after 3-6 months, they are ready to stop taking SSRIs because they feel more capacity to process intense emotions.
Klim used to work at a clinic with a high proportion of Medicaid patients who were often low-income with few resources. For those patients, medication was the only realistic option. “They couldn’t afford nutritious food. I tried hard to address their foundational needs, but sometimes medication was the only thing available to me. I use medications when it seems necessary or if appropriate, based on personal history or financial status,” says Klim. Most of her patients are not interested in anti-depressant medication at her current clinic, so she rarely prescribes it.
These days the most common medication she prescribes is thyroid medication, but she first explores other methods to optimize thyroid function before going the medication route.
Level 7: High Force Interventions (Suppress Pathology)
Klim points to two ways she commonly sees conventional medicine attempt to suppress pathology in postpartum patients. Birth injuries can lead to uterine prolapse or significant pelvic floor dysfunction. The first option usually presented by the conventional care model is surgery. Klim feels this approach bypasses pelvic floor therapy and other therapies that should be tried before resorting to such a high-force intervention.
Second, many people experiencing symptoms of severe PMS or premenstrual dysphoric disorder in the late postpartum time frame, once menstruation has returned, are prescribed the birth control pill as their only treatment option, Klim sees. “These conditions (PMDD) can absolutely be related to postpartum depression or some other imbalance that happened during the initial postpartum recovery time.” How does this suppress pathology? “There’s nothing wrong with taking the birth control pill to prevent pregnancy,” explains Klim. “But when given birth control to suppress hormonal ups and downs, that’s not serving people in the long run. It’s only suppressing the problem at hand.” Klim notes that hormonal imbalances that cause PMDD or PMS are signs of a deeper root problem.
Ultimately, much healing comes from the strength of the doctor-patient relationship. “We all know there can be stigma around mental health issues. By doing regular check-ins, really getting to know the patient on a personal level, and being a safe place for them to reflect and share their experience – that’s where we can shine as naturopathic doctors,” notes Wing.
“Ultimately, the solution for our postpartum depression epidemic is to change our narrative and culture on a large scale and start having these conversations,” says Klim. “You shouldn’t suffer alone. There are treatments for so many conditions, especially postpartum depression, pelvic floor dysfunction, and pain. It is possible to have a positively transformational and healing postpartum journey. I encourage people to seek help and education and not allow their symptoms and problems to be normalized by the conventional medical community.”
References
1. Depression Among Women | CDC. Published May 23, 2022. Accessed May 5, 2023. https://www.cdc.gov/reproductivehealth/depression/index.htm
2. Government of Canada SC. The Daily — Canada leads the G7 for the most educated workforce, thanks to immigrants, young adults, and a strong college sector, but is experiencing significant losses in apprenticeship certificate holders in key trades. Published November 30, 2022. Accessed February 20, 2023. https://www150.statcan.gc.ca/n1/daily-quotidien/221130/dq221130a-eng.htm
3. Taylor BL, Nath S, Sokolova AY, et al. The relationship between social support in pregnancy and postnatal depression. Soc Psychiatry Psychiatr Epidemiol. 2022;57(7):1435-1444. doi:10.1007/s00127-022-02269-z
4. Feinberg E, Declercq E, Lee A, Belanoff C. The Relationship between Social Support and Postnatal Anxiety and Depression: Results from the Listening to Mothers in California Survey. Women’s Health Issues. 2022;32(3):251-260. doi:10.1016/j.whi.2022.01.005
5. Low SR, Bono SA, Azmi Z. Prevalence and Factors of Postpartum Depression During the COVID-19 Pandemic: A Review. Curr Psychol. Published online January 7, 2023:1-18. doi:10.1007/s12144-022-04181-w
6. Hadizadeh-Talasaz Z, Sadeghi R, Khadivzadeh T. Effect of pelvic floor muscle training on postpartum sexual function and quality of life: A systematic review and meta-analysis of clinical trials. Taiwan J Obstet Gynecol. 2019;58(6):737-747. doi:10.1016/j.tjog.2019.09.003
7. Li Q. The Effects of Yoga Exercise on Pelvic Floor Rehabilitation of Postpartum Women. J Healthc Eng. 2022;2022:1924232. doi:10.1155/2022/1924232
8. Aoki C, Imai K, Owaki T, et al. The Possible Effects of Zinc Supplementation on Postpartum Depression and Anemia. Medicina (Kaunas). 2022;58(6):731. doi:10.3390/medicina58060731
