How to Celebrate your Amazing Placenta

There are many ways to celebrate your amazing placenta! 

  • Simply tell it, “thank-you for nourishing my baby” after your birth
  • Ask your doula or medical staff for a “placenta tour” – take pics or video if you like
  • Plant a tree over it
  • Placenta prints
  • Bury it in the earth and do a little ceremony to honour it
  • Cord keep-sake
  • Placenta capsules
  • Tinctures 
  • Smoothie cubes

It’s easy to take it home from the hospital. Just bring a labelled container, ask your nurse to put the placenta in said container, and then keep it cold. If it won’t be used within 3 days then put it in the freezer. The hospital may ask you to sign a “Release of Live Tissue” form.   

Contact me for more information about our placenta services.

Perineum Care and Recovery

Calendula Pads

For swelling, pain, heat.  Make 5-10 pads 6 weeks before due date.
Calendula flowers promote healing and are soothing when applied topically.

  • Calendula Mixture: Make tea from dried calendula leaves (1 full tea ball per cup water steeped for 10 min) or use tincture (20-30 drops per cup water).  Add 1-2 drops of lavender essential oil or some lavender tea to mixture.
  • Partially dip maxi pads – preferably long, organic – in calendula mixture briefly, just to soak top layer. Another option is to use a sprayer to wet the tops.
  • Freeze pads in bowls so they’re curved like the female body. Store in Ziplocs (labeled with your name) in freezer.
  • Bring the pads to birth-place! Hospitals and birthing centers may have a freezer you can use. If not, consider bringing a cooler or just wait to use them until you return home.
  • Apply immediately after birth.

Perineum Care after your Birth

Peri-bottles are one of a new birth mom’s best friends. Kind of like a bidet in a bottle or “A soothing spritz for your lady-bits!” according to Ninja-Mama.

Here are some tips and advice about using peri-bottles:

  • Plan ahead – find out if your local hospital provides one. Most do for use during the postpartum stay and beyond. Your midwife may also provide one for homebirth.
  • If they provide at one the hospital, take it home. It’s not fancy but it works fine.
  • Plan to have one peri-bottle in each bathroom the birth mother will use. The Frida Mom (sold locally at Groovy Mama and Hello Baby) and Ninja Mama are genius peri bottles. Most hospitals provide the one pictured 3rd on the link above, and it’s also sold locally at Jolly’s.
  • Use it every time you use the toilet. Just spray while peeing or after as a rinse.
  • Warmed water or a peri-rinse such as calendula infusion feel best. Room temp will feel cold but it’s okay too.

Perineum Rinse

Soothing and healing for swelling, pain, abrasions, tears, bruising.  It’s safe to use with stitches.  This can be prepared during early labor or ahead of time and frozen/refrigerated.

  • Fill a peri- or spray-bottle with calendula mixture (above), a healing solution (below) or warm water.
  • Hospitals will provide a peri-bottle.  A spritz bottle works too.
  • Squirt solution on perineum after every washroom use, shower/bath, or in between if extra relief is needed. Do not rinse solution off.
  • If urination burns then squirt during urination – start just before releasing urine – or pee in the bath.
  • Allow the area to dry between applications. Air-time or even a cool blow drier can be helpful.
  • Note: if the rectum is sore or stitched, support the perineum with a cloth during bowel movements (like pooping into a cloth).

Sitz Bath

(Not sure why we call it that; it’s just a shallow bath! Full tub works just as well.)

  • Soak your perineum in a bath for 15 minutes, 3 times daily. Shallow water is fine.
  • Add Epsom salt and if you wish to use herbs, add 1-2 cups raw herbs or healing herb tea, ¼ cup tincture, or up to 5 drops of pure essential oil. If you wish to use plain water then spray the healing solution after the bath.
  • Some women like cool water for inflammation while others find warm water soothing. Experiment with temperatures but avoid extremes during the initial postpartum days, and keep the rest of your body warm.
  • Do not sit on a donut-shaped vessel in the bath as it adds pressure.

Healing Herbs

Calendula is healing, along with other herbs such as comfrey, lavender, witch hazel, tea-tree, yarrow.  Feel free to ask me about the various healing properties of the different herbs.  Nice sitz-bath blends can be purchased – look for an Epsom salts base with herbs or pure essential oils; no fragrance or additives.   There are some nice soothing perineum sprays on the market, such as Earth Mama Angel Baby New Mama Bottom Spray, sold in Regina at Head-to-Heal Wellness and Groovy Mama in Cathedral, or Hello Baby in East.

Recovery from a Difficult Birth

After a difficult birth follow the above recommendations plus:

  • Keep knees together as much as possible for the first 2 weeks, even while walking
  • Avoid stairs
  • Lift nothing heavier than the baby
  • Allow area to “breath” – air time or cotton panties (no synthetics)
  • Avoid sitting or standing for long periods of time
  • Avoid perfumes, chemicals
  • Avoid straining on the toilet – good nutrition and lots of water, support perineum with a cloth during bowel movements (like pooping into a cloth)
  • See a Physiotherapist who specializes in women’s pelvic floor to heal pelvic floor muscles; recover from perineum tears; avoid or heal incontinence, painful intercourse and pelvic pain
  • Consider seeing a complimentary practitioner who specializes in and is experienced with maternal postpartum recovery, such as a Webster certified chiropractor or an osteopath, to help ensure pelvic organs, bones, ligaments are healthy and aligned.

Angie The Doula – Postpartum Warning Signs for Mother and Baby

CALL 811/DOCTOR/MIDWIFE WITH ANY WARNING SIGNS.  CALL 911 FOR EMERGENCY HELP!

If you call 911, have someone clear a path for EMT (halls, stairs etc), turn on outside light, put pets away, unlock door, clear driveway.)

Maternal Warning Signs

  • Vaginal bleeding heavy enough to soak a super-pad front to back in 1/2hr-1hr. Note: if blood starts to pour continuously, lay down immediately and call 911;
  • Foul-smelling bleeding or discharge
  • Passing clots bigger than a toonie
  • Temperature greater than 38C (100.4F)
  • Feeling flu-like
  • Uterus is painful to the touch
  • Uterus feels soft and is at or above the navel, and doesn’t respond to gentle massage
  • Sore, red, hot, tender area on leg or calf
  • Painful, swollen, red breasts or red / hot / lumpy spots
  • Sudden and extreme pain on nipples with feeding (may be thrush)
  • Persistent dizziness (call 911 if accompanied by bleeding)
  • Fainting (call 911 if accompanied by bleeding)
  • Feeling depressed, very anxious, unhappy or are crying without reason and cannot sleep or eat

Baby Warning Signs

  • Blue or grey in the lips, face or chest. Call 911.
  • Temperature of greater than 37.4C (99.3F) or lower than 35C (96.6F) (note: consider environment – e.g. is baby wrapped in layers in a hot room?)
  • Laboured breathing
  • Extra-sleepy and has not fed in the past 6-8 hours
  • Has not urinated or passed meconium (feces) in the first 24 hours
  • Yellow skin in the first 24 hours
  • Red patches, pimples or bumps
  • Vomits after every feed
  • High pitched cry or extremely irritable, inconsolable
  • Lethargic
  • Red, hot area around cord-stump; swelling of stump; discharge of pus, blood or meconium
  • Red blood in urine (note – some girl-babies get a little ‘period’ due to hormones)
  • Bright red diaper rash
  • White spots in mouth that don’t rub off (thrush)

Angie The Doula – Normal Postpartum Care of Mother and Baby

If you’re concerned, see Warning Signs for Postpartum.

In the first 24 hours after birth it is normal for birth mothers to:

  • Expect a fairly heavy flow for the first 24 hrs, like a heavy period in appearance and scent. Flow should gradually taper in the following few days, then continue lightly for approximately 4-6 weeks.
  • Pass small clots and gushes, especially after lying down for some time
  • Have a firm uterus that feels like a grapefruit below the navel
  • Experience night sweats
  • Urinate frequently
  • Feel exhausted and need rest

In the first 24 hours after birth it is normal for babies to:

  • Breathe irregularly, including pauses and some periods of rapid breathing
  • Spit up mucus
  • Have blue hands and feet with pink body, face and lips
  • Sleep for 4-6 continuous hours after birth then wake up every 2-3 hours to breastfeed
  • Pass stool (but may be within 48hours)
  • Urinate

Postpartum Care – Mother

  • In the first week, only responsibilities should be to eat, sleep and feed and cuddle baby
  • Sleep when the baby sleeps
  • Get assistance with getting up for the first day. Never get up while holding the baby (first 24hours), in case of fainting.
  • Do not lift anything heavier than the baby for 3 weeks after a gentle vaginal birth; 6 weeks after a Caesarean or traumatic birth.
  • Take temperature daily for the first 5 days; twice daily if membranes were ruptured more than 12 hours before birth or in case of traumatic birth.
    • Oral temperature: 15min after ingesting hot or cold, or being in hot water. Put tip under and against tongue to 1 side of frenulum, close mouth and wait for the beep (or 5min for glass thermometer; remember to shake well before use)
  • Light movement is fine during the first 6 weeks. Any increase in cramping, bleeding, or discharge going from brown to red means you’re doing too much!

Uterus recovery:

  • In the first 1-2 days, gently massage uterus (back and forth motion) several times daily to ensure it’s firm like a grapefruit
  • Urinate often
  • Breastfeed often
  • Nothing inside the vagina

Pain:

  • Take arnica to aid with tissue healing
  • After-pains are due to the uterine contractions and tend to be stronger with subsequent pregnancies and during breastfeeding. Lay or sit, apply pressure (e.g. pillow) and heat (hot water bottle), take extra calcium, and consider calling midwife for homeopathy.
  • It’s safe to take acetaminophen (Tylenol x-strength) every 6 hours (for pain) and ibuprophen (Advil) every 4 hours for swelling for the first few days after birth
  • Avoid aspirin, alcohol, herbal supplements with willow-bark as they promote bleeding

Perineum:

  • Keep area as clean and dry as possible
  • Use peri-bottle of warm water and 1 dropper of calendula tincture after using the toilet
  • Wear the lightest pad necessary and change it with every visit to the washroom.
  • Apply frozen calendula pads to perineum/hemorrhoids several times daily for 2-3 days
  • If any tears/suturing to perineum, soak in a clean bath each day with ½ cup of Epsom salts or sitz-bath herbs added. Keep knees together as much as possible, including while walking or on stairs.  Airtime helps speed recovery.
  • Begin light elevator-Keigels and pelvic floor exercises

Nutrition:

  • Drink plenty of water and nutritional drinks, including Pregnancy Tea Blend
  • Eat whole foods – 3 meals and 2-3 snacks daily (just like during pregnancy)
  • Continue prenatal vitamins, acidophilus, essential fatty acids for at least 6 weeks
  • Continue or begin to take iron supplements if they were prescribed

Normal Postpartum Care – Baby

  • Feed when the baby wants but a minimum of every 4 hours around the clock (see “breastfeeding” below). A breastfed baby shouldn’t be offered anything other than breast milk/ colostrum.
  • If baby’s definitely satiated and still wants to suck, it may save nipples to offer a clean pinkie; insert to first knuckle, pad up.
  • Keep the cord-stump dry (fold diaper below) and clean. No need to put anything on it, but calendula tincture is acceptable.
  • When changing diapers wipe from front to back, only once per cloth. Clean folds of skin but do not open genitals and never retract foreskin.
  • Clean baby’s hands, folds in neck, and face with a clean damp cloth daily
  • Bathing is recommended only once or twice weekly with gentle and “edible” soap
  • If fingernails are long then prevent scratching by cutting with newborn-clippers or gently chew them off
  • Keep the baby at a comfortable temperature. If concerned take baby’s temperature.  Put the end of the thermometer at deep centre of armpit, then the hold arm against side until thermometer beeps (or 5min for glass; remember to shake well before use).
  • For plugged tear duct gently but firmly press at the inner bridge of the nose with the pad of your finger beside the baby’s inner eye. Stroke up to remove blocked material, then downward 3 or 4 times to the nostril.  Repeat several times daily until it clears.
  • Sleep with the baby in your room. Baby should sleep on her/his back, on a firm surface away from puffy blankets and pillows.

Breastfeeding

  • Feed baby frequently, usually 10-12 times/24 hrs after first day or so. Baby may have long periods of sleep in the first 24 hrs so may feed less frequently. Feed the baby on cue, minimum every 4 hrs or so. Babies usually nurse for 15-20 minutes.
  • Baby’s mouth WIDE open before latching! If painful, retry the latch over and over until it’s correct.  This will prevent sore nipples. Don’t do even 1 feeding with improper latch.
  • Should feel a pull but not a pinch
  • Breast well supported in one hand, where an underwire goes, away from nipple
  • Baby position: skin to skin, belly to belly, nose to breast, pull in very close so that very little/none of areola is visible, with both baby lips open (not tucked in).
  • Nipple care: Expect nipples to be tender for a few days.  Express colostrums onto nipple /areola after each feed. Allow to air dry.  Do not use soap or chemicals on nipples.  In case of chaffed or dry skin, Lanolin or pure vitamin e-oil can be used (but try the colostrum first).  Change nursing positions
  • If breasts get engorged with milk (hard and full-feeling), apply refrigerated green cabbage leaves, and reapply new ones as they “cook”
  • Avoid the use of pacifiers or artificial nipples

PLEASE CALL IF YOU’RE TEMPTED TO USE FORMULA IN SPITE OF PLANNING TO BREASTFEED

Angie The Doula – Postpartum Support and Maternal Mental Health Resources

At two weeks postpartum, the realities of new parenthood can be a whopper. Many new parents find this time hard, especially during this pandemic when most people don’t have the support they’d normally have. Remember that new normal that most families find around 4-6 weeks? That might feel like forever at this point. 

This is a good time to check in about maternal mental health. Partners can struggle with mental health too. Here are some good resources:

Postpartum Support
  1. Maternal Mental Health Issues This online article includes risk factors (any of these that can be addressed can help make postpartum life easier), things to help, local resources, what partners can do.
    There’s a big range between thriving and needing clinical mental health services. This article has suggestions for things that can help in that space.
  2. Self assessment tool: This version of the Edinburgh Postnatal Depression Scale (EPDS), Edinburg Screening & Care Guide, includes valuable information about risk factors and where to find help. This is the form your health care provider would use if they screened for maternal mental health.
  3. Self assessment tool: The Postpartum Progress Checklist has more questions than the EPDS. It can be used to facilitate discussion between postpartum clients and their health care providers.  

If you’re struggling, then here are some things to consider as next steps:

  • Gather up support. I have a list of postpartum doulas to share in a range of experience and fees. (My list includes several doulas not on the DofR site. I train them and only recommend people I trust. If fee is a barrier or consideration, I can likely help you find someone that fits your budget and needs.)
  • Ask the public-health nurse to come in for a chat.
  • Take your self-assessment tools and/or concerns to your 2-week medical checkup. 
  • Make an appointment with your doctor or midwife.
  • If you have a health plan at work or in-house mental health counsellor, then that will be your fastest route to get counselling and psych services.
  • Call 811 if you need non-emergent medical advice as they are supposed to be well-trained in postpartum mental health.
  • Get medical attention today if you have thoughts of harming self or baby. Unfortunately, that usually means a trip to the ER.
  • In case of psychosis, call 911.

I want to reassure you of two things in case medical help is needed:

  1. Breastfeeding is still possible with almost all mental health drugs. (Many women are reluctant to get help for fear of not being able to BF.)
  2.  Families are kept together during mental illness, as long as there’s one healthy adult (parent, grandparent, relative or close friend as guardian). If a parent has to be admitted to the psych unit then the baby stays with the other parent or guardian. Visits with the mentally ill parent are arranged as soon as possible. A few of my clients have been down this road and it’s not easy but they received excellent care and recovered.   
postpartum support

I teach a variety of Child Birth Education classes and prenatal workshops online for people all over.  I have been a birth doula since 2002, and have helped over 300 clients with their births and over 1000 through prenatal classes. Learn more about my birth doula services, and contact me with any questions you may have.

Placenta Capsules FAQs

What qualifies you to provide this service?
Proper training and a lot of experience:  We’ve offered this service since 2009 and between us have done 500+ placentas, making us the most experienced encapsulators in Saskatchewan.  We are both OSHA certified and trained in Universal Precautions, food science and preservation.  We train placenta encapsulators through Birth Ways International.

How long does it take?  The capsules are ready in 1-2 days from when we get the placenta.

How many capsules will I get?
That depends on the size of your placenta.  Most women get over 100 capsules.  The average is around 115.  Bigger placentas can fill close to 140 capsules.

What’s the difference between gel and veg caps?
Gel caps are made from animal gelatin and veg caps are vegan, made from plant materials.  See a detailed ingredients list for our high quality capsules.

How do you clean and care for your equipment?
The processing is done using OSHA Blood Borne Pathogen Standards. All surfaces and equipment are cleaned, then disinfected, then twice-sterilized using chemical methods. (This is “over-kill” but is reassuring to us and our clients!)  We use high quality equipment that can be properly sterilized and is kept in like-new working order.

Can I keep my placenta if I have a caesarean birth?
Yes.  The steps are exactly the same.  Simply ensure your O.R. nurse knows you wish to keep it.

Am I “allowed” to keep my placenta?  Do I need permission from my doctor?
It’s yours to keep.  Simply write in your birth plan or tell your care-provider, “I’m keeping my placenta.”  Other details are for you to share or not as you choose.  Obstetrical staff at Regina General Hospital and nearby rural hospitals are quite used to women keeping their placenta.  If you’re at another hospital that has concerns, then you can sign their Release of Live Tissue waiver.  Remind the people attending your birth that you wish to keep it.

Can you make capsules from my placenta if I choose to use epidural or other medications in labour?  Yes.

Is my placenta safe to encapsulate if there’s meconium (baby poops inside) during the birth?
Yes.  The initial cleaning process and proper dehydration takes care of this.

Are there any cases where my placenta can’t be encapsulated?
In the rare case of uterine or placental infection during labour, your placenta will be taken away to the pathology department for analysis.  We’ve processed well over 500 placentas and have never received one that was infected (we do watch for it though).  All placentas are inspected after birth by midwives/doctors, who do not send infected placentas (or anything else) home with patients.

If your placenta is left at room temperature for too long then we are unable to process it.

Do you serve out-of-town clients?
Yes.  We have systems in place to make this easy for you.  We provide detailed, easy-to-follow instructions.

How do I package the placenta for you?
At Regina General Hospital, the placenta is usually put into a square plastic container; you can use that for storage and transport.  We provide detailed instructions to bring your own container as a back-up.  You can ask your nurse to get it ready.  While it’s not her “job”, most are happy to help.  At home births or other hospitals you’ll need to provide your own container (we provide detailed instructions).  If you have your baby at night or are shipping the placenta, then you’ll keep it cold (detailed instructions provided) until the morning when it’s picked up.

How do I get the placenta to you?
One of us picks it up at Regina General Hospital or at your home in Regina city limits, depending where you give birth.  If you have your baby out of town then you can have it delivered to us.  We provide detailed instructions.

How do you ensure the capsules are returned to the right person?
This is one of the most important parts of the process!  One of several advantages to working in partnership is that we can process two placentas at the same time in two separate locations. We have a triple labeling system in place to ensure 100% accuracy; your placenta is attached to a label at every stage of processing, from placenta pick-up through to delivery of capsules.  These are a matter of routine, and are followed with every client’s placenta, even though we rarely have 2 placentas in the same building at the same time.

How do I get the capsules back?
We deliver the capsules anywhere within Regina city limits.  If you live out of town then we can ship them or send them with someone going your way (we can drop the package off anywhere in Regina to that person).

How long do the capsules last?
They’re best used within 1 year, stored at room temperature in an airtight container (glass jar).  After that they don’t necessarily go “bad”, but the nutrients start to diminish.  If you wish to keep them longer, then the freezer can extend that for up to another year if they go in within the first few months.  (We don’t recommend this because we hear from so many women who put them in the freezer and promptly forgot about them.)

How do I store the capsules?
Just keep them in the glass jar.  There’s no need to refrigerate them.  They’re good for up to a year at room temperature in a cupboard.  If you wish to keep them longer, then store in a deep-freeze for up to two years.

Can you make capsules out of my frozen placenta?  Yes.

How do we proceed? 
Please follow the steps on our encapsulation page.  There’s a form for you to complete and all the information you need is there too.  We need your estimated due date and contact info.  You can send an e-transfer, post-dated cheque or provide cash with the placenta.

What if I Haven’t Made Arrangements Yet?  We can usually accommodate you.  In an ideal world everything will be set up ahead of time.  However if you just decided to do this while you’re in labour – or even after your birth – and need to make quick arrangements, please text during normal “awake” hours.  (If you have your baby after 9am or before 8am, please put your placenta in fridge or on ice and get in touch in the morning.)  Please follow the steps on our encapsulation page.

Do you buy or sell placentas, or placenta products?
We do not!  This is not only unethical and unsafe, but is illegal in Canada.  (If anyone offers to do this, please report them to the Public Health Department.)  We provide the service of turning your own placenta into capsules for your own use.

Use of Herbs During Pregnancy & Lactation

Herbal medicine is specific category of health-care.  Many herbs, including essential oils, are safe and beneficial during the childbearing year, while others can be dangerous.  Pregnant women must be cautious with any remedies, especially during the first trimester when the fetus is most vulnerable.  There’s a lot of misinformation concerning herbs.  Here are lists of commonly used herbs that are considered safe and unsafe through pregnancy and postpartum.

Here We Go Again: Facts vs Fear-Mongering in Placenta Encapsulation

Placenta capsulesYesterday the CBC posted another article on placenta encapsulation.  The article is low on fact and filled with fear-mongering.  Certainly an article like this should lead service-providers to pay attention to their practices, ask questions, and re-evaluate protocols to ensure safe services are being offered.  An article of this nature should also lead clients to ask questions of their encapsulators.  Unfortunately, when a big media company publishes an article with an inflammatory headline, most people don’t read through, and of those that do, few know how to evaluate the information presented.

Let’s get to the facts.

Drying Up Breastmilk

While breastfeeding is actively promoted in almost all Canadian communities, a new mother may need or want to prevent further lactation or dry up her milk.  Reasons include still-born, surrogacy, medical conditions requiring treatment contraindicated with breastfeeding, past abuse, and lifestyle choices.  For many women it’s a very difficult decision.  Women need acceptance and supported in their choices.  To that end, here’s information to help a woman cease lactation in the safest and least painful way.

Postpartum Mood & Anxiety Disorders (PMAD)

This is the updated term for postpartum depression (PPD).  PMAD is a form of clinical depression or mental illness that can begin at any time after childbirth, from days to even years after in some cases.  PPD is not something that is anyone’s fault or that necessarily be controlled.  Between 3-24% of new mothers are afflicted, and up to 50% of male partners of women with PPD also experience PPD (Clinical Rounds, MCU Oct 2011).  Although hormone drops are often blamed, no causation has been proven.  PPD is more serious than postpartum blues; if the blues last longer than 2 weeks and aren’t resolved by rest and support then seek help.

Symptoms of PMAD include any of the following:  crying for no reason, inability to cope, feeling overwhelmed, sadness, anger, hopelessness, impaired memory or concentration, loss of interests, nightmares, bizarre / strange / intrusive thoughts, perceived or actual difficulties bonding with baby, feelings of resentment or aggression toward baby or family members, apathy toward baby, thoughts of suicide.  Call your midwife or health practitioner in case of any of these symptoms.

Risk Factors of PMAD

Note:  PMAD can hit any woman at any time postpartum – for no apparent reason.  However the following increase the risk.

  • Personal or family history of depression, related to birth or not
  • Traumatic birth
  • Pain
  • Fatigue
  • Inflammation
  • Low blood-iron levels
  • Twins or multiples
  • Being “run-down” e.g. fatigue, low blood sugar
  • Stress e.g. such as social, economic, relationship, health concerns, child-care issues
  • Lack of social support
  • Perceived or actual isolation
  • Formula feeding in place of breastfeeding
  • Cigarette smoking
  • Infant temperament
  • An affected partner

“Baby-blues” is a normal, natural emotional reaction to birth that last hours or a few days.  Symptoms are mild and transient and occur in 50-80% of new mothers around day 3, when your milk comes in.  You may experience tears, exhaustion, worry, irritability, and lack of confidence.  Mothers experiencing baby-blues need support, rest and care to prevent it from progressing to depression.  If it lasts longer then it’s prudent to follow the measures listed under “Prevention and Treatment Strategies.”

Postpartum psychosis is a rare but severe and sudden mental illness that requires immediate 911 medical attention.  Symptoms include those for PPD, plus some or all of the following:  refusal to eat, fatigue, frantic excessive energy, confusion, delusions, loss of memory, failure to recognize familiar people, visual or auditory hallucinations, irrational statements, distorted thinking, suicidal or infanticidal thoughts and behaviours.  Seek 911 medical help immediately.

Prevention and Treatment Strategies

Although there may be factors that can’t be controlled, the best defence against PMAD is a well supported, healthy mother.  There seem to be higher rates of PMAD in Western cultures, likely due to stress and isolation.  In almost every other culture, new mothers are surrounded by women and family to take care of them.  All they’re expected to do is rest, recover, breastfeed and bond with baby for the first 40 days.  In North America most new mothers are expected to take care of themselves, their baby, and the household; and of course entertain a steady stream of visitors who want to check out the baby.

  • Prevention starts during pregnancy
    • Learn as much as possible about birth, breastfeeding and life after baby
    • Arrange postpartum support to allow for rest and bonding i.e. circle of friends or family, postpartum doula, community resources
    • Learn to say no
    • Plan to do nothing for 8 weeks; have freezer full of healthy tasty prepped food, kitchen stoked with non-perishables, household items stocked, major home chores done, hire house-keeper, dog-walker etc, get groceries delivered
  • Early intervention leads to shorted duration
  • Limit visitors and length of visits!!! Have a visitor rule: everyone has to bring a healthy meal – fresh or frozen – and do a chore from a “to-do” list on your fridge.  Set a time limit.
  • Take one day at a time
  • Ask for help
  • Manage pain, even if that means taking pain meds while breastfeeding
  • Have and use a simple schedule, allowing for the unpredictability of newborns
  • Take it slow; re-enter world gently if hibernating with new baby (40 days highly recommended)
  • Adequate sleep; sleep when the baby sleeps
  • Breastfeed
    • Hormones of breastfeeding, prolactin and oxytocin, help reduce PPD
    • Several studies find breastfeeding mothers actually get more sleep on average than formula feeders
    • Benefits of breastfeeding for both mother and baby far outweigh any risk of anti-depressant drugs effecting baby
  • Do something that brings joy daily
  • Find a way to have a little time alone daily, including time to relax (meditation, rest, praying, reading – whatever’s rejuvenating)
  • Self-care e.g. shower, get dressed, eat, get out for walk
  • Healthy foods (see Postpartum Nutrition handout)
  • Ingesting placenta e.g. dry and encapsulate
  • Craniosacral therapy, especially in case of lost consciousness during birth process
  • Community support programs such as Y’s Moms and LaLecheLeague groups
  • Mental health professional, ideally one who specializes in postpartum mental health
  • For mild PMAD, take supplements of a fish oil high in EPA and St John’s Wort; can be taken with antidepressant medication; safe with breastfeeding
  • Psychiatric care may be required including antidepressant drugs, many are safe for breastfeeding
  • Many antipsychotic drugs are not recommended with breastfeeding, but there may be alternative schedules available for some women (e.g., taking high dose at night and then not using breastmilk until 8-12 hours later – do this only upon advise from psychiatrist, who will help determine safe dosages and timing on a case-by case basis)

Support Measures to Consider

  • Support with housework, meals, daily tasks from one with whom mother feels comfortable
  • Postpartum doula
  • Call midwife or health practitioner with any concerns or questions regarding blues or depression
  • Families Matter Postpartum Support 1-888-545-5177
  • Sask Health Link 811
  • Online support at Mothering Magazine’s Forum: mothering.com/community

What Partner Can Do

Be there. Be present and involved.  While PMAD affects the mother directly, it’s a family issue.  Partners can’t “fix” this, but can be supportive.

  • Call midwife or health practitioner right away with any concerns
  • Don’t wait for mother to reach out – find help for her
  • Remind partner that she’s loved and partner is there for her
  • This is no one’s fault – remain non-judgemental
  • If she cries just hug and hold – allow the tears
  • Remind mother to get fresh air or do something for herself daily.  Make it happen.
  • Do something as a family – take a walk, cuddle by the fire
  • Self-care as this is a difficult time for partners too.  New parenthood is an adjustment for both parents even without challenges such as PMAD.  Eat well, rest when possible, and get fresh air.
  • Remember anything that takes care of mother (food, chores etc) is also taking care of baby
  • If partner can’t be there and take care of food / home then arrange for people who can
  • Listen attentively – partner may be the only person she opens up to
  • Remind her that she’s not alone, this will get better and you’ll all get through together
  • Ask “what can I do” or “what do you need” rather than “do you need anything”
  • Point out triumphs such as growing a healthy baby, meeting with a counsellor
  • Guard the door – only supportive helpful visitors are allowed and only if mom truly has energy
  • Be open with those closest family / friends about what’s happening
  • Observe, as health practitioner will ask about patterns and behaviours
  • Be wary of partners mental health; up to 50% of male partners of women with PPD also experience PPD (Clinical Rounds, MCU Oct 2011)

For mild issues some women find just getting out for fresh air daily, or having a bath, time with girlfriends, a nap, or whatever their thing is, helps.

Local Resources

  • Healthline Phone (part of public health care) as they have the training to screen and refer now and alert crisis if needed (811 is the new number)
  • Smiling Mask www.thesmilingmask.com and/or book by Carla O’Reilly & Tania Bird (this is a brilliant resource started by 3 local Regina women who suffered from PPD)
  • Edinborough screening tool – self assessment.  This is now part of the EPDS Screening, available at http://skprevention.ca/?s=EPDS .  There’s some other good info on that page too.  Take this to a qualified care provider if you score in a range that needs to be addressed.  Do this test at regular intervals.
  • Marlene Harper (Private therapist) 306-584-2731, Regina (note i don’t know her personally but she comes recommended by other mamas)
  • Online Therapy – cognitive behavior treatment program for maternal depression (Pilot program; may or may not continue long term)
    • Includes 7 interactive evidence based modules
      Therapist-assisted via email and telephone
      Provided at no cost
      Inclusion criteria:  SK resident, > 18 years, minor-major depressive symptoms, have a child <1 year
      For more information or to refer:
      –Website: www.onlinetherapyuser.ca
      –Email: Nicole Pugh: pugh…@uregina.ca
      –Phone: (306) 585-5369; (306) 337-3331

Holistic helpers who may be able to offer help, and could certainly compliment any medical care.
Dr. Vanessa DiCicco, ND – http://wellfamily.ca/meet-nds/vanessa-dicicco/
Cheryl Lloyd, hypnotherapist www.tranquiljourneys.ca

Psych Unit at RGH
Visitors are welcome!

 

References

Calgary Health Region. (2007). From Here Through Maternity. Calgary: Alberta Health Services.

Corwin, E., Murray-Kolb, L., & Beard, J. (2003). Low Hemoglobin Level Is a Risk Factor for Postpartum Depression. The Journal of Nutrition , 133, 4139-42.

Kendall-Tacket, K. P. (2005). The Hidden Feelings of Motherhood (2nd ed.). Amarillo, TX: Pharmasoft Publishing, L.P.

Kendall-Tackett, K. (2010, Aug). Nighttime Breastfeeding and Maternal Mental Health. Retrieved Sep 2011, from Science & Sensibility: http://www.scienceandsensibility.org/?p=1398

La Leche League Canada Health Professional Seminar, Calgary AB.  Preserving the Simplicity of Breastfeeding in a Complex World: a Paradigm for Depression, Stress and Postpartum Healing. 1 day seminar; Dr. Kathleen Kendall-Tackett.  2008.

Lim, R. (2001). After the Baby’s Birth – A Complete Guide for Postpartum Women (Revised). Toronto: Celestial Arts.

Sarah Breese McCoy,  J. Martin Beal, Stacia Miller-Shipman, Mark Payton, Gary Watson. (2006). Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature. Journal of the American Osteopathic Association , 106 (4), 193-198.

The Mother Reach coalition . (n.d.). Postpartum Mood Disorder . Retrieved Sep 2011, from Mother Reach: http://www.helpformom.ca/

Varney, H., Kriebs, J. M., Gegor, C. L. (2004). Varney’s Midwifery, 4th Ed. Toronto: Jones and Bartlett Publishers.