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.
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
- 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
- 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.
- 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:
–Email: Nicole Pugh: pugh…@uregina.ca
–Phone: (306) 585-5369; (306) 337-3331
- Includes 7 interactive evidence based modules
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!
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.
What’s a doula?
A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother and partner during pregnancy, birth & early postpartum. In much of the world today and throughout history, women support women through labour & birth.
What’s the difference between a midwife and a doula?
Doulas work as part of a team with doctors or midwives, but not instead of. They provide non-medical support and comfort measures (e.g. encouragement, massage, positioning suggestions). They do not perform clinical tasks such as heart rate, blood pressure, or internal exams.
Midwives are highly trained in the medical aspects of birth. The carry oxygen, medicines, resuscitation equipment and other gear, and are known as primary care-givers during birth. In North America primary/medical birth care is offered by either a midwife or a physician.
Why choose a doula over simply using a friend or family member as support?
Doulas are trained and experienced in childbirth support. They know the sounds and behaviors of laboring women, and what that may indicate about progress. Doulas are trained in pain-reducing comfort measures, natural methods to keep labor progressing, and to support both the laboring woman and her partner. Doulas are familiar with local hospital policies & practices and have often built a rapport with the doctors, nurses and midwives. See http://evidencebasedbirth.com/2012/06/26/why-wouldnt-you-hire-a-doula/
In most Canadian hospitals, women are allowed 2 support persons – usually that’s her partner and a support person. Some hospitals accommodate a 3rd support person. Homebirths and birth centers encourage women to have all the support they wish.
How does the doula fit in with nursing staff?
Doulas do not replace nurses or other medical staff, but rather work as part of the team. They are there to comfort and support the mother & her partner. Nurses change shifts; doulas stay.
How does a doula assist with communication in hospitals during labor & birth?
During prenatal meetings doulas learn what’s important to a couple and discuss how to make informed decisions. A doula may remind or encourage a client to ask the questions necessary to understand a procedure and make informed decisions. Doulas do not speak on a client’s behalf nor intervene in their clinical care. They do not make decisions for clients, nor judge the decisions clients’ make, but are there to support those decisions.
What difference does the presence of a trained doula have on birth outcomes?
The presence of a doula tends to result in shorter labours with fewer complications and less interventions. When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer caesareans and requests for medical intervention, and less postpartum depression. In case of unplanned circumstances, doula support helps reduce negative feelings about one’s childbirth experience. Studies ,,, have shown that babies born with doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.
Analysis of six randomized trials1 demonstrates that lack of doula presence correlates with:
- Double the overall caesarean rate
- 33% increase in length of labour
- 67% increase in oxytocin use
- 2 ½ times more requests for epidurals
Will a doula make my partner feel unnecessary?
A responsible doula compliments and enhances the father/partner in their supportive role rather than acting as a replacement. (While I respect people’s individual circumstances, I will use “father” words for most of this paragraph.) The presence of a doula allows the father to support his partner emotionally during labor & birth without the pressure to remember everything he learned in childbirth class! The father typically has little-to-no actual experience with the birth process, yet is expected to act as a coach. Some partners feel (accurately) that this is a huge expectation. Many fathers experience the birth as an emotional journey of their own and find it hard to be objective. A doula is supportive to both the mother and her partner, and plays a crucial role in helping a partner become involved in the birth to the extent he/she feels comfortable. Studies have shown that fathers usually participate more actively during labor with the presence of a doula than without one.
When a couple works well together during the birth process they’re better able to handle the challenges of early parenthood. An incredible bond forms or is made stronger.
How often and when do we meet?
We’ll meet 2-3 times before the birth. The introductory meeting is any-time – it’s never too early. The prenatal meetings are best done between 24-36 weeks. After your baby is born there will be a minimum of one postpartum visit, more if needed or desired.
Are doulas only useful if planning an un-medicated birth?
The role of the doula is to help attain a safe and pleasant birth, not to choose the type of birth. The presence of a doula is beneficial no matter what type of birth you are planning. In fact, women who choose a medicated birth need as much support as those who choose a natural birth, but a different kind of support. For women who know they want a medicated birth, the doula still provides emotional support, informational support and comfort measures to help the women through labor and the administration of medications. Doulas can help a mom deal with possible side affects and by filling in the gap that medication may not cover; rarely does medication take all discomfort away.
For a mother who faces a cesarean, a doula provides comfort, support and encouragement. Often a cesarean is an unexpected situation and moms are left feeling unprepared, disappointed and lonely. In this case doula support is especially helpful during the early postpartum period.
What if I planned a drug-free birth then change my mind during labour?
Doulas don’t make decisions for clients or intervene in clinical care, nor do they judge women’s choices. They provide informational & emotional support while respecting a woman’s decisions.
What kind of comfort measures do you use during the labour & birth process?
While there are common comfort measures taught in doula training courses, each doula also brings her own tools and methods. Ours include the following:
- Positioning suggestions
- Massage & various touch methods
- Homeopathy & Bach Flowers (optional; no extra charge)
- Encouragement & reassurance
- Heat or cold as desired
- Hydrotherapy (water for comfort in labour, and/or water-birth)
- Create space for partner, and recommendations to help partner to offer support
- A calm, reassuring presence who trusts the birth process
When do we call you in labour?
Please call at the first signs of suspected labour. We’ll discuss what those are. From then on you’ll keep us posted on your progress and what’s happening.
When and where do you join us in labour?
When depends on the woman, her partner, and the labour. Early support often takes the form of checking in by phone and/or dropping by your place. Your doula joins you either at your home or in hospital or birth center and remains with you until 1-2 hours after the birth.
How does shared-care work?
Doulas team up to provide enhanced service. Clients benefit from combined experience, education, and availability. Since doulas are on call for up to a month for each client, shared care allows them time for important life events and days off without having to turn clients away or rely on unfamiliar back-up. Clients meet both doulas prenatally so they’re familiar with whichever one attends birth.
What if you can’t be at the birth?
In the rare circumstance that one of your doulas can’t be there, you will be well supported. We work with reliable back-ups who offer excellent care. Fees remain the same. If the back-up is likely to be part of care, some clients wish to meet her prenatally, which can be arranged.
Do we pay more to work with 2 doulas?
No. Fees are outlined in the contract. The cost of working with both doulas is the same as hiring one of them individually.
What kind of postpartum support do you offer?
Your birth doula usually stays for 1-2 hours after the birth, until you’re ready to be on your own with your baby. We also visit in the first day or two postpartum, offering basic breastfeeding support, answering questions, and going over your birth. We are available for questions and can offer resources (educational and community). A second postpartum visit is offered.
What if I need extra help with breastfeeding or baby-care?
The information above describes our work as birth-doulas. Another kind of doula, a “postpartum doula”, specializes in extended care and breastfeeding support. There are also breastfeeding counselors and lactation consultants that can be arranged through public health or hired privately. We can provide resources and contact info. If you’re on the Mother-Baby Unit the nurses or unit Lactation Consultants can provide support.
Where’s that name from?
In ancient Greece “doula” meant the highest female servant who helped the lady of the house through child-bearing. Medical researchers Marshall Klaus and John Kennell, who conducted several randomized clinical trials on the medical outcomes of doula attended births, adopted the term to refer to labour support as well as prenatal and postpartum support.
 Klaus, M.H.; Kennel, J.H.; Berkowitz, G.; Klaus, P. “Maternal Assistance and Support in Labor: Father, Nurse, Midwife or Doula?” Clinical Consultations in Obstetrics and Gynecology 4 (December 1992).
 Sauls, DJ. Effects of labor support on mothers, babies, and birth outcomes. J Obstet Gynecol Neonatal Nurs. 2002 Nov-Dec; 31(6):733-41.
 O’Driscoll, K. and Meagher, D. Active Management of Labor. 2d ed. London: Bailliere Tindall, 1986.
 Klaus, M.H. and Kennel, J.H. Parent-Infant Bonding. St. Louis: C.V. Mosby, 1982.