Postpartum Depression, Bottle Feeding and Infant and Mother Separation at Birth

There is a new study out by the University of Albany done by evolutionary psychologists that puts forward the idea that a woman who feeds her baby a bottle instead of breastfeeds may be at risk for postpartum depression due to the fact that her body will interpret this as an infant loss. The article states:

“for most of our evolutionary history the absence or early cessation of breastfeeding would have been occasioned by the miscarriage, loss, or death of an infant, and, at the level of basic biology, a mother’s decision to bottle feed rather than nurse unknowingly simulates that loss.”

This was a small scale study, only 50 mothers were surveyed. However, they still found interesting information:

“those who bottle fed their babies scored significantly higher on a postnatal depression scale than those engaged in breastfeeding.? The increased risk of depression among mothers who relied on bottle feeding held true even after controlling for such factors as age, education, income, and the mother?s relationship with her current partner.”

They also found that mothers who bottle feed tend to hold their infants more, which they have seen in primates whose babies have died and they cling to those babies for prolonged periods afterward. What I found most interesting though was this:

The UAlbany research team noted that the common hospital practice of isolating newborn infants together in a nursery for the first couple of days after birth, and the resulting intermittent separation of the mother from her baby during the initial post childbirth period, could also serve to simulate child loss and contribute to or set the stage for subsequent postpartum depression.

“Bottle feeding and hospital procedures that simulate child loss may increase the risk of postpartum depression,” Gallup said. “These practices fall within a growing number of medical issues that could benefit from a perspective of human evolutionary history.”

It is very interesting and significant that the common hospital practices here are linked to an increased risk of postpartum depression. The Edinburgh Postnatal Depression scale was used in this study to asses whether women were suffering from postpartum depression. However, they could also have been suffering from postnatal traumatic stress, since the Edinburgh scale only picks up depression symptoms and not trauma symptoms, and separation from infants is a key trauma risk. Either way, connecting postpartum mood disorders with the routine practices of separation of infants and mothers in a hospital seems to be a step in the right direction toward reforming maternity care.

Reducing Infant Mortality

Please watch this video and then spread the word about how to reduce infant mortality. Click here to visit the website and get help with writing to your legislator, or sending them this video.

Reducing Infant Mortality from Debby Takikawas on Vimeo.

Ricki Lake debates Dr. Lisa on the The Doctors

Part One

Part Two

What do you think about what was said in this debate?

New Study On Scheduled Cesareans

There is a new comprehensive study about the safety of cesareans before 39 weeks gestation.? From the article, Early Repeat C-sections Increase Risks, Study Finds, published in the Washington Post, there is this quote about the study:

The study of more than 24,000 full-term infants found that those delivered at 37 weeks to mothers who had elective repeat C-sections were about twice as likely as newborns delivered at the recommended 39 weeks to experience breathing problems, bloodstream infections and other complications. Babies born at 38 weeks were 50 percent more likely to have problems; the risk was about 20 percent higher just a few days early.

The article states that the rate of cesareans is now over 30%, and that there is a great deal of debate as to why this is.? However, they then go on to say:

Although a pregnancy is considered full term after 37 weeks, the American College of Obstetricians and Gynecologists recommends that elective repeat C-sections occur no earlier than 39 weeks to make sure the baby has fully developed. But some women opt to deliver a little earlier for a variety of reasons, including being eager to see their baby, being tired of pregnancy or for convenience.

The article here suggests, with no data or studies to back it up, that the women themselves are convincing their OB’s to disregard their instructions from ACOG, go against evidence based care, and put the babies at risk in order to give in to the mothers whims.? I find it very curious that women hold so much power in this regard, when most other choices they make in childbirth in a typical hospital would be disregarded.? If doctors are so concerned for mothers choices, even when it means breaking their own rules and putting babies in harms way, then why aren’t the choices that women make for their labors and births that do not infringe on any rules or cause harm to their babies respected?? I doubt very much that doctors are truly allowing women to make an informed choice on this.? Perhaps women who are getting a repeat elective cesarean are showing an interest in an earlier delivery, but, are they then given the risks, benefits, or alternatives to delivering early?? Did they make a truly informed choice?? Or are they making a decision based on the belief that their baby is “full term” and is ready to be born?? In the absence of any cited study on the subject, it is my feeling that the article is making quite the presumption.

Here is all the study really had to say about the matter:

Of 24,077 women who gave birth through a repeat C-section between 1999 and 2002, 13,258 were clearly elective — meaning the researchers could find no evidence that the baby or mother was in distress or any other medical reason the woman could not attempt to deliver through labor. Of those, nearly 36 percent of the deliveries occurred before 39 weeks.

It is unclear from the study why there were so many “elective” cesareans performed.? It is not clear to me whether the researchers considered a repeat cesarean to be elective or not.? If the researchers didn’t consider a previous cesarean as a medical reason as to why the mother should have another one, then that would explain the large number of scheduled “elective” cesareans.? It doesn’t seem that any data was provided as to whether the mothers or the doctors were selecting the time in which these cesareans would be scheduled.

The articles goes on to talk about the findings in the study about the true risks of a scheduled cesarean before 39 weeks:

More than 15 percent of the babies delivered at 37 weeks suffered a complication, such as problems breathing, low blood sugar, infections or conditions that required intensive care, compared with about 8 percent of those delivered at 39 weeks. About 11 percent of those delivered at 38 weeks experienced complications. Babies born at 37 weeks were four times as likely as those delivered at 39 weeks to have breathing problems.

It seems very clear cut, but then another angle is presented:

While other experts agreed that the study provides important information to help women and their doctors make decisions about timing C-sections, some said the risks of complications are relatively low and need to be weighed against the small but not insignificant chance that waiting a week or two would result in more stillbirths.

The article does end with a voice of reason though:

But Spong said the magnitude of the risk of stillbirth from waiting is unclear, and the new study shows the risks of complications from early delivery is significant.

“It’s hard to advocate doing a Caesarean at 37 weeks to try to prevent a stillbirth when we don’t really know the true risk,” she said.

Overall, I feel this is a very good study that has been done.? Many babies and new parents will be saved the possible traumatic experience of the NICU.? Many doctors, who already had some research and guidance from ACOG to tell them not to schedule repeat cesareans before 39 weeks, will now have this additional comprehensive study that clearly shows the impact of doing so.? This also may bring to women’s and doctor’s consciousness that cesareans themselves are not perfectly safe for all involved no mater what.? They need to be carefully planned and managed and only performed in cases of true emergency, or they could possibly do more harm then good.

Study Shows That Pregnant Woman Do Not Lose Cognitive Ability

Here is the link to an article entitled “Pregnancy does not cloud the brain, says Australian study”. Many people, including pregnant women themselves, feel that pregnancy clouds their judgment. Perhaps this study will put that myth to rest.

Some notable quotes from the article:

A study by the Australian National University’s centre for mental health research found that there is no evidence to suggest that impending motherhood affects a woman’s cognitive ability.

“It really leaves the question open as to why (pregnant) women think they have poor memories when the best evidence we have is that they don’t.

The professor said research on rodents had found that mother rats had an improved capacity to do more than one task, navigated mazes more efficiently and suffered less anxiety and fear.

“There’s enormous changes in the rat brain during pregnancy so you might actually expect that women perform better during pregnancy than when they’re not pregnant,” Christensen said.

The Effects of Birth Trauma on Breastfeeding

Here is a recent article on new research from Cheryl Beck on the effects of birth trauma and breastfeeding. The article is entitled “Study shows birth trauma can impact new mothers’ ability to breastfeed”.

Highlights from the article include:

For some, the trauma propels them into persevering in breastfeeding to prove their “success” as a mother and perhaps to make up to their infant for the difficult birth.

Yet for others, birth trauma sets in motion a chain of events “intrusive flashbacks, detachment from their child, and physical pain” that can curtail their attempts to breastfeed.

Beck concludes that intensive one-on-one support for traumatized mothers may be necessary to help them establish breastfeeding. Sensitivity and awareness by medical professionals of the traumatized mother’s needs may also be helpful.

During the postpartum period, it is suggested that healthcare providers be attentive to the symptoms that may indicate a new mother is traumatized, such as being withdrawn, having a dazed look, or suffering temporary amnesia.

See the linked article above for more information.

A Serious Look at Post-Partum Depression

Post-partum depression hangs a dark cloud over what is otherwise supposed to be a happy, blissful time of unconditional love. Generalizations of tears, insecurities and hopelessness do not grasp the entirety of what PPD can entail.

A licensed professional counselor with a focus on post-partum depression recently gave a presentation to a moms’ group in my area describing symptoms, signs and prevention of PPD.

She shared a checklist that you can view online. She also recommended Post-Partum Survival Guide: It wasn’t supposed to be like this as a good resource for information, but I was unable to find it to purchase online. Surprisingly (or not), post-partum depression is still not widely studied and certainly not clearly understood. Some practitioners, be they doctors, counselors or psychologists, do not recognize PPD as an illness. For yourself or your friends, it is important to make sure that the person whose help you seek shares your philosophies and is compatible with the mom and her family.

Everyone is encouraged, of course, to research for themselves on this topic, and information provided here is not intended for medical advice. If you or someone you know shows signs of PPD, seek help. Sometimes just having someone validate the feelings is all that is needed. Other times, medication might be needed, but that is at the discretion of the doctor and client.

Here are a few suggestions, however, that are easily provided as a friend or that can usually be obtained if you only ask. We were told that these can help with regular depression, too.

Take time for healing
Eat, sleep, exercise
Take breaks
Maintain marital intimacy, dates (does not have to include sex)
Recognize achievements even if it’s just changing the diapers all day
Laugh daily
Express negative feelings
Attend to positive feelings, a gratitude journal might be helpful
Act to change, don’t just talk about it
Let go of self-blame
Get social support
Recharge your batteries
Let go of expectations
Have a loose structure; plan to rest
Allow some crying time; set a timer for 20 minutes if needed, but cut yourself off when the timer goes off
Avoid major life changes, if possible

With up to twenty percent of American women experiencing PPD, it is necessary to be aware, especially for African-American women and women in lower income levels who are more at-risk.

There is also Postpartum Support International that has a toll-free helpline and is working to pass legislation in support for mothers. Please visit their site for more information. An additional good article on PPD is on Scientific American.

Know the resources in your area. Be familiar with the signs and symptoms. Be willing to help a fellow mom. Be willing to ask for help.

Anesthesia and Brain Development

Today I came across this article in which the author describes research being performed to determine anesthesia’s effect on developing brains. The article is talking about children who undergo surgery but can easily relate to the use of epidural anesthesia in birth. Many practitioners blow off parental concerns related to effects of anesthesia in labor, despite their validity. While a lot of investigation is going on about the effects of television, vaccinations, video games, etc. on our children’s brains why are we not spending more time/money/energy on the events surrounding their entrance into the world?

Women Willing To Accept “Natural Birth Risk”

A study done in the UK shows that women are more likely to accept risks to have a “natural birth” (I think ‘natural’ means ‘vaginal’ in this case, not ‘drug free’) than their care providers are. When women are given the power to make an informed choice about their births, they are willing to take risks to avoid a cesarean section.

To be fair, this wasn’t a very broad study. However, the majority of the women chose to take the risks and go for the “natural” birth. With attitudes like that, it is hard to imagine why the cesarean rates are so high. I feel it must have something to do with the care provider’s influence or sway over the woman while she is in labor.

Click here to read the article.

Post Traumatic Stress Disorder After Childbirth

There has been a great deal of awareness about Postpartum Depression in recent years, but not so with Post Traumatic Stress Disorder after childbirth. The reason for this is likely that people believed this to be a very rare disorder. Only three years ago, after my son was born and I began to experience symptoms of this disorder, there was barely any information available about it online or elsewhere. The rate of occurrence was reported to be between 1.5 and 5.9%. There were only two websites at that time that focused on this issue, both of which were from other countries.

There is a new survey out that suggests that PTSD after childbirth occurs quite a bit more frequently then previously thought. The survey is called New Mothers Speak Out and was a follow up survey to the Childbirth Collective’s Listening To Mothers II survey. The survey found that 9% of the 900 women screened met all of the diagnostic criteria for PTSD, and 18% showed some signs of it.

This new data indicates that many more women are suffering from PTSD, or symptoms of trauma after childbirth then previously thought. It is not clear why there is a discrepancy in figures, if it is because the women are not seeking treatment, or they are being misdiagnosed. Either way, it is very good that this issue is being brought to people’s attention.

One of the main risk factors for PTSD is having negative interactions with care providers and staff during your birth experience, and feeling not in control of your labor or birth. When women, birth care providers, and staff are aware of these risk factors, adjustments can be made that may help prevent PTSD or symptoms of trauma from occurring. Women may decide to choose providers or birth settings where they feel they will have more control over their experience and will be respected. Care providers and staff should be aware of how their treatment affects women and strive to allow her to be in control of her own experience and to respect her wishes and individuality. It is also shown that a large amount of medical interventions can be a big risk factor for experiencing PTSD after childbirth. Both women and care providers should be aware of this and try not to use interventions that are not necessary. Another risk factor is previous trauma, which can be screened for before a woman gives birth. If previous trauma is an issue it may be helpful for the care provider and the woman to strategize on how to work with this issue during labor and birth. Debriefing shortly after a birth that was perceived as traumatic by the mother can also be very helpful for some women and this should be an option for women who find themselves experiencing symptoms of trauma.

The Wall Street Journal just ran an article about this issue entitled Birth Trauma: Stress Disorder Afflicts Moms. There is a very interesting accompanying podcast found here.

Today, there are more resources available for PTSD after childbirth then there was three years ago when I was searching for information. There is a growing awareness of the issue and this will hopefully help to prevent it from occurring in the majority of cases. In the cases where there are true emergency situations, an awareness and the subsequent adjustments in treatment of the mother and her baby can hopefully help to minimize the trauma that the woman might experience.