To many of us from afar, it may seem that the postpartum period is one of pure, inexplicable joy brought by something so precious and exquisite as new life.
To many new mothers, however, it may become frustrating and unclear why the postnatal period can be filled with almost just the opposite: “baby blues” or, more intense than that, postpartum depression.
The term “baby blues” refers to an emotional state of tearfulness, unhappiness, worry, self-doubt and fatigue. Typically, these emotions emerge within a week after delivery and diminish within a week or two. Postpartum depression (PPD) is usually characterized by more intense and unsubsiding feelings of emptiness, hopelessness, rage, loneliness, worry, sadness, failure, and despair; anxiety is commonly interwoven among these features of PPD1.
Women with PPD are not alone! Research has demonstrated that PPD affects about 10-15% of women in the year after giving birth2,3. Certain risk factors place a woman at an increased risk for developing PPD including1:
- History of depression, anxiety, or psychiatric illness
- Family member who has been diagnosed with depression
- Stressful life event during pregnancy or shortly after delivery such as the death of a loved one
- Medical complications during delivery
- Mixed feelings about the pregnancy
- Lack of emotional social support
- Drug or alcohol abuse problems
PPD can be attributed to a multitude of factors. Estrogen and progesterone drop quickly following childbirth which triggers chemical changes in the brain1. Furthermore, sleep deprivation is a common theme among new mothers that can exacerbate the symptoms of PPD.
Extensive literature highlights the efficacy of physical exercise as an intervention for depression, specifically because of its positive effect on sleep, physical well-being, and stress. Research focusing on the effect of exercise specifically on postpartum depression is more limited. The existing literature has found pram-walking4, yoga5, and individualized aerobic exercise programs6-9 to be effective in lessening depressive symptoms.
As women’s health physical therapists, we may be bias ourselves to be more cognizant of our patients’ physical symptoms. I challenge us to widen our view so that we see the whole presentation: mind, body, and spirit. These new mothers are overwhelmed. Their energy tanks are on empty; all their fuel is burned simply by getting through…rather, surviving the day.
I propose an increased emphasis on exercise prescription for this population. Many mothers will whip out their laundry lists of excuses (mighty valid, may I say):
- “I have no time”
- “I have no energy”
- “I have no one to watch the baby”
- “I’m too tired”
I propose we purposefully listen, empathize, and validate these concerns and engage in conversation about the potential benefits about incorporating physical activity into their daily routine. I propose we work together to develop a feasible plan and I propose that we, as physical therapists, support this plan by researching and providing resources to our patients about community resources available to this population (pram-walking groups, etc.).
We can do more for our postpartum patients to improve their quality of life than helping to strengthen the pelvic floor and abdominals. We can be a teammate to these ladies in their pursuit of a more physically active, happier, and bliss-filled life.
- National institute of mental health. “Postpartum depression facts.” Available at:https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtms
- Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. 2006;33(4):323-331.
- Stocky A, Lynch J. Acute psychiatric disturbance in pregnancy and the puerperium. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(1):73-87.
- Armstrong K, Edwards H. The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women. Int J Nurs Pract. 2004;10(4):177-194.
- Buttner MM, Brock RL, O’Hara MW, Stuart S. Efficacy of yoga for depressed postpartum women: A randomized controlled trial. Complement Ther Clin Pract. 2015;21(2):94-100.
- Daley AJ, Blamey RV, Jolly K, et al. A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial. Psychol Med. 2015;45(11):2413-2425.
- Dritsa M, Da Costa D, Dupuis G, Lowensteyn I, Khalifé S. Effects of a home-based exercise intervention on fatigue in postpartum depressed women: Results of a randomized controlled trial. Annals of Behavioral Medicine. 2008;35(2):179-187.
- Dritsa M, Dupuis G, Lowensteyn I, Da Costa D. Effects of home-based exercise on fatigue in postpartum depressed women: who is more likely to benefit and why? J Psychosom Res. 2009;67(2):159-163.
- Heh SS, Huang LH, Ho SM, Fu YY, Wang LL. Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women. 2008;35(1):60-65.