The devastating gaps in women’s health care—especially postpartum—is now painfully in the spotlight. It is heartbreaking that it has taken an unimaginable tragedy for the world to pay attention to a crisis women have been living through for far too long.
Women deserve to be heard, believed, supported, and cared for—not only during pregnancy, but in the vulnerable weeks and months that follow.
One of the foundational problems is that women are often dismissed, ignored, not believed, told to “just relax”, exercise & eat better, and to just wait and things will “just get better.”
Medical dismissal, frankly medical gaslighting is not just frustrating, but also damaging and potentially dangerous. There is a difference between disease management and health care.
What does “postpartum” even mean?
One of the huge problems is that medicine itself does NOT agree on a definition!
Both the American College of Obstetricians (ACOG) and Gynecologists & American Academy of Family Physicians (AAFP) define the postpartum period as “12 weeks following birth” and it’s often referred to as the “4th trimester.”
Meanwhile, the Center for Disease Control (CDC) and World Health Organization (WHO) define the postpartum period up to a year after giving birth.
Different definitions may serve certain purposes, but a woman’s health care needs DO NOT END at six or 12 weeks post-delivery! Rather they often become LOUDER and more problematic, as the nutritional deficiencies, hormone imbalances and sleep deprivation cause longer and further damage to the brain. I cannot emphasize enough how dangerous this is for the woman as well as her family.
Growing a baby takes a multitude of energy and nutrients from the mother so without supplementation and replenishing these, the mother is depleted for years post-birth!
Therefore, I have my patients continue a comprehensive (not prescription, those are the most inadequate) prenatal vitamin and high quality Omega3 for the first six months postpartum or six months post-nursing or pumping, whichever is longer.
What causes postpartum depression, anxiety and psychosis?
A multitude of hormones plummet dramatically post birth for 72 hours. Then the potential hormone fluctuations that follow—which as a doctor I see minimally for 6 months, often a year and easily as long as TWO years postpartum—can cause various neurotransmitter disturbances in the brain. This leads to every version of anxiety, depression and even psychosis.
Psychosis does not look like what is portrayed in the movies. It can be that the woman is fully functioning on the outside, however randomly her brain will see, say, hear, feel things that are there that are not.
Progesterone metabolizes into allopregnanolone which moderates GABA, the calming neurotransmitter. Without proper progesterone levels the brain literally cannot sleep or be in a relaxed state.
Progesterone replacement is VERY safe, very calming to the brain and nervous system.
Without it, your nervous system is likely to ramp up into various levels of anxiety. Since there are no known “normal” progesterone reference ranges, please make an appointment with an experienced hormone expert to prescribe the correct dose of progesterone, if any, for you.
The same lack of normal applies to all possible nutrient deficiencies so it’s best to see a functional medicine doctor for proper doses and levels.
Why are supplements during postpartum important?
Without certain nutrients, the brain is vulnerable to misfiring, which can lead to anxiety, depression and psychosis. Most easily deficient and essential to brain functioning are B vitamins. Many women unknowingly have a MTHFR genetic issue that causes a dysfunction at various levels to methylate B vitamins.
So often, I keep or put women on a specific methylated B complex that is right for them during pregnancy and postpartum.
There are many case reports on neuropsychiatric patients most often having a B12 deficiency, which resolves postpartum symptoms when properly replenished. Vitamin B12 is essential for nerve function so a deficiency can cause a reversible neuropsychiatric syndrome like depression or psychosis. It’s also quite common for more than one deficiency to occur.
What test should a woman ask her doctor about for the postpartum period?
Postpartum depression, anxiety and psychosis are VERY real medical conditions. Postpartum anxiety is the most prevalent of the three as well as the most often missed, overlooked or ignored.
I highly encourage every woman to:
- Schedule a postpartum health screening with your doctor. Telemedicine works great to do appointments right after birth without having to pack up your new baby and get yourself ‘presentable’ to an appointment. In this way, earlier screening is more accessible.
- Ask for screening questionnaires for any symptoms you feel you may have. These can include anxiety, depression, a mix of both, or even psychosis. Do not be afraid to share any unwanted thoughts, auditory or visual disturbances. It is safest for you (and your baby) to share everything you are experiencing, as the brain postpartum is quite potentially vulnerable and your doctor needs all the information to help you.
- Firmly ask for these labs three to six weeks postpartum, or sooner if symptoms present.
- Progesterone
- TSH
- Total T4
- Free T3
- T3 Uptake
- Reverse T3
- Anti-TPO
- Anti-TG
- Homocysteine – (B vitamin function)
- B12, serum
- Magnesium, RBC
- Iron, TIBC, Ferritin
- Folate
- CBC
- CMP
- Thiamine
If you are experiencing a high level of mental disturbance, go to the ER, at any point there can be a medical emergency that needs to be immediately addressed.
After the medical emergency is resolved, then there is time to address underlying causes.
Women Should Not Have to Navigate Postpartum Alone
Our culture harms women with the impossible idea of what mothering “should” look like. But throughout history and across various cultures child raising has also been provided by grandparents, extended family, older siblings, and other community members in addition to parents.
The combination of low hormones and nutrient deficiencies along with lack of sleep for months with a newborn is a recipe for mental disaster. Every woman needs a thorough evaluation as well as support the first year minimally post delivery.
There is care that can help & heal your brain! Please talk to your doctor, or contact our office, about what is going on to get the healthcare you deserve and need after these massive changes in your body.
