"Oh, she’s just got a bit of baby blues,” was about as much as was said about such matters…" – Linda Fairley, on practising midwifery in Manchester, 1970s
We’re back, back in the UK, and I’ve got a head cold to celebrate. It’s very festive! But despite my English virus, I couldn’t be happier or more grateful.
James and I enjoyed our Spanish año, but opportunities for Midwife Diaries kept popping up that we need to be in the UK for. I’ve not lived in the UK for years, and every morning run reminds me how beautiful it is. Morning light on terraced roofs and cottages gives me a sense of belonging, and my top secret midwifery novel is set here in Leicester so it’s taking off under my fingers…
I have so many midwifery topics I want to write about. I’ll be working with an applicant, or writing to a distressed or elated student midwife (those seem to be the two settings, midwifery training is hard!) about a particular topic, and something I thought I knew will shift under my feet.
This is what happened with ‘baby blues’ – I thought I knew the physiology and care concepts well, but it’s like being on shifting ground; if I pull some grass and twigs away there’s a cavern of midwifery knowledge underneath.
The new ideas I found are big and bright.
‘Baby blues’ being the only diagnosis for mentally unwell postnatal Mums is luckily in the midwifery past.
Postnatal depression is much better identified than it used to be, and there is less stigma attached – though care still has a long way to go.
We now understand there is a spectrum of mental being after pregnancy, ranging from severe postpartum psychosis at the most unwell end, to feeling totally well on the other.
Baby blues however, which affects as many as 70% of women between day 3-10 of the postnatal period is often described as ‘normal’.
Midwives and families listen, try and validate women’s feelings, help prioritise sleep and take some pressure off.
The woman will hopefully be monitored carefully to make sure a low mood, anxiety, mood swings and tearfulness don’t go on to the point where postnatal depression is diagnosed, and counselling, antidepressants, or cognitive behavioural therapy are indicated. Postnatal depression still kills women, so this is vital.
I and many of my old colleagues have sat with women while they cried, listened, given hugs, and prescribed the holy trinity of tea, sleep and empathy.
But I’m not sure when I was a practising midwife that I didn’t inadvertently belittle the ‘baby blues’.
I definitely said things like ‘It’s totally normal to feel like this on day 3 or 4.’
Is that a helpful thing to say?
Every woman in the postnatal period has challenges – and having a grand hormonal shift and exhaustion on top of that, is not as one doctor from the 1970s charmingly put it ‘just a trivial, fleeting phenomenon.’
With baby blues, do you know how epic a hormonal change we’re talking about?
Once the hormone factory which is the placenta is no longer in the uterus, oestrogen levels drop off a cliff to become 10% of their pregnancy value.
Want to know how long it takes after birth to get to the 10% mark?
Seriously, that’s like an oestrogen sky dive from space.
Progesterone levels fall as well, becoming almost undetectable only 72 hours after birth. Endorphins fall after labour too.
Prolactin, which is the key hormone involved in milk production, and is known to produce a calming and relaxing effect, rises and falls in line with breastfeeding.
Oxytocin goes up and down like a yoyo with breastfeeding too.
And by day 7 after birth, oestrogen levels are for most women at postmenopausal levels!!!
We know oestrogen has a significant effect on serotonin, the neurotransmitter that is involved in mood regulation, so it follows that some women at least will be affected by this physiology.
This ‘baby blues’ thing is not so much a hormonal rollercoaster as a hormonal ‘Changing Rooms’.
In a short space of time, a woman’s mental space has its emotional furniture moved around unasked, the fireplace ripped out, walls painted a different colour, and a baby put in!
I’m not sure ‘baby blues’ quite does it justice.
The thing is, because 30-70% of women experience mood changes, it is ‘normal’, even if it doesn’t feel like it.
A better word might be ‘expected’ as I don’t think something so mind altering should be described as ‘normal’.
Some women don’t seem to be affected by the hormone changes. This is interesting because there appears to be a genetic protection that some women have.
In one fascinating study, a group of women were given hormones to create a ‘fake pregnancy’, and after three months, the hormones were removed abruptly to mimic ‘birth’. In that study 50% of women were completely unaffected.
But the 50% of women in the study who’d previously had postnatal depression developed depression again – the researchers thought this was because of the drop in oestrogen.
The researchers hypothesised the difference in reaction was genetically influenced.
There are also interesting studies which suggest for many women, oestrogen supplementation could help with postnatal depression.
In a Cochrane review, it was found that oestrogen therapy did produce an improvement in women with severe postnatal depression, and at least one specialist obstetrician believes this is a key part of UK postnatal depression therapy that’s lacking.
Dr Studd even suggests that there’s a pattern: women who get PMT, have wonderful pregnancies with a great sense of wellbeing, then suffer postnatal depression, and go on to suffer menopausal depression, are likely experiencing oestrogen withdrawal.
Oestrogen therapy could be something that works well for them – though this treatment requires more research, and fiddling about with hormones is something so complex it shouldn’t be done lightly. Oestrogen supplementation could decrease the amount of breast milk produced, for example.
But for women who are near suicidal, and on ineffective antidepressants, it could be life changing.
I’m getting off my original topic.
When I’m ill or down, I like to rationalise it. Not having a reason for feeling that way can make you feel crazy.
I think that if we explained to women experiencing the ‘baby blues’ that the hormonal changes are similar to those of the menopause, except over a timeframe of 7 days, and with emphasis on endorphins and serotonin, it would help.
We could even venture that baby blues at around day 3 or 4 might act as a reminder to other members of a woman’s ‘tribe’ that she needs help, and no parent can do it all on their own. I find it hard to believe evolution would have selected for ‘baby blues’ unless it had a function.
Conjecture maybe, but the hormone facts are important and something I’d want to know in my first week after having a baby.
Overall we need to give good psychological care, because of the epic physiological changes.
Now I’d love to hear from you, if you have a moment:
1. What do you say and suggest to women experiencing baby blues in the first week postnatally?
2. Have you experienced baby blues yourself? Would knowing the specifics of the huge hormonal changes have helped you?
I also hope that you remember to self-care when giving emotionally challenging support to women – empathy takes a heck of a lot of energy, and down time for midwives is an essential part of care and practise.
Have a wonderful winter week, much love,