Tag: waterloo region

Dr. Ryan J Van Lieshout, MD, PhD, FRCPC

*A note from Climb Out of the Darkness Waterloo Region: Postpartum Depression is one of six diagnosable conditions which affect birthing parents during the postpartum period. This group of conditions, Perinatal Mood and Anxiety Disorders, can be experienced at any point during pregnancy and postpartum. The blog post below speaks directly to research, treatment and affects of Postpartum Depression. For more information regarding other Perinatal Mood and Anxiety Disorders, continue to follow us on Facebook at https://www.facebook.com/ClimbOutTeamWaterlooRegion throughout May and June as we share more knowledge and expertise from Waterloo Region.

Postpartum Depression and Its Impact
Postpartum depression (PPD) is the most common complication of childbirth, affecting 20% of mothers. Left untreated PPD increases the risk of future depressive episodes, parenting difficulties, and problems with mother-infant attachment. The children of mothers with PPD struggle more in school and are three times more likely to develop emotional and behavioural problems. They also have five times the risk of these problems in adolescence, and are eight times more likely to develop depression in adulthood.

The COVID-19 pandemic has further exposed vulnerabilities in systems that lead to inequalities for mothers with mental health problems and their children and has profoundly changed mothers’ preferences for receiving mental healthcare (i.e., to virtual/online). Even under ideal conditions, the healthcare system is poorly equipped to treat problems requiring urgent psychotherapy, and as few as one in ten mothers with PPD receive evidence-based care. Even when detected, mothers rarely have access to the treatments they most prefer (i.e., psychotherapy), and are treated by their family doctors with medications. They also face long wait times to access specialist psychiatric services or have to pay up to $225 per hour for private psychological treatment.

Current clinical practice guidelines recommend evidence-based psychotherapies (e.g., cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT)) for the majority of mothers with PPD. Medications are recommended after psychotherapy, but are often prescribed before them because psychotherapy is so difficult to access.

The Impact of Treatment
Without treatment, up to 40% of women will have PPD symptoms until their children enter school. While treating PPD can reduce its adverse effects, safe, timely, accessible interventions are essential to optimizing for mothers, their partners and their children. Treating PPD not only helps mothers, but can have significant positive effects for their partners and children. Indeed, studies of evidence-based psychotherapies or mother-infant interventions (those focused on mother-infant interactions) suggest that treating mothers has the potential to improve the mother-infant relationship and reduce expressions of sadness, fussiness and disengagement among infants. Treating PPD also reduces parenting stress and improves maternal reports of emotion regulation in infants. Emotion regulation is particularly important because it is associated with a 3-fold increase in the risk of later school failure, polysubstance dependence, and criminal conviction,11 and is implicated in the development of almost all forms of psychiatric problems.

Recently, our group used neurophysiological methods to show that PPD treatment results in healthy changes in the brain and behavioural systems core to emotion regulation in infants. In this work, maternal receipt of group CBT for PPD led to a normalization of brain and parasympathetic nervous system physiology to that seen in the infants of non-depressed mothers.

Innovation in Increasing Access to Psychotherapy
One of the biggest barriers to realizing these improvements is the difficulty women have accessing psychotherapy for PPD. The need for engaging, easily accessible, safe, and effective psychotherapeutic treatments is urgent. While computerized CBT and psychotherapy apps are widely available, significant time and motivation are required for success, discontinuation rates are high, and therapist support is required for clinically meaningful gains.

In order to meet the need of women for psychotherapy in the perinatal period, researchers have recently developed several novel methods of service delivery that can increase the number of women receiving effective treatment for PPD. These methods capitalize on the widespread availability of reliable internet connections, the efficiency of group therapy, and the concept of task-shifting (the process of delegation whereby tasks are moved from specialized experts to those with less training (e.g., nurses, recovered peers)).

For example, we recently trained public health nurses to provide group CBT for PPD, and recent data suggest that this is effective regardless of whether it is delivered in-person or online. We have also task-shifted group delivery of CBT-informed support for PPD to women who have previously experienced and recovered from PPD. Recovered peers are seen as a particularly credible, non-judgemental, and empathic source of support, reducing stigma and judgement. Peers can normalize symptoms for women with PPD, provide valuable knowledge based on experience, and serve as positive role models, highlighting different pathways to recovery. The early results of this work suggest that when such interventions are delivered by peers, they can increase treatment uptake and effectively treat PPD.

Finally, we recently developed and are in the process of testing a 1-day CBT-based workshop for PPD. The delivery of psychotherapy in large groups (up to 30 participants) is a relatively new idea, but may be capable of addressing mothers’ needs as well as treating the number of women with PPD that are required to reduce its burden on a large scale. Brief (i.e., 1-Day) interventions are appealing because contain the core content of longer treatments, but their efficiency makes them easier to deliver beyond traditional treatment settings. The early results of these workshops suggest that they may effectively reduce depression and anxiety whether they are delivered face-to-face or online. We now hope to test the effectiveness of these workshops delivered by public health nurses to increase their scalability.

The Future of PPD Treatment
Researchers around the world are also testing out different models of psychotherapy delivery that could increase availability and uptake. Refinements to online and app-delivered psychotherapies, as well as the evolution of chatbots (artificial intelligence software that can simulate a conversation or chat with a user in natural language through apps, website, and telephone) could improve access in Canada and around the world.

Research suggests that treating PPD can have benefits for mothers and their families, and that a many different types of interventions can be effective. However, the best outcomes are obtained by mothers and their families when they have easy access to the evidence-based treatments that they want and need. Many new and innovative approaches to increasing psychotherapy engagement and availability are being developed and tested, and could help mothers to recover and lead happier and healthier lives, with benefits for them and their families.

*Dr. Van Lieshout is a perinatal psychiatrist and Co-Director of Elle Psychotherapy (elletherapy.ca). He is also the Canada Research Chair in the Perinatal Programming of Mental Disorders and the Albert Einstein/Irving Zucker Chair in Neuroscience at McMaster University where his research focuses on increasing access to evidence-based psychotherapies, as well as their impact on offspring brain development.

Lisa Brenner
http://www.wiserootstherapies.com/

The postpartum time, also referred to as the fourth trimester, in Ayurveda is known as the Sacred Window. It is said that the way the first 42 days after delivery are spent have a direct impact on the next 42 years of life.

So, what is Ayurveda and how does it relate to postpartum? Ayurveda is a centuries old practice originating in India known as the ‘Science of Life’ and offers a holistic and individual approach to health and wellness. Having an understanding of our constitution and the elements at play within us can help guide us in our day to day lives. This will help us find and maintain a balance of the three Doshas leading to greater overall well-being. The three Doshas are Vata (air/ether), Pitta (fire/water), and Kapha (earth/water). During birth and in the immediate postpartum (and longer if we are not adequately cared for) Vata is known to be high, vitiated, or out of balance. When Vata is unbalanced we can be fearful, anxious, angry, have trouble sleeping, become depressed, feel overwhelmed, and disconnected. When Vata is left unchecked this can lead to greater un-wellness and dis-ease.

There are 4 pillars of care for postpartum healing. Rest, Nutrition, Meditation and Breathwork, and Body Care. Let’s explore each of these in more detail.

Rest
In Western culture taking time to rest is often seen as a weakness. We are expected to get up and keep doing all the things. Ayurveda views the first six weeks postpartum as the most critical in ensuring our long-term health. Birthers are supported in resting so as to give their body, mind, and spirit time to balance and process everything they have just experienced. It is advised to have complete rest for at least two weeks, and try to stay off of your feet as much as possible for the remaining 4 weeks. The only task birthers should be doing during this timeframe is bonding with their baby.

Nutrition
The focus for postpartum nutrition should be on the following: warmth, comfort, nutrient dense, easy to digest, and well-spiced. This will aid in healing and rejuvenation and will help to promote good digestion for both the birther and their baby. Foods like soup, porridge, stew, rice pudding, dhal, kitchari, stewed fruit, and spices like cinnamon, ginger, cloves, nutmeg, cumin, and black pepper will provide much needed warmth and nourishment. It is also important to increase your healthy fats intake which will help to balance hormones quickly, build your milk supply, and improve your mood.

Meditation and Breathwork
Mindfulness techniques are a wonderful practice to utilize in postpartum. Practices like meditation, breathwork, journaling, or gratitude lists helps to focus the mind and calm the nervous system. This takes us out of the fight or flight response and into a more relaxed state where we can be calm and think clearly. The best way to do this is to integrate mindfulness into your day. As you are feeding the baby, taking a shower, or going for a walk, you can bring your awareness to your breath and feel it flowing in and out of the body; you can do a counting meditation, inhaling to 5 and exhaling to 5; you can simply take notice of your surroundings…what do you see or hear? Even 10 minutes a day can have a profound effect on your mental well-being.

Body Care
One of the most beautiful aspects of Ayurvedic care is bodywork. There are 3 key components of body care in postpartum. The first is massage. Warm oil massages known as Abhyanga are lovely to receive anytime, but especially in postpartum. One of the best ways to soothe and lower Vata is through touch. Massage is a wonderful tool for both the birther and their baby. Even 5-10 minutes of self-massage every day can have profound effects on your energy, mood, sleep, and overall well-being. Massaging your baby helps their digestion, enhances bonding and communication, promotes deeper sleep, tones muscles, and releases tension from being in the fetal position.The second component is herbal baths. A special blend of herbs that are healing and soothing for postpartum are made into a tea which can be added to the bathwater, used as a sitz bath, placed in a peri bottle for use after going to the washroom, or used diluted around the umbilical cord for healing. The third component is belly binding. A long piece of cotton muslin is wrapped around the body firmly but gently from just below the hip bones up to the lower ribs. This can help with stability in the hips and pelvis and reduces the feeling of emptiness in the womb. It is a gentle support for the muscles and organs.

Incorporating these practices into your postpartum care will help you to feel strong, empowered, and well: physically, mentally, and emotionally. Receiving proper care allows you to feel calm, radiant, and aligned, avoiding depletion, aging, overwhelm, anxiety, and depression.

As many of us no longer have a village around us to support us, it is necessary to create this for ourselves however we can. Before baby arrives make a list of everyone that you can call on for support. Family, friends, and neighbours can take turns preparing meals, cleaning the house, assisting with older siblings, and anything else that needs to be done. If you don’t have family nearby, hiring a postpartum doula is a great way to ensure you get the rest you need to not only fully heal and recover but also to thrive in your new role as a parent.

TK Pritchard (they/he)
Executive Director
SHORE Centre
shorecentre.ca
Honouring sexuality, diversity and choice.

Think back to your experiences of sexual health education. What did you learn about pregnancy? Perhaps you learned how to prevent it – although I would hazard a guess that the information didn’t go far beyond “Wear a condom,” “Don’t have sex,” or “Birth control exists but we aren’t going to tell you much about it.” Maybe you learned about sperm and eggs, but I imagine few learned about emergency contraception or about pregnancy options including parenting, adoption and abortion. Perhaps you were taught nothing at all – and you wouldn’t be alone in that reality, either.

When we learn about pregnancy, it is often romanticized as a key journey in life-a milestone-which you will embark on only when you are older, financially stable, and in a heterosexual, cisgender marriage. You will create a pregnancy easily via sex involving a penis and vagina, being pregnant will be beautiful and uncomplicated, and you will naturally know what to do once the baby arrives.

But this is so far from the lived experiences of many. We don’t talk openly about the myriad of ways families can be formed and when we do, we create hierarchies about the best ways to do this. LGBTQ2S+ people are commonly left out of pregnancy and parenting education all together. We still leave little room for the possibility that people may not want to get pregnant or parent at all, and we don’t talk about pregnancy options such as abortion. Many people who do want to get pregnant will struggle with infertility, miscarriage, and pregnancy loss. Additionally, countless will be coerced into continuing a pregnancy and others will have no financial, material, or emotional support systems in place.

We don’t talk nearly enough about the physical, emotional and social changes and realities of being pregnant, giving birth, and parenting. We set people up to struggle by not offering all the information, by glossing over how and why people may need support, and by painting a surface level ideal which all people are expected to successfully achieve. When we uphold a societal expectation that pregnancy and parenting are expected, manageable, and uncomplicated we are directly impacting people’s social, emotional, and mental health and well-being. This romanticized narrative provides such little information about what actually happens to people’s bodies when they are pregnant that the various changes and effects can be overwhelming and scary. When someone is struggling (which is common), the real lack of transparent information, and the normalization that pregnancy/parenting is purely wonderful and innate can leave them feeling helpless, alone and like a failure.

What if we stopped framing pregnancy as a beautiful mystery or life goal for when you are married, or as a punishment for having sex? What if we just talked about it honestly? Imagine a world where all people receive age-appropriate education which prioritizes choice and autonomy in every sense. Where young people learn that there are many different ways to create a family. Where we speak openly about the complexities of pregnancy, being clear that a person with a uterus gets to choose if they wish to be pregnant. Where education includes the idea that some people want to get pregnant and are unable to, and that pregnancy loss is common.

We could live in this world. We could build real, comprehensive information about pregnancy and all of the social, emotional, mental and physical components into the health and physical education curriculum. We could ensure it is also provided to people of all ages through healthcare providers, prenatal/parenting classes and more. This would allow people to make truly informed choices and provide vital and realistic information and expectations. Information is powerful both at an individual and collective level. If more people had a complex understanding of pregnancy it could shape so many important aspects of our communities. For example, it could dismantle stigma around needing support during pregnancy, after giving birth and after pregnancy loss, or change our healthcare system to better care for people experiencing pregnancies or provide more funding for inclusive, client-centered community services There is so much that we could do better.

It’s more than time that we recognize we need real, honest and inclusive education from the start. You are not broken or a failure if your experience does not look the way your schoolteacher or prenatal/parenting class described it to you. There is room for your story here, and in fact it’s our collective stories which can help make space for others. Pregnancy and parenting can be many things and your experiences are valid. You are not broken or alone, we just don’t talk about it.

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