Four Steps to Managing the Postnatal Hormone Rollercoaster
Although it’s relatively well understood that hormonal changes around the menstrual cycle can affect mood and mental health, it’s perhaps less well-publicised how the enormous hormonal changes after childbirth - far greater than those around your period - can have a huge impact on your mood. How well your body deals with hormones depends on how well you look after yourself during pregnancy and after. In this article, I explain the hormones that govern pregnancy and your postnatal phase, and give you some practical ideas for simple lifestyle changes that might be the difference between embracing motherhood and feeling resentful of it.
A whistlestop guide to hormones in pregnancy
During pregnancy your two sex hormones, oestrogen and progesterone are at very high levels. It has been likened to the equivalent of 100 birth control pills a day! But starting with the delivery of your placenta and continuing for 3-5 days after giving birth, the levels of these two hormones drop dramatically, back to your pre-pregnancy levels. It’s a very sudden drop, considered the biggest hormonal change in the shortest period of time at any stage life in humans. If you think about common premenstrual symptoms - tearfulness, low mood, grumpiness, irritability and so on - and magnify that many times over then you can begin to appreciate the sort of emotional upheaval this can cause.
Thyroid hormone productions increase during pregnancy, too. These support brain development in the baby, and regulate metabolism and energy in the mother. This means having a properly functioning thyroid is important for maintaining energy levels and supporting normal weight loss after giving birth. Importantly from a mental health point of view, postnatal thyroid issues is a risk factor for postnatal depression. Correct production and functioning of thyroid hormones depend primarily on the nutrient iodine, as well as selenium, zinc and tyrosine (more on nutrition and mental health next week).
Another hormone to know about that can have an effect on mental health is cortisol. This hormone is needed for energy regulation and is released in response to stress. However, it’s important to know not all stress is bad as we experience normal body stress everyday, e.g. during exercise or to wake us up in the morning (for a more in depth article of stress, see my previous blog post on how stress affects health). In the third trimester of pregnancy, cortisol production increases to three times higher than pre-pregnancy levels - some consider this to be the reason we experience a surge of energy and display ’nesting’ behaviour towards the end of pregnancy!
Postnatal hormones
When you go into labour, the hormone oxytocin is responsible for powering your contractions. This is one reason why remaining at home for as long as you can in a calm, dimly lit environment can help ensure your labour progresses well and doesn’t stall. Oxytocin is known as the ‘love’ hormone - so it is released when you are feeling relaxed and loved. Oxytocin also stimulates breastmilk production; conversely, a baby sucking on the breast stimulates oxytocin production - it’s a beautiful hormonal conversation between baby and mother. This hormonal conversation promotes bonding, which is particularly important in the first few hours after birth - the mother’s body is primed to receive that initial oxytocin message to start the conversation.
As well as promoting bonding, oxytocin sustains a good, steady mood in mum. It’s one of the reasons why breastfeeding is a protective factor against postnatal depression. During pregnancy, the hormones oestrogen and progesterone give you a sense of well-being, but as these hormones are back to pre-pregnancy levels, oxytocin and another hormone, prolactin (which stimulates milk let-down in breastfeeding) step in instead.
However, oxytocin is also known as the ’shy’ hormone - any hint of stress and it gets frightened. This means that going to hospital too early during labour could slow down contractions, while a traumatic birth or one that doesn’t go to plan can cause a release of stress hormones which could delay bonding and breastfeeding, and have long term effects on mental health.
Similarly, when your oestrogen and progesterone return to normal levels around your first period postpartum, they can be affected by stress hormones. Incomplete healing from birth, broken nights, nutrient depletion from pregnancy, childbirth and breastfeeding, the sheer responsibility of looking after a newborn - these are all major contributors to stress levels in a mum postnatally, sometimes many years later. Overtime, the body becomes unable to cope effectively with the constant need to deal with the stress. As a result, the risk for postnatal mental health issues can happen at any time around childbirth, not just in the first year.
Four steps to balancing hormones
Hormones are complicated, and it is incredible the changes you go through during and after pregnancy. Once you know what happens to hormones in this time, you can start to appreciate the importance of really paying attention to supporting them.
Making small lifestyle changes is the best way to do this. Although every person is different, almost everyone needs to start with these four basic steps:
Sleep and rest
This is always one of the hardest to sell to new mums given how difficult it is to get more than 2 hours of sleep at a time. But your body is amazingly resilient, and as long as you are making sure you are taking the opportunity to sleep when you can and ensuring it is good quality sleep, you can get good rest. Here are three ways to make the most of it:
Get to bed early and have at least one nap in the daytime.
At night, keep your room cool and use blackout blinds.
Avoid any screens after 8pm - try not to use your phone or watch TV
(I wrote about this more extensively in last week’s post, have a read!)
Gentle movement
Quite often mums want to start exercising as soon as they can after giving birth. This is probably as much to do with a personal sense of wellbeing and control as a desire to lose weight. However, in the 9 months of growing your baby, your body has gone through enormous changes - loosened joints, weakened connective tissue, separated abdominals, stretched pelvic floor - that can take up to a year to heal properly. You need to leave more time than you think! But movement is also vital for healing and for good mental health. These three steps can help make sure you are moving wisely:
Wait at least 6 weeks after giving birth before starting any movement; longer if you’ve had a C-section
Start with walking with your baby in a carrier
Find a professional or join a class but make sure they know what they’re doing. Look for someone with specialist training and experience in postnatal exercise, and make sure they mention the pelvic floor at some point in their promotional material. Any good postnatal movement coach needs to know how to protect and heal the pelvic floor.
Relax and laugh
Waking up multiple times in the night is not much fun, and it can be easy to find yourself becoming more and more tense as time goes on. Plus it is so hard to find time as a new mother to even do the basics such as have a shower, let alone do something for yourself. But don’t forget that you are still you. You’ve profoundly changed as a mother, but you are still important. In fact you are the most important person to your little one. I hate being prescriptive and telling people to meditate or practice mindfulness. These are helpful, but depending where you are, the idea of sitting down to a meditation is laughable. So I love to tell clients to focus on joy. Because laughing is a fantastically great way to relax. Try scrunching up your shoulders and tensing your muscles and then laughing - it’s not easy, or at least it probably forced you to drop your shoulders and lean back a bit! Finding joy in your new role as mother can go a long way to maintaining good mental health. These are my favourite ways to find calm and joy:
Listen to music and dance. Choose your favourite. Your baby and toddler will probably enjoy you lip-syncing and dancing to Spice Girls’ Wannabe more than singing another nursery rhyme to them.
Replace a shower with a bath a couple of times a week at least. If you don’t have a bath, try a foot soak. Make sure it’s a good ten minutes where you can shut the door, light some candles and listen to some music that you love.
Talk to others. You are definitely not alone. There are other mothers out there who are finding motherhood tough. Often describing what you’re going through can make it seem a lot better than you thought, and often by the end of the chat you have probably found something to laugh about.
Eat well
I’m going to go into this in much more detail in next week’s post focusing on nutrition and mental health, but I can’t not mention it here too! There are specific nutrients that are particularly important for good mental health which you’ll learn next week, but for now, these three principles will get you most of the way there anyway:
Eat real food regularly - have at least three meals and two snacks a day
Make sure you have a source of protein and fat at each meal and snack
Aim to add as much colour as possible to your plate every day. I find it useful to take a photo of my food for a few days and check how colourful it is. The skies the limit here - go with as much colour as you can.
There’s no avoiding the hormone rollercoaster your body goes through from pregnancy to childbirth through the postnatal phase to your first period and your breastfeeding journey. But the way your body responds to it can be changed. Honouring the fourth trimester (read my article from two weeks ago!), learning how to rest with a newborn (last week’s article!) and taking care of your food (next week’s article) will go a long way to getting you to a place of calm and joy as a mother.