Excerpted from The Fourth Trimester
WHAT EXACTLY IS HAPPENING WITH MY HORMONES?
The changes we experience during pregnancy and birth encompass more than physical and energetic changes: they also include hormonal changes too. During pregnancy, you not only grew a baby inside you, but you also grew an organ—the placenta. After you deliver the placenta, your hormones start to shift dramatically. In the first day or two after delivery, you will probably experience an exhilarating high. No matter how your baby was born, what satisfaction and accomplishment it is to finally meet your baby! It is normally after the first forty-eight hours, as the endorphins start to wear off, that women begin to experience fluctuations in moods and emotions. This is what is labeled the “baby blues.” Because there is so much information and fear out there about postpartum depression, many women panic, thinking that this weepy time will last forever. For most women, these cascading emotions normalize at around two weeks postpartum.
From the time the placenta was birthed to when breast milk comes in, a woman’s estrogen and progesterone levels plummet to the levels of a menopausal woman. Progesterone, the calm and chill hormone that you became accustomed to in pregnancy, goes offline, so the hormones needed for breastfeeding can come online more quickly. The process of hormonal calibration continues for months, as the body works to get the uterus back to normal size and to produce an increasing amount of breast milk for a growing baby. The body is flushing itself of excess fluids that store now-unnecessary hormones. One of the reasons that new mothers are encouraged to stay warm and sweat a lot is so this process of flushing can be thorough and complete. Tears can also be a part of this process of elimination.
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Rather than understanding the role of each specific hormone, it is important to understand how they work in coordination with each other. For this purpose, I love the way that Dr. Claudia Welch, in her book Balance Your Hormones, Balance Your Life, divides hormones into two categories: yin sex hormones and yang stress hormones. Our body only has so much energy and raw material with which to create hormones. Because our survival is the fundamental need, our body will always prioritize the making of stress hormones that are critical to our survival. Many things register as a greater threat to our nervous system than they actually are. Perceived threat results in a cascade of stress hormones being released. If we are under stress, our body will direct resources to our survival responses, which are related to stress, rather than to our pleasure and sex circuitry, which is related to our ability to relax, bond, and breastfeed.
Fortunately the converse is also true: if sex hormones are being produced, the body is less likely to produce stress hormones. So if a woman feels safe, secure, and protected, her body will produce the sex hormones that reinforce this feeling of relaxation, which, in turn, helps with milk production and the healing process.
The Hormones You Need to Know About
The sex hormones are the feel-good hormones. Women’s dominant sex hormones are estrogen and progesterone. Both are produced in the ovaries until, early in the second trimester of pregnancy, the placenta takes over the hormone production and they are produced by the placenta.
Estrogen is the juiciest female hormone, giving women our trademark sex characteristics, like voluptuous breasts, wide hips, and full lips. During pregnancy, estrogen maintains the strong uterine lining, increases the blood circulation, and acts as the master regulator of the other key hormones. After giving birth, estrogen levels drop and stay low for as long as a woman is breastfeeding. Estrogen is found in every tissue of the body and is responsible for lubrication.
Progesterone is estrogen’s counterpart. A woman’s progesterone levels increase to up to two hundred times their normal levels during pregnancy. So it is a steep drop when progesterone leaves the body after the delivery of the placenta, allowing milk production to begin. After the baby is born and the placenta is delivered, the ovaries need to take over the job of producing progesterone again. Progesterone is what gives some pregnant women a happy, dreamy, even-keeled emotional state; the sharp decrease in progesterone can leave a new mom feeling like she has less resilience to all the changes postpartum. Progesterone only returns to a normal level when a woman begins ovulating.
Oxytocin has been called the “love hormone” and the “cuddle hormone.” It promotes attachment and bonding. Oxytocin is released after a thirty-second hug, and also while watching cute puppy or baby videos. Oxytocin is responsible for the fetal ejection reflex, uterine contractions during birth, and the special bonding that occurs between all of the people who are present at the birth. Touch is one of the best ways to encourage oxytocin and why new moms need as much loving touch as they are offering to their new babies.
Relaxin is produced at ten times its normal rate during pregnancy, so ligaments and joints soften, making space in the pelvis for the baby to come out. Because relaxin affects all the joints, some women may experience pain in other joints in the body, as they become looser and less stable. As long as women are breastfeeding, relaxin will continue to be produced in the body, so joints and ligaments may not return to their most strong and stable place until after breastfeeding has been stopped.
Stress hormones aren’t all bad. They help to accelerate some fetal development as well as give women the added energy needed to push a baby out! But most often, we are producing way more stress hormones than we need, and that blocks us from accessing the positive, nurturing sex hormones that we need to experience a pleasant, even blissful, postpartum period.
Adrenaline and cortisol work together. Adrenaline is responsible for a short-term burst of fight-or-flight energy that then quickly decreases. Cortisol is always released with adrenaline but is longer acting and, therefore, has longer-lasting effects. During pregnancy, cortisol increases, especially during the last trimester. This is thought to help speed fetal lung and brain development just before birth. After childbirth, while it is mostly the sex hormones that are responsible for milk production and letdown, some cortisol is also needed. Too much cortisol, though, will compete with the sex hormones, contribute to anxiety and stress, and block access to the oxytocin circuitry that can make the milk letdown of breastfeeding feel relaxing and pleasurable.
While a stress response to an event as big as birth is normal, this healthy amount of stress can be mitigated when a postpartum mother is bathed in sex hormones. The “baby blues” can be less blue if a woman is surrounded by people who love her and she is receiving love through delicious food and caring touch.
To understand more about the role of hormones and how to work with them holistically, I highly recommend the book WomanCode by Alisa Vitti. This book was so instrumental in my own healing process that I asked Alisa to write the foreword for this book. Her website, FLOLiving.com, is an accessible resource that provides hormonal support postpartum and beyond so that you can easily understand the steps it takes to balance your hormones with nutrition and lifestyle changes. Implementing the five-step protocol, which has helped many women heal from gynecological challenges including painful periods to polycystic ovarian syndrome to fertility challenges, is an accessible step to balancing your hormones postpartum.
If you need more help and support, the next step is to request bloodwork from your ob-gyn, a naturopath or a functional medicine doctor. Knowing what is happening with your physiology, with respect to immunity and thyroid function, is important before landing on diagnoses of depression.
Asking for Blood Work
Just as it is a proactive step in your health care to schedule a postpartum visit with a physical therapist, it is also wise to ask your ob-gyn at your six-week checkup for a full blood panel to check your hormone levels and immune function. Because antidepressants and birth control pills are often blanket prescriptions in women’s health, underlying hormonal or immune system imbalances may be missed and left untreated. This situation can be avoided by simply asking for blood work at your doctor visit.
It is especially important to check your hormone levels before considering taking antidepressants, so you are treating the right problem. I have recently seen an increasing number of women in my practice who have developed autoimmune disorders in the postpartum period. Many women experience a significant difference in thyroid function after having a baby. A staggering one in twelve postpartum women is diagnosed with Hashimoto’s disease, an autoimmune disorder of the thyroid. Under-functioning thyroid and adrenal glands can present much like depression. The blood work can also show you how your body is processing cortisol.
While a mother and baby physically separate at birth, their energy and emotional systems are still intricately interconnected.
After you deliver the placenta, your hormone levels drop dramatically and begin a months’ long process of recalibration from growing and birthing a baby to now nursing a baby and helping your body recover.
Between forty-eight hours and two weeks postpartum it is normal to be weepy and emotional, also known as the “baby blues.”
Sometimes hormone imbalances, autoimmune disorders, isolation, and lack of support can look like depression.
Before taking the pill or antidepressants, ask your ob-gyn or a naturopath for a blood-work panel to check your hormones and your immune-system function.
Are there parts of you that feel left behind in the birth experience? Do you feel that your baby was able to complete his or her birth process?
What is the experience like for you to be physically separate yet very emotionally and energetically connected to your baby now?
In what ways can you honor and stay connected to your womb space?
Excerpt from The Fourth Trimester by Kimberly Ann Johnson, published by Shambhala Publications, 2017.