Postpartum depression (PPD) is a major depressive episode occurring during pregnancy or within the first year after childbirth. In the setting of PPD a woman will have persistent symptoms, which would include but not be limited to: depressed mood, anxiety, sleep disturbance and/or feeling of being overwhelmed. A true PPD will result "significant functional impairment", ie: a woman will not be able to function well in her day-to-day activities.
PPD is not the same as the “Baby Blues” which is when symptoms are present for only a few days or one to two week. The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the U.S. Preventive Services Task Force all recommend that postpartum women be screened for depression with one of several validated standardized screening tools and offered treatment if indicated. One such standardized screening tool for PPD is called the "Edinburgh Postnatal Depression Scale (EPDS) ". Click the button below and see Handout #17 for a downloadable pdf file of the EPDS that includes the scoring system or you can do an online assessment here.
Screening... Screening... Screening...
According to the American College of Obstetricians and Gynecologists, standardized screening should be preformed at least once during pregnancy, and again during the early postpartum period. Whereas, the American Academy of Pediatrics recommends screening at the well child visits for the first 6 mos (at 1moth, 2 months, 4 months, and 6-months).
Risk Factors:
According to the American Academy of Family Physicians (AAFP) key risk factors are:
Psychiatric and psychological factors:
Social and economic factors:
Pregnancy and birth-related factors:
Medical factors:
One of the best and most effective NaPro Treatments is our protocols for managing Postpartum Depression and Anxiety. Women just LOVE how quickly they respond to this treatment.
We use bioidentical (micronized) progesterone, which can be given either via injection, orally, or even vaginally. We will have a dialogue first, during which time I will provide education regarding the pros and cons of using the different formulations.
My personal preference is to use injectable progesterone:
If you don't like to take shots... or you don't have some to inject you... no problem!
Yes! Progesterone supplementation is safe even if you are breastfeeding your baby.
I prefer to order your progesterone solution from use Kubat's Compounding Pharmacy.
11107 Mill Valley Rd. Omaha, Nebraska, 68154.
Ph: (402) 558-2474; FAX: (402) 561-1252.
Kubat's is one of the few pharmacies who will provide you with an injectable solution that is 100mg/ml. Thus, we can minimize the number of injections you will need to take. Additionally,
the pharmacists there are exceptionally well-versed in providing progesterone for Napro Protocols. After I call in the Rx, a pharmacist will call you to discuss cost and you will confirm you wish to move forward. Kubat's also offers expedited shipping.
Please view the FREEDOM TO TEACH INSTRUCTIONAL VIDEO. Injections should be administered in the upper-outer quadrant of the buttocks (shown in the video) and you should always alternate sides.
Common side effects of the injections are:
Here are a few tips to avoid these common side effects:
Please download the handout entitled, "St. Paul VI Progesterone Injection Instructions & Landmarks" posted below. We will be reviewing this handout together during your Telehealth visits.
Again, only bioidentical hormones supplementation is offered. Bioidentical progesterone can be purchased through a retail pharmacy (eg: CVS, Walgreens, Walmart, etc... it is called "micronized progesterone" as a generic, also known as "Prometrium". Pts can also purchase this via a compounded pharmacy (cash pay only). This medication is generally well-tolerated. Some common side effects are quite pleasant, eg: you may feel more relaxed or sleepy and your might find your mood may improves. Some more unpleasant side effects may be: next-day fatigue, nausea, headaches, or dizziness. Most often the unpleasant side effects can be easily managed by taking the medication right before you lay your head down on the pillow and/or changing to a compounded formulation. Please know prometrium and generic progesterone capsules contain peanut oil, so you CANNOT take this if you have a peanut allergy.
Sometimes the Prometrium or generic micronized progesterone that is purchased will include a package insert which will "warn" of possible birth defects. However, this warning refers to progesterone substitutes that are often prescribed in oral contraception pills, not the bioidentical progesterone we are prescribing. NaPro providers, who were trained at the St. Paul VI Institute, have been safely prescribing micronized progesterone to many, many women to support pregnancies for over 35 yrs and they have not encountered problems.
If the oral medication is not strong enough or if the side effects are bothersome, we can try a vaginal suppository. This will be prescribed for you by a specialty pharmacy called a "compounding pharmacy". You can see a list of compounding pharmacies by viewing Handout #21 here.