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What does LDRP stand for?

LDRP stands for Labour Delivery Recovery and Postnatal


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Joanne - or Joe - Bingley was a nurse with 20 years experience. She longed for a child and had experienced problems with conceiving and had at least two known miscarriages. She had also been turned down for both IVF and adoption because she was overweight.So she was overjoyed to eventually gave birth to a daughter Emily Jane in February 2010. However efforts to breastfeed were not successful and Emily was losing weight. So Joe began to bottle-feed and her daughter started to thrivenbspbut this perceived failure appears to have been the trigger for a severe bout of postnatal depression. Joe was only sleeping a couple of hours a night had a 39glazed39 look and expressed the belief that she was a bad mother and that Emily would be better off without her.nbspShe repeatedly requested help and felt that her pleas were not being taken seriously. And then 10 weeks after Emily was born she announced early one morning to her sleepy husband Chris that she was going out for a walk and proceeded to throw herself under a train.An independent report based upon the evidence available concluded that she should have been hospitalised at least 3 days prior to her death and that if this had been done she would probably have made a full recovery.Her widowed husband Chris is nownbspfocusing on publicising this issue and de-stigmatising postnatal depression. So what IS postnatal depressionnbspnbspSymptoms of postnatal depressionUp to 80 of women suffer with some form of postnatal 39baby blues39 with symptoms such as tearfulness irritability sleeplessness headaches difficulty concentrating and feelings of isolation - all of which may last for a few days. However this is not the same as postnatal depression or postpartum depression PPD nor is it a precursor to the more serious postnatal psychosis.nbspAccording to the MIND report 2006 one in six women are known to be affected by postnatal depression either during pregnancy or following childbirth.nbspSymptoms of PPD can occur anytime in the first year after giving birth and include but are not limited to the followingFeeling low despondent and hopelessnbspFeeling overwhelmed unable to cope or inadequateDisrupted sleep patterns including insomnia or sleeping all the timeLoss of appetite ndash or feeling hungry but not being able to eatLow or no energy or exhaustionFeeling empty and lacking pleasure in activities that would normally be enjoyableWithdrawing socially and having little interest in the outside worldImpaired motor skills such as speaking and writingnbspDifficulty in concentrating or making decisionsPhysical symptoms such as stomach and chest pains headaches and blurred visionFeeling anxious or getting panic attacksFeeling guilty about being a bad mothernbspBeing irritable and hostile towards othersFeeling sad and tearful crying easily or without reason and being unable to be comfortedFeeling hostility towards - or a lack of interest in - the babyObsessive fears about the babyrsquos health andor wellbeing andThoughts about death self-harm suicide ornbspharming the baby.nbspCuriously a small but significant proportion of men also suffer postnatal depression. Men have been shown to experience a drop of a third in their testosterone levels when they become fathers. This is thought to reduce the aggression the man feels and to increase their frustration tolerance in order to protect the baby while they are very vulnerable.nbspSeveral factors have been shown to make postnatal depression more likely includingnbspBeing a single parent being in a poor relationship or the pregnancy being unplanned or unwantedA previous history of depression or depression related to a pregnancyLow socioeconomic status. Women in the lowest income brackets are more than twice as likely to get postnatal depression as those in the highest.Bottle rather than breast-feedingBeing a smokernbspHaving low self-esteemStresses relating to a lack of social support or childcareAnxiety and stress relating to life or the pregnancyProblems with the baby39s temperament or health including colicBeing lesbian bisexual or of African origin.nbspFurthermore some of these factors have been shown to be additive.nbspPostpartum psychosis is less common than postnatal depression and involves a complete break with reality involvingnbspthought disturbances delusions hallucinations andor disorganised speech andor behaviour. Whereas postnatal depression will eventually spontaneously resolve postpartum psychosis will not and needs intervention.nbspGiven that this problem afflicts one in every six women many public figures have spoken openly about their experience of postnatal depression as shown below.nbspnbspThe medical approach to postnatal depressionAllopathic medicine defines postnatal depression as a psychological or psychiatric problem and treats the symptoms withnbspantidepressant drugs andor psychotherapy.nbspThis approach is based upon the theory that depression is caused by a deficiency of neurotransmitters and specifically serotonin the 39feel good39 hormone and noradrenaline norepinephrine. These neurotransmittersnbspare fundamental to health because they transmit nerve impulses throughout the nervous system and have a profound effect on mood and self-esteem in addition to having many other important functions within the body.In truth medicine and psychiatry have no idea what mental illness is and they have created an artificial division between the mind which is assumed to be the brain and the body. Whereas natural medicine regards depression as a symptom of an underlying disorder and considers that there may be many different causes which are currently all being lumped together under the same heading and treated in a one-size-fits-all way. Whatever the cause allopathic medicine probably only alleviates the symptom until such time as the body can right itself.nbspBelow are listed just some of the possible causes for postnatal depression.nbspnbspSerotonin deficiency and PPDSerotonin is a neurotransmitter produced in the brain that is often referred to as the 39feel good39 hormone. In order to synthesise serotonin the brain needs a steady supply of the amino acid tryptophan and vitamin B6.Most protein foods contain a very small percentage of tryptophan when compared with other amino acids added to which only about 3 percent of the tryptophan consumed is actually converted into serotonin in the brain.Serotonin is the end result of a series of biochemical steps which convert the tryptophan in the diet into 5 hydroxy-tryptophan 5HTP and on to serotonin. Each of these steps requires specific nutrients.Iron and vitamin B3 niacin are required to convert tryptophan into 5HTP along with sufficient other B vitamins and magnesium which is required to convert vitamin B6 into its active form pyridoxyl-5-phosphate or P5P. Without enough 5HTP and P5P available in the brain serotonin cannot be synthesised at adequate levels.nbspThe adrenal stress hormone cortisol also causes tryptophan to be converted into kynurenine rather than serotonin. In addition drinking coffee smoking drinking alcohol and eating chocolate all promote the release of cortisol and may reduce the amount of serotonin produced.The antidepressant drugs known as selective serotonin reuptake inhibitors SSRIs artificially increase the amount of serotonin available to the neurons. However another kind of postnatal depression can be caused by low levels of noradrenaline norepinephrine and this kind of depression will be resistant to - or may actually be made worse by - taking SSRIs.nbspThe depression experienced by women with low serotonin levels is usually accompanied by a great deal of anxiety whereas that induced by low noradrenaline levels feels like they are in a deep dark hole. Women with low noradrenaline levels often improve dramatically in response to effective treatment of underlying thyroid and adrenal gland disorders see below.nbspnbspnbspPostnatal adrenal gland exhaustionOur adrenal glands are responsible for producing the stress hormones adrenaline epinephrine noradrenaline norephinephrine cortisol and dehydroepiandrosteronenbspDHEA in addition to oestrogen and aldosterone.It is estimated that the levels of stress most of us face on a daily basis are now 100 times higher than those faced by our grandparents. Added to which the adrenal glands also have a very high requirement for nutrients including vitamins C and B and most people39s diets are now deficient in these essential nutrients. nbspThese factors combine to produce underfunctioning or exhaustion of the adrenal glands and this may be precipitated by the nutritional and physical demands of pregnancy and childbirth. There are also dramatic changes in the balance of hormones after birth see below which can also cause the adrenal glands to crash. In addition the brain synthesises serotonin and dopamine in line with levels of adrenaline and noradrenaline so underfunctioning of the adrenal glands may affect the amount of serotonin produced in the brain.There are several tests that can be used to diagnose adrenal fatigue and effective treatment might include injections of vitamins ginseng andor liquorice supplements specific adrenal support complexes and the use of desiccated bovine adrenal glands. It is also important to allowing enough sleep and rest for the adrenal glands to recover and for the diet to be optimal.nbspnbspPostpartum thyroiditisPostpartum thyroiditis PPT is the development of a transient postnatal thyroid disorder which normally spontaneously resolves within a year.nbspHowever the problem often recurs after subsequent pregnancies and a quarter of women who have had postnatal thyroid disorders will go on to develop permanent hypothyroidism in the 10 years after giving birth.One in every 13 women will develop postpartum thyroiditis which is an autoimmune disorder. Up to half of women who test positive for antithyroid antibodies in the first trimester willnbspdevelop thyroiditis in the postpartum period. In addition to which such women stand a 70 chance of experiencing PPT in subsequent pregnancies.A quarter of women who tested positive but did not go on to develop PPT during the first pregnancy will develop it during subsequent pregnancies. And for those women that have experienced PPT once nearly half will go on to experience it in at least one more pregnancy.Suboptimal maternal thyroid function has serious implications for the developing embryo too - especially in the first trimester.nbspIn consideration of this in 2002 the American Association of ClinicalnbspEndocrinologists AACE recommendednbspscreening all women considering conceptionnbspandor all pregnant women in the first trimester for thyroid dysfunction.Subclinical hypothyroidism ie blood tests are returned as being 39normal39 andor the presence ofnbspthyroid peroxidase antibodies has been found to be associated with subfertility and infertility miscarriage preterm deliverynbspgestational hypertension during pregnancy pre-eclampsia postpartum thyroiditis and postpartum depression.nbspEffective treatment for PPT may include short term use of thyroxine combined with nutritional support of the thyroid gland using either blends containing the amino acid tyrosine which is the main nutritional precursor for all the thyroid hormones and the mineral iodine or desiccated bovine thyroid glands to help regenerate the thyroid gland.The fact that Joe Bingley was overweight had problems conceiving had experienced multiple miscarriages and finally had severe postnatal depression may indicate that thyroid problems may have been the root cause of her PPD.nbspnbspLow progesterone and postpartum depressionProgesterone is so named because it is the pro-gestational hormone supporting conception survival of the fertilised egg maintenance of the endometrium which nourishes the fertilised egg and embryo and a full-term pregnancy. It also governs the synthesis of the adrenal hormones including adrenaline nor-adrenaline and cortisol as well as the sex hormones.At ovulation progesterone levels rise tenfold from 2-3 mg per day to approximately 22-25 mg per day. This progesterone surge is the source of increased libido at this time.nbspIf fertilisation of the egg does not occur within ten or twelve days progesterone levels fall dramatically triggering the shedding of the endometrium as menstruation. If the egg is fertilised the empty egg casing in the ovary the corpus luteum starts to produce progesterone until production is taken over by the placenta which secretes an ever increasing supply reaching 300-400 mgday during the third trimester - 100X preovulation levelsnbspIf progesterone levels drop during the pregnancy or the progesterone receptor sites become blocked then this may result in miscarriage as the endometrium is shed.After birth there is a major shut downnbspof progesterone production and this may be associated with the loss of adrenal and thyroid gland function and the development of postnatal depression.nbspFor this reason some physicians administer high doses of progesterone by injection after birth for 8 days and the woman then uses progesterone pessaries until menstruation resumes. The results of this therapy can be very dramatic - starting to work within hours and according to research conducted by the Pope Paul VI Institute in 2004 decreasing symptoms to one quarter of those pre-therapy. Furthermore 95 of women respond positively which makes this approach far more effective than either psychotherapy or antidepressants and one that some consider should be the first line of approach in the treatment of postpartum depression.nbspApplying a natural progesterone cream to the skin can help to remedy these symptoms.nbspProgesterone and oestrogen are kept in balance and endocrine disrupting chemicals which mimic oestrogen and bind to oestrogen receptor sites may ultimately be responsible for progesterone deficits. The widespread use of synthetic sex hormones in the contraceptive pill depot injections and hormone-releasing coils may also be responsible for creating an imbalance.nbspAlso according to a study at the University of California Irvine levels of placental corticotropin-releasing hormone CRH during the 25th week of pregnancy were a predictor of the likelihood of developing postpartum depression.nbspnbspLow blood sugar and postnatal depressionLow or poorly controlled blood sugar levels hypoglycaemia and dysglycaemia respectively are known to be associated with depression and the dramatic changes in the functioning of the endocrine system at birth may cause compromised insulin production or there may be a blocking of insulin receptor sites on the cells. This can create functional hypoglycaemia where even if blood glucose levels are 39normal39 sugar cannot enter the cells. This produces depression and often results in attempts to remedy the low blood sugar by comfort eating which leads to weight gain.nbspTreatment includes regular small nutritious meals eliminating all sugar and processed foods and possibly taking supplements to help support pancreatic function such as chromium or glucose tolerance factor GTF.nbspnbspZinc deficiency and postpartum depressionTrace minerals are now very deficient in our soils due to modern farming methods and then they are further depleted by food refining processing and preparation. The refining of wheat flour for example removes 80 of zinc. And in some areas of the world zinc deficiency is thought to be responsible fornbsplearning disabilities in one-third of children.nbspOther factors that deplete zinc include stress this can be physiological such as pregnancy and not necessarily psychological viral infections the consumption of sugar coffee alcohol and nicotine. In addition the taking of corticosteroid drugs andor the contraceptive pill depletes body reserves and digestive problems such as low stomach acid which may go undiagnosed may prevent its absorption.The levels of the trace minerals copper and zinc tend to be inversely related to one another. The developing foetusnbsphas a high requirement for zinc which is required for growth and development. Maternal blood levels of zinc are known to fall by about 30 during pregnancy and then to decline further during breast-feeding as the motherrsquos reserves are used up. Rising maternal copper levels coupled with zinc and vitamin B deficiency make postnatal depression much more likely according to the late orthomolecular medicine practitioner Dr Carl Pfieffer MD PhD. He also stated that he had never seen evidence of postnatal depression in patients treated with zinc and vitamin B6.One Polish study found that the mother39s mood postnatally was inversely related to their blood zinc levels and that thenbspmothers who tested positive during pregnancy for mild depressive symptoms also had depleted blood zinc levels. nbspIf you are positive for more than 3 of the following consider the possibility of zinc deficiencynbspStretch marksIrritabilityLoss of appetitePoor wound healingFrequent infectionsWhite spots on 2 or more nailsA baby who has reflux or colicPoor sense of smell or tastePale skinAcne or greasy skinCreaky joints andHair loss.nbspCopper toxicity and postpartum depressionIn a study by Crayton and Walsh published in the Journal of Trace Elements in Medicine and Biology innbsp2006 copper levels were found to be significantly higher in women that had a historynbspof postnatal depression compared both to non-depressed women and to depressed women without a historynbspof postnatal depression. However in this study it appears to be the balance between copper and zinc that is the key factor as zinc levels did notnbspdiffer across the three groups.nbspExcess copper in the brain is known to alter the balance of dopamine and noradrenaline norepinephrine two mood-regulating chemicals.During pregnancy a womanrsquos blood copper levels typically double normalising again after childbirth. The authors of the study speculate that in women who develop postpartum depression copper levels fail to normalise possibly because of a genetically determined flaw in the protein that regulates copper levels. Or it may be that as the body39s resources are mobilised during pregnancy that copper appears in the circulation from storage or that the hormones of pregnancy cause elevated copper levels in some way.nbspMagnesium deficiency and postnatal depressionMagnesium serves several extremely important roles in the body. One is that it is involved in the synthesis of steroid and sex hormones. Another is that there is a reciprocal relationship between the macrominerals calcium and magnesium which act as electrolytes in the body with magnesium regulating the passage of calcium ions within neurons controlling nitric oxide production and enabling nerve conduction.Deficiency of magnesium is well known to produce neuropathologiesnbspwhich could manifest as depression.nbspAgain our diets have become deficient in magnesium with only 16 of the magnesium found in whole wheat remaining in refined flour. The heavy emphasis on eating calcium rich foodstuffs especially during pregnancy may also help to create a relative magnesium deficiency. Finally magnesium deficiency can also be induced by stressnbsphormones.nbspPregnancy and childbirth are a huge physical metabolic and psychological challenge. Magnesium is important to muscle contraction and the powerful and prolonged contractions of labour will consume vast amounts of magnesium. The production of stress hormones may also compound this problem further exacerbating any deficiency. Recoveries of less than 7 days from major depression have been demonstrated using 500ndash1200 mg of magnesium per day.nbspnbspOther nutritional deficiencies implicated in PPDThe fact is that a deficiency of any single nutrient can alter brain function leading to depression and the mother39s body has just raided all its resources to make a small human being and so has been under the greatest nutrient stress of her life.nbspnbspquotEven in the absence of laboratory validation of nutritional deficiencies numerous studies utilising rigorous scientific designs have demonstrated impressive benefits from nutritional supplementation.quotDr Melvin Werbach MDnbspOther nutrient deficiencies which have been implicated in PPT includeOmega oil deficiencynbspOmega 3 oils are critical to brain function as they form an important component of the cell membrane and help to regulate the passage of all molecules in to and out of the cell. Again almost everyone is thought to have become deficient in omega 3 oils in recent decades due to dietary changes.nbspThe mother39s brain may become massively depleted of omega-3 fatty acids during pregnancy when the brain of the foetus is developing quickly - or may be depleted further during breastfeeding.nbspB vitamin deficiency Some of the most common deficiencies found in depressed individuals are folic acid riboflavin vitamin B12 and vitamin B6. Supplementing these B vitamins can result in dramatic improvements in mood. Taking the contraceptive pill is also known to deplete vitamin B6 which is essential in the manufacture of serotonin. nbspS adenosyl methionine deficiency S adenosyl methionine or SAM is a methyl donor which is important in the synthesis of brain compounds including neurotransmitters. Supplementing folic acid increases SAM.nbspnbspAntidepressants and postnatal depressionAllopathic medicine treats postpartum depression symptomatically mostly using selective serotonin reuptake inhibitors SSRIs including Prozac Zoloft and Paxil.nbspThese drugs work by preventing the reuptake of the neurotransmitter serotonin in the synapses between nerve cells thus artificially elevating their levels in the brain. They also draw serotonin out of storage in the brain cells into the synapses.nbspEven where the depression is related to low neurotransmitternbsplevels in the brain the underlying cause is often a deficiency of the nutritional precursors that the body needs to make these neurotransmitters. So this approach depletes the body39s reserves of serotonin and the serotonin precursors arenbspused up more rapidly making the underlying deficiency worse. Overstimulation of the neurons may also result in permanent brain damage or the downregulation of serotonin receptors thus compounding the original problem.nbspSSRIs may also create dangerously low levels of the neurotransmitter dopamine in some people.nbspAll of which meansnbspthat once the woman has started to take antidepressants it can be difficult to wean off unless the underlying problems are addressed concurrently.The other issue for the new mother is that whatever pharmaceutical drugs they take will be passed to the baby in the breast milk and appear to concentrate in the baby39s brain. Some studies have linked the maternal use of Prozac to colic in nursing infants. And a baby with colic can push an already stressed mother to breaking point.nbspSome mothers choose to take antidepressants and bottle feed their babies. But this can deprive the baby of their intended nutrition and also deprives the mother of the oxytocin release associated with breastfeeding which calms her and aids bonding with her baby. This can in turn worsen the depression.nbspSSRIs can bring feelings of numbness and of separateness from others and common side-effects include nausea drowsiness insomnia sexual dysfunction headaches trembling digestive problems and agitation. SSRI drugs also seem to disinhibit some people resulting in violence suicide and the mother potentially harming her baby.Many experts including the psychiatrists and authors Joseph Glenmullen M.D. and Peter R. Breggin M.D. think that SSRIs are overprescribed and that their dangers are dramatically downplayed.nbspTheir use needs to be tapered off gradually with the guidance of a knowledgeable physician. And the SSRIs may take weeks to take effect so they are not the immediate fix some imagine.nbspFinally according to a study conducted by Appleby et al 1997 counselling proved as effective as antidepressant therapy over a 12 week period.nbspSuggestions for postnatal depressionMost of us are malnourished and this becomes particularly critical when trying to get pregnant during the pregnancy and after the birth when the mother has to continue nourishing herself and her child. Consider the following suggestions.Eat sufficient protein It is important to consume enough high quality animal protein to rebuild the body and to produce breast milk so make sure you include a portion of meat fish eggs or cheese at every mealtime or snack. You might want to consider including a protein shake in addition to protein consumed at meals.Stay hydratednbspIt is particularly important to maintain hydration levels if you are breastfeeding and it is suggested that nursing mothers drink ten tall glasses of water every day. Avoid alcohol Alcohol is also best avoided for a variety of reasons including causing dehydration making any depression worse and being passed to the baby in the breast milk.Reduce caffeine and sugar consumptionnbspHigh caffeine and sugar intakes are associated with higher rates of depression and are best avoided.Stabilise your blood sugar levels Eliminate sugar and refined foods and eat small amounts of complex carbohydrates such as whole grains regularly.nbspAvoid low fat dietsnbspStrict low fat diets have been linked to feelings of depression and even suicide Nutrition Review April 2000.nbspEat and supplement omega 3 oils Includenbspplenty of oily fish nuts seeds grass fed meat and eggs from chickens fed on high omega 3 seeds in addition to supplementing omega 3 oils throughout pregnancy and breastfeeding.nbspSupplement a multivitaminmineralnbspTake a high quality multi especially formulated for preconception pregnancy andor breastfeeding.nbspIncrease your zinc intakenbspEspecially if you identified with several of the zinc deficiency symptoms listed above. Good dietary sources of zinc include lean meat poultry fish organ meats and whole grain bread. Supplement zinc at about 25 mg per day.Increase your B vitaminsnbspRich sources of B vitamins include brewer39s yeast wholegrains green leafy vegetables beans and wheat germ. In addition to which you may want to take a vitamin B complex supplement containing around 50 to 100mg of the major B vitamins and possibly 800mcg of folic acid and 88mcg vitamin B12 day take together.Increase your magnesiumnbspintakenbspMagnesium rich foods include seeds nuts beans dark green leafy vegetables and seafood. Supplement magnesium as glycine or taurine 125 mg with each meal and before bedtime. nbspEat tryptophan-containing foodsnbspFoods that contain tryptophan the serotonin precursor include turkey cottage cheese eggs lobster mung beans tofu bananas pineapple spinach asparagus and sunflower and flaxseeds and their oils andor supplement 5HTP.Exercise and fresh air Do not underestimate the curative value of daylight and gentle exercise.Consistenthealthy sleep patterns Try to go to bed at the same time every night and if you need to take a nap during the day.nbspFinally postnatal depression is a physiological and psychological crisis and as such requires serious timely and meaningful intervention. If you need help make sure that you ask.nbspnbspFurther resourcesFor more about postnatal depression please see thenbspJoe Bingley Memorial Foundation website.You might also be interested in the followingnbspEndocrine Gland DisordersAntidepressant Prescribing UpBook Review Your Thyroid and How to Keep it HealthyBook Review Adrenal FatigueDepression and Mercury ToxicityModern MalnutritionToxic LegacyFor a comprehensive approach to detoxification and diet refer tonbspThe Natural Recovery Plan booknbspIs Depression Overdiagnosednbsplisted undernbspFatigue Syndromes and Toxicitynbspin the Audio HubnbspnbspnbspWhat39s Wrong With PsychiatryPsychiatry No Science No CuresDifference Between Medical Disease amp Psychiatric DisordernbspOr for all media use the Search facility at the top of the pagenbspPostnatal depressionnbspArticle summaryThis article looks at the recent tragic suicide of Joanne Bingley while suffering with severe postnatal depression. Whilst the allopathic medical world treats depression using antidepressants the naturopathic world regards depression as a symptom of a variety of toxicities deficiencies and hormonal disorders and seeks to identify and treat the underlying cause. The most common likely causes are detailed along with restorative treatment options.nbspnbspClick the icon for the blog version of this articlenbspClick the icon ifnbspyou would like to republish this articleTo receive a FREE report and the newsletter fill in your email details in the box on the top left.The Natural Recovery Plan Newsletter December 2011 Issue 24. Copyright Alison Adams 2011. All rights reservedDr Alison AdamsnbspDentist Naturopath Author and Online Health