Health beyond pregnancy: The postpartum period

In some traditional cultures including the Chinese, the postpartum period consists of a month of special care designed to allow the new mother to concentrate on recovering from pregnancy and childbirth, and on breastfeeding her baby. During this month, close relatives, usually the maternal mother or other senior female members of the family, will either organise daily visits or stay in the new mother’s home to undertake all domestic tasks and ensure that both mother and baby enjoy proper nutrition and rest. In contrast, in many Western countries women have little or no support during the first weeks after childbirth, which may prevent or delay their recovery. In addition, women often have to go back to work well before they are back to full strength putting an enormous burden on their energy and health.

Understandably, many of the concerns and preventative measures during the third trimester of pregnancy relate to labour and childbirth. However, the importance of health during the postpartum period tends to be somewhat overlooked and as a result women may feel isolated, depressed, and unable to cope with their new situation. This can be a very difficult time especially for first-time mothers who may have little idea what to expect or unrealistic expectations of their new role, and can find themselves physically unable to perform some of the tasks they could easily undertake before childbirth.

 TCM views of postpartum symptoms

After labour is over it's time to rest and recover

According to TCM, a great deal of Blood and Qi are used up during pregnancy, labour, and childbirth; inevitably resulting in the deficiency of these substances. In addition, TCM regards breast milk as an extension of the mother’s Blood, and restoring the blood lost during childbirth is seen as an essential requirement to produce not only enough milk but milk that is rich enough to provide all the essential nutrients to the baby. Interestingly, periods may return sooner for mothers who choose not to breastfeed (1), which establishes a connection between breast feeding and menstrual blood.

When Qi and Blood are severely deficient or have been deficient during the pregnancy, stagnation may also occur as the body struggles to continue functioning without enough resources. Stagnation of Qi and Blood may also occur when there have been complications during the pregnancy or the mother has over-exercised or not followed a suitable life-style. The table below shows how the most common postpartum symptoms can reflect the TCM patterns of Qi deficiency, Blood deficiency and Qi and Blood stagnation:

TCM patterns	Possible post-partum symptoms
Blood deficiency (Liver or Heart)	Insufficient lactation Insomnia Anxiety Depression
Qi Deficiency (Spleen or Kidney)	Exhaustion Frequent urination Low appetite Indigestion Bloating after eating Loose stools Incontinence
Qi/Blood stagnation (Liver or uterus)	Hormonal imbalance Abdominal pain Blocked milk ducts Painful breasts

While deficiencies of Qi and Blood are a natural consequence of pregnancy and childbirth, leaving them unchecked can cause many of the symptoms associated with the postpartum period. Because of this, having a month to rest and recover may prove essential for the health of both mother and child. This may need a mental shift in Western societies, where new mothers feel they should go back to a normal level of activity and of physical fitness as soon as possible. This contributes to a decline in general health that is often attributed to lack of sleep but which is in fact a result of never recovering properly from the pregnancy.
 

Self help techniques that involve an adequate diet and rest are often enought to provide relief to mild symptoms during the postpartum period. Where symptoms are severe or involve pain, inflammation, bleeding or a high temperature a health practitioner or midwife needs to be contacted immediately. 

A qualified TCM practitioner can offer individual advice regarding diet and supplementation. Acupuncture and Chinese herbal medicine can also be used to strengthen the Qi and Blood and relieve symptoms such as mastitis, difficult lactation, insomnia, anxiety, depression, pain, digestive problems, and incontinence. 

What you can do

Plan ahead, is all in the preparation!

Cooking help is essential after childbirth

In order to support good health after pregnancy steps need to be taken from the third trimester to ensure that you will be able to obtain proper rest and nutrition during the first month following childbirth. Without this, you may end up with deep exhaustion and depression as a result of lack of rest and feeling isolated and overwhelmed. 

Your partner or other members of your family need to be aware of the fact that you will need help with house chores and cooking during this time as you are going to need as much rest and possible. Establishing who is able to help beforehand will take a huge stress off your shoulders and will bring enormous benefit to you and your baby. Do not be shy to ask friends to sign up for checking on you and help with a few chores or even offer you a home-cooked meal at different times during the first month. If there is not family or friends around, then you and your partner need to make sure you will be able to have at least one nutritious home-cooked meal every day and that you will not be forced to perform tasks that you may not be up to. I have seen many women who waste away during this period as a result of not being able to prepare themselves proper meals because they cannot go shopping or they spend so much time nursing that there is no time or energy left to cook. To avoid going through this or having to resort to take-away food or un-wholesome pre-packed supermarket meals that are laden with salt, sugar and chemical additives you and/or your friends and family can prepare some wholesome meals to be kept in your freezer for days in which there is no help at hand.

Once the above measures are in place, you will be able to do the essential things in the postpartum  period:
 

1) Rest rest rest: 

 You may feel that you are not doing much and haven’t done since before giving birth, but it is not so. Your body has instead been heavily taxed by the growth of a baby that not only took a lot of room but used up a lot of the energy resources you would have normally had for yourself. You spent 9 months surviving on less that you would normally need to feel ok, and then went into a process in which the whole of your body went into an enormous effort to open the way and give birth to your baby. This probably lasted longer than a marathon, at the very least. 

You will undoubtedly feel exhausted after all this, and the whole of your being will be screaming for rest every time you have the opportunity. If you make a conscious effort to lie down and sleep as much as you can during the first month postpartum, you will have a lot more chances to get back to full strength sooner rather than later. Rest at this time will be the prime contributor to rebuilding your Qi which will in turn fuel the proper functioning of all your organs.

2) Eat to nourish your Qi and your Blood: 

Chicken soup helps strengthen the body

•  At this time you will benefit greatly from following the basic TCM advice regarding diet, putting particular emphasis on avoiding cold and raw foods that will take more energy than they will provide. Soups and stews seasoned with ginger and warming herbs such as fennel and basil, will provide you with the warmth and nutrition that you need at this time. Chicken soup is regarded as particularly nourishing and can be prepared onion, ginger, and vegetables. This can be prepared with tofu, miso, and sweet potatoes or pumpkin if chicken is not an option.

• Protein intake needs to be high especially for nursing mothers as they can easily become increasingly Blood deficient. Small amounts of good quality protein need to be consumed at regular intervals throughout the day. If you have little appetite, favour protein-rich snacks over carbohydrates so that you have enough sustenance.

• Foods that particularly nourish the Blood include dark green leafy vegetables such as curly kale, spinach; dark beans such as black soya beans, kidney beans, aduki beans; and naturally sweet foods such as grapes, molasses, dates, figs, and unsulfured apricots.

• Toxins in the form of alcohol, drugs and chemical additives need to be avoided completely. Not only will they go straight into your breast milk, but they will prevent your full recovery.

• Coffee should also be avoided as it can put too much stress on the adrenal glands which will have a detrimental effect on the whole body. Black tea can be taken sparingly.

3) Keep warm:
Because it is a function of Blood and Qi to warm the channels and protect the body from pathogenic factors, new mothers (especially lactating ones) are not encouraged to expose themselves to the elements. Exposing yourself to cold, dampness, excessive heat, or wind before building up your energetic resources through rest, warmth, and an appropriate diet can have a long-term detrimental effect on your health. This is also true for the new born who, having just come out into the world, has no way of fending off new influences or pathogens. 

Making a conscious effort to recover from pregnancy and childbirth through proper nourishment and rest will provide a good basis for the mother's future health and will also provide the necessary resources for abundant and nutritious mother's milk. This is also a time where the partner can feel useful through providing help and support rather than feeling redundant or left out of the close bond formed between mother and baby.

 Reference:

1. http://www.bellybelly.com.au/post-natal/your-period-and-ovulation-after-baby