“The postpartum period is a time of transition for a woman and her new family, when adjustments need to be made on physical, psychological and social levels.”
-Dr. Elizabeth Shaw, McMaster University
It comes as no surprise that after growing a baby for 9 months, a woman’s body has gone through many physical changes. But what happens after delivery? Though visits to your doctor or midwife will slow drastically (going from seeing them a few times per month for prenatal visits to only once or twice total postpartum), the shifts that your body undergoes plow on, full speed ahead.
As postpartum care is not emphasized in our current health model, many women are left uninformed, confused or having unrealistic expectations immediately after giving birth. Today, we will shed some light on the often-overlooked topic of the postpartum period, breaking it down into the following key areas: nutrition, physical changes and expectation management.
Nutrition for repletion, healing and breastfeeding
It is well known that nutrient needs are higher than baseline in pregnancy. After all, health experts agree that growing and birthing a human being is very “nutritionally expensive”. But were you aware that many nutrient needs in the postpartum phase are actually higher than they were during pregnancy?? Why is that, you may ask.
For starters, the baby gets first dibs on nutrients during pregnancy. So, if you happen to not get enough of a nutrient or nutrients you AND the baby need while pregnant, your stores may already be depleted to some degree going into delivery. It takes a lot of nutrition to replete those stores. And even more if you breastfeed, as that preferential transfer of nutrients continues in moms who are breastfeeding, according to registered dietitian and prenatal expert Lily Nichols.
There is also the fact that you require additional nutrients for healing, especially if you sustained tears or a surgical wound. Beyond that, even more nutrition is needed to account for blood loss following birth (any type of delivery) plus postpartum blood loss, and to support connective tissue repair.
Some noteworthy nutrients that play a big role in the postpartum phase:
Iron – Help replete iron stores from blood loss with foods rich in iron. Some examples include: organ meats (liver, kidney, heart) and slow cooked meats like pot roast or pulled pork. If organ meats don’t sound super appetizing to you, you can “hide” liver in recipes by mixing it in with ground beef in various recipes like meatloaf, Shepherd’s pie, etc. Or you can take an organ supplement.
Collagen – Collagen supports healing of connective tissue, helps skin regain elasticity and assists the uterus in its journey to shrink to its pre-pregnancy size. Good sources include bone broth, slow cooked meats, chicken skin and pork rinds. You can also use powdered collagen and mix into things like hot tea, coffee or smoothies.
Nutrient highlights for breastfeeding:
Choline – This nutrient is critical for an infant’s brain development, and needs are at an all-time high while nursing. Aim for a minimum of 550 mg/d if breastfeeding. Good sources of choline include eggs, organ meats, fatty fish, beef, lamb and dairy.
Fatty Acids/DHA – DHA (an omega-3 fatty acid) content varies greatly in breastmilk, and is dependent on the mother’s diet. Nichols notes that infants whose mothers had adequate DHA in her breastmilk had better neural & visual development.
Vitamin D – Vitamin D levels vary greatly in breast milk, and the majority of women do not have sufficient D levels. Recent research has proven that maternal supplementation of 6,400 IU daily of Vitamin D ensures that a breastfed baby gets enough vitamin D without any additional supplements.
While there are specific nutrients that a postpartum woman needs more of, the importance of adequate calories and fluid intake cannot be stressed enough. The average breastfeeding woman burns an additional 500 calories per day in the first 6 months. 500! Pay attention to hunger cues and try to ensure snacks and meals are easily accessible (social support can play a big role here – more on that in a bit.) Fluid needs are much higher as well, especially if nursing. Try to shoot for a minimum of 100 oz. water per day (or ¾ -1 oz. water for every pound of body weight). Break it down into one glass every time you feed the baby if that helps you remember. Drink, drink, drink!
The physical changes that take place in a postpartum woman’s body are innumerable. Here we will cover a few of the major ones:
Pelvic Floor – Pregnancy and birth have had a huge impact on your pelvic floor. After all, your ligaments loosened, posture and center of gravity shifted, uterus grew exponentially, body size changed rapidly and organs were rearranged. Even if you had a relatively smooth pregnancy, labor and delivery, your pelvic floor needs to get back into alignment, strengthen and regain proper function after everything it endured. See the latest wellness article for more comprehensive info on this!
Diastasis recti – Diastasis recti (DR), or the unnatural distancing of your abdominals from each other, afflicts many women (and some men, too!), especially during and after pregnancy. It’s important to note that while pregnancy and childbirth play a huge role in developing or worsening DR, there are many factors that contribute to a DR diagnosis (including posture, the way you move, performing certain exercises incorrectly or unsafely, and the amount of visceral fat you carry.)
Symptoms of DR include a bulge or pooch in your midsection (some refer to this as “tenting” in your stomach, especially upon straining or contraction), lower back pain, poor posture and even bloating & constipation. While there is certainly a cosmetic component, associations have been made between DR and conditions such as pain in abdominal and pelvic region, pelvic floor dysfunction and even abdominal aortic aneurysm.
If you are curious about whether or not you have DR, here is a way to self-check from Healthline.com:
- Lie on your back, legs bent, feet flat on the floor.
- Raise your shoulders up off the floor slightly, supporting your head with one hand, and look down at your belly.
- Move your other hand above and below your bellybutton, and all along your midline ab muscles. See if you can fit any fingers in the gaps between your muscles.
- If you feel a gap, or separation of one to two finger lengths, you likely have a moderate case of diastasis recti. After a few weeks postpartum, the gap will start to narrow as your muscles regain strength.
Note that some people may feel a separation of three or more finger widths. A gap of greater than two fingers likely warrants evaluation by a physical therapist. Discuss with your provider if you think you may benefit from therapy to help heal this.
For many women, postpartum DR may correct itself in time. For others, it will warrant working with someone like a pelvic floor physical therapist. Whether you have mild or severe DR, it is essential to ensure proper posture, avoid exercises that exacerbate the condition (crunches, sit ups, planks), and avoid lifting heavy loads until your abdominal muscles have healed and strengthened.
Hair loss – Due to soaring hormone levels in pregnancy (especially estrogen), many women experience a lot of hair growth and improved hair texture during pregnancy. However, after delivery, these hormones plummet, causing hair follicles to transition out of their growth phase and into what is known as the resting phase (part of the normal hair pattern that includes growth, rest & fall). Usually the follicles begin to shed after 3-4 months in the resting phase, which is why many women start to really notice hair loss at around the 3-month postpartum mark. Rest assured this is completely normal, and the hair will grow back once hormones stabilize.
To offset hair loss, ensure a well balanced diet as best you can (the importance of nutrition repletion plays a big role here, too!), avoid use of harsh chemicals on your hair, and try to throw in self-care activities to minimize stress (easier said than done with a newborn!) – gentle exercise, a massage or short meditation can help to relieve stress.
Managing expectations is arguably the most crucial piece of the postpartum puzzle. As a society, we are frequently exposed to content of new moms “bouncing back” to their previous high intensity workouts, social lives and pre-baby bodies within weeks. For most women, these things are (very) unrealistic. Shifting focus from what you would like to have in the future to the best way you can manage the present is a great first step in expectation management. Try concentrating on healing your body, learning your baby and adjusting to new sleep schedules instead of pining away for those pre-pregnancy jeans in the closet. All of these things take time and patience.
Some other notes to help you mentally prepare for that initial postpartum period:
Social Support – During those first few weeks, it’s helpful to get as much rest as possible. You need rest to heal (no matter what type of delivery you had), so accepting the help of others is very advantageous. Whether that is in the form of meal deliveries, housekeeping help or emotional support, these things will go a long way to help you focus on recovery and adjusting. If you don’t have a strong social support, hiring a postpartum doula can be an option if that is available for you. Don’t expect to be able to “do it all” by yourself -it’s just not possible!
Baby weight – Every woman’s body adjusts differently after baby. Some women lose wight quickly with minimal effort, while others have a longer and more complicated road. Whichever category you fall into, listen to cues from your body (for movement, hunger, rest, etc.) and nourish whatever it is telling you. Focus on proper nutrition, hydration, rest, mindful movement and (most importantly) emotional support, and the rest will fall into place. Remember, you did not gain that weight overnight! 10 months on, 10 months off is a good weight loss time frame suggestion.
Growing another human requires hundreds of changes in your body over a relatively short amount of time. Be patient with yourself, and try to focus on your needs and the baby’s needs. As best you can, try not to compare your journey with anyone else’s, as every woman is different, every body is different and every baby is different. Your experience is unique to you. Try to honor that as best you can! And as always, speak with your provider if you have any concerns (physically or emotionally), as they are always valid.
Be Kind. Be Well. Boiler Up!
Author: Madison Templeton, registered dietitian and health coach, One to One Health
One to One Health operates the Center for Healthy Living on Purdue’s West Lafayette Campus