Beyond Birth: Postpartum Care from an Integrative Medical Perspective

Guest post by Seattle Naturopathic Physician and Acupuncturist, Grace Chang, NC, LAc

What to look out for and how to maximize your postpartum visit

The body is capable of amazing things, especially when it comes to carrying, developing, and delivering a baby. Your hormones shift, ligaments stretch, and organs move to literally level up your body to bring forth new life! While there are healthcare guidelines and resources available to support the pregnancy, follow-up care after baby for new mothers often falls short. I believe the care postnatal is just as important as the prenatal and I am on a mission to evolve the “bounce back” narrative. We will explore how the body recovers and how you can maximize your postpartum visit. 

In conventional medicine, the postpartum period is from the birth of the baby to about 6 weeks after, when the body is considered physiologically “back to normal” at pre-pregnancy state. This line of thinking is not only inaccurate, it does not encompass the continued physical, psychological, and emotional demands of new moms! The United States lacks institutionalized support around birth and it does not recognize it the same as other medical events. A knee surgery, for example, involves 3-5 follow-up visits with the surgeon to evaluate healing. An automatic referral to physical therapy is applied and work accommodations are made for the physical recovery. Mothers here, on the other hand, get 1 postpartum check-up and have to seek out additional care such as pelvic floor physical therapy. 

In other cultures, the interpretation of postpartum is much different. Some recognize the 4th Trimester, honoring the 12 weeks after birth, while others argue that the entire first year after childbirth is a time for renewal. Maternity leave packages also vary across countries. To say the least, postpartum is very much a healing journey that sets the stage for long-term well-being.

Let’s talk about some of the often overlooked physiological changes that happen postpartum:

Hormonal Shifts

Within the first few days, your sex hormones progesterone and estrogen go from super-elevated to a steep plummet to almost menopausal levels. It is suspected that this dramatic drop, while important for breastfeeding, may play a role in postpartum depression. About 50-75% of new mothers experience a shift in emotions called “baby blues” right after delivery. 15% of them will continue into postpartum depression, which is longer-lasting and more serious.

Some mothers may experience other transient hormone changes, such as postpartum thyroiditis. This affects about 5% of birth mothers, showing symptoms of either hyperthyroidism or hypothyroidism. Most of the time, the thyroid function is restored within 1 year postpartum. In some cases, hypothyroidism and the need for medication continue long after.

Immune System

A mother’s immune system also changes postnatal as the body recovers from pregnancy. Studies have found the body’s inflammatory markers stay elevated and may take 3-4 months to return to normal cellular function. 

It is during this time women may experience immune flare-ups related to skin health, allergies, or autoimmunity.

Vascular Changes

After delivery, 50% of mothers become anemic with the blood loss and hemodynamic changes as the uterus returns to normal size. Some women may even get their periods again within the month, losing blood even more.  Studies have found that it can take at least 4-6 months for hemoglobin to return to normal.

Developing a baby during pregnancy increases the blood volume and the work a mother’s heart has to do. The heart muscle pumps harder to maintain flow and blood pressure. Even vision changes can occur with the vascular and hormone shifts. Following up on these body systems postpartum are essential to make sure the body recalibrates, thus decreasing risk factors for developing cardiovascular disease. 

Microbiome Diversity 

A mother’s gut and vaginal microbiome experiences stress from changes during pregnancy and as well as postnatal. New moms are susceptible to developing yeast infections or vaginitis. Most mothers don’t even realize there is a problem, because there are so many other changes happening in the body.

Studies have shown that the gut bacteria of the mother can drastically change during and after pregnancy. Those who develop gestational diabetes, for example, enter postpartum with a very different microbiome compared to those who did not have glycemic changes. 

Maximizing The Postpartum Period

Talk postpartum at your prenatal visits

In general, I encourage my mamas to talk about postpartum care and challenges at their prenatal visits and have their 6 week postpartum visit scheduled ahead of time before their discharge. That way there is something in the books before they even head home. Keep your midwife or primary care provider’s contact in hand in case you need to see someone sooner.

Rebuilding and Recovery

During the first 6 weeks, getting as much rest and nourishment is your priority. In Traditional Chinese Medicine, the yin/yang theory states that birth is a shift from a warm and abundant yang state to a cold and deficient yin state. The body is depleted of Qi and blood right after childbirth. It is important that Qi and blood have the opportunity to replenish, since they are the body’s foundations and need to be strong to prevent other deficiencies from developing in the future. Restoring Qi and blood involves eating balanced meals, staying warm, catching some Zzz’s, hydrating, and engaging in limited physical activity to help the body heal.

Balancing Work

Socioeconomically, this period can be a challenge. For many, return-to-work is imminent and access to resources may not be stable. If your employer offers postpartum leave, I recommend you take it even if the work culture looks down on it. My hope is that this article gives you the resources and information you need to understand why your body needs the time and to create that work culture shift for other parents in the future. If your work postpartum leave is limited, communicate/negotiate with your employer about changes to your hours, breaks and even temporary changes to your responsibilities at work.  Reach out to your community ahead of time to ask for support to set up meal trains or grocery delivery. You can even ask for meal-prep help or add meal delivery service gift cards onto your baby registry. There are online forums out there for mothers to connect with local families.

6 Week Health Check

At the 6 week follow-up, you should be feeling stronger, but we need to understand that it is not typical for you to be feeling “back to normal,” which I believe takes a minimum of 3 months and up to 1 year. When you head to your doctor’s office, check-in with your body to see if there are any symptoms to discuss. Topics that should be screened include:

• Nutrition
• Mental health
• Sleep management
• Blood pressure check
• Sexual health
• Digestion and bowel movements
• Aches and pains
• Breast and nipple health
• Vaginal health and Pap smear
• Pelvic floor recovery

If you follow-up with your primary care provider, this would be a good time to have your blood work checked. I typically order a comprehensive blood panel that includes inflammatory markers, hormones like thyroid, and nutritional assessments like iron levels. I also believe every new mother would benefit from pelvic floor physical therapy to strengthen the stretched muscles and ligaments of the pelvis and abdomen.

12 Week Health Check

Once you are at 12 weeks, I expect most of the body’s systems to have returned to homeostasis. However, as a community, we need to raise the bar for better postpartum expectations and healing is unique for everyone .I recommend following up again if there were concerns found before. Have your mental health reassessed. Labs can also be repeated to catch any challenges your body is facing at a later phase of your postpartum journey.

Postpartum is a time to honor the birth parent and their body’s healing process and it extends well beyond the first month. Healing is unique for every birth mom. Remember that your body is resilient and some tending to the garden will surely bring forth its bounty.

Dr. Grace Chang is a naturopathic doctor and acupuncturist practicing functional medicine and primary care in Seattle. Her mission in medicine is to empower women to embrace their inner strength, their bodies, and their health. Dr. Chang integrates Western and Eastern modalities together, believing that the more we tune into our bodies, the more we can prevent dis-ease. Her clinical interests include hormones, digestive concerns, skin health, and IV nutrient therapy. 

Follow her on Instagram @drgracechang .

Resources:

Chauhan, Gaurav. “Physiology, Postpartum Changes.” StatPearls [Internet]., U.S. National Library of Medicine, 8 Dec. 2020, www.ncbi.nlm.nih.gov/books/NBK555904/.

Groer, Maureen E, et al. “Immune Changes and Dysphoric Moods across the Postpartum.” American Journal of Reproductive Immunology (New York, N.Y. : 1989), U.S. National Library of Medicine, 17 Sept. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4323631/.

T;, Taylor DJ;Lind. “Red Cell Mass during and after Normal Pregnancy.” British Journal of Obstetrics and Gynaecology, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/465384/.

Trifu, S, et al. “THE NEUROENDOCRINOLOGICAL ASPECTS OF PREGNANCY AND POSTPARTUM DEPRESSION.” Acta Endocrinologica (Bucharest, Romania : 2005), Acta Endocrinologica Foundation, 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6992410/.

Mutic, Abby D, et al. “The Postpartum Maternal and Newborn Microbiomes.” MCN. The American Journal of Maternal Child Nursing, U.S. National Library of Medicine, 1 Nov. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5649366/.

Dyer, Lauren. “A Tcm Approach to Nourishing the New Mother: Acupuncture & Dietary Therapy for Postpartum Healing.” Pacific College, 8 Sept. 2020, www.pacificcollege.edu/news/blog/2018/04/30/tcm-approach-nourishing-new-mother-acupuncture-dietary-therapy-postpartum.

Major, Mandy. “What Postpartum Care Looks LIKE Worldwide, and How the U.S. Compares.” Healthline, Healthline Media, 26 Mar. 2020, 

Miller, C M, et al. “The Impact of Postpartum Hemoglobin Levels on Maternal Quality of Life after Delivery: A Prospective Exploratory Study.” Annals of Hematology, U.S. National Library of Medicine, Dec. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5096959/. 

You can follow Grace on Instagram!