Mothering the Mother: The Importance of Postpartum Care
by Rev. Pilar (Ma’at) Grant
Nov 02, 2011
What is the Postpartum Period?
As a midwife, I have worked with pregnant mothers and their families for over twenty years. I myself am a mother of seven amazing and beautiful human beings. During this time, I have witnessed as well as experienced how women are almost forgotten after the birth of their babies.
Postpartum, also called the fourth trimester, puerperium and postnatal is recognized as the period just after birth and the subsequent six weeks that follow. Postpartum is as important as any other phase of the birthing process. During pregnancy, labor and birth of the baby, a mother’s overall health is depleted. The mother is constantly giving of her life force energy, therefore it is most important she is replenished and cared for after birth. Many elders have told me women who don’t take care of themselves in their childbearing years, especially after the birth of a baby, are sure to feel discomforts during menopause.
Postpartum is a significant time for the mother, baby and family. Many physiological, psychological and spiritual changes occur. During this time, the uterus contracts, breasts may enlarge and become tender in preparation for breastfeeding and hormones fluctuate. Internal organs that have moved to accommodate the baby are slowly shifting back to their original positions. As mothers, we need to desire and expect quality holistic postpartum care. As health practitioners, it is imperative that we are more attentive to the postpartum mothers we are serving. Caring for the mother in a loving way will help restore strength, vitality, muscle tone, mental clarity and an overall sense of well being.
Major Areas of Concern for Mother Postpartum
There are five major physiological changes that postpartum mothers experience.
Healing of the uterus and uterine wall
After the birth of the placenta, the top of the uterus is at the level of the navel. The uterus will remain this size for about two days and then it continually gets smaller. In about five to six weeks, it has regained its pre-pregnant size. The regeneration happens very quickly except at the placental site. Complete healing of the placental site takes up to six weeks or more. Wise women have told me that it can take up to three months for the placental site of the uterus to heal. They suggest that mothers refrain from sexual intercourse and inserting anything into the vagina for three months.
Vaginal restoration and healing of the pelvic floor muscles including the perineum
There are many changes in the vagina after birth. Vaginal discharge is experienced, whether it is a vaginal birth or caesarean. This is called lochia. It is much like a menstrual period and can be experienced for two to six weeks after birth. Lochia comes from blood and tissues that have built up in the uterus during pregnancy. In vaginal births where tearing has occurred, the mother usually experiences swelling and pain. The tearing may be repaired by the use of stitches depending on the severity. If this is the case they will dissolve over the course of a week. For a mother who has not experienced tearing, the vaginal lips can still appear slightly swollen. Although the vagina stretches significantly to accommodate the birth of the baby, immediately after birth, the vagina shrinks tremendously forming a smooth walled passage. The perineum, the area between the vagina and anus, may also be sore due to a tear during labor or an episiotomy.
Restoring strength and tone to the abdominal wall muscles
The abdominal wall will remain soft and flabby for a while after birth due to the rupture of the elastic fibers and the prolonged distention of the uterus. It usually takes several weeks for the abdomen to return to its pre-pregnancy appearance. For mothers of 3 or more children, the abdominal wall may have separated and will remain lax.
Establishing a good milk supply and successful breastfeeding
The same hormones that initiate contractions in labor help to initiate breast milk. Within 24 hours after birth, the breast produces colostrum, a golden yellow liquid that is full of antibodies that serve as the newborns first immunization to disease. Breast milk has the proper amount of sugar, fat, water and protein for the baby’s growth. Not only is breastfeeding good for the child, it is also great for the mother as well. Suckling on the breast creates a rush of oxytocin in the mother’s body. This hormone helps the body secrete milk. Suckling also helps in contracting the uterus and protects the mother from hemorrhaging.
Endocrine system and hormonal shifts
After giving birth, estrogen and progesterone, which are released by the endocrine system, significantly lower. During pregnancy, the body produces these hormones in abundance. It takes around three days for hormonal levels to return to their pre-pregnancy state. The body experiences a shock with the sudden change in hormones, impacting the mother’s mood, body functions, digestion, and ability to sleep.
Due to major shifts in hormones after birth, mothers may experience mood swings. In the first week, postpartum women usually start out happy and joyful because of the high of the birth. However, in a few days the joys of birth can turn into depression and or a sense of melancholy. This is due to the physical and mental stress of birth, a breakdown of tissue components and a withdrawal of estrogen and progesterone leading to an imbalance of electrolytes and hormones.
Without proper care, many women develop postpartum mood disorder. Postpartum mood disorder is a mental health disorder striking within the first year of giving birth. It can occur in any woman after birth whether she is a first time mom or not .The postpartum mood disorders can range from Baby Blues to Psychosis.
Baby Blues is a condition that affects 80 percent of new mothers, with the onset between 3-14 days postpartum. Twenty percent of women with baby blues will go on to develop Postpartum Depression. Postpartum Depression affects up to 25 percent of new mothers. Symptoms can be exhibited right away or several months after delivery. Prior incidents of postpartum depression sometimes may put a woman at a 50 to 80 percent higher risk of recurrence. Postpartum Psychosis is the most severe postpartum mood disorder. PPP is rare, believed to affect only one to two new mothers in one thousand. Treatments of these illnesses may require medication, psychotherapy and, in extreme cases such as Postpartum Psychosis, hospitalization.
US Undervaluing Postpartum Period
In the US, there is no set standard of care for women postpartum. Most are routinely sent home from the hospital with only instructions on a paper and told to make an appointment in 5 to 6 weeks. Homebirth mothers usually see their midwife for 2 to 3 days postpartum and then again in about a week. After that, mothers are not seen again until 6 weeks. I was shocked to learn that some midwives give no postpartum visits and women are advised to visit an OBGYN in 6 weeks. Many women return to work still experiencing postpartum issues.
Postpartum care is not ignored throughout the entire nation. In the south where I grew up, there are women who still know and try to teach the important rituals during the monthly menstrual period and afterbirth. They understand the significance of staying warm, eating foods that stick to your ribs, not getting wet and catching a chill due to pores being open during the menses and afterbirth. These remedies are usually referred to as old wives tales or superstition. However, the elders argue that because they followed these rituals, they did not suffer from the same reproductive problems that women today do.
How Other Countries and Cultures Approach Postpartum
In other cultures throughout the world, the postpartum period is just as important as the prenatal period. The care of the mother and newborn are not left in the hands of the doctor or midwife exclusively. The entire family and community come together to support a new mother, ensuring she has enough rest, food, herbs, comfort and assistance with household responsibilities.
In Chinese culture, the new mother is treated like a queen during what is referred to as the “sitting month.” For a month, she is cared for in total. She does not leave the house and is nursed back to health by her mother or mother-in-law. Her only responsibilities are to eat, sleep and nurse. The family handles all housework and care of other children. Visitors are very limited. Due to a belief that a woman’s heat is lost during childbirth, she is given only warming foods and healing teas and tonics to restore balance.
In Indian culture, mothers are traditionally forbidden to touch the ground for six weeks after birth. Other female members of the family take turns with the housework, caring for the newborn as well as preparing special foods. The mother eats only fresh, non-processed foods that have warming spices to restore heat to her body. The postpartum mother also experiences daily massages, bringing comfort and easing the pain accumulated from pregnancy and labor.
In Korean, Indonesian, Malaysian and Haitian cultures, there are resting periods ranging from 21 to 40 days. In all of these cultures, the women do not cook or clean. They rarely leave their homes. New mothers are encouraged to rest and only move moderately to help the uterus contract. Often times the women are wrapped at the uterus to bring internal organs and tissues back into place. Cold foods, washing of hair and cold weather are forbidden because of the heat that is lost during childbirth.
The one thing that all of the rituals have in common is the care being centered on healing the whole body. These postpartum rituals have worked for centuries and will continue to be effective.
In addition to the physical benefits of holistic care in non-western cultures, incidents of postpartum depression are also significantly lower than they are among mothers here in the U.S. Our culture can learn a lot from women around the world. Our holistic care can contribute not only to our own health but the overall health and well-being of our entire families.
Benefits of Herbs, Nutrition, Love and Pampering Therapies during Postpartum
I have used herbs in my midwifery practice since the beginning and have not found a more reliable friend. Because the herbs are plant based, they do more than just eliminate discomfort or pain; they nourish the body with vitamins and minerals. Using herbs in the postpartum period is a great choice.
In China, emmenagogues are used to clear the afterbirth and clean the uterus and prevent infection. The day after the delivery make a soup of tang kueil, persica, hong hwa (safflower), motherwort and blackened ginger. The ingredients stimulate circulation very strongly to treat pain and exhaustion after the delivery. They heal and tone the entire painful area of the lower abdomen and help the mother regain strength and balance.
Another way to use herbs is an after birth tea. This herbal tea is incomparable. It increases circulation, cleanses the womb, increases breast milk, balances hormones, relieves pain a nd gives the mother an overall good relaxed feeling. Fathers like it as well. The herbal afterbirth tea is composed of oranges, lemons, ginger, cinnamon powder/sticks, lemongrass, raspberry, borage, star anise and honey. To make the tea, grate the ginger and add it and the cinnamon sticks to a large pot of water. Bring it to a boil and then add the star anise seed. Let it boil for 25 minutes. Add oranges and lemons and turn it on low for 10 minutes. Add the rest of the ingredients, turn off the fire and let it steep. Strain, add honey and enjoy.
Herbs can also be used as a bathing treatment. The after birth bath aids in the healing of the uterus and perineum. It also helps with circulation. It is relaxing and soothing and allows the mother to rest comfortably into sleep. The after birth consists of castor leaves, rosemary, oranges, lemons, orange leaves, avocado leaves and lavender oil. Add all of the ingredients to a large pot and bring to a boil for about 20 minutes. Pour all of the ingredients into the bathtub. Start by making sure that the water is not too hot before entering for a warm relaxing sitz bath.
Eating well is essential to the recovery of a mother during her postpartum period. There are many foods that aid in the healing. I have found that the best foods for the recovering mother are those that have high vitamin and mineral content including whole grains, vegetable soups, cooked greens, root vegetables and pure clean water.
How Instituting Postpartum Therapy Can Prevent or Treat Many Common Problems
I myself have noticed the difference with having postpartum care and not having any. I have been anemic most of my life and for my first birth, had no postpartum care. Afterbirth I was very weak and dizzy. Due to the way I tore, I also had trouble walking. The hospital staff treated me well but after I was discharged I didn’t see the doctor until I was 6 weeks postpartum.
When I went to see the doctor, I was told I was severely anemic and that my vagina did not repair properly. I would need to have surgery to have it corrected. If I had been seen by a doctor 4 or 5 weeks earlier, they would have recognized my low iron and could have redone the stitches.
It is very important that women are assessed during the 6 weeks postpartum. We can help eliminate many of the common problems and concerns during this time. By giving mothers the loving and gentle care and nourishing both body and spirit, we can support healing with ease.
During the postpartum period, many common problems can occur. The following are some issues that may arise and natural treatments I have used for years with much success.
A nice sitz bath will do the entire vaginal area good. If you have stitches, only take one a day. Make a healing and soothing sitz bath with comfrey and rosemary. Another option is to sprinkle the comfrey powder on your sanitary napkin. A third remedy is to use a squirt bottle during urination filled with warm water and 1 to 2 drops of lavender or tea tree essential oil. This is soothing and helps prevent infection.
One problem may be engorgement. This is when breasts are swollen and painful due to a plentiful supply of milk and baby not drinking enough to keep up with the production. One remedy that has worked for me and mothers I work with is to soak your breasts in marshmallow root tea. This warm tea soak helps the ducts to release the milk while easing the pain. Another option is to take a warm shower and let the warm water run on your breasts.
A second breast issue may be mastitis or infection in the breast. With mastitis, the breasts are usually painful, red and swollen. The marshmallow root tea soak works for this as well. However, my best choice for this is using the herbs echinacea and propolis in combination. This combination has cleared up and prevented many infections postpartum.
Nettle leaf tea and burdock root are good tonics for urinary issues afterbirth. They strengthen and tone the kidneys, bladder and the other organs of the urinary system. Burdock also helps to relieve edema and water retention afterbirth.
Hemorrhoids are an indication of poor circulation. White oak bark, cayenne pepper and psyllium husk work wonders to increase circulation and get rid of the hemorrhoids. These three herbs can only be taken after pregnancy. Take one capsule of each herb 3 times a day for 7 days.
Aloe vera gel is also very soothing to hemorrhoids. Put it on a cotton swab and apply it directly to the hemorrhoids. This will feel soothing and cool. Witch hazel helps to reduce the swelling and pain of the hemorrhoids. Soak a cotton ball in witch hazel and apply to the area.
Drink plenty of water and herbal teas and soups. If you had a c-section or if you’re drinking and eating liquids have provided no relief, then you should take a mild herbal laxative. The one that I have used for 16 years with great results is by Russell Harrison Herbal Company. One or two capsules are usually all that it takes to get your system moving right.
Rest is the best remedy for this. This is the main thing a mother needs postpartum. Motherwort is good because it helps to calm and relax the mother.
After birth pains
Calcium magnesium combination has been my friend since I gave birth to my 5th child. Although I had afterbirth care, no one knew what to do to relieve afterbirth pains. I suffered for days with the worst pain I have ever endured. I did some extensive research and discovered the benefits of calcium and magnesium. By the time I was ready to give birth to my 6th baby, I knew I wouldn't suffer anymore. I took 1000mg of calcium and 500mcg of magnesium as soon as the baby was born and I didn't feel the afterbirth pains. I was aware of the afterbirth uterine contractions yet experienced no pain. I took one to two tablets a day for 1 week.
Calcium magnesium taken one hour before bed helps you to sleep soundly. A nice cup of raspberry and chamomile tea will help the mother to rest well
A new mother must be encouraged on a daily basis. Whether this is her first or fifth baby, she must be told that she is doing a wonderful job. It is also important that she is given time to sit, meditate and focus on herself. Slow deep breathing exercises help her to stay focused and calm. A nice deep relaxation technique will help to relieve fatigue and give mother a sense of confidence and well-being. This will help her to be more attentive, loving and caring to herself and her newborn baby. Mothering the mother is one of the greatest gifts that you can give a mother afterbirth. She will be forever appreciative of all the love. We must all work together to change the way that we view postpartum care. Let us begin to focus on the mother as well as the beautiful new babies.
Rev. Pilar (Ma’at) Grant B.Msc. is a professionally trained wellness expert assisting women around the issues of birth, herbal therapy, nutrition and health for over 22 years. She is a wonderful mother of 7 beautiful spirits. All of her children were born naturally, including one hospital birth and six homebirths, three of which were water births. Ma’at is also professionally trained in Herbology, Massage Therapy, Doula Work( DONA Certified), LA Leche League Peer Counseling, Aquanatal Instructing, Yoga for Positive Health, Rites Of Passage Facilitating and is a Metaphysical Minister Therapist. She has a Bachelors in Metaphysical Sciences and is currently enrolled at the University of Sedona/Metaphysics where she is pursuing a PHD in Philosophy with an emphasis in Life Coaching. She is a Belly Dancer who performs with “Fatimah and The Butterflies.” Ma'at enjoys assisting people in realizing their dream of a blissful birth whether it be a human birth or the birth of new ideas and lifestyles. By assisting people in realizing their true potential, she believes they will create a reality of Love, Health, Wealth, Abundance, Pure Light and Joy!
Ma’at is known as BirthMama offering services in:
Nutritional and Herbal Consultations for Pregnant and Non Pregnant women.
Herbal and Natural Care for men, women and children
Pre and Post-Natal Doula Services ( Afterbirth Care for Mothers)
Workshops on Birth and Health and Wellness Issues ( CEU’s available )
Metaphysical Spiritual Counseling offering directions in Meditation/Breathing Techniques for overall positive Health and Wellness.
Birth Mama also instructs Beginner Belly Dance Class on Wednesdays 6:30pm at Milly Frank Studio 120 E. Live Oak Ave. Arcadia, CA
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