Ask any mother about her postpartum experience, and you will most likely hear the good parts (the joy of meeting her new baby, drinking wine again, etc.)  and the not-so-good parts (no sleep, endless feedings, and diaper changes). 

 

If there are little to no complications during childbirth, most mothers in the United States will return home from the hospital or birthing center 2-4 days after delivery. If you are breastfeeding, you will be told to eat an additional 500 additional calories per day and to continue taking a prenatal vitamin to replenish nutrients that will be passed on through breastmilk. 

 

Aside from breastfeeding, there are many reasons why adequate nutrition for the postpartum stage is important for your health. Key nutrients play a role in the postpartum but are often overlooked with the emphasis being placed solely on the additional calories & nutrients needed for breastfeeding. 

 

Healing in the Postpartum

Healing from the delivery of your baby can be a painful and slow process. The connective tissues that were stretched greatly during pregnancy and labor (vaginal birth) can take 6 months or more to heal. A surgical wound from a c-section takes 6 weeks on average to heal. The placenta, which was the main nutrient source for your baby while in utero, must detach after birth and leaves behind a large wound. The muscles of your pelvic floor, which supported all the additional weight from your placenta, and the baby can take up to 1 year to return to normal functioning.  If you were like me, you might require intense pelvic floor therapy to correct a myriad of pelvic floor issues that can result from pregnancy and delivery. 

 

 

Key Nutrient for Postpartum: Protein

When you are healing from a wound or connective tissue damage, such as during childbirth, protein needs skyrocket. The predominant form of protein in connective tissue is called collagen. Certain amino acids (the building blocks of protein) deposit collagen into your wounds during the healing process. Not eating enough protein during the healing process can impair your body’s ability to make collagen. 

 

Sadly, the Dietary Reference Intakes (DRIs) do not specify any additional protein needs for the postpartum mother. However, for anyone healing from a wound, protein needs increase by about 1.25- 1.5 times. This is a rough estimation of your protein needs since every mother goes through a different healing process post-birth. 

 

Certain factors can impact the amount of protein your body needs, such as the degree of tearing (vaginal birth) and/or surgical wound (c-section birth) and what stage of postpartum you are in. The majority of healing takes place in the first 6 weeks postpartum, so your additional protein needs will decrease as your body heals. 

 

Protein foods often get skipped over in the name of convenience during the early weeks of postpartum. It’s much faster to grab a granola bar than it is to cook a piece of meat in the oven. But there are quick and easy ways to get protein in your diet to help with healing. 

 

Quick and easy protein options: 

 

Canned salmon or tuna (low mercury brands, such as Safe Catch)

Hard-boiled eggs

Pre-cooked rotisserie chicken

Nuts & seeds

Protein powder added to smoothies, muffins, pancakes

Pre-made bone broth (for collagen)

 

Fluids Matter

Fluids are also important for wound healing, and if you are breastfeeding, you might need up to 16 cups of fluid per day. Sounds pretty impossible, right? Instead, I recommend drinking to thirst and making sure your urine is very pale yellow vs. “highlighter” yellow or light brown, which can be a sign of dehydration. As long as your drink of choice isn’t caffeinated or alcohol, it counts! This includes milk, juice, broth, seltzer water, and high water content fruits & vegetables such as melon, citrus fruit, cucumber and celery. 

 

Key Nutrients for Postpartum: Iron

Postpartum anemia is a chronic deficiency of iron occurring after delivery. A certain blood marker called hemoglobin is measured to diagnose postpartum anemia. 

 

There are 2 main reasons why postpartum anemia occurs. First, if you were anemic during pregnancy or even pre-pregnancy, and secondly, if you bled excessively during your delivery. 

 

Normal blood loss after delivery is about 300 milliliters (mL). If you bleed more than 500 mL, the risk of anemia goes up by 15 times.  If you bleed more than 1000 mL, this is considered “severe” blood loss and increases your risk for postpartum anemia by 74 times! It is estimated that 3-5% of mothers experience severe blood loss post-delivery. (1)

 

Since many mothers are not aware of their blood loss totals and are only told to eat an additional 500 calories and continue a prenatal vitamin if breastfeeding, postpartum anemia occurs in 24% of mothers at 1 week postpartum (if not supplementing with iron). (2) 

 

To correct the iron deficiency, iron supplementation is recommended. Unfortunately, many prenatal vitamins do not contain iron. 

 

Seriously……why?                             

 

 A few reasons here. 

 

First, since you are no longer growing a human, iron needs drop from the 27 milligrams (mg) of iron per day needed during pregnancy (3). And since most mothers do not regain their menstrual cycle while breastfeeding (until feedings become less frequent), iron requirements are set 3 times lower than in pregnancy, at just 9 mg per day (3). Once Aunt Flo returns, the blood you lose monthly increases your body’s need for iron again to 18 mg per day (3).

 

Second, iron can cause gastrointestinal discomfort when found in vitamin form, such as a prenatal vitamin.  

 

Because of this, I highly recommend eating iron-rich foods during the early postpartum days, especially if you were anemic before or during pregnancy, or were told that you bled more than normal during delivery. Aim for 18 mg of iron per day. 

 

Iron-rich foods include: 

 

Beef and chicken liver

Mussels

Oysters

Beef

Sardines

Chicken

Turkey

Ham 

Veal

 

If you are vegetarian or vegan, there are non-meat sources of iron such as: 

 

Fortified breakfast cereals

Beans

Tofu

Wheat germ

Pumpkin and sesame seeds

 

To boost your absorption of iron from the foods listed above, combine them with a good source of vitamin C, such as citrus, berries, and broccoli. Avoid coffee and tea while you eat foods with iron, since these can inhibit your absorption of iron. 

 

Key Nutrients for Postpartum: Iodine and Selenium

Thyroid problems can occur for mothers in the first year after childbirth. For 8% of postpartum mothers, a condition called postpartum thyroiditis results from too much thyroid hormone in your body. (4) 

 

Symptoms of postpartum thyroiditis can include: 

 

Anxiety, irritability, depression

Rapid heartbeat

Difficulty losing weight or unexplained weight loss

Sensitivity to hot or cold

Fatigue

Difficulty concentrating

Insomnia

Constipation

Dry skin

Hair loss (past 6-9 months postpartum)

Anemia

 

 

If you tested positive for thyroid antibodies during your pregnancy, or you have an autoimmune condition, you may be at higher risk of postpartum thyroiditis. 

 

To support a healthy thyroid, iodine is key. Since 40% of prenatal vitamins do not contain iodine (5), and iodine is not required on the Food and Drug Administration (FDA) nutrition facts panel, you may not be getting the recommended 290 micrograms (mcg) per day (if breastfeeding) or 150 mcg per day (if not breastfeeding) in the postpartum. (6) 

 

Sources of iodine include:

 

Iodized salt  

Seafood

Sea vegetables (ie: seaweed)         

Dairy

Eggs

Beef liver

Chicken

 

Selenium has also been shown to be beneficial for your thyroid. Iodine and selenium work together to support the thyroid. Selenium is also not required on the FDA nutrition facts panel, which means you may not be getting the recommended 70 mcg per day (if breastfeeding) or 55 mcg per day (if not breastfeeding) in the postpartum. (7)

 

Sources of selenium include: 

 

Brazil nuts

Yellowfin tuna

Sardines

Oysters

Clams 

Halibut

Shrimp 

Salmon 

Crab

 

 

One word of caution about iodine and selenium, however. If you chose to supplement vs. eat whole food sources of iodine and selenium, pay attention to the total amount in the supplement. Too much of either can cause a deficiency in the other, so getting the recommended amount (but not too much) is important. Other harmful effects can occur if you exceed the Upper Limit (UL) for iodine, which is over 1,100 mcg per day (8) and over 400 mcg per day for selenium. (9) 

 

Key Nutrient for Postpartum: Omega 3

Omega 3 is a nutrient with anti-inflammatory properties. One area of your body that benefits from this is your brain. Docosahexaenoic Acid, or DHA, is the most abundant form of Omega 3 in your brain. 

 

Why does this matter for you in the postpartum? 

 

Postpartum depression, which affects 1 in 7 mothers (10)  is considered an inflammatory illness. During the perinatal period (during pregnancy and postpartum), your DHA is in high demand from the baby. Numerous studies have shown a higher incidence of maternal depression when Omega 3 levels were low. (11) The typical “American” diet is very low in Omega 3 as well. 

 

Now for some good news! 

 

Research has shown that Omega 3 has a moderate effect on reducing depressive symptoms for perinatal mothers. (12) To reap the benefits of Omega 3s, and DHA specifically, aim for 200 mg of DHA daily. (13) Like iodine and selenium, Omega 3 (nor DHA) is not required on the FDA nutrition facts panel, so you might be wondering what foods contain this nutrient. 

 

Sources of DHA: 

Algae 

Coldwater fatty fish (salmon, tuna, herring, sardines)

Shellfish

Pasture-raised eggs

 

As you can see, not many foods provide this valuable nutrient. Supplementation is common, and if you chose to go that route, always let your healthcare provider know before you start taking any supplement, especially if you’re breastfeeding. 

 

Heal first, then nourish your baby

After 9 months of growing a baby and then delivering that baby, your postpartum body is in need of some extra care. Healing should be your first goal, then nourishing your baby (however you chose to feed them). This doesn’t mean you should ignore your baby’s hunger cues until you are fully healed- but it does mean that getting adequate nutrition (for yourself) to heal properly should be a daily focus, not an afterthought. 

 

Sidenote: This is NOT the time to be concerned about losing “baby weight” or getting back into your pre-pregnancy clothes, regardless of what society expects of mothers. Most people that have that opinion have never gone through childbirth themselves…obviously.

 

Whether you are healing from a painful delivery, building up your blood supply, facing thyroid irregularities, or depressive thoughts, remember that key nutrients support your healing process. In addition to the extra 500 calories/day if you’re breastfeeding, protein, iron, iodine, selenium, and Omega 3s are key nutrients for your postpartum journey.