How to Heal Fatigue After Baby

The first 12 weeks after birth are a critical time of healing and bonding, yet so little reverence is paid to this “fourth trimester.”  A mother’s body has done the incredibly challenging work of growing a baby and giving birth, and now she must recover while potentially nourishing her baby (if she chooses and is able to breastfeed). The transition from pregnant to postpartum brings some dramatic changes, especially in regard to female hormones.

Many women experience symptoms like hot flashes, tearfulness, and fatigue during the first several days to weeks. However, symptoms which persist or worsen may warrant further investigation. As was stated above, pregnancy and postpartum are incredibly demanding on the body and can lead to nutrient deficiencies and abnormal metabolic function for some women. There is also evidence that these issues contribute to postpartum mood disorders and significant fatigue.

What’s Normal Postpartum?

While it can be challenging to determine whether symptoms are the result of a “normal” hormone response, or something more serious, it’s always a good idea to check in with your healthcare provider. In general I recommend that women consider basic nutrient testing to determine whether they are meeting the demands of the healing process and breastfeeding. These labs include but are not limited to:

  • Vitamin B12
  • Folate
  • Vitamin D3
  • Ferritin

According to the available data, the strongest association between nutritional factors and Postpartum Mood Disorders are specific to serum Vitamin D levels. However, there is also a correlation between low ferritin and B vitamin levels and postpartum mood (1,2,3). Additionally, B vitamins are critical for thyroid and metabolic function, and each of aforementioned nutrients can influence energy levels. If you are struggling with excessive fatigue, it is essential to have your nutrient levels evaluated. It should also be noted that DHA and EPA essential fatty acids may be beneficial for symptoms of PPD, and supplementing with up to five grams daily has been shown to be safe. Therefore, testing may not be necessary.

In some cases, persistent symptoms may be indicative of a more serious issue. About five percent of women experience postpartum thyroiditis (4). If you have even been diagnosed with a thyroid issue, it’s important to understand that your risk is higher, but some will experience issues for the first time after having a baby.  Women with this condition may encounter symptoms which include:

  • Depression or anxiety
  • Irritability
  • Fatigue
  • Muscle cramps
  • Unexplained weight loss of difficulty losing weight
  • Insomnia

If you suspect you might be dealing with thyroiditis, it’s important to seek out a healthcare provider who will run a full thyroid workup to ensure proper diagnosis.

What Can I do for Postpartum Fatigue?

Speaking specifically about fatigue it’s important to recognize that postpartum is a state of depletion, and the focus should be on restoring maternal stores. Regardless of the results of your lab work here are some steps you can take to support your healing and improve energy levels:

Let nutrition be the foundation. It is essential for postpartum mamas to consume adequate calories, especially while breastfeeding. It is commonly recommended that nursing women consume an additional 500 calories above their own requirements for the purpose of making milk. Additionally it’s important to take in adequate carbohydrates, as these are necessary to support the health of your adrenal glands (which influence energy levels). Foods rich in iron (like organ meats and bone broth) are incredibly nourishing, as are healthy sources of fat like nuts, seeds, and fatty fish. Finally, I recommend continuing to take a prenatal vitamin.

Nourishing movement. If fatigue is an issue, HIIT is may not be appropriate, but that doesn’t mean you shouldn’t be physically active. Consider babywearing walks, yoga, or any movement that is pleasurable. You should feel energized when you’re done, not more depleted! A great place to start is with our Conscious Core program.

Pour a cup of Tea. Herbal adaptogens are an excellent way to support and nourish the adrenal glands, and this is why we love Teamotions Teas. These teas are expertly crafted with herbs to support healing and vitality, and can be a wonderful addition to your postpartum care routine. My personal favorite is the Seek Peace blend.

Rest when your baby rests. It’s what we’re all told to do, but from personal experience I know how tough it can be to fight the urge to “get things done” while the baby sleeps. If you are struggling with fatigue, rest is critical, and if you don’t feel like napping consider listening to a guided meditation (check out Expectful ), or taking a long epsom salt bath.

Guard your energy. In the first few months after having a baby your time and your energy are precious. It’s important to recognize that you are not obligated to meet the expectations of others. Maybe you have family members that want you to bring the baby for a visit, or maybe you were planning to attend a friend’s wedding. It’s important to know that sometimes saying “no” is the ultimate form of self care, and this practice will serve you well into your motherhood experience. Also, if there are people in your life that are particularly draining (you know the ones I’m talking about) it’s okay to take a step back from those relationships. You have to take care of you first mama!

The Current State of Postpartum Affairs

While this should be a time of rest and recuperation, many women are faced with the harsh reality of subpar postpartum support. From the pressure to return to work because of unpaid maternity leave to lack of community resources, the majority of women in the United States face significant challenges postpartum.

Despite astronomical maternity care spending (about $50 billion annually), the United States allocates very little to postpartum care, which has resulted in less than optimal outcomes (5). While the World Health Organization recommends breastfeeding until age two (or beyond), currently the U.S. rate at six months is just about 51.8% (6). Additionally, it’s estimated that between 15-20% of women struggle with postpartum depression or anxiety (7).

I wanted to point out these systemic shortcomings because in my experience, both in clinical practice and as a BIRTHFIT Regional Director, I’ve seen many women struggle with issues (like significant fatigue) and not get adequate support from their healthcare providers. Additionally, some don’t feel comfortable talking about their experiences, and others don’t realize that what they are going through may warrant further investigation. Luckily it appears that change may finally be on the horizon.

In April of this year, the American College of Obstetrics and Gynecology (ACOG) published updated recommendations for fourth trimester care. Whereas the current standard of practice is to see women between 6-8 weeks after birth, the updated recommendation is to see them within the first three weeks after delivery. From there, women should receive ongoing care throughout the first three months, culminating in a visit at 12 weeks from which they will transition to annual well woman care (8). This is an important shift because it demonstrates a recognition that significant issues can arise prior to the six week visit, and early intervention could minimize or prevent them. Furthermore, it would provide every woman the opportunity to check-in with her healthcare provider to determine whether her experience is “normal.”

It is my hope that these latest recommendations from ACOG are widely adopted in the very near future. It is clear that women need immediate and ongoing support throughout the fourth trimester, to ensure early intervention when issues arise.

To all the women who are living in the postpartum haze, be kind with yourself and don’t be afraid to advocate for your health. If you are dealing with significant symptoms like fatigue, anxious feelings, or anything that doesn’t feel right to you, seek out a provider who will listen to your concerns and provide you with the care you need. Finally, treat this precious time with respect and tenderness, and remember SLOW IS FAST.

Brittany Anderson

Women’s Health Nurse Practitioner

BIRTHIFT Regional Director

Nashville, Tennessee

@birthfit_nashville

 

Sources

  1. Albacar, G., Sans, T., Martín-Santos, R., García-Esteve, L., Guillamat, R., Sanjuan, J., . . . Vilella, E. (2011). An association between plasma ferritin concentrations measured 48h after delivery and postpartum depression. Journal of Affective Disorders,131(1-3), 136-142. doi:10.1016/j.jad.2010.11.006
  2. Sparling, T. M., Nesbitt, R. C., Henschke, N., & Gabrysch, S. (2017). Nutrients and perinatal depression: a systematic review. Journal of Nutritional Science, 6, e61. http://doi.org/10.1017/jns.2017.58
  3. Gur, E. B., Gokduman, A., Turan, G. A., Tatar, S., Hepyilmaz, I., Zengin, E. B., . . . Guclu, S. (2014). Mid-pregnancy vitamin D levels and postpartum depression. European Journal of Obstetrics & Gynecology and Reproductive Biology,179, 110-116. doi:10.1016/j.ejogrb.2014.05.017
  4. Postpartum Thyroiditis | Thyroid Symptoms & Treatments. (n.d.). Retrieved from https://my.clevelandclinic.org/health/diseases/15294-postpartum-thyroiditis
  5. Rosenthal, E. (2013, June 30). American Way of Birth, Costliest in the World. Retrieved from https://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html
  6. CDC Newsroom. (n.d.). Retrieved from https://www.cdc.gov/media/releases/2016/p0822-breastfeeding-rates.html
  7. Pregnancy & Postpartum Mental Health. (n.d.). Retrieved from http://www.postpartum.net/learn-more/pregnancy-postpartum-mental-health/
  8. Women’s Health Care Physicians. (n.d.). Retrieved from https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/ACOG-Redesigns-Postpartum-Care

 

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