Postpartum Hemorrhage and Nutrition Recommendations
Blood Loss Postpartum
During perinatal education courses, you learn about possible, but often rare complications that can occur during labor and delivery. One such complication is a condition known as postpartum hemorrhage which can occur in both vaginal and cesarean deliveries. Postpartum hemorrhage was the 4th leading cause of pregnancy-related death in the United States between 2011-2014 (1). While it is normal to lose some blood after giving birth, excessive blood loss above the expected averages of 500 ml in a vaginal singleton birth or 1000 ml in a cesarean singleton birth is considered postpartum hemorrhage (2). Depending on the severity of the hemorrhage, treatment options range from uterine massages to pitocin to operative procedures (3). Once bleeding is controlled, recovery is expected to be more challenging and will depend on how much blood loss is experienced as well as how much of a woman’s reserves, such as iron, are depleted.
How to Recover from Postpartum Hemorrhage
One of the four pillars of BIRTHFIT is nutrition. The importance of nutrition is stressed during the perinatal period to not only nourish a growing baby, but also to nourish a woman for the postpartum period. When there is excessive blood loss during delivery, overall blood volume decreases as well as all of the components of blood, including iron, and can result in iron deficiency anemia. Iron is utilized to make hemoglobin which is a part of red blood cells that transports oxygen throughout your body. Symptoms of iron deficiency anemia include feeling weak and tired, dizziness upon getting up from lying or sitting, feeling out of breath, and difficulty concentrating (4). While symptoms of iron deficiency anemia and new motherhood overlap, those of iron deficiency anemia are magnified. If, for example, a woman is borderline anemic during her pregnancy and experiences significant blood loss during delivery, symptoms of iron deficiency anemia can be severe and will hinder her postpartum healing and impact her postpartum experience.
Diet plays a major role in recovering from postpartum hemorrhage by replenishing these nutrient stores, especially iron. Heme iron, found in animal products, is a highly absorbable form of iron and can be found in red meats like beef, venison, and lamb and organ meats such as liver (5; 6),. Recipes for stews, meatballs, and chilis are easy ways to add these meat options to your diet. (See the books Real Food for Pregnancy by Lily Nichols, The First Forty Days: The Essential Art of Nourishing the New Mother by Heng Ou, and Nurture: A Modern Guide to Pregnancy, Birth, Early Motherhood—and Trusting Yourself and Your Body by Erica Chidi Cohen for recipe ideas). If your diet does not include red meat, seafood like oysters and sardines have higher levels of iron (6). Non-Heme iron, found in plant-based foods, is not as absorbable as heme-iron, though is still very beneficial (5; 6). High concentrations of non-heme-iron foods include lentils, spinach (dark leafy greens), and cashews (6). Smoothies and/or warm lentil salads are great ways to utilize those foods.
Additional iron-rich containing foods include encapsulated placenta. In the book Real Food for Pregnancy, Nichols mentions a study which showed a nutritional analysis of placenta capsules could provide 24% of a woman’s daily iron needs (when taken in a dosage of 3,200mg of dehydrated placenta per day) (7). However, depending on the severity of a woman’s anemia, additional supplementation beyond food may be recommended by your provider (5;6). Suggestions can include Floradix and/or desiccated liver.
To enhance the absorption of non-heme-iron from food, consider simultaneously consuming vitamin C-rich foods (6). Vitamin C containing foods include citrus, peppers, and broccoli. In addition, it is wise to avoid consuming dairy with iron-rich foods as calcium may inhibit the absorption of iron (6).
On a final note regarding iron-rich diets and/or iron supplementation, constipation is a common and unpleasant side effect (5;6). Consuming a high-fiber diet of whole foods such as unaltered fruits and vegetables will help to avoid bathroom difficulties.
To increase blood volume, staying hydrated is also extremely important. An average non-pregnant woman should consume about half of her bodyweight in ounces. In order to restore blood volume, it should be expected that drinking more than average would be beneficial, especially if the woman is also breastfeeding. Fluids can include water, fruit-infused water, herbal teas, homemade gatorade, and/or coconut water.
BIRTHFIT stresses the importance of prolonged postpartum care in order to heal from labor and delivery. Nourishing your body with healing foods, staying hydrated, and intentionally resting counteracts anemia and will lead to a successful recovery.
Bailey Zimmel, DC, L.AcBIRTHFIT Charlotte @birthfitcharlotte
- Ngwenya S. Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting. International Journal of Women’s Health. 2016;8:647-650. doi:10.2147/IJWH.S119232.
- Practice Bulletin #183, “Postpartum Hemorrhage” https://www.acog.org/About-ACOG/News-Room/News-Releases/2017/ACOG-Expands-Recommendations-to-Treat-Postpartum-Hemorrhage
- Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therapeutic Advances in Gastroenterology. 2011;4(3):177-184. doi:10.1177/1756283X11398736.
- Nichols, Lily. Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition. USA:; 2018.