Picture this: you've just given birth. You have a week-old newborn, and you are feeling all of the feels that come with being a new parent. You are also EXHAUSTED. However, it's just been a week, right? You chalk your exhaustion up to having just gone through the marathon that is childbirth (regardless of how you birthed your baby!) and the fact that you are up at all hours of the night feeding and caring for this new little life.
Weeks go by. You are still tired. You have your six-week postpartum visit with your provider and are cleared to start working out and resuming intimacy. But you are so tired and feel like something is off. You think to yourself, "This must be normal. I'm still adjusting to life with a new baby." While part of this is true—you are still adjusting to life with a new baby—you don't have to feel this way, and there could be a reason you feel tired and off.
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What is the Postpartum Period?
Pregnancy and childbirth are some of our bodies' most taxing phases. The body goes through an immense amount of physiologic changes in order to grow a life and birth that life into the world. The postpartum period is the period after which the baby is born until about one year (although there is some debate about when the postpartum period ends because there is variation as far as when things return to the pre-pregnancy physiologic state).
Many people have their six-week follow-up with their provider as their only visit postpartum; most often, labs are not drawn at this visit. What if I told you that we can, and should, be getting to the root of your symptoms? One important way to do this is by getting lab work run in the postpartum period.
Possible Symptoms During the Postpartum Period
During the postpartum period, there are many adjustments and new changes that the body goes through. The body needs time to heal after childbirth, and healing can look and feel differently to different people. However, there are some things that, while they may be common, are not necessarily normal, especially if they persist. Some examples of these symptoms are:
- Fatigue
- Sleep deprivation
- Hair loss
- Stress
- Anxiety
- Depression
- Constipation
- Pain with sex
- Hemorrhoids
Possible Causes of Postpartum Changes
Micronutrient Deficiencies
The body goes through many physiologic changes during pregnancy and the postpartum period. One of these changes is a higher nutrient need to support the growth of the fetus, to prepare for birth, and to prepare the body for lactation. All of these nutrients come from the pregnant person. The nutrients from whatever that person eats, or however they supplement, get used to maintain all the changes necessary for pregnancy and postpartum.
Because nutrient requirements increase during this time, there is a risk of deficiency in particular nutrients. Nutrient deficiencies that persist in postpartum can cause the various symptoms above because our bodies need these nutrients for hormone production and signaling, neurotransmitter production, energy, and healing. If the person chooses to breastfeed, the nutrient demand is even higher. Additionally, when nutrient deficiencies are present, hormone imbalances can be perpetuated.
Here are a few examples of nutrients that are commonly deficient after pregnancy:
Iron
Iron deficiency can cause various symptoms like fatigue, hair loss, and headaches, and there is some speculation that iron deficiency anemia (IDA) is linked to postpartum depression. The high demand for iron during pregnancy, paired with blood loss during childbirth, can lead to persistent iron deficiency. Studies have shown that 10-30% of postpartum people have IDA.
Vitamin D
Vitamin D deficiency symptoms can include fatigue, hair loss, depression, anxiety, and poor wound healing. Research shows a connection between vitamin D deficiency and postpartum depression.
Magnesium
Pregnancy can deplete magnesium stores. So if there is inadequate magnesium intake, there can be a deficiency. Symptoms of deficiency include fatigue, reduced appetite, muscle cramps, and nausea. Magnesium is important for many different biochemical reactions in the body, including neurotransmitter production and metabolism. A deficiency could play a role in postpartum depression. Magnesium has a relaxing effect on the nervous system and can also help reduce stress in the postpartum period.
Omega-3s
Omega-3s are important for many biological processes in the body and play a role in cardiovascular, brain, immune, and endocrine health. Omega-3 deficiency has also been linked to postpartum depression.
Hormonal Imbalance
There are many different hormonal changes that happen to ensure a healthy pregnancy. After childbirth, estrogen and progesterone dramatically drop. Prolactin increases to stimulate milk production, and oxytocin increases to facilitate bonding with the new baby. The high levels of endorphins present during childbirth dramatically decline, and the decrease of estrogen can cause low serotonin levels. Estrogen and progesterone start to come back to baseline around three months postpartum, but with stress and lack of sleep, there can be hormone imbalances. Stress and sleep deprivation can increase cortisol levels, which can cause hormone fluctuations. These fluctuations can lead to fatigue, irritability, anxiety, depression, and more.
Thyroid hormones can also be impacted during and after pregnancy, and a hypo- or hyperthyroid state can be another cause of the various symptoms listed above. During pregnancy, the thyroid gland enlarges, and circulating iodine decreases. The concentration of beta-human chorionic gonadotropin hormone (HCG) increases and directly impacts thyroid stimulating hormone (TSH) due to similar chemical structures of HCG and TSH. This leads to an increase in free triiodothyronine (free T3) and free thyroxine (free T4) levels, leading to a decrease in TSH. After pregnancy, thyroid hormones return to baseline. However, some women experience postpartum thyroid disorders such as postpartum thyroiditis. Postpartum thyroiditis can start as a hyperthyroid state causing symptoms such as irritability and palpitations. In the hypothyroid state, patients may experience dry skin, constipation, cold intolerance, fatigue, hair loss, and difficulty concentrating.
Functional Medicine Labs to Consider for Patients in the Postpartum Period
Here are a few basic labs that should be run in the postpartum period and why they are essential. Based on the timeline of the body returning to the pre-pregnant physiologic state, labs should be run around six weeks postpartum, 3-6 months postpartum, and 3-6 months after finishing breastfeeding if the person is breastfeeding.
Thyroid panel (TSH, free T4, Free T3, antibodies)
Postpartum thyroiditis happens in about 5% of people who give birth. While that number doesn't seem significant, think of it this way–out of 100,000 people who give birth, 5,000 will have thyroiditis. That's not a small number. Therefore, it is crucial to run a thyroid panel to ensure that the thyroid is working optimally after childbirth–especially if there are symptoms.
Vitamin D
Testing Vitamin D is extremely important in the postpartum period. Vitamin D plays many important roles in the body, such as promoting calcium absorption, regulating immune function, regulating thyroid function, modulating inflammation, and regulating glucose metabolism.
Iron Panel and Ferritin
You may remember getting your iron levels checked during pregnancy. This is because iron requirements in the body increase during pregnancy– blood volume and oxygen demand increase. Iron deficiency anemia (IDA) is prevalent during pregnancy and postpartum, so assessing iron levels via an Anemia Panel is important.
Lipid Panel
Lipid levels change during pregnancy, and it is important to evaluate them in the postpartum period. Lipid levels (specifically total cholesterol and low-density lipoprotein (LDL)) can remain elevated in the postpartum period. In some people, these elevations can persist. Elevated LDL and total cholesterol is associated with a greater risk of cardiovascular disease. Additionally, some research suggests that there may be a connection between elevated LDL and total cholesterol and postpartum depression. One study suggests that low high-density lipoprotein (HDL) can be used as an indicator for depression in the postpartum period. A lipid panel is a great tool to track cholesterol changes.
Comprehensive Metabolic Panel
A comprehensive metabolic panel (CMP) will give us insight into your fasting blood glucose, electrolytes, total proteins, and liver enzymes. Your liver plays a role in the metabolism of reproductive hormones and also plays a role in thyroid hormone conversion and metabolism.
Micronutrient Analysis
Because pregnancy can deplete so many important nutrients, a Micronutrient Panel can be a helpful tool to evaluate a person's nutrient status after pregnancy and to help guide treatment options.
DUTCH Complete
The DUTCH Complete Test is an excellent tool for evaluating hormones like progesterone and estrogen over a month's time. This test also evaluates estrogen metabolites, which helps the practitioner assess how the body metabolizes estrogen, which is helpful for gaining an understanding of the root cause of symptoms. It also measures cortisol levels and melatonin levels, which are useful markers to assess during the postpartum period, especially since stress levels can be high during this time.
Functional Medicine Treatment for Postpartum Patients
Nutrition
During the postpartum period, a diet rich in protein, healthy fats, and adequate micronutrients is vital for healing. A balanced diet can help to restore hormone balance and nourish the body, replacing nutrients that may have been depleted during pregnancy. If breastfeeding, the depletion of nutrients continues, making a healthy diet even more essential during this time. In particular, people should ensure that they are getting adequate sources of iron, vitamin D, selenium, iodine, calcium, vitamin C, B12, omega-3s, and magnesium, which can be found in the following food sources:
- Iron: Beef liver, white beans, lentils
- Vitamin D: Fortified milk and cereals, trout, salmon, mushrooms
- Selenium: Brazil nuts, tuna, halibut, sardines
- Iodine: Cod, seaweed, oysters
- Calcium: Yogurt, calcium-fortified orange juice, sardines
- Vitamin C: Red pepper, orange, grapefruit juice
- B12: Beef liver, clams, nutritional yeast
- Omega-3s: Salmon, flaxseed, walnuts, chia seeds
- Magnesium: Pumpkin seeds, chia seeds, almonds, spinach
Depending on lab test results and whether a person is able to get adequate amounts of certain nutrients in the diet, a provider may suggest repleting certain nutrients in supplement form. One suggestion is continuing to take prenatal vitamins during the postpartum period, especially while breastfeeding, since the micronutrient demands increase. However, speaking with a doctor before incorporating any new supplements is important.
Herbs for Postpartum Fatigue and Stress:
Ashwagandha
Ashwagandha is an adaptogenic herb, and some research suggests that it can be helpful for subclinical hypothyroidism. It has also been found to reduce stress and improve sleep. Work with your provider to determine if ashwagandha could be beneficial for you.
Shatavari
Shatavari has been found to promote lactation. It is adaptogenic and helps to support healthy responses to stress and hormone balance. Shatavari is known as a female tonic and can be a helpful addition during the postpartum period.
Chamomile
Chamomile can be beneficial for sleep and anxiety. One study showed that it had modest anxiety-reducing effects in people with generalized anxiety disorder. Chamomile has a relaxing effect on the body, which can be helpful for new parents as they wind down for bed.
Tulsi
Tulsi is a helpful herb for stress. One study showed that it was beneficial for reducing general stress in its participants. Tulsi can be a lovely tea to sip on for relaxation.
Other Treatment Options for Postpartum Fatigue and Stress
Acupuncture
Acupuncture is an ancient practice that involves the insertion of thin needles into certain points on the body. Acupuncture is used for many different conditions, and research shows that acupuncture can be beneficial for reducing stress and anxiety. This could be a great modality to incorporate into the postpartum period. There is also an added benefit because the new parent gets an hour to relax and rest while receiving an acupuncture treatment.
Support System
The postpartum period can be difficult. While there are so many lovely things about having a new baby, many changes and adaptations come with this journey. Having someone (or a few people) to talk to about how you are feeling after birth, relating to your baby, and feeling in your new role can be extremely helpful. Reach out to loved ones for support during this period. Support may look like cooking your meals, cleaning your house, doing your laundry, or taking care of the baby while you head out to your appointments. Another helpful tool is counseling. A professional on your care team can give helpful tools to navigate this new journey and also help to identify more serious symptoms of postpartum depression or anxiety.
Summary
The postpartum period is filled with joy and new beginnings, but it can also be a stressful time for parents as they navigate raising a new human in addition to all of the changes that they are experiencing in their own bodies. Pregnancy and childbirth are taxing on the body, and every postpartum person deserves care and attention as they heal and adjust. Sometimes the symptoms that people experience extend beyond being sleep deprived with a new baby, and it is important to get to the root cause of these symptoms. Lab work in the postpartum period is necessary and should be incorporated into every postpartum journey.
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