Last week, I discussed the importance of self-care. Postpartum depression affects one in five new mothers, and although rare, postpartum depression can lead to suicide. In fact, in the UK one study found that 28% of maternal deaths one year postpartum were due to suicide, making it the leading cause of maternal death one year postpartum. The statistic that’s generally given is that suicide is the second leading cause of death for mothers one year postpartum in the U.S., but because in the U.S. we don’t track maternal deaths very carefully, we just don’t know. Mothers with a history of mental illness are particularly at risk.
Why are the first 42 days the most important?
This means that self-care isn’t just not selfish, it can be life-saving. One interesting number jumped out at me as I was researching this topic – 42. As in, the first 42 days postpartum are the most important for self-care (and quite honestly, community care) for the mother. The study in the British Medical Bulletin cited above found that the suicide risk for mothers was highest in the first 42 days following delivery. This corresponds with the belief in Ayurvedic tradition that in the first 42 days following delivery, mothers must be tended to with great care. Her health and well being during those 42 days, in Ayurvedic tradition, will determine the next 42 years of her life. I’m not sure how that fits with multiple pregnancies and the like, but it’s a nice way to remember that taking the very short window after childbirth to heal can have long-term positive effects. I’d like to imagine that at 78, when these twins are 42 years old (yikes!) I’ll still be happy and healthy, as will they.
This video below walks through some of the Ayurvedic postpartum practices, and contains a lot of information on foods to eat postpartum, which form my second pillar of focus for postpartum self-care, nourishment.
The Second Pillar: Nourishment
How we define “healthy eating” varies a lot by culture. In the U.S. we love our food fads; we’ve moved from the low-fat craze to the low-carb craze to the gluten-free craze to whatever is next. I have a bit of an aversion to diets in general, but I love real food. Cooking & eating are a central part of my family’s life together. Bob loves to cook and it was always something we shared. We’ve become foodies together, enjoying creating new recipes and now growing food from our community garden plot. Although it’s taken a back burner as our lives have gotten more busy, I still take pleasure in cooking a good meal and so does Bob.
In many Asian cultures, specific foods are recommended for moms as particularly nourishing. The focus is on high-calorie, nutrient-dense, and easy-to-digest foods that are generally considered “warming.” In other words, chuck the salad for a few weeks. One recipe I’ve seen several times is a sweet rice pudding with “warming” spices such as ginger and cinnamon. The recommendation is to make it with white basmati rice, rather than brown rice, as white rice is easier to digest. Other favorites include bone broths from beef, chicken, and pork; soups made from bone broth; and calcium-rich dairy foods. Yams, clarified butter, bananas, apples, and pears also make the list. In the next two weeks – provided the twins don’t arrive during that time – I’m going to create some simple freezer meals that are nutritious for postpartum mothers.
Korean Seaweed Soup
Double-Dark Chicken Noodle Soup
Pig Trotter Soup with Soybeans
Sweet Potato Leek Soup
Nepali Rice Pudding – this recipe calls for a sugar called “jaggery,” which I bought on Amazon here, and ghee
Slow Cooker Bone Broth – I made this and it’s amazing! I aim to drink a cup every day.
Feeding the Masses
I breastfed my oldest son for 16 months, when I only stopped because I had to be hospitalized for my heart condition. With Gus, I breastfed for about a year, with a bit of supplementation with formula the last couple of months. Breastfeeding is touted as the best way to nourish babies, and has a lot of benefits for mom. Truthfully, I believe that most of the benefits of breastfeeding are actually for mom. A few recent studies have found fewer differences between breastfed siblings and formula fed infants than other studies have found with non-sibling children, suggesting that at least some of the IQ differences found between breastfed and formula fed infants might be due to socioeconomics. However, benefits to moms are significant. Lower instances of ovarian cancer, breast cancer, cardiovascular disease, not to mention weight loss, are all great reasons that most should breastfeed. Plus, once many moms get past the initial difficult startup costs of breastfeeding, many moms find it easier than worrying about always having to worry about getting fresh water for formula if they’re not in the house.
My plan is to breastfeed the twins with some supplementation, at least for as long as I’m at home. I’m not sure if pumping for twins is going to be feasible, so right now my focus is that as long as I’m home I will breastfeed. With both my older sons, I had an almost OCD-like obsession with breastfeeding; not allowing other to feed them and never allowing any supplementing. I think it really hurt me with my second son in never letting myself have a break.
In order to breastfeed successfully, paying attention to your nutrition is essential. Dr. Barbara Luke in THE book on good health while pregnant with multiples, writes, “The nutrient content of breast milk is amazingly constant, whether the mother is underweight or overweight, anemic or well nourished – which means that if your diet is inadequate, your own health will suffer.” She recommends diets for moms breastfeeding twins, triplets, and quads, with a focus on calcium and grains which are high in zinc and folic acid. I’ve used her recommendations to create my nourishment checklist.
Being pregnant with twins, having a heart condition, and having suffered with several major depressive episodes, it sometimes feels like I own a small pharmacy. Prenatal vitamins. Folic acid. Iron supplements. Calcium/magnesium supplements. Fish oil. Beta blockers. Antidepressants. Probiotics. For some reason, though, once I give birth I then immediately seem to forgo everything but the “necessary’ items – my beta blockers and antidepressants.
Although there’s debate over the utility of supplements such as vitamins in general, almost no one questions the importance of a multivitamin with folic acid for expecting mothers. Folic acid has been linked to lower instances of spina bifida, a birth defect that causes a baby’s spine to develop incorrectly. Anecdotally, I find that I seem to get sick a lot less often when I’m diligent about taking my multivitamin, pregnant or not. For moms expecting twins, doctors usually recommend additional iron supplements as anemia can be a problem, and even with supplements and extra red meat I still developed slight anemia this pregnancy.
This time around, I’m going to keep up my pill popping regimen as it’s kept me and the babies extremely healthy. During breastfeeding we’ll all need those extra nutrients. Adding in vitamin D seems like a smart move as well, although hopefully there will be some sunshine this time around. After I had Gus it was one of the coldest and snowiest winters on record, and we barely left the house to get some natural vitamin D through sunshine. Additionally, Omega-3s seem to have some benefit for preventing the baby blues and postpartum depression.
There’s other information out there about additional supplements, such as vitex and chamomile, but I’m not an expert in any of that so I’ll let you search out that information on my own. Some folks also advocate encapsulating your placenta. I attempted that during my first pregnancy but the hospital thought I was A. creepy, and B. wouldn’t let me take it, so there went that. Not everyone can just demand their placenta a la the Kardashians. My acupuncturist makes a special herbal blend for postpartum mothers and I usually drink that as a tea. Other kinds of teas are recommended to support breastfeeding, such as fenugreek and fennel. Again, I’m the furthest thing from an expert on this, so please use Dr. Google.
If you do decide to supplement, even just with multivitamins, make sure you tell your doctor about everything you’re taking. You may want to clear it with her at your next appointment, just to be safe. Due to my extensive medical history I overshare. You should see my “birth plan.” It’s basically a list of phone numbers of doctors, drugs I take, and every “procedure” I’ve had done ever. It’s approved by my cardiologist. No requests for birthing tubs or movement during labor here. Just the facts, ma’am.
To make sure I’m eating enough of the right foods and taking my supplements, I made a “nutrition checklist.” It’s nothing special, but this is what works for me. The checklist creates a feedback loop so I can record my progress. Sometimes, when you’re feeling crappy, it’s helpful to go back and realize, “Gee, it’s been three days since I’ve taken my vitamins. I should get on that.” It’s easy to slip into automatic thinking and attribute your crappy feeling to something internal, rather than seeing an external cause for it.
The “specific and measurable” aspect of this goal is quite simple; go through nutrition checklist every day.
Next week, I’ll discuss body care and how it can provide another pillar of postpartum care for new moms. And although I know that exercise is a great way to beat depression, part of my plan for honoring and caring for my postpartum body involves not exercising for at least the first six weeks postpartum, at least not in the “getting-to-the-gym” or “going-for-a-run” sense. Stay tuned!
 Oates, M. (2003). Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. British Medical Bulletin, 67(1), 219-229. http://bmb.oxfordjournals.org/content/67/1/219.abstract#cited-by
 Luke, B., & Eberlein, T. (2011). When you’re expecting twins, triplets, or quads. Harper.
 flickr photo by joyosity http://flickr.com/photos/joyosity/8972128250 shared under a Creative Commons (BY) license