The Tot Q&A: Postpartum Care with Josie Bouchier
When you’re swept up in the energy of having a newborn, it’s often easy to forget to look after yourself. Womens’ Wellness & TCM expert, Josie Bouchier answers questions on how to prepare for the first six weeks postpartum and how to take care of yourself while also looking after your baby.
Q: What herbs or specific nutrients, breastfeeding friendly, would you recommend to support energy? So much you have to be careful with breastfeeding!
A: Yes, you do need to be careful what you ingest while breastfeeding since baby will ingest it, too. I highly recommend a good quality (pharmaceutical quality if you can) prenatal multivitamin and fish oil. A consistent vitamin regimen will help to replenish vital nutrients lost during labor and delivery–even if it was months or years ago!–and can help maintain or enrich breast milk supply. Unfortunately, most of our food is severely stripped of vitamins and minerals due to unsustainable farming practices, especially in the U.S. When the soil is not replenished, then crucial nutrients do not make it into our food, or into our bodies. This day and age it’s of upmost importance to supplement even healthy diets with proper vitamins and minerals to experience optimal health and energy.
As for herbs, I typically prescribe an ancient Chinese medicine herbal formula called Ba Zhen Tang which tonifies Mama’s Qi (“chee,” aka energy) and Blood. No matter what kind of birth experience you have, you lose a tremendous amount of Qi and Blood during delivery, which directly effects your energy levels, hormone levels, mood and mental health. Replenishing your Qi and Blood can help you get through your day, sleep better, feel more balanced hormonally and more even keel emotionally. It can also help increase or maintain breast milk supply. You can ask your acupuncturist to order this formula for you, if they don’t already carry it. I also love to recommend Bach Flower Remedies to my postpartum (and pregnant) patients because they are so effective and have no interactions or contraindications during pregnancy or breastfeeding. Bach Flower Remedies are unique in that they solely address the emotions, which I think is a huge part of where our energy goes as Mamas.
Q: Any tips on sleep and recovery with a newborn and a 20 months old active toddler?
A: Postpartum recovery (and sleep) is a completely different journey when you also have a toddler at home. One of the most useful pieces of information I learned during that time came from a parenting method called Hand in Hand Parenting, which is based on child brain development. (You can check out their website handinhandparenting.org for more info.) I learned that toddlers do not need you to match their high energy levels, nor do they need to be out and about in the world until they are 7-10 years old. What toddlers need the most from you is connection, i.e. your presence, your time, and your attention, which you can give them while resting on the couch and feeding your newborn. One of the ways I learned how to offer connection to my toddler while breastfeeding my newborn was to “follow the laughter.” This is a method they teach where you simply keep doing what makes the child laugh, and then you laugh yourself, too. Sometimes I would make a funny face or a noise over and over again, both of us laughing, for 15 or 20 minutes. Laughing together like that causes a bonding brain connection that fills the toddler’s emotional cup.
After this type of interaction, my daughter always felt content to play and entertain herself for awhile, which freed me up to rest and care for her baby sister and for myself. Win-win! The other piece of advice, and permission, I’d like to offer you is to ask for or hire help. No one was ever meant to care for their baby alone or to take care of themselves alone. Traditionally, we had a community of people around us to tend to our needs and our baby’s needs. One of the most nurturing things you can do for yourself is to create this community for yourself, or hire it if you have the means. In Ayurvedic tradition, which has many similarities to Chinese medicine, it is said that the way a woman is cared for in the 40 days postpartum will effect her health for the next 40 years. Prioritizing care for yourself will have lasting effects–put in the time, energy, and money now. You are worth it. As for improving sleep with a newborn and a toddler, I recommend talking with a lactation specialist to help you formulate a strategy that is customized for you and your family. Even if you’re not breastfeeding, lactation specialists are often super knowledgable about coordinating sleeping with feeding. Every family’s arrangement and style of sleeping, feeding, and parenting are so vastly different that it’s helpful to consult with someone one-on-one, or even have a specialist come to your home, in order to get the best sleep advice.
Q: What can you do for PP anxiety and emotional well-being that is safe while breastfeeding?
A: One of the best tricks you can do to nip anxiety in the bud, whether or not you are postpartum or breastfeeding, is to take deep belly breaths. This can be done anytime, anywhere, and it’s the single most effective thing you can do to flip the switch in your brain from “fight or flight” to “rest and relaxation.” Our breath is the one loophole where we can control our autonomic nervous system that normally functions without our consent (think growing our hair, healing a wound, digesting our food), and usually keeps us in a stressful, anxious “fight or flight” mode. Taking a couple minutes to breathe from your belly, as often as you can throughout the day, will have a profound impact on your level of anxiety and emotional well-being. I also highly recommend acupuncture for postpartum anxiety and emotional well-being because it is completely safe while breastfeeding and extremely effective. Even better if you can find someone that specializes in women’s health.
Bach Flower Remedies are also wonderful because they are safe while breastfeeding, can be found at most health food stores, and they solely address emotional well-being. Additionally, make sure that you have a solid support system in place, whether it be a therapist our counselor and/or 1-2 close friends you can text or call when you are feeling at the end of your rope who will simply listen and let you vent and offer love and encouraging words. There is no shame in taking western prescribed anti-anxiety or antidepressant medications that are considered safe while breastfeeding if you need extra support. I don’t think all-natural approaches are always appropriate for everyone, especially in the acute phases of postpartum recovery. If your emotional well-being is at risk, don’t be afraid to reach out and ask for help. Every Mama I’ve ever worked with struggles to some degree with postpartum recovery, it’s something that needs to be talked about more and brought into the awareness of everyone around us so that it’s no longer a taboo subject.
Q: Is there a way to prevent postpartum depression/baby blues?
A: Unfortunately, there is no surefire way to prevent postpartum depression, but there are many things you can do to lessen the odds, soften the impact of the postpartum phase, and set yourself up for a more successful experience. Consistent acupuncture throughout your pregnancy can help keep your hormones balanced, which can help prevent postpartum depression. Just make sure you find someone that specializes in women’s health and/or pregnancy, because there are certain acupuncture points that are contraindicated during pregnancy, and you want someone who knows what they’re doing.
Setting up a reliable support system and using it now, before you deliver, can do wonders for your mental-emotional state once baby is born. Whether this support system includes a therapist or counselor, or 1-2 close friends or family members, just make sure that any one of these people is only a phone call or text away at any given time. Eating a healthy diet and staying on a consistent vitamin regimen that includes a high quality (or pharmaceutical grade) prenatal multivitamin and fish oil, can lessen the depletion you’ll experience after giving birth. If you’re less depleted, you’re less likely to slip into postpartum depression.
Lastly, consider encapsulating your placenta and/or have a Qi and Blood replenishing Chinese herbal formula ready to start taking immediately after your baby’s birth. In Chinese medicine, the placenta is considered an “herb” that replenishes a woman’s Qi and Blood, helps to balance her hormones, mitigate mental/emotional swings, and help the breast milk to come in. Contact a trusted doula to help you find a practitioner who is skilled in encapsulating placentas, or ask your acupuncturist for an herbal formula called Ba Zhen Tang. Like I mentioned earlier, there is no shame in taking western prescribed anti-anxiety or antidepressant medications (that are considered safe while breastfeeding if you are breastfeeding) if you need extra support. I don’t think all-natural approaches are always appropriate for everyone, especially in the acute phases of postpartum recovery. If your emotional well-being is at risk, don’t be afraid to reach out and ask for help. Every Mama I’ve ever worked with struggles to some degree with postpartum recovery, it’s something that needs to be talked about more and brought into the awareness of everyone around us so that it’s no longer a taboo subject.
Q: If I had trouble breastfeeding and pumping with my first because of low production, will I have trouble with my 2nd? Anyway to prevent these issues like start pumping from day 1, etc?
A: Just because you had trouble with pumping and low production with your first pregnancy does not necessarily mean you will have trouble with your second. According to Chinese medicine, the two most important factors to keep your milk production levels high and easily flowing are adequate nutrition (and digestion to absorb and assimilate the nutrients you put in your body), and low stress levels. In Chinese medicine, breast milk comes from transformed food, so make sure you’re eating a nourishing, balanced diet and consistently taking your prenatal vitamins. Additionally, be sure to include foods that are “galactagogues,” which means that they promote breast milk production. Galactagogues include whole grains, dark leafy greens, fennel, garlic, chickpeas, nuts, seeds, ginger, papaya, and spices like cumin, anise, fennel, and turmeric.
When we’re emotionally stressed, our Liver Qi (energy) constricts, especially in our chest area. When our energy is constricted, this can stop or greatly hinder the flow of breast milk. Massaging the breasts in a clockwise circular motion can help restore the energy, blood, and milk flow. You can use a small amount of coconut or sesame oil to make it easier to massage, and you may also want to use a heating pad to warm the area. This is a great practice to do at any time of day, but it will be particularly beneficial from 1pm-3pm, when the Liver Qi is at it’s weakest. Another thing you can do to restore energy flow to the breast / chest area is to practice de-stressing techniques. My favorite and most effective is belly breathing. When you take deep belly breaths, you instantly flip the switch in your brain from “fight or flight” to “rest and relaxation.” When you exist more often in “rest and relaxation” mode, you restore the flow of energy throughout your body, including your breast milk. I choose something to remind me to check in with my breathing several times throughout the day. For example, every time I take a drink of water, I also take a belly breath.
Q: What are the best easy healthy foods to have on hand for quick snacking while taking care of baby?
Some of my favorite go-to, one-handed snacks are: veggies (good carb) with hummus (good protein) and olive oil (good fat) / mashed canned sardines in marinara sauce (good fat and good protein) with whole grain crackers (good carb) / apple (good carb) with almond butter (good fat and good protein) / mozzarella cheese sticks (good fat and good protein) with whole grain crackers (good carb) / turkey slices (good fat and good protein) with veggies (good carb) / sprouted grain toast (good carb and good protein) with mashed avocado (good fat), salt and pepper. I also find it useful to make big batches of soups, stews, or broths that can be easily portioned and quickly heated up in a mug in the microwave, or on the stovetop. Sipping on broth throughout the day is a wonderful way to nourish the body when you don’t have the time or energy to make a complete snack. You can also buy miso paste and simply stir a couple spoonfuls in hot water to make a yummy miso soup. In Chinese medicine, it’s important not to put out your “digestive fire” by consuming too much cold or raw food. Balancing uncooked snacks, like those mentioned above, with warm soups, broths, and teas will help to nourish and strengthen your digestion after giving birth.
Q: I second the question about easy healthy snacks when exhausted and busy with the babies! And ways to not feel so isolated when stuck inside so much caring for them.
A: As for feeling isolated, caring for small ones can feel extremely isolating in today’s modern parenting culture. When I was home all the time with my daughters, I relied heavily on social media to feel connected to the outside world. I also fell in love with an app called Yoga Glo because it had guided meditations and yoga classes for every ability level and time commitment. Whether you have 5 minutes or 50 minutes, you can log in and choose a guided meditation (there are several specifically aimed at parents) or a yoga session and it’s just you and the instructor for that amount of time. I always ended the class or meditation feeling renewed and centered, and most importantly, like I just had an interaction with another adult. I’m sure there are several apps that exist like this one, but that was the one I loved. It was a life saver! I also recommend FaceTiming or talking on the phone with one adult per day, whether it’s a friend, family member, counselor or therapist. Plan on it, even if it’s just for 5-10 minutes. It can make a world of difference.
Q: Any way to get the oxytocin flowing postpartum? Had a c-section and I don’t have those “feel good” feelings like I did with my first. I’m currently 3 weeks postpartum, breastfeeding and exhausted.
A: Oxytocin is known as the “love molecule” and is produced whenever you experience feelings of love or connection. This can mean snuggling with or even just thinking about a beloved animal, or watching a romantic movie that makes you feel good. Being intimate with your partner can also help stimulate oxytocin, even if it’s just a long hug, a shoulder or foot massage. Closing your eyes and visualizing someone you love, or thinking about sending or receiving love from someone significant to you can increase oxytocin production. Try being present, observing someone completely who is in front of you, and sharing a meal. Focus your attention on loving yourself and those around you, and see what happens.
Q: Any big nutrition Don’ts while breastfeeding?
A: Luckily, there aren’t any major dietary “don’ts” while breastfeeding. However, avoiding contaminated food is probably the best thing you can do for your health and your baby’s health while breastfeeding. The best way to find up-to-date information on mercury toxicity in seafood, and pesticide toxicity in produce, is to check the Environmental Working Group’s website periodically. You might even want to keep a copy handy of the Dirty Dozen and the Clean Fifteen while grocery shopping so you know which produce to buy organic, and which produce is ok to eat even if it’s conventionally grown.
Additionally, caffeine and alcohol are best consumed mindfully and in moderation since baby will experience some residual effects from both. Try to time your consumption just after you’ve nursed or pumped, which will give your body some time to process the caffeine or alcohol and it will be much lower concentration, if any, at baby’s next feeding. A good rule of thumb is if you don’t feel the effects anymore, neither will your baby. The other thing to watch out for nutritionally while breastfeeding will be different for every Mama and baby–food sensitivities or allergies. Signs that your baby might be sensitive or allergic to a certain food or foods can include eczema, rashes, increased fussiness, gas, diarrhea, congestion, and vomiting. Keeping a food journal can help to make correlations between symptoms and foods.
Q: What’s a good prenatal routine you would recommend if you only have 15 minutes every day? Postpartum? It could be legs up the wall, just want to know what’s important.
A: Hands down it would be pelvic floor strengthening, both during pregnancy and postpartum. During pregnancy, I would seek out a prenatal Pilates instructor and have them teach you a 15 minute routine to do daily at home. That way, they can customize your routine for where you are in your pregnancy and account for any possible physical limitations and medical history. Once you are in the postpartum phase, I highly recommend an online program by Wendy Powell called MuTu. As part of the program, she gives you a 15 minute daily exercise routine that you can do anytime, anywhere at home and it works wonders! She offers much more extensive workouts as part of her program, but I only did the 15 minute daily routine and noticed a huge difference in my postpartum recovery. She also takes into account where you are in your postpartum recovery and you can start out slow and simple and then get more advanced. Hope this helps!
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