10 Principles of postpartum care
photo by Kevin Liang
As a child growing up in a large, extended Punjabi family (my dad was one of 10 children) I was used to there being babies around. As a 7 or 8 year old, my favourite thing about family gatherings would be holding babies and toddlers. One of my favourite shows as a child was A Birth Story on The Learning Channel, I would be riveted to the episodes detailing each couple’s journey of bringing a baby earthside.
I always knew there would be a time when my work would transition toward birth, and after doing my doula training in the UK (the land of my birth) in 2022, I have been slowly immersing myself in the endlessly fascinating and deeply inspiring work of supporting women and families through immense life transitions.
A birth and postpartum doula provides emotional, physical (coping measures during birth, postpartum holistic care), and spiritual care to a mother and her family before, during, and after birth. A doula is an invaluable asset during this critical time, directing parents towards curated and evidence based research, as well as often providing full spectrum care including supporting the emotional and spiritual process of moving through a miscarriage, abortion, or stillborn if applicable.
A doula will hold your hand, provide massage, discuss ideal birthing positions, personalize education, discuss recommended herbs and foods, provide warmth and cool compresses during labour and be a holistic guide through what can be a very challenging and hormonally huge time!
My own mother struggled with her mental health during postpartum so being a postpartum doula truly feels like a calling for me. I believe that if we can support healthy attachment, bonding, and wellness for families directly after birth and for the months and years following - it has the potential to change our society for the better. When our nervous systems are more regulated we can parent better, when we know the demands of a baby and can learn to understand their unique language we can be guided toward meeting their needs. We don’t need to be perfect. If we can meet a mother/baby dyad’s needs most of the time we help to create secure attachment which has lifelong effects for both mom and baby. Not to mention that birth can help strengthen kinship and community ties in the wider mycelial web of connection.
According to many cultures, the mother baby dyad requires three key pillars after birth - rest, warmth, and nourishment. The amazing book, “The First Forty Days” by Heng Ou outlines some key teachings rooted in the author’s Chinese tradition.
Spending as much time in bed, around the bed, and in the house for the first month can help support the mother’s health for decades to come. From a TCM (Traditional Chinese Medicine) and Ayurvedic (Traditional Indian Medicine) perspective, birth is extremely depleting and the mother must recover her energy. After such a profound opening and the immense exertion required, it is necessary for the mother to give herself as much rest as possible to allow her organs to move back into place after accommodating baby. Not to mention, there are usually several weeks of bleeding due to shedding the endometrial lining and allowing a wound (from where the placenta was attached) to heal adequately. Tearing, swelling, and suturing can also be part of this big physical initiation into motherhood.
There is physical and emotional healing that needs to happen, some things I have picked up during my research and observation include:
1) The benefits of co-sleeping or having baby in a bassinett next to the bed, so that it is easy for the caregiver to just roll over, feed, and change the baby without having to walk around. Many people in the Global North have deep fears around co-sleeping that are largely unfounded. Many countries around the world have co-slept for millennia. Co-sleeping allows for nervous system co-regulation and there are safe positioning steps you can take to ensure that baby is well, this includes the C curve as well as having no pillows or blankets anywhere near the baby. Having a mattress on the floor can be ideal or having a bed that is directly up against the wall to prevent any risk of falls.
Babies are programmed to wake up every few hours to feed, they are not tiny adults with sleep schedules. Learning to adapt to this requires flexibility. Having baby sleep next to you can make a world of difference for how much sleep you get. I see many parents inadvertently falling asleep on a couch with a baby when trying to get them to sleep in a different room - this is way more dangerous than co-sleeping in a safe bed space. For more info about co-sleeping: https://cosleeping.org/ https://llli.org/news/the-safe-sleep-seven/ https://www.youtube.com/watch?v=g5fOogsUpIk&feature=youtu.be
One of the most memorable stories I have heard in this arena is from a dear friend of mine who told me she actually slept more after she had a baby because she chose to embrace rest and having her baby sleep with her. How revolutionary!
2) Birth requires a village, we must take care of mothers so that they can take care of their babies. Instead of giving gifts like baby clothes and baby equipment - consider providing parents with a housecleaning service, nourishing meal delivery, professional massage, acupuncture, counselling, and doula services. These prove to be so much more helpful than a toy that the baby cannot even play with or clothes they will outgrow in a few weeks.
If you are visiting new parents - don’t ask to hold the baby. Instead ask what you can do to make their life easier, is it doing some laundry or washing the dishes? Bring along a nourishing meal or soup. Give the mom a foot rub and a shoulder massage. Or if the parents are super tired, consider offering to take care of the baby so they can have some alone time or some time with just the two of them in a different room.
3) Relationships shift after birth. Everyone I know who has had a kid, says that overcoming the monumental changes in their romantic relationship was something they hadn’t considered. Expanding our families requires us to reimagine ourselves in new ways and in a new identity. Our relationship with our significant other is bound to go through some huge changes- and having space to process and heal together is imperative. Consider doing healing work as a couple after having a baby and continue to prioritize date nights and quality time together. Intimacy takes many forms and explore new ways to connect to each other, instead of pouring every ounce of your energy into your baby.
It is important for men in particular to have good role models and support in their life. Often, men can feel helpless or useless after birth since a woman’s body is often providing nourishment to the baby. A partner is so vital to the wellbeing of the birthing person and to the baby. New dads can take the lead in creating the most relaxing home environment for the new family by taking care of food, running baths, changing bed linens, and being an all around support for the mom. This is not the time to expect a woman to cook meals or be contributing to the household - it is a time for her to rest, relax, nourish. If she is able to feel supported in this way it will make such a big difference.
Take a longer paternity leave if you can, or set aside financial resources so that you can all bond as a family and have slow, sweet days in the bubble of love that birth creates.
4) New mothers require deeply nourishing foods. Focusing on easily digestible, warm, cooked, mushy, and gelatinous foods after birth is so important. Think of congees, oatmeals, cake, pureed fruit, soups, stews, bone broths, warm teas, and nutrient dense foods are essential to the mother’s healing. The mother’s digestive system has to literally find its way back to a new position after shifting and compressing to accommodate the baby. Consider ancestral diets when feeding a new mama, also consider foods that can be easily eaten with one hand since usually the baby will be being held. Do not expect a mother to cook for herself or for you - keep her well fed and nourished. It is a time for the mother to receive so that she can give to her little one. Meal trains are a great idea for friends and family to set up prior to the birth. Dropping of food without any expectations of a visit is sometimes helpful for the new parents. Keep visits short when visiting new families and make yourself useful as a support person.
5) Wear and hold baby as much as humanly possible as a parent. Kangaroo care, as termed by Dr. Bergman refers to groundbreaking research about the benefits of skin to skin beyond the first hour or first day. Pre-term babies heal so much better when they can feel the warmth and skin of their caregiver. In the book “The Continuum Concept,” Jean Liedloff discusses an indigenous approach to raising children which include continuing life as normal and wearing your baby nearly constantly so they can rest and observe the world with you. Liedloff argues that children who are raised this way are inherently social, generally happy and peaceful. While I certainly have many qualms with this book and its language I am super grateful for the alternative imagining of child-rearing that it evokes.
My observation is that many aspects of childbirth and child-rearing have become too intellectualized and complex in the Global North. Simple joys such as sensory exploration, the power of connected touch, talking to your baby, and being close to them makes a world of difference. You don’t need the fanciest gadgets or expensive equipment to meet your baby’s basic needs - you simply need to be patient, present, and resourced. Spending time in nature as the baby gets older and practicing grounding techniques can also be very soothing for little ones and parents. Parents need to fill their own cup in order to be able to give so fitting in short periods of self-care and meditation can go a long way too.
6) Warmth. In the postpartum period it is very important for the mother to remain warm. In TCM, the uterus and the feet are closely connected, so by keeping the feet warm you help to keep the uterus warm. Warmth in the form of herbal baths, yoni steaming, warm broths and soups, have a profound effect on helping the body heal. If there are perineal tears, this is also very important. Herbs such as motherwort, shepherd’s purse, lady’s mantle, rose, chamomile, calendula, aloe vera, and fennel can be so incredibly useful in the postpartum period in a variety of ways. Consult a well qualified herbalist before working with plants to ensure you have the right ones for your constitution.
7) Bodywork. An ayurvedic approach to healing postpartum includes daily massages for at least a month. Gentle massage and energy healing can be done as earlier as immediately after giving birth and specifically, gentle abdominal massage can help the uterus to eventually shift back into it’s pre-pregnancy size (it moves from the size of a pear to a watermelon!). Massage is deeply grounding and helps a mother’s body to feel held and cared for.
8) Ceremony. Offering a “closing of the bones” ceremony helps a mother’s body to close the birth portal while also guiding the pelvis and the muscles/bones that stretched during pregnancy and birth to return to a new state. Ceremony and ritual helps us mark one phase into another and provides meaning during huge life transitions. This can look a number of ways. Many families and cultures choose to honour the placenta (sometimes understood as the baby’s first mother or a twin, since it provides all nutrients and gets rid of all waste as well as breathes for the baby) by burying it in the earth and/or planting a tree. Returning the placenta to the earth has also been said to help the baby’s soul ground into the land where it was born and help the baby fully come into its body and feel at home.
9) Emotional support and processing of the birth story. Writing or sharing the birth story is important for many mothers and this might happens several months or even a year after the birth. Coming to terms with such a massive life change takes its own time, especially if there was any sort of trauma during the birth. Birth requires every part of a woman, and how she feels during birth can reverberate through the rest of her life in profound ways. Having a loving witness such as a doula, or a trained perinatal counsellor around to help process the birth experience is so crucial in helping make sense of what happened. Integration often doesn’t happen immediately.
10) Education. Educating yourself about postpartum and birth is so very important. Expand beyond the medical system to consider holistic modalities and cultural approaches to birth. Having these rituals and practices in place helps us to find our place in our lineage. Birth is directly tied to ancestry. What did the women and men in your culture and family do to mark a birth? How was a birth celebrated? How was the mother nourished? Of course, some traditions become antiquated and are not applicable but older women and healers in a village usually held this knowledge. Now, we often turn to grandma google. Don’t automatically dismiss the “old wives’ tales” - use the knowledge that feels empowering and resonant. You are on your way to feeling resourced, capable, and supported in this next beautiful stage of life.
