Post-Partum Care

Understanding Post-Partum Care

Post-partum care is the care a mother receives while her body recovers and adjusts after childbirth. The postpartum period starts right after the placenta is delivered and generally lasts about 6 weeks, although some changes continue longer.^[1] Because this period involves bleeding, healing, hormonal change and mood risks, it needs medical oversight, and the clinic's role is supportive only.

Common symptoms

After birth, the uterus gradually shrinks back to its prepregnancy size, blood volume and fluids shift, and the drop in estrogen and progesterone allows milk production to begin.^[1] Mothers often notice cramping, vaginal bleeding and discharge, perineal or incision pain, tiredness, breast fullness, and sleep disruption.^[1]

Mood changes are also common. The baby blues bring tearfulness, irritability and anxiety in the first days to weeks and usually pass within a few weeks, while postpartum depression is more severe and can last for months if untreated.^[2]

Causes and risk factors

These changes are a normal result of pregnancy and delivery, and the main task is separating normal recovery from complications.^[1] Perinatal depression is often undiagnosed because mothers may be reluctant to disclose symptoms, partly from stigma.^[2]

How it is diagnosed and treated conventionally

Your obstetric provider checks recovery, bleeding, wound healing, blood pressure and mood, and screening for perinatal depression should be routine in postpartum care.^[2] Depression treatment typically combines psychotherapy, support groups and, when needed, antidepressant medicine, some of which can be used during breastfeeding.^[2]

Other care includes pain relief, pelvic floor recovery, lactation support, contraception planning and a gradual return to exercise. Your provider decides what is right for you.

Why Post-Partum Care calls for a whole-person approach

Recovery after birth is physical, hormonal and emotional at once. Healing tissue, sleep loss, feeding, hormone shifts and new demands on the mother all interact.^{[1, 2]}

Support that addresses several of these is a reasonable addition to medical care. The factors below are the ones most relevant here.

Hormonal change and lactation

The rapid fall in estrogen and progesterone after delivery triggers prolactin and oxytocin signaling that starts milk production.^[1] Worries about low milk supply are common and are a frequent reason mothers stop breastfeeding early.^[3]

Pain and physical recovery

Pain after birth can come from the perineum, a cesarean incision, uterine cramping, the back and swollen breasts.^[1] Breast engorgement can be painful, and the Cochrane review of 21 trials found little consistent evidence for any single treatment.^[4]

Mood and sleep

Postpartum mood problems range from short-lived baby blues to depression, and anxiety and insomnia often accompany them.^[2] A systematic review found a range of non-drug approaches, including relaxation, massage and acupressure, associated with lower baby-blues scores, with no one approach clearly best.^[5]

Support and stress

Stigma and fear of disclosure keep many mothers from reporting symptoms, so social support and open conversations with providers matter.^[2]

Acupuncture as supportive care in Post-Partum Care

What the research shows

No studies were found that test acupuncture as a program for postpartum recovery as a whole. The research below looks at specific symptoms, and some of it studied acupressure or other point-based methods rather than needles.

For postpartum depression, a 2019 meta-analysis of 12 trials with 887 mothers found better depression scores with acupuncture, though the result was borderline and results varied widely between trials. Its authors called the evidence uncertain.^[6] A 2022 review of six earlier reviews rated their methodological quality as critically low and the evidence as mostly low quality, concluding that acupuncture may help but that firm conclusions are not possible.^[7]

For postpartum low back pain, a pilot trial of 70 women found that real acupressure lowered pain, activity limits and depressive symptoms more than sham acupressure.^[8] A multicenter trial of 1,200 women in China tested acupoint hot compress, which is heat applied to points on the skin, not needles. It reduced urinary retention, uterine contraction pain and depressive symptoms and increased milk volume.^[9]

For lactation, a systematic review of 23 randomized trials found that auricular acupressure with seeds was associated with earlier lactation and lower risk of low milk production. The authors said stronger designs were needed before it could be called evidence-based.^[10] A broader review of complementary therapies in pregnancy, birth and the postpartum period concluded they may help pain, anxiety and depression, based on 17 trials.^[11]

How acupuncture may work

The mechanisms in postpartum recovery have not been established. The lactation review reported that serum prolactin generally favored auricular therapy, which suggests one possible pathway, but this has not been confirmed.^[10]

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with points chosen for your symptoms. Gentle point pressure or warming may also be used. We reassess after a short course of visits. Please check with your obstetric provider before starting.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you have a bleeding disorder, take blood thinners (including those prescribed after delivery) or have a pacemaker. Needle sites should avoid an unhealed incision or infected skin.

Ayurvedic medicine as supportive care in Post-Partum Care

The Ayurvedic view

Ayurveda describes the period after childbirth as sutika kala, a time when Vata is considered easily disturbed and the mother is thought to be depleted and in need of warmth, rest and nourishing food. These are traditional ideas, not biomedical facts.

Therapies that may be used

Traditional postpartum care emphasizes:

• Warm, soft, easily digested meals prepared with spices customarily used after birth
• Rest, protection from cold and steady sleep
• Gentle warm oil massage (abhyanga) if your provider agrees, avoiding any wound or incision
• Herbs prescribed individually by a qualified practitioner, such as shatavari for lactation, which has traditional use and a small trial^[13]

Panchakarma procedures are not appropriate in the postpartum period, and strong cleansing therapies are not used. Please do not start any program without your obstetric provider's agreement.

What the research shows

The research is limited. A placebo-controlled trial of 120 postpartum women found that shatavari root extract was linked with faster breast fullness, more expressed milk volume and higher maternal satisfaction over 72 hours, with no adverse events reported.^[13] This is a single short trial, and it does not show effects on long-term breastfeeding.

No trials of the traditional Ayurvedic postpartum regimen as a whole were found. A review of complementary therapies found that massage and yoga had benefits for pain and mood in this period, though these are not specifically Ayurvedic.^[11]

Herbal medicine as supportive care in Post-Partum Care

Herbs and formulas that have been studied

Herbs studied after birth are mostly milk-supporting herbs, such as shatavari, fenugreek, fennel, ginger, moringa and Chinese formulas.^[3] Herbal compresses have also been studied for breast pain from engorgement.^[4]

What the research shows

The evidence is limited. A Cochrane review of 41 trials involving 3,005 mothers found the certainty of evidence for oral galactagogues was low to very low. It could not say whether they affect how long mothers keep breastfeeding, and results for natural herbs were too varied to pool.^[3] An earlier systematic review of six trials found that five reported more breast milk, but the trials were small and had flaws, and the authors made no recommendation for herbs.^[14]

For engorgement, herbal compresses may reduce breast pain, but the evidence is low certainty.^[4]

Safety and herb-drug interactions

Little is known about the safety of herbs during breastfeeding. A systematic review of herbs during breastfeeding found studies of poor methodological quality and said more research on safety is needed.^[15] For this reason herbs are used with particular care while breastfeeding and only with your pediatric and obstetric providers' knowledge.

St. John's wort can lower the blood levels of many drugs and has caused serotonin syndrome with SSRIs, which matters if you are being treated for postpartum depression.^[16] Herbal and dietary supplements can also cause liver injury.^[17] In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[18] Herbs should come from tested sources and be prescribed individually.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes the postpartum period as one of blood and qi deficiency, which loosely parallels blood loss, fatigue and hormonal shifts.^[1] Researchers studying acupressure and auricular therapy for lactation look at prolactin signaling.^[10]

Ayurveda's view of aggravated Vata after birth can be set beside disrupted sleep, pain and anxiety. No study has shown that a dosha or TCM pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care after childbirth is complementary and supportive. Keep your obstetrician, midwife and pediatric provider, attend your postpartum checkups, and do not stop or change prescribed medicines, including antidepressants, without your prescriber. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

We do not diagnose postpartum complications or depression. Please bring your delivery summary, any instructions from your provider, any incision or wound instructions, and a full list of medicines and supplements, and tell us if you are breastfeeding.

When to seek urgent medical care

Some postpartum symptoms can signal a serious complication and need medical attention right away.

• Heavy bleeding that soaks through a pad in an hour, or large clots
• Fever, chills, foul-smelling discharge, or a red, swollen or draining incision or tear
• Severe abdominal pain, or a painful, red, hard area in a breast with fever
• Pain, swelling or warmth in one leg, chest pain or shortness of breath
• Severe headache, vision changes, or seizures
• Thoughts of harming yourself or your baby, or feeling unable to cope; call or text 988

Perinatal depression can increase the risk of suicide.^[2] For any emergency, call 911 or go to the nearest emergency department.