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5 Ways to Prepare for the Postpartum

May 15, 2020
prepare postpartum naturopathic doctor toronto

When people are pregnant, they often think about what life will be like with baby. However, the immediate postpartum sometimes get overlooked. Today, I’m discussing 5 simple ways how you can prepare for the postpartum.

Create Your Nest

It’s likely that most of your time in the immediate postpartum will be feeding baby and getting rest. Many people believe they need to ‘get back to it’ days after birth – but the truth is that your body has done A LOT over the past 9 months, and some people liken birth to participating in a marathon.

In Traditional Chinese Medicine, there’s a huge emphasis on resting for the first 40 days after birth in order to replenish your energy stores. So, if you’re going to be recuperating in your home for the next little while, you may want to consider purchasing some items to cultivate some comfort.

This may include:

  • Comfortable chair that can glide back and forth
  • Side table to hold your water, phone, etc.

You essentially want to make your space as nice and cozy as possible so you can enjoy the immediate postpartum as much as you can.

Stock Your Pantry & Freezer

Oftentimes when you’re caring for a newborn, cooking isn’t top of mind. But eating well is important to you may want to replenish iron and blood, repair tissues and support hormones, enrich breastmilk and support mood.

When my clients begin maternity leave, they usually start preparing meals that can be frozen and easily warmed up when needed. Traditional Chinese Medicine emphasizes simple yet nourishing meals to support your body in the postpartum. This includes soups, stews, and broths (even during those warmer months!).

Soft and simple meals (read: easily digestible) are recommended because your digestive system was displaced during pregnancy and needs time to return to its original position and function. Eating a meal that takes a lot of energy to digest, may upset your system.

Ideally all your meals should contain some type of protein and fat to nourish your body and help with repair and recovery. Hydration is also quite important as you likely need to replenish fluids lost at birth. Moreover, if you choose to chest/breastfeed, water is needed for milk production.

Lastly, many wise people recommended adding gift cards your registry – specifically to grocery stores/local restaurants. Basically, if you’re able to purchase ready-made food, it will save you lots of time and energy (not to mention, washing dishes!).

Stock-up on Your Supplements

I often get questions from patients asking which (if any) supplements they should take in the postpartum. Obviously this depends person-to-person, but for the most part there are a few to consider having in your cabinet.

These include:

  • Prenatal Vitamin: You won’t be done with this one yet! If you’re chest/breastfeeding, your baby is getting many of their nutrients from you. So it’s necessary for you to continuously replenish that store for their needs as well as yours!
  • Fish oil with EPA and DHA: Fish oil in general is a great supplement to have on hand for your overall health and mood, and the DHA specifically will help with your baby’s neurological development.
  • Probiotics: If you ended up testing positive for Group B Strep, you will most likely get antibiotics during your birth. Supplementing with healthy bacteria will aid in replenishing your gut – which will not only benefit your immune system, but will support baby’s too. There are specific strains for the vaginal microbiome as well.
  • Vitamin D: Generally, most of us are low in vitamin D. Low levels have been shown to contribute to postpartum mood disorders. To determine how much you need (because this is one of those vitamins where dose does matter), a simple blood test can be done.
  • Iron: Low ferritin levels (the iron storage form), can also contribute to postpartum mood disorders. While iron is present in prenatal vitamins, sometimes more is needed. Again, a blood test would tell you how much is needed – test, don’t guess!
  • Lactation Herbs: There are tons of these – so speak to your ND before buying a particular brand. Goats Rue is an herb that works universally – supporting prolactin, milk production, insulin sensitivity, and the nervous system. But something to keep in mind is that if you’re experiencing milk production issues – it’s usually best to consult with a lactation consultant first before using herbs. Sometimes the latch is the issue!

When determining what exactly you’ll need in the postpartum, it’s important to work with someone who can provide you with the correct information, safe products and dosing.

Catch Your Zzzs

Your sleep quality and quantity may likely change in the postpartum. So if you have an opportunity, rest up before baby comes! Like I mentioned earlier, pregnancy can be like a marathon and preparing your body is important. Whether you’re taking naps throughout the day or going to bed a few hours early – every last bit counts.

When baby arrives and when it’s safe to do so (this article was written as we’re all physical distancing), don’t be afraid to ask for help! Whatever task that can be taken off your hands, and placed into the hands of family and friends will save you time and energy, ad hopefully allow you to get some rest.

Build Your Community

When people say it takes a village – it’s true! Your village doesn’t need to be made up of just family and friends though – healthcare providers can also provide support! The following are some professionals that you may want to seek out. Some clinics (like the one I work at) are tailored towards pregnancy and the postpartum, and usually have most of these services all under one roof (and many provide virtual visits as well).

  • Lactation Consultant (In person & virtual): A lactation consultant can be helpful for chest/breastfeeding support, especially promoting a flow and a healthy latch. Usually the first person you should talk to when it comes to feeding.
  • Postpartum Doula: A postpartum doula may be helpful at providing support for both you and your newborn. This may include chest/breastfeeding support, completing small tasks around your house (ie. laundry, tidying up), and providing a wealth of knowledge about the postpartum period.
  • Therapist (In person & virtual): Sometimes birth doesn’t as expected. You may want to consider adding a therapist to your postpartum team, to help process your delivery and your new role as a parent.
  • Pelvic Floor Physiotherapist (In person & virtual): It’s a common misconception that you don’t need to seek a pelvic floor physiotherapist if you’ve had a c-section. Your pelvic floor may still need support! Especially if you experience pelvic girdle pain and diastasis recti abdominus (DRA). Typically, you would see a pelvic floor physiotherapist around 6 weeks after birth.
  • Massage Therapist: A massage therapist can be helpful at helping to mobilize scar tissue, especially if there have been any adhesions.
  • Naturopathic Doctor (In person & virtual): A naturopathic doctor may be helpful for any postpartum depletion that you may be experiencing (diet-wise, energy/fatigue), and using acupuncture or herbs to help promote healing.
  • Acupuncturist: An acupuncturist may be helpful at promoting a general feeling of well being as well as helping with healing.
  • Chiropractor (In person & virtual): A chiropractic doctor may be helpful as reducing any aches and pains that you may be feeling, especially neck and pelvic pain.

Be sure to contact these specific healthcare providers to determine when would be the appropriate time to come and see them – especially if you’re noticing physical issues.

Final Thoughts

Now that you’ve gone through this list and hopefully picked up something new – you may consider checking in with a Naturopathic Doctor like myself to tailor some of these suggestions.

I’m offering virtual appointments during this time to support pregnant people throughout each trimester and the postpartum.

Can Sleep Deprivation Affect Fertility?

April 22, 2020
fertility sleep naturopathic doctor toronto

As many of us are practicing physical distancing and working from home, it’s a great time to focus on sleep – especially if you’re hoping to become pregnant in the near future! This is because sleep deprivation can affect fertility – no matter if you’re a man or a woman.

Sleep deprivation happens when there’s a decrease in your total amount of sleep over a certain period of time, or when there’s a shortage of sleep per night. It can also happen during shift work or from jet-lag.

Sleep deprivation can contribute to many adverse health conditions (ex. high blood pressure, depression and anxiety disorders, glucose dysregulation, etc.). Studies in humans who experienced a shorter duration of sleep experienced with high cases of mortality. Unfortunately in animal studies, long-term sleep deprivation lead to death!

Today I’m going to tell you how your sleep routine might be impacting your fertility and what you can start to do to get back on track!

Female Fertility and Sleep

In women, sleep affects many reproductive hormones.

TSH and Sleep

With respect to the thyroid, thyroid stimulating hormone (TSH) has a significant increase in women experiencing acute sleep deprivation. This can lead to anovulation, amenorrhea (no period), and recurrent miscarriages.

Prolactin and Sleep

Prolactin is a hormone that plays a role in reproduction, and in the postpartum, it stimulates milk production (for chest or breastfeeding). In sleep deprivation, prolactin levels may increase causing hyperprolactinemia which is associated with anovulation, PCOS, and endometriosis.

Estrogen and Sleep

Estrogen, specifically estradiol, is needed for the development and maintenance of female sex characteristics. In sleep deprivation, estradiol increases and is associated with poorer sleep quality.

Melatonin and Sleep

Interestingly enough, melatonin is a hormone and is quite important when it comes to fertility! Melatonin is secreted at night, basically telling your body that it’s time to go to sleep. As the night progresses and it turns into morning, melatonin production decreases until it’s shut off completely.

With fertility, melatonin enhances reproductive function by syncing your sexual behaviour with the appropriate season and timing for mating and conception.

When you’re ovulating, melatonin protects your eggs from stress. But if your melatonin level is low, it’s associated with stress which can ultimately impact the quality of your eggs.

If you’re undergoing IVF, taking melatonin may actually help improve your outcomes – like the number of eggs retrieved, egg quality and maturation, and fertilization rate. This is also seen in women with PCOS. Before placing melatonin in an online shopping cart, consult with your ND to determine if melatonin as a supplement is right for you.

Shift Work and Female Fertility

In women working shift work, studies showed an increased odds of abnormal menstrual cycles and infertility was also seen – however no early spontaneous pregnancy loss was noted. Nevertheless, a study looking at female flight attendants (when work coincided with sleep), there was an increased risk of first-trimester miscarriages.

Male Fertility and Sleep

Sleep deprivation in men can affect their sexual behaviour (even if they had previously excellent sexual behaviour). It specifically affects the time to initiate sex as well as a decreased rate of penetration and ejaculation.

Testosterone and Sleep

Sleep deprivation can lead to increased stress levels which can contribute to lower testosterone production in males. Moreover, low testosterone may cause men to feel tired during the day, find it difficult to concentrate and focus on tasks.

In a rat study, sleep deprivation also led to lower testosterone production. Sleep deprivation also affected rat’s sperm too! Sperm motility, which is the ability of the sperm to move properly, was also significantly reduced.

Simple Sleep Tips

Fertility Sleep National Sleep Foundation Sleep Duration Recommendations

Around 39% of people who responded to the National Sleep Foundation’s survey reported getting less than 7 hours of sleep on weeknights! Because many of us are currently working from home, improving our sleep habits may be possible. Here are a couple of tips to help get you started:

  1. Stick to a schedule. Ideally you want to be going to bed and waking up around the same time each day including weekends. Aim for at least 8 hours per night.
  2. Avoid a few things right before bed like coffee, alcohol, smoking and large meals.
  3. Avoid exercising late into the night, ideally you should not exercise any later than 2-3 hours before bed.
  4. Aim to designate your bedroom for sleep and sex. If it happens to be your makeshift office right now, consider setting a bed-time alarm so you’re able to put everything away at a consistent time. This way, you can stick to your sleep schedule.
  5. Let’s face it, most of us are using some type of device before bed. If you have the option, consider turning on night mode, reducing the amount of blue light that you’re being exposed to.
  6. Your bedroom should also be dark and cool – which means that those cute, fuzzy pj’s may not be the best option for sleep.
  7. In the mornings, expose yourself to bright light! I like to open the blinds once I make my way to my living-room office (it gives me a great view of my tree ad neighbourhood birds). Or you can even consider a sunrise alarm, where you’re woken up to gradual to bright sunlight in the morning.

These are all great options to start with before considering supplements like melatonin – which undoubtedly can be helpful, but fixing your routine is foundational.

If you have any tried and true sleep tips that have worked for you, please share them below!

Reference

Lateef, O., & Akintubosun, M. (2020). Sleep and Reproductive Health. Journal Of Circadian Rhythms18(1). doi: 10.5334/jcr.190

Walker, M. (2017). Why We Sleep: Unlocking the Power of Sleep and Dreams (1st ed.). Scribner.

Exercise During Pregnancy

April 10, 2020
exercise pregnancy naturopathic doctor toronto

Now that you’re pregnant, you’re probably wondering about exercise during pregnancy. I’m summarizing the Canadian guidelines for physical activity throughout pregnancy set by the SOGC.

By exercising during pregnancy, you’re positively affecting your and your baby’s health. If you don’t have any contraindications to pregnancy (which are posted below), now is the time to start doing something. Especially if you were previously inactive and/or considered overweight or obese.

How much and what type?

Ideally you should aim for about 150 mins of moderate-intensity activity over the week (think: 30 minutes, 5 days a week).

If you’ve been previously inactive, you may want to begin gradually at a lower intensity, and increase the duration and intensity as your body gets used to it.

Aerobic and resistance training, with a pinch of yoga are great options. And in terms of improving health outcomes for you and your baby, you should aim to do all of them within the week.

Some activities do carry a higher risk and are considered contraindicated during pregnancy – like scuba diving, any activities with physical contact, danger of falling, and non-stationary cycling. Avoiding high-heat activities like hot yoga – as it may cause dehydration.

What the F is DRA?

DRA, known as diastasis rectus abdominus, may occur in some people. Essentially, your abdominal muscles may begin to separate. If you’re noticing that this has happened, book a visit with your pelvic floor physiotherapist to see what you can do. This means that you may also want to avoid ab strengthening exercises for the time being.

One of my colleagues filmed a video about DRA a few years ago. Check it out if you’d like more info

What about the first trimester?

Studies show that exercise in the first trimester doesn’t increase the odds of miscarriage or congenital anomalies. In fact, not exercising during the first trimester increased the odds of pregnancy complications like gestational diabetes, gestational hypertension, excessive gestational weight gain and depressive symptoms.

Let’s keep it real though, most people are exhausted in their first trimester – so the idea of anything besides walking is absolutely not appealing. But, if your energy hasn’t taken a nose dive, or if you’ve reached the point in your second trimester where you feel like you can start your routine again – let’s get to it!

Should ALL pregnant people exercise?

Exercising during pregnancy can provide many health benefits, but there are women who shouldn’t engage in strenuous exercise as its contraindicated. Keep in mind, this doesn’t mean they’re not allowed to move and continue their activities of daily living.

Absolute contraindications to exercise include:

  • Ruptured membranes
  • Premature labour
  • Unexplained or persistent vaginal bleeding
  • Placenta previa after 28 weeks
  • Preeclampsia
  • Incompetent cervix
  • Intrauterine growth restriction
  • High-order multiple pregnancy – like triplets
  • Uncontrolled type 1 diabetes
  • Uncontrolled hypertension
  • Uncontrolled thyroid disease
  • Other serious cardiovascular, respiratory or systemic disorder

Relative contraindications to exercise include:

  • Recurrent pregnancy loss
  • Gestational hypertension
  • A history of spontaneous preterm birth
  • Mild/moderate cardiovascular or respiratory disease
  • Symptomatic anemia
  • Malnutrition
  • Eating disorder
  • Twin pregnancy after week 28
  • Other significant medical conditions

Obviously, if you fall into any of these categories you’ll want to check in with your OB/Gyn or Midwife to see about your specific health situation – especially if you fall into the ‘relative’ category. You’ll want to figure out the advantages and disadvantages of exercise with your care provider before you start to exercise.

Tell me about KEGELS

During pregnancy, you may start noticing some urinary incontinence – perhaps some leaking will occur when you’re running, jumping, and laughing. Although this is common, it’s not considered normal. Many books or other professionals will tell you to start doing kegels. Do NOT do this. Instead, visit a pelvic floor physiotherapist so they can assess your pelvic floor. The reason being is that your pelvic floor may be “tight” yet weak (hence the leaking), and doing kegels can cause your pelvic floor to become tighter, not stronger. However, sometimes kegels can be helpful – but it’s super important to get a professional assessment before starting these.

Never heard of kegels before? Check out this video filmed by one of my colleagues!

Final Thoughts

Exercise during pregnancy is a great thing if you don’t have any of the above absolute/relative contraindications – but always speak to your care provider if you have any questions.

If you’ve been a bit sedentary in the first trimester (that’s okay, pregnancy is tiring!), start slow with low intensity and shorter durations and increase as you go.

If you happen to notice any abdominal separation or even leaking while jumping/running/laughing, be sure to book an appointment with a pelvic floor physiotherapist. I’m writing this post during the COVID-19 pandemic and a lot of health care practitioners have transitioned to virtual visits, so there’s still an opportunity to see a pelvic floor physiotherapist or naturopathic doctor if you have the ability to do so.

References

Mottola, M., Davenport, M., Ruchat, S., Davies, G., Poitras, V., & Gray, C. et al. (2018). No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy. Journal Of Obstetrics And Gynaecology Canada40(11), 1528-1537. doi: 10.1016/j.jogc.2018.07.001