The Top 4 Postpartum Health Issues and How to Avoid Them

As a mother of three and functional medicine physician specializing in women’s health, I’ve become a fierce advocate for the expansion of postpartum health support, awareness, and education.

In the United States especially, far too many women are thrust back into the demands of everyday life (while attending to the demands of a newborn) without sufficient time to recoup- their-losses, when it comes to healing and restoring their bodies, minds, and spirits.

In other cultures women are revered, deeply cared for, and encouraged to rest and bond with their baby postpartum for weeks—or even months, before being expected to return to life-as-usual

I’m not saying this is realistic for most of us, nor that every culture does things this way.

However, I believe the absence of a proper recovery, bonding, and recalibration period is largely to blame for many of the postpartum health issues we see today…and these issues can persist throughout the spectrum of motherhood.

How the spectrum of motherhood can deplete your health

Notice I didn’t say: “how pregnancy can deplete your health”; that’s because pregnancy is just one part (albeit a big part) of the motherhood spectrum.

Let’s take a brief look at each phase:

Preconception: whether you plan/planned your pregnancy or not, most patients I see for fertility concerns are already close to maxed-out in terms of stress, nutrient deficiencies, and other subclinical conditions before getting pregnant.

What do I mean by subclinical conditions? Things like adrenal burnout/HPA axis dysfunction, hormonal imbalances, nutrient deficiencies, gut health issues/leaky gut syndrome, autoimmune disease, and thyroid health issues.

Adding a pregnancy on top of that further depletes the mother’s health reserves, setting her up for a tough postpartum recovery.

Pregnancy: growing another person inside your body requires a huge amount of resources for things like hormonal production, making extra blood, growing a placenta, etc.

Your body is designed to give that baby everything he or she needs to make it to term—which means mommy’s needs are often sacrificed.

That’s right, your body will favor your baby’s health over your own since he or she relies on you entirely to grow and develop.

That means your body will pull stored nutrients or fluids, for example, if it must to support your baby’s health.

Labor and Delivery: the physical act of labor is a miracle unto itself, requiring massive amounts of adrenalin, hormones, and physical, mental, and emotional strength (no wonder it’s been likened to running a marathon!).

Plus, since most women experience significant blood loss (especially if surgery is needed), all that expenditure takes its toll.

Breastfeeding: we certainly receive amazing benefits from breastfeeding, such as faster healing, those warm fuzzy oxytocin feelings, and protection from certain diseases like diabetes, breast and cervical cancers.¹,²,³ However, it’s also taxing due to the fact you’re expending more calories, fluids, and nutrients to meet your baby’s needs.

But…isn’t it all worth it?

Of course it is! And most of us would do it all over again—nausea, labor, cracked nipples/endless bottle sterilizing and all—in a heartbeat for our children.

However, as we become aware of how the spectrum of motherhood affects our bodies we can better prepare to prevent, spot, and conquer these top four postpartum health issues.

Postpartum Health Issue #1: Postnatal Depletion

Feeling worn out after having a baby, even for several months (or even a couple years if you get a temperamental sleeper) is entirely normal.

Afterall…newborn babies, teething babies, toddling babies, etc. wake up a lot and new research suggests it takes a woman at least a year to recover from pregnancy and birth.⁴

However, feeling worn out is different from Postnatal Depletion, a real syndrome that affects a large number of women for months or even years after giving birth.

Here are some examples of its symptoms:

• You feel like a complete zombie, never feeling rested after a nap, better night’s rest, etc.
• You’re easily overwhelmed… like making a grocery list or planning a playdate puts you over the edge.
• You cry a lot, even after “the baby blues” should have gone away.
• You can’t sleep, even when given the opportunity.
• Feeling like you’ve poured yourself out completely with no time/space/energy to replenish yourself.

Postnatal depletion is caused by many of the things we listed above, including sub-optimal preconception health and labor and delivery (even if it was a “normal” experience).

In addition, interruption in your sleep cycle, lack of emotional and social support, a hurried diet (like grabbing whatever processed food you can on-the-go), the same routine over and over, pre-existing physical conditions (especially autoimmune or thyroid issues… which we’ll cover coming up), toxicity, and social isolation all contribute.

Plus, in the COVID era many of us are without the option of family or hired-help for support…which puts extra pressure, work, stress, etc. directly onto mom.

Postpartum Health Issue #2: Postpartum Thyroid Issues

Did you know that all women are more susceptible to thyroid health issues postpartum?⁵ Yet few of us are offered thyroid testing in our postpartum follow-up visits.

There are a number of reasons thyroid issues tend to surface, including:

• Pre-existing, subclinical thyroid conditions—these are often present before pregnancy then crop up with a vengeance postpartum.
• Postpartum depletion—can either trigger an old thyroid problem or start a new one.
• Poor conversion of thyroid hormones—this can be due to lack of sleep, hormonal changes, inadequate nutrition, or all of the above. For example, if you’re not eating enough nutritious food while breastfeeding, your body could perceive a low-calorie diet and stop converting necessary amounts of T4 to T3 (instead diverting it to reverse T3).

Then there’s Hashimoto’s disease, a common autoimmune condition that mostly affects women. Over time the autoimmune destruction of the thyroid gland creates a problem with low thyroid function. We know that the risk of autoimmune disease is much higher in the 1st year after vaginal delivery.⁶ In fact “44.3% of women who develop an autoimmune disease have onset after the first year of pregnancy.”⁷ More on this below…

Postpartum Thyroiditis is also an autoimmune condition exclusive to postpartum moms (as if it weren’t hard enough) that can initially cause hyperthyroidism (an overactive or inflamed thyroid) which then turns into hypothyroidism (an underactive thyroid) over time.

Postpartum Thyroiditis occurs in the first year postpartum, usually around month four when women might initially experience anxiety, weight loss, and sleep disruption… before hypothyroid symptoms step in and the exhaustion ensues.⁸

It’s worth noting that many women who experience Postpartum Thyroiditis will recover “normal” thyroid function within 12-18 months (based on current medical testing guidelines, which leave much to be desired).

However, 20-30% will experience persistent hypothyroidism past that point.

Symptoms of thyroid dysfunction are often ignored as they can mimic those of “normal” postpartum ailments, and can be all over the map. Some symptoms include:⁹

• Anxiety
• Bloating
• Depression
• Digestive issues
• Fatigue
• Feeling like you can never get enough sleep
• Hair loss
• Irregular periods
• High cholesterol or blood sugar
• Hormonal issues
• Infertility
• Insomnia
• Joint pain/body aches
• Lack of motivation
• Lowered immunity/greater susceptibility to colds, viruses, etc.
• Low libido
• Miscarriages
• Mood swings
• Skin issues
• Trouble focusing
• Weight problems (typically weight gain or trouble losing weight)

If you sense your thyroid might be off, I always encourage you to test! In fact, I screen every single postpartum mom in my practice for thyroid dysfunction and Hashimoto’s. Conventional lab panels are often inadequate, so keep reading and I’ll tell you what to check…

Postpartum Health Issue #3: Postpartum Depression

Postpartum depression is a very real issue… but perhaps instead of looking at it like a mental health disease, I would consider that postpartum depression can be a symptom of another physiological issue such as:

• Postnatal depletion / nutrient depletions—as covered in point #1 above. Take B12 deficiency, for example, which is common postpartum (especially if you had certain anesthetics during labor and delivery). B12 deficiency can produce a variety of mental and cognitive health issues from depression and memory impairment to brain fog and schizophrenia.¹⁰

• Thyroid issues—which, as you learned above in point #2, are associated with anxiety, mood disorders, depression, insomnia, fatigue, and cognitive issues.

• Hormonal imbalances—these are par for the course right after having a baby. However, when sex hormones are low, either due to poor thyroid function, lack of sleep, and/or nursing, it can have a profound affect on mood and self-esteem.

• Gut infections—new research into the gut microbiome has revealed that our gut and brain are directly connected by what’s known as the gut-brain-axis. This axis transmits nerve signals from your brain all the way to your intestines. Plus, your gut houses about 90-95% of your serotonin, the “feel good” neurotransmitter, along with dozens of other neurons and microbiota associated with depression and mental illness.¹¹ So, if you have a gut or digestive health issue and/or your gut microbiome is imbalanced it might also affect your brain/mood and hormonal levels. We’ll talk much more about this fascinating new discovery in future articles.

In addition to the physiological factors, there are many mental, emotional, and even spiritual factors that take place postpartum, such as:

• Redefining your whole self as a new mother!—It’s been said that when a woman gives birth she also goes through a rebirth herself to become a mother…and that’s no small feat! This is also true for fathers, so it can help to talk about the transformation together…and talk to other mothers too.

• Lack of support/lack of tribe—This is especially prevalent in COVID era, as many mothers/parents have been forced to figure things out on their own. In times like these, using other communication mediums daily to keep in touch with the outside world is very important.

• Isolation–Feeling isolated is very common for mothers, especially after the first few weeks have passed and all your help goes home…but you’re still not fully recovered. It’s even worse if you have a colicky or high-needs baby who cries all the time and hates to ride in the car/go out (been there!). The best cure for isolation is to get out…even if it’s hard or doesn’t seem “worth it”, it’s amazing how your perspective can change when you get out. I found with all of my babies that even a daily walk in my neighborhood did wonders for my mental health.

Postpartum Health Issue #4: Autoimmunity

There is a lot we don’t know about autoimmune disease—a group of inflammatory conditions in which the immune system attacks healthy tissue—however one thing we know for sure is that pregnancy increases a woman’s risk.¹²

Per a study of 1,035,639 women, researchers found that 25,570 of them developed an autoimmune disease following pregnancy…which is quite significant.¹³ The researchers who conducted the study hypothesize that cells from the fetus flood the mother’s bloodstream causing an autoimmune reaction…but it’s only a hypothesis.

Then there’s the fact that women are far more susceptible to autoimmune conditions than men. There are many other theories about the reason behind this, including the fact women’s immune systems are designed to be more complex than men’s and thus have a stronger inflammatory response when they’re triggered (and inflammation is at the crux of autoimmunity).

There’s also the role female sex hormones like estrogen play in autoimmunity;¹⁴ which is why many types of autoimmune conditions seem to miraculously disappear during pregnancy and/or breastfeeding…then return with a vengeance.

Finally, there is some evidence that the X chromosome (considered the female chromosome) may be related to autoimmune susceptibility.¹⁵

A growing body of research suggests that intestinal permeability also plays a huge role in autoimmunity. Intestinal barrier function “controls the equilibrium between tolerance and immunity to non-self antigens.”¹⁶ In other words, when intestinal barrier function is compromised, the body’s ability to regulate the immune response is out of balance and autoimmunity can ensue.

What you can do to prevent, heal, and overcome postpartum health issues

While these conditions may seem complex…and even overwhelming, they are absolutely preventable and treatable!

The best thing you can do to prevent postpartum health issues is to prepare your body for pregnancy, if you have the foresight. In other words: work with a functional medicine doctor to get as healthy as you can in that preconception period, so you can avoid things like nutrient deficiencies, undetected thyroid issues, etc. down the road.

You’ll also want to eat a whole foods, nutrient-dense diet (ideally) before, during, and after pregnancy. This can help keep inflammation in check while providing all those magical nutrients you need to nourish yourself and your baby.

Supplement wisely by taking a pharmaceutical-grade prenatal vitamin as well as a fish oil high in DHA. Read more about how to pick the best prenatal vitamin at heymami.com.

I also recommend looking into nutrigenomics testing so that you can better understand your unique nutrient needs and vulnerabilities, by looking at changes in genes like MTHFR and others.

Test, don’t guess! This means getting nutrient levels checked during pregnancy, working with a functional medicine doctor to test for any autoimmune or gut health issues, and insisting on a full thyroid panel about 4-6 weeks postpartum and again later on if indicted.

Be your own advocate! If you feel like something is wrong then chase it. Women have incredible intuition about their own health, all they need is to find the right provider to guide them to the best solutions.

In closing I’d just like to say that women deserve so much better when it comes to postpartum care.

This isn’t your OBGYN or midwife’s fault, as they’re often limited to the support they can offer after a few weeks postpartum…which means you really do need to advocate for yourself and know where to get help.

As a functional medicine doctor (and mother of 3 who’s been through my share of motherhood-health-challenges) specializing in women’s health, I’d be honored to help support your postpartum journey through advanced lab testing, individual nutritional recommendations, functional medicine consultations, and much more. Virtual consults are extra convenient with a baby in your arms!

My office also offers virtual holistic nutrition consultations and postpartum health coaching with our nutritionist, Jessica Doyle. She is a Certified Nutritional Therapy Practitioner (CNTP), a certified health coach for preconception, pregnancy and postpartum, and a former labor and delivery nurse.

Click here to contact my office and learn more about our services!