Welcome, Carnival of Evidence-Based Parenting readers! This month’s Carnival, in honor of Mother’s Day, is Transition to Motherhood. I will be linking to the full carnival and to individual posts as they come in during the day.
Marissa Meyer made headlines when she decided to take only a two week maternity leave before returning to work as the new Yahoo! CEO. There’s a reason why. The conventional wisdom is that the first 6 weeks after giving birth are critical to bonding, healing, and breastfeeding.
Ms. Meyer did end up increasing Yahoo’s maternity leave. I have far from any schadenfreude on this. I believe she did so for business reasons, the same way her edict banning working from home was business-related. And so far I have seen no indications that she regretted her two week leave – especially as she had a nursery built in her office, allowing her to keep her baby close.
She’s entitled to her choice. Running a Fortune 500 company, after all, portends all manner of sacrifices. Men make similar sacrifices too, at the expense of their families.
However, I’m glad I was not newly postpartum during the time Ms. Meyer was in the news. I felt bad enough that I couldn’t get the laundry done, my makeup on, the dishwasher running. I couldn’t even contemplate working a full day. And that sort of new mother stress – expecting to bounce back immediately – is the product of how we view motherhood and maternity in the Western world.
In fact, the Western world is unusual in how fast mothers are expected to return ‘to normal’ after giving birth. Even during 6+ weeks of maternity leave, mothers in the Western world generally go on outings, do the shopping, the cooking, and the cleaning.
In contrast, in many other cultures around the world, to include Chinese, Haitian, Cambodian, Thai, Indian, Bangladeshi, Ethiopian, Mexican, Guatemalan, Arab (to include in Jordan, Palestine, and Egypt), Indonesian, Malaysian, and Korean there is a 30-40 day ‘confinement period’ for a new mother. Even the book of Leviticus describes a 40 day postpartum confinement period.
Fascinated by all this, I set out to write an article with research discussing the postpartum confinement period. What does the ban against cold food mean? Just how important is the first 40 days anyway?
Sadly, there was not a lot of research at my fingertips. That is not to say I did a full literature review, but a typical Google search did not reveal the answers I wanted.
As a ‘conservative’ in the sense that I often trust the wisdom of those who come before me, I’m inclined to believe there is something to this 40 days/6 weeks number. Perhaps it has only to do with the fact that lochia (postpartum bleeding) can last up to 6 weeks, and then most cultures took that fact and extrapolated that the woman is weak. But given my discharge orders even banned vacuuming for the first 6 weeks (a ban I took to heart, believe me), there is probably something to the fact that gosh darn it, the mother needs as much care as the baby. And, the prevalence of the hot/cold belief indicates there’s likely something to it.
Alas, without convincing research, all I can do is try to break down some of these cultural beliefs to the best of my ability.
Being ritually unclean is a concept in many religions that often applies to bodily discharge. It’s no mystery then why a postpartum woman would be considered ritually unclean. Bodily discharge is an unavoidable side-effect of giving birth. Lochia is the term for the discharge of blood, mucus, and placental tissue that may continue up to 6 weeks after delivery.
Best way to deal with this? Well, pads of course, but enterprising nurses and midwives have thought up various ways to maximize absorption and pain relief in one.
One way is the ice diapers – a newborn diaper cut open with ice placed inside. Maximum absorption + relief.
Frozen padsicles is another. Take a maxi pad, and put some witch hazel on it. Freeze.
Western medicine agrees with traditional medicine on this one. Women need rest after giving birth. Definitely no exercise and no sex for the first six weeks, say most hospital discharge instructions.
Now, traditional cultures take it quite a bit further. In some, women’s feet cannot even hit the floor for 30 days. And, as the name implies, during confinement public outings are definitely banned.
The jury is out on whether postpartum confinement helps prevent PPD, exacerbates the possibility of PPD, or has no effect. However, a major difference I and many others have noticed is that there is a focus on the mother in addition to the baby. In the Western world, traditionally the postnatal period focuses primarily on the baby. The sore, tired, and overwhelmed mother is largely ignored.
It is possible an increased focus on the mother — to include normal household duties being largely taken over by others — could help prevent PPD. In addition, successful breastfeeding, due to the time and focus the mother can dedicate to the baby, can perhaps also help hinder PPD — both because breastfeeding failures can lead to an increase in PPD symptoms and because hormones associated with breastfeeding can protect against PPD. However, in traditional cultures, the very isolation of the woman for 30-40 days may be the thing to lead to depression. Certainly, getting out of the house with the baby (taking strolls to Starbucks, for example) is anecdotally helpful to many women during the postpartum period.
To help get the rest one needs, I’d advise the Western mother to line up help for the first few weeks with baby – but productive help. People who will take on tasks without being asked, for example. It’s a fine line, as the presence of relatives, no matter how helpful, can also be stressful.
Regardless, I, and most other experienced mothers, would advise women to not expect to get into a routine the first few weeks. Focus on bonding and feeding (whether formula feeding, breastfeeding, or combo feeding). Have meals pre-prepared or line up a meal train for help.
Luckily there is more and more research on the postpartum depression and anxiety experienced by some mothers. Check out Katherine Stone’s website Postpartum Progress for all the latest, and for resources. However, there is much less research out there on the “Baby Blues”, commonly thought to be a result of the hormone changes occurring after birth. Anecdotally, women talk about “Day 3”, or “Day 5” or some variation thereof in which extreme weepiness and hopelessness hit very forcefully – something that can be quite disconcerting if one does not expect it.
Does placenta encapsulation help avoid the baby blues and/or PPD? As expected, there is not much research out there. However, speculation exists that the placenta helps keep up levels of CRH – the corticotropin-releasing hormone — which in turn may protect against the stress of labor and delivery.
A common confinement theme is the need for heat and fear of the cold – to include showers and ‘cold foods’ such as vegetables and sandwiches.
Like everything else, I can’t find much on this. However, a feeling of being constantly ‘cold’ postpartum could be related to thyroid problems, anemia, or just hormones — all things somewhat common for the postpartum mother.
Heat and a fear of showers also brings up the topic of needing heat to heal perineal wounds. Cold packs and ice are applied for the first few hours, but after that, western medicine recommends heat therapy, often in the form of a sitz bath – sitting in a few inches of very warm-but-not-hot-water. You can also get special herbs for the bath.
One can do this by sitting in a regular bathtub, or there is a plastic device that sits on the toilet and constantly refreshes the water. Why the plastic device? Because some health care providers are very against a real bath postpartum, for the fear that germs (such as foot germs!) may end up infecting wounds and the cervix.
How long do you need to wait before being able to take a real bath? Oh, the difference between the traditional healthcare providers and the midwives on this one! It’s almost as bad as “Can you take a bath when in labor” question.
Some care providers say you can take a bath immediately. Others say wait two weeks. Others say wait 6 weeks. Still others say just wait until postpartum bleeding is over.
I am one of the few people in the universe that HATED that nifty little sitz bath device. The reason the first time around was that it hurt. I had severe tearing and some other issues so the pressure it put on my stitches was not fun. So, despite my own discharge instructions (which said no bath until active red bleeding ended), I took a freakin’ bath.
When L was born, my South Asian grandmother started going on about how I needed to eat some kalo jeera. I had no idea what she was talking about, and I basically ignored her.
One failed breastfeeding attempt later, I was ready to listen. When J was born, I asked my mother what the heck kalo jeera was. It was basically black cumin seed, ground up.
Black cumin seed is a galactagogue, which means it is purported to help with lactation. Other galactagogues are fenugreek, brewer’s yeast, mulunggay, blessed thistle, goat’s rue, alfalfa, flaxseed, and steel-cut oats.
To maximize your galactagogue power, consider making lactation cookies, or drinking Mother’s Milk Tea, or buying More Milk Plus capsules. Also, since the over-drinking of water may at some point negatively affect lactation, try water with electrolytes, Gatorade, or coconut water to keep you hydrated.
Like confinement and the eating of foods that serve as galactagogues, postpartum belly wrapping is common in many traditional cultures. My grandmother was distraught when she realized I wasn’t belly wrapping, and insisted my stomach would become flabby. (She was right). For the record, I did own a postpartum girdle-thingy, but despite trying to use it after both children, I hated it, and was just like, “screw it, I’ll be fat”.
To sum up: traditional cultures may have a few things right here. Rest. Eat foods that will help you heal (and increase milk, if you are breastfeeding). Take care of your body with heat therapy.
After all, it’s only 40 days.
Here’s a quick list of our contributors for this second edition of the Carnival of Evidence-Based Parenting:
The Transition to New Motherhood (Momma, PhD)
Bonding in Early Motherhood: When Angels Don’t Sing and the Earth Doesn’t Stand Still (Red Wine and Applesauce)
The Connection Between Poor Labour, Analgesia, and PTSD (The Adequate Mother)
For Love or Money: What Makes Men Ready for New Fatherhood (Matt Shipman)
What the Science Says (and Doesn’t Say) About Breastfeeding Issues, Postpartum Adjustment, and Bonding (Fearless Formula Feeder)
No, Swaddling Will Not Kill Your Baby (Melinda Wenner Moyer, Slate)
Sleep Deprivation: The Dark Side of Parenting (Science of Mom)
The Parenting Media and You (Momma Data)
40 Long Days and Nights (Six Forty Nine)