Tag Archives: Anemia

Adjusting to Motherhood Part 2

Adjusting to parenthood is difficult for any woman. Medically, there are three areas that can make the adjustment particularly challenging. This is by no means an exhaustive list. However, I have noticed these conditions are more prevalent than any others in my medical practice.

1. Fatigue: it appears that being fatigued is a rite of passage that most mothers must pass through. It is not uncommon for a new mom to experience fatigue for the first six weeks or so after delivery. With the recovery from delivery, getting use to a new sleep schedule and nursing a baby, a mama is bound to get fatigued. You should see a health care professional if the fatigue lasts longer than six weeks; is disabling; worries family members or prevents you from performing normal activities.   When any of these criteria is met, it is worth consulting  a health care provider to rule out anemia or hypothyroidism. Both conditions can be tested for by a simple blood test.

Postpartum anemia is a very common cause of fatigue among new mothers. A woman who was anemic in her last trimester will most likely suffer from postpartum anemia. A diet rich in green leafy vegetables, lentils, beans  and organic meat will help alleviate anemia. I never recommend organ meats as a way to replenish iron stores. The liver is an organ of detoxification. Meaning that all the toxins the animal has ever been exposed to is broken down by the liver. I do however recommend supplemental iron in addition to dietary modification in most cases. Not all iron supplements are created equal. Most supplements contain ferrous gluconate or sulfate. These forms of iron are not well absorbed by the body and are more likely to cause constipation and abdominal discomfort. I prefer a chelated form of iron. This is much better absorbed by the body without any side effects. Ideally, iron should be taken with Vitamin C and  on an empty stomach to increase its absorption.

Other ideas to alleviate fatigue include co sleeping in the same room as the baby and sleeping during the daytime when the baby naps.

2. Post partum depression: affects as many as 10 – 20 percent of mothers . It is a more serious form of postpartum blues. About fifty percent of women experience postpartum blues with irritability, crying easily, feeling overwhelmed, confused and anxious. Symptoms usually begin a few days after birth and can last up to six weeks. This is believed to be due to hormonal changes, fatigue and interrupted sleep.

Women with postpartum depression usually have difficult time bonding with their child and may experience sadness, fatigue, irritability and disinterest in life.

If you think you may have post partum depression consult with a licensed health care provider for proper diagnosing. Having a strong social network is important for alleviating post partum depression. This includes joining a moms group or just creating time to connect with other moms, friends and family. Moderate exercise such as walking is great or joining a stroller exercise group. It is okay to ask for and receive help. Get as much rest as possible and find some time for yourself to recharge.

It is important to have a diet that is high in fruits, vegetables and good sources of protein and essential fatty acid. Choose an essential fatty acid supplement that is free of heavy metals and high in DHA. Good dietary sources of essential fatty acids include fish oil, chia seeds and hemp hearts. A gluten and dairy free diet has been shown to help alleviate depression. There are several herbs such as: panax ginseng, rhodiola, shisandra and ashwagandha that are effective and safe for nursing mothers. Talk to a licensed health care provider for a treatment option that is best for you.

3. Low milk supply: most women are able to make more than enough milk for their child. However there are  several reasons for low milk supply such as anemia and hypothyroidism in mother, supplementation with formula, scheduled feedings, pacifiers, nipple shields and medication.

Eating a well-balanced diet full of good protein sources, fruits and vegetables and oatmeal daily  helps with low milk supply. Also, a good latch is paramount to having adequate milk supply. Herbs such as fenugreek, blessed thistle, vitex, milk thistle, hops, shatavari, alfalfa, goat’s rue, raspberry leaf have all been shown to be helpful with milk supply.

It is always beneficial to solicit the services of a good lactation consultant to help with latch assessment and offer additional suggestions.

Are there other challenges you have encountered?

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Top 5 supplements for a healthy pregnancy and baby

As a mother of two boys, maternal and child health are very dear to my heart. Pregnant women in my practice often ask me which supplements they should be taking during their pregnancy. These five supplements are what I recommend to every woman of child-bearing age who might one day get pregnant.  Why you ask? Because these are the supplements that keep on giving. Even after a mother has had her baby, these supplements continue to benefit both the mother and baby.

1. Iron:  is an important vitamin for both maternal and fetal health. It is involved in the transport and storage of oxygen. It is required for energy and it supports the growth and development of the fetus and placenta. It is also involved in brain development and cognition.  Anemia in pregnancy may result in a baby with a low birth weight.

Interestingly enough, iron in breast milk is small but much more absorbable and the amount of iron is more dependent on maternal stored iron. A recent research study found that mother’s that were supplemented with iron during pregnancy had higher iron levels in their breast milk.  Meaning that it is important for pregnant and soon to be pregnant women to have a healthy iron level before they give birth. An anemic mother will lead to an anemic baby once born. Most women at some point or another in their pregnancy become anemic. It is always a good idea to start out with a reservoir of iron instead of a deficiency.

It is important to get a good digestible source of iron that will not cause constipation. My preference is chelated iron bisglycinate. It is relatively inexpensive and it works well. According to the University of Maryland Medical Centre, pregnant women need 27mg of iron daily. Even if a woman is mildly anemic, I still treat them with supplemental iron due to an increase risk of post partum bleeding.  As always please consult a licensed care provider before taking any supplement.

2. Probiotics: these are microorganisms that live in our entire digestive tract.  Lactobacillus and bifidobacterium are the major microorganisms and they play an important role in digestive and immune health. There is research to suggest that maternal levels of bifidobacterium affect infant levels as early as 3 days. Bifidobacterium  readily passes from the breast milk to the nursing baby. Probiotics enhance our immune system, enhance the assimilation and absorption of vital nutrients, promote healthy skin, decrease atopic disease (asthma, allergies, eczema) and act as Group B Strep prophylaxis. While you can get probiotics in supplement form, I always encourage people to get additional probiotics through foods such as sauerkraut, kim chee, yogurt, miso or anything fermented.

3. Omega 3 fatty acids: the 3 main types of essential fatty acids are EPA, DHA and ALA. They are called essential fatty acids because they must be obtained from the diet. EPA and DHA are readily found in seafood such as fish, squid and algae. ALA is mainly found in flaxseeds, soybean oil, canola oil.  I will discuss the problems with soybean and canola oil in a later blog. ALA is not readily converted to DHA by the body so I usually just supplement patients with DHA and EPA. During pregnancy and breastfeeding, the mother is the primary source of essential fatty acids. DHA in the developing infant is needed for visual and neurological development, cognition and hand/eye coordination. For pregnant and nursing mothers, essential fatty acids can help with mood stabilization and to banish baby brain.

4.  Vitamin D: with the war against sun exposure in full bloom, Vitamin D deficiency is becoming rampant. I have my issues with the whole everyone must wear sunscreen year round campaign but this is not the place for that discussion. Being a physician in the Pacific Northwest, I see and treat a lot of Vitamin D deficiency. Vitamin D deficiency is now becoming a significant public health concern especially the further  away  you are from the equator. Vitamin D deficiency has been linked to gestational diabetes, pre eclampsia, infection, Cesarian section and fetal growth restriction. Vitamin D in addition to calcium is also required for proper bone development. A recent paper published in February of this year suggested that supplementation may be a simple way to reverse adverse risk factors associated with low Vitamin D status. A licensed health care practitioner can check your Vitamin D status for you and suggest an appropriate Vitamin D dosage based on your lab results.

5. Prenatal Vitamin: research is just now starting to focus on the role of micronutrients in pregnancy outcomes. According to recent research,  reduction in  essential micronutrients may contribute to recurrent spontaneous abortions.   A good quality prenatal will provide you with all the important micronutrients such as magnesium, selenium, zinc, copper, chromium, manganese among others. In addition, these vitamins and minerals will be in a form that is easily absorbed by the body. Not all supplements are created equally. For example, most supplement companies sell magnesium in oxide form. This form is not readily absorbed by the body whereas the malate or citrate form is much better absorbed. I always advise women to start taking their prenatal vitamins well before they are thinking of getting pregnant. The worse thing that can happen is your hair grows thicker and faster. I also tell women that they need to think of their  womb as a garden. The egg and sperm represent the seed. In order to get a good yield of produce, you have to prepare your garden and fertilize it preferable with organic manure. When you have good soil and good seed, you have a good harvest. Pregnancy is no different.

Are there any supplements you find helpful for pregnancy and post partum?