Looking after Mom and baby Post-Partum

Postpartum Psychosis and Other Postpartum Disorders in TCM

TCM and Postpartum Disorders: Caring for the Mother After Childbirth

Most of the attention surrounding childbirth is naturally focused on the baby. Once the baby arrives, however, the mother may be expected to recover quickly, sleep very little, feed the baby, manage a household, and remain cheerful through the entire experience.

Her body may have other ideas.

From the viewpoint of traditional Chinese medicine, childbirth is a major physical event that consumes Qi, Blood, and Jing. Blood has been lost, tremendous energy has been expended, and the mother’s hormonal, emotional, and physical life has suddenly changed. Her hormones have just dropped up to 100%! Even an uncomplicated delivery may leave her temporarily depleted and vulnerable.

This does not mean that every postpartum symptom is caused by deficiency. Blood stasis, retained fluids, infection, Heat, Phlegm, emotional stress, and lack of sleep may also contribute. Postpartum treatment must therefore be individualized rather than based simply on the fact that the patient recently gave birth.

Common Postpartum Problems

Fatigue and Weakness

Some tiredness is expected after childbirth, but severe or persistent exhaustion may reflect Blood deficiency, Qi deficiency, anemia, thyroid dysfunction, infection, depression, medication effects, or another medical problem.

A TCM practitioner may look for signs such as pallor, dizziness, weakness, spontaneous sweating, poor appetite, a pale tongue, or a weak pulse. Treatment might focus on rebuilding Qi and Blood while supporting digestion.

Traditionally, formulas related to Ba Zhen Tang or Gui Pi Tang may be considered when the presentation fits, but they are not appropriate for everyone. A mother with infection, retained tissue, significant Blood stasis, or another excess condition requires a very different approach.

Persistent Bleeding and Abdominal Pain

After childbirth, the uterus contracts and gradually discharges blood and tissue known as lochia. Some bleeding and cramping are normal, but heavy bleeding, large clots, worsening pain, foul-smelling discharge, faintness, or fever require prompt medical evaluation.

TCM may interpret some postpartum pain as Blood stasis, particularly when the pain is sharp and fixed and the discharge is dark or clotted. Sheng Hua Tang is a well-known traditional postpartum formula intended to warm the channels, move Blood, and relieve pain. It should not be casually prescribed for all new mothers, especially when bleeding is excessive or the medical cause has not been established.

Insufficient or Difficult Lactation

Low milk production may be associated in TCM with deficient Qi and Blood, while painful breast distention may be associated with constrained Liver Qi or obstructed milk flow.

Acupuncture, rest, adequate food and fluids, and appropriate herbal treatment may be supportive. However, poor milk production can also result from ineffective latching, hormonal problems, medication, retained placental tissue, or illness. A qualified lactation consultant and the mother’s medical provider should be involved when the problem persists.

A red, hot, painful breast accompanied by fever or flu-like symptoms may indicate mastitis and should receive prompt medical attention. Herbs and acupuncture should not delay antibiotics when bacterial infection is suspected.

Night Sweating and Feeling Overheated

Postpartum sweating may occur as the body eliminates retained fluids. Persistent night sweating, dryness, thirst, restlessness, or sensations of internal Heat may be interpreted as Yin or Blood deficiency.

Sweating accompanied by fever, chills, pelvic pain, foul discharge, breast redness, or feeling seriously ill may indicate infection rather than a simple deficiency pattern.

Constipation and Digestive Problems

Blood loss, dehydration, pain medication, reduced movement, and fear of aggravating stitches can all contribute to postpartum constipation. TCM treatment may involve nourishing Blood, gently moistening the intestines, moving Qi, or strengthening digestion.

Strong purgatives are generally inappropriate for a depleted postpartum patient unless there is a clear reason for using them. Breastfeeding must also be considered before prescribing herbs.

Urinary Problems and Pelvic Weakness

Urinary leakage, difficulty urinating, pelvic heaviness, and weakness may occur after delivery. TCM may describe some cases as Spleen Qi sinking or Kidney Qi weakness, but urinary retention, severe pain, fever, or burning should be medically evaluated.

Pelvic-floor therapy is often an important part of recovery and can be used alongside appropriate acupuncture or herbal support.

Postpartum Depression

The “baby blues” commonly begin within the first few days after delivery and generally improve within several days to two weeks. Postpartum depression is more severe and persistent. It may involve deep sadness, anxiety, hopelessness, irritability, guilt, loss of pleasure, difficulty bonding with the baby, or feeling unable to manage ordinary daily life.

From a TCM viewpoint, postpartum depression may involve several different patterns:

* Heart and Spleen Qi and Blood deficiency: fatigue, poor appetite, anxiety, palpitations, insomnia and excessive worry

* Liver Qi stagnation: frustration, irritability, frequent sighing, emotional tension and breast distention

* Blood deficiency failing to nourish the Shen: sadness, anxiety, dizziness, pallor and restless sleep

* Phlegm obstructing the mind: mental fogginess, heaviness, withdrawal and difficulty thinking clearly

* Yin deficiency with Empty Heat: night sweating, agitation, dryness, insomnia and feeling overheated

* Blood stasis: fixed pain, dark lochia, clots and emotional distress associated with unresolved postpartum pain

Acupuncture and individualized herbal medicine may be considered as complementary support, particularly for sleep, appetite, anxiety, physical recovery and mild-to-moderate emotional symptoms. They should not replace professional mental-health care when depression is persistent, severe, or interferes with the mother’s ability to care for herself or the baby.

A mother who has thoughts of suicide or of harming her baby needs immediate medical help—not an ordinary future appointment.

Postpartum Psychosis

Postpartum psychosis has recently received widespread attention because it is being discussed in a highly publicized criminal trial. The facts and legal responsibility in an individual case must be decided by the courts, but the public discussion has highlighted how poorly understood postpartum mental illness remains.

Postpartum psychosis is not simply an extreme form of the baby blues. It involves a loss of contact with reality and is a psychiatric emergency.

Symptoms may include:

* Hallucinations

* Delusional or bizarre beliefs

* Extreme confusion

* Paranoia

* Mania or unusually elevated energy

* Rapid or disorganized speech

* Severe agitation

* Dramatic mood changes

* Going without sleep

* Thoughts or commands involving suicide or harm

Symptoms often begin suddenly, commonly during the first two weeks after childbirth. The affected mother may not realize that she is ill, so family members may need to recognize the danger and act for her.

In traditional Chinese medicine, symptoms resembling psychosis might historically have been described as Phlegm-Fire disturbing the Shen, Phlegm misting the mind, extreme Blood deficiency, Blood stasis obstructing the Heart, or a combination of deficiency and excess.

These descriptions may help a TCM practitioner understand the patient’s constitution during recovery, but they do not replace a psychiatric diagnosis. Postpartum psychosis should never be treated solely with acupuncture or herbs.

The mother should not be left alone, and another responsible adult should protect and care for the baby. If there is immediate danger, call 911 or go to the nearest emergency room. In the United States, call or text 988 for crisis assistance. The National Maternal Mental Health Hotline is available at 1-833-852-6262.

Postpartum psychosis is treatable. Hospital care, antipsychotic medication, mood stabilizers and sometimes electroconvulsive therapy may be required. With prompt professional treatment, recovery is possible.

After the patient has been stabilized, TCM may have a supportive role in rebuilding strength, improving appetite, addressing residual insomnia, and assisting general postpartum recovery. Any herbs must be coordinated with the medical team because of possible interactions with psychiatric medication and possible transfer into breast milk.

Do Not Assume Every Postpartum Problem Is “Normal”

Seek urgent medical care for symptoms such as:

* Very heavy bleeding

* Chest pain or difficulty breathing

* Seizures

* Severe abdominal or pelvic pain

* Fever above 100.4°F

* A severe headache, especially with visual changes

* Painful swelling in one leg

* Confusion, hallucinations or delusions

* Thoughts of suicide or harming the baby

These symptoms may indicate hemorrhage, infection, a blood clot, postpartum preeclampsia, psychosis, or another emergency.

Rebuilding the Mother

Chinese medicine has long recognized that the weeks following childbirth deserve special care. The mother needs nourishment, warmth, sleep, practical assistance and time to recover. She should not be expected simply to ignore her symptoms because “all new mothers are tired.”

TCM can offer valuable individualized support for many ordinary postpartum complaints. But good care also means recognizing the limits of complementary medicine. Heavy bleeding, infection, blood clots, severe depression and postpartum psychosis require prompt medical diagnosis and treatment.

In my opinion, the western diet and lifestyle have weakened both men and women. This has, in the case of childbirth, led to a massive difference in the way women recover, compared to history. Just think of the way coffee has become part of life. Although the way coffee burns through Blood is generally ok before pregnancy, the consumption of coffee during pregnancy can be destabilising. And that's only one of the ways we have left a traditional diet. Please think about enrolling in my course "The Art of Nourishment".

The goal is not to choose between Chinese and Western medicine. The goal is to give the mother—and her baby—the safest and most complete care possible.