A primer on Ayurveda for the childbearing years: Part 4: Ayurveda for postpartum self-care. (Postpartum Care).

Editor's note: This is fourth in a series of articles about Ayurveda and women's health. Please refer to the Spring, Summer, and Fall 2001 issues of Special Delivery for Parts 1, 2, and 3 of this series, and for definitions of terms.

The postpartum period is a very tender time for mother and baby. Ayurveda's recommendations can protect them from taking on imbalance and stress during this sensitive time. During pregnancy, the woman is to be worshipped as a Creatrix. During postpartum, this level of devotion and caring is twice as necessary, for it includes both Mother and Child.

Ayurvedic teachings tell us that postpartum is one of the special times in a woman's life--her whole physiology is changing quickly and can be set to actually rejuvenate the mother. The women I know who have followed these teachings postpartum have had better postpartum experiences and continued to feel better as their life went on. In contrast, most women in our culture try to get back to "normal" life as quickly as possible--it's almost as if it is a sign of strength to act as though postpartum isn't a special time. This is dangerous for the future health of the mother--if she overdoes it and is careless in the weeks following the birth she can be setting herself up for imbalances that can plague her for the rest of her life.

One example of what can happen was June, an athletic and healthy pitta woman, who felt great right after her birth. She proceeded to go on long, strenuous hikes just two weeks after giving birth. In the year following the birth, June found herself getting weaker instead of stronger and having frequent bouts of illness--something that hadn't happened for her before. Only through strong attention to her imbalances that stemmed from postpartum could she rebuild her immune system and strength to withstand the stresses of motherhood.

With postpartum care and attention the picture can look much healthier. Stacey, a vata woman, had already given birth once before. During that postpartum she developed a sleeping problem (vata-type, waking at about three AM) that stuck with her for years. When she began using Ayurveda she finally cleared up the problem. Then she became pregnant again and was worried that she may fall back into the old pattern. However, this time she followed the Ayurvedic postpartum recommendations and she ended up feeling great after her postpartum, with no sleep disorders.

The postpartum period is generally one of great change. The changeable sleep schedule, the loss of fluids common to postpartum, changing hormonal balance, the loss of weight, and the extra space left in the abdomen after childbirth means vata is there for the mother. Women who went through a cesarean section are even more vata due to the opening up of their abdomen and uterus, which lets air and space into their most inner body. The mothering of a newborn with its irregular and changeable schedule also contributes greatly to vata dosha easily going out of balance. Vata-reducing measures are necessary to prevent vata symptoms or the possibility of vata moving any excess pitta or kapha in the body to form symptoms of those doshas.

For the baby, leaving the contained and watery womb to go into the spacious, airy, stimulating, and relatively dry world also means a big increase in vata dosha. The baby is just unfolding into this world, learning to adapt and to act in a dance with life. Introduction of harsh stimuli and separation from the mother during this time are insults to the tender nervous system of the newborn. So during this time vata reduction is the basic care plan to help both mother and baby.

As mentioned in Part 1 of this series, vata is made up of ether (space) and air. It has the qualities of: dry, cold, light, changeable, mobile, and rough. Its "home base" in the body is the abdominal/pelvic area--so key in childbearing. When it is balanced, we express it through living in a flowing, flexible, enthusiastic, and creative way. Some of the symptoms of imbalance are constipation, shakiness, gas, cramps, sleep disturbance, and fatigue. Emotional symptoms of vata imbalance are feelings of being overwhelmed, fearful, and/or distracted. It is also related to grief.

Vata-reducing measures are counter to the qualities of vata. We use moisture and oiliness, warmth, heaviness, routine, stillness, and a quiet, smooth, and flowing lifestyle.

Many of these Ayurvedic postpartum teachings were first promoted in our country through the Mother Baby Program of Maharishi Mahesh Yogi and further developed by Martha Oakes, Diplomate Ayurvedic Postpartum Practitioner, Experienced Ayurvedic Postpartum Doula Trainer. If you would like to learn more about training or consult with her, you can reach her at www.sacredwindow.com or [phone]. She also has a self-published book available expanding on the information in this article, recommended if you want to try it or help others with it.

First of all, we must "mother the mother." While the new mom is mothering the baby, she too must receive care. In this way both baby and mother are best nurtured. She should not be entertaining visitors, cleaning house, doing laundry, or cooking meals. To the best of their ability, families must plan together ahead of time and in a thorough manner, how to have the mom taken care of for four to six weeks postpartum. Most people may not be able to provide care for a full six weeks--at least two is the minimum to prevent the mom from doing too much. In our midwifery practice, we usually said two weeks minimum with an extra week for each other child in the household.

One danger is that the partner will try to take up all the slack, becoming exhausted too. This can be emotionally as well as physically trying. It is important to call on the community to support the family at this time. Churches, coworkers, friendship circles, and support groups are often good places to find this help. If a woman doesn't have this kind of community when she becomes pregnant it is most important to start developing it--it will serve her throughout parenthood.

The pregnant women can ask a friend to coordinate volunteers. They could use a sign-up sheet at the baby shower or blessingway and then the friend would call people after the birth to confirm when they would come by to clean, drop off food, or do some laundry. Specific personal food needs and guidelines should be in writing and given to everyone providing food. Enough food could be supplied for both supper and lunch.

Another time-honored technique for mothering the mother is to have family or friends come and stay for some time postpartum. It's imperative that everyone feels absolutely comfortable about the person staying there--or the stress will offset the help provided! Plenty of communication about boundaries needs to be made before, during, and after the visit to keep things clear and easy.

Oiliness is needed to offset the dryness and roughness of vata. This is provided postpartum through daily oil massage with warm sesame oil, eating food with plenty of ghee and olive oil, and sesame oil enemas (when working with a trained practitioner).

The daily oil massage is best done by someone trained in Ayurvedic postpartum massage--but these practitioners are still few and far between. The techniques used by these women are specially suited to the vata needs of the women and their changing bodies. However, any trained massage therapist could give a slow, gentle, firm, steady, integrative, repetitive massage with warm sesame oil to good effect. Plenty of oil to the head is important for calming the nervous system.

It's good to have someone there to help with the baby during the massage time. Try to schedule it so feeding happens just beforehand so mom can relax as deeply as possible. Whoever massages should be ready for the needs of the baby to nurse on the massage table. The massage can start in the first days for a vaginal birth, after one week for a cesarean birth.

Many people can't afford daily massage by someone for two to three weeks, so doing self-massage or having a friend or partner do the massage for at least some of the time is another viable option. Whoever does the massaging should remember the principles to balance vata through massage--slow, gentle, firm, steady, integrative, repetitive massage with four to eight ounces of warm sesame oil.

Besides calming vata, daily massage helps the body reintegrate into its non-pregnant state. It keeps circulation going--very important for someone not moving around a lot during the recovery period. This may help prevent blood clots forming from blood stagnation. Massage also stimulates all the organs and energy points of the body to promote general health and emotional well being.

Warmth must be provided by keeping the room temperature comfortably warm. During and after the massage a hot water bottle can be applied to the abdomen to bring warmth deep into the vata part of the body. Warm baths after the daily oil massage will also keep the cold of vata from lodging in the body. This is often a favorite part of the postpartum treatment. Cold drafts should be avoided at all times.

Rest may seem elusive for a postpartum mom at times between baby care and self-care. But rest she must--especially when the baby sleeps. Helpers are what can allow this to happen. If the house is a mess or other household tasks are not covered, most people find it hard to rest. This is one time Ayurveda allows sleeping in the day because the mom is recovering from childbirth and also having her night-time sleep interrupted by the baby nursing. A nap is recommended after her daily oil massage and hot bath. Sometimes soothing music can help to calm and allow rest--choose tranquil music to use when the energy starts getting too hectic.

Many women are anxious to resume their former shape and want to exercise as soon as possible. Women should know that it is common for some to not get back to their prepregnancy weight for six months. Some women don't lose that last extra weight until they end breastfeeding and their hormones shift again. Exercise programs should not begin in earnest until after the first month and the lochia flow has ended. Doing some gentle stretches and brief walks outside later in the postpartum period will refresh and feel good without straining and using energy that would better go to the transitioning body in other ways.

Containment of the uterus by wrapping the abdomen after the massage and bath will keep vata from staying in the space left by the baby leaving. This is a common practice in traditional cultures, which proves helpful today as well. If the uterus is allowed to flop around freely while the ligaments are still loose it is more likely it will assume a position that will inhibit circulation, as well as the outflow of the lochia, causing stagnation that can lead to later problems.

Quiet and seclusion are other forms of containment and important to avoid overstimulation for both mom and baby. Both are wide open and very sensitive. It's not the time for lots of out-of-town visitors or to have large parties of people. One case involved a baby born only three days earlier being brought to church and passed from person to person. Everyone was very excited and loving--but it was too much and the baby ended up getting sick. I cringe when I see obviously newborn babies at the supermarket.

The mom's nervous system is also reworking itself with the new levels of hormones and like the other times of hormonal change--adolescence and menopause--reducing stimulation allows for a smoother transition.

We put a sign on the door of families of newborns with a birth announcement and a "We Mother the Mother" statement requesting people who visit to stay only fifteen minutes, and to lend a quick hand to do dishes, vacuum, or take a load of laundry to do. We educate the women about the importance of limiting visitors and have them warn people ahead of the birth. After the first few weeks a celebration can include everyone!

Routine and simplicity are other ways to calm vata. When our body recognizes a rhythm happening in eating, it digests better; in resting, it rests better. Again, preparation ahead of birth time makes it possible to foster simplicity by being familiar with the self-care routine, having meals preplanned and supported, and household needs covered.

Wholeness includes eating whole foods prepared to calm vata, yet modified for the specific needs of postpartum women. Martha Oakes presents a dietary plan to support postpartum rejuvenation. It includes all the tastes in proportions most healthy for postpartum women, avoiding the extremes. It favors foods that offer clear, life-giving energy, avoiding those that stress the body or add the energy of decay (such as fermented and aged foods).

Another aspect of wholeness is cultivation of the baby and mother bonding, tied closely to breastfeeding. Breastfeeding is a given in Ayurveda. If a mother is imbalanced it can not only affect her milk production--it can also pass on the imbalance in her milk to the baby. If the mother avoids vata imbalance, drinks sufficient fluids, and eats a healthy diet, her milk will also be balanced. More fluids may be needed at this time due to the vata influence.

Infant massage, which can be used to encourage father and baby bonding, is another aspect of the wholeness for the baby and family. Massage is practiced universally in India and it starts as soon as the umbilical cord is healed. Then daily oil massages are given to babies before their warm bath. Randomized, controlled studies on both preterm and healthy full-term infants show that massaging daily with sesame oil was most effective in promoting growth and length of time babies slept after the massage.

At the same time vata needs attention, a postpartum woman's digestion is very often disturbed. One way to look at it is that giving birth can use every bit of energy in the body, depleting the digestive fire. It must be rekindled in the postpartum period so that the food she eats is well digested to serve in making balanced milk for the baby and for her own recovery and rejuvenation. Digestive fire kindling guidelines are followed as closely as possible and digestive teas and herbs are used to get things going.

If the mother avoids vata imbalance, drinks sufficient fluids, and eats a healthy diet, her milk will also be balanced--imbalanced moms make imbalanced milk that can affect the baby. More fluids may be needed at this time due to the vata influence.

Babies generally digest the breastmilk in about two hours, so constantly feeding the baby may end up depressing the digestive fire of the baby and cause digestive disturbances. Also, babies may be sensitive to some foods the mother may be eating. If the mother drinks cumin coriander fennel tea regularly it will help the baby's digestion as well as help move out any gas that may form before it becomes a tummy ache.

If the baby is having mucus problems it is often due to the mother eating too much cold food or kapha-(mucus) increasing food. However, don't cut out all of the kapha foods because they are necessary for formation of the plasma, which, in turn, forms the breastmilk. Because this may be a delicate balance, take some fresh ginger tea as soon as there are signs of excess mucus beginning to show up in mother or baby. (Several cups a day would be needed in this case--otherwise use it as a general digestive once or twice a day.) In general, newborn babies are treated by giving the herbs to the mother.

By a couple of weeks postpartum it's possible to have a good idea of what the constitution of the baby is by how she/he looks and acts. Through this, one can cultivate a suitable environment to nurture the type of personality the baby tends to have. Children in general are in the kapha stage of life--when things are forming and are more dense. This is one reason for children having more mucus than adults.

Vata baby: Thinner, long fingers, easily distracted; when emotionally imbalanced is overwhelmed. Vata babies need a strong rhythm to lifestyle, calm, avoiding overstimulation, teaching how to be grounded.

Pitta baby: Medium, tends to be fair skinned, light thin hair or almost none, sensitive skin, wants stimulation, more focused, gets frustrated; when emotionally imbalanced is angry. Pitta babies need developmentally appropriate challenges, teaching how to relax and wind down.

Kapha baby: Rounder, larger, very deep "innie" belly button, calmer personality; when emotionally imbalanced is clingy. Kapha babies need stimulation, teaching how to be motivated.

Remember--most of us are combinations of vata, pitta, and kapha rather than just one pure type, so go with what seems most predominant.

By taking the advice and support of Ayurveda during the postpartum, mothers and babies will be setting the stage for a happier, longer, and healthier lives.

--Terra Richardson practiced homebirth midwifery thirteen years in Boulder, CO before retiring to focus on Wise Womanhood, offering classes and a holistic healing practice using Ayurveda, flower essences, and Reiki energy healing. She coauthored Pregnant Feelings with Rahima Baldwin Dancy and wrote soon-to-be-published Giving Birth to Ourselves--Contemplations for Midwives and Other Birth Companions. You can learn more about her classes and practice at http://www. wisewomanhood.com or by calling [phone].