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The Fourth Trimester: Postpartum Care

We can spend hours reading on risk vs benefit of epidural, weighing the pros and cons of delayed cord clamping, practising hypnobirthing trying to ease breathing during delivery, preparing detailed birth plan with the intent for skin-to-skin, but often we neglect ourselves and put our needs last. A lot happens within the first twelve weeks of a mother having a baby. Just after childbirth, women experience a range of challenges and distresses, including recovery from delivery, sleep deprivation, infant care, and fighting postpartum depression. The fourth trimester is the idea of a transitional 12-week period immediately after labour of baby. Every mother and their newborn baby will go through it although not everyone has heard of it. It is a time of immense physical and emotional modification as babies adjust to being outside the warm and cozy womb they’ve called home for the last few months, and you adjust to your new life as a mum. If you are a new mother reading this article, welcome to your new reality – the fourth trimester!

In this article, we discuss and review from the mother’s point of view the development and recovery of fourth trimester, and the types of supplements recommended for the healing and boosting of energy for the recuperation process.

 

Timeline of Recovery

The journey of motherhood is magical. The early days will be both rewarding and stressful. The fourth trimester is a bumpy ride full of emotions, positive and negative vibes due to hormonal changes.

What is Vaginal Delivery Recovery Like?

We always hear about mothers commenting that vaginal birth recovery is faster than what mothers who have gone through a caesarean procedure. Some women feel mostly recovered after 6 to 8 weeks, but most women commonly do not feel like their pre-pregnancy self until after a few months. Here are what we can expect post-delivery from a typical vaginal birth:

  • Vaginal soreness: from perineum tear and/or episiotomy
  • Trouble peeing: due to stretching of bladder during childbirth
  • Diarrhoea: due to stretching of rectum muscle during childbirth

What is Caesarean Recovery Like?

Extra precautions are needed as we require more time to recover after delivering a baby through caesarean section. It is a major surgery involving a horizontal cut made in the lower abdomen which takes a minimum of six weeks to heal. It is important to remember that every person’s recovery journey is different as the physical recovery from C-section exerts stress on the body.

Here are what we can expect post-delivery generally (not confined to C-section):

  • Vaginal discharge: shedding of extra tissues and blood that nourished the baby
  • Afterpains: from uterus contractions as uterus is trying to shrink back to original size
  • Constipation: side effects from painkillers
  • Breast swelling and soreness: from breastfeeding
  • Hair and skin changes: thinning of hair due to shifting hormone changes, and stretch marks
  • Baby blues: feeling roller coaster of emotions

 

As you start to feel better, refrain from the temptation to do more. Overdoing things at this point can set you back in your recovery. Focus on nourishing your body with good healthy foods and some supplements as below, drinking plenty of water (especially if you are breastfeeding), and getting enough rest.

 

Pegaga

Pegaga, also known as Centella Asiatica1, is a traditional herb in the parsley family. C. asiatica extract demonstrated amazing amplification in the cyclic adenosine mono phosphate content in human adipocytes (fat tissues) with a successive increase in non-esterified fatty acids content. This thereby gives rise to its slimming effect which is especially appreciated during the postpartum period.

Asiaticoside isolated from C. asiatica displayed synthesis of type I collagen in human dermal fibroblast cells1,3. It is observed that pegaga extract helped to epithelialize wound or grow into new skin at a quicker rate, and heightened the rate of wound contraction which is involved in the healing response.

 

Date

Date is a good source of simple sugars giving the quick energy boost post-birth, rich in vitamins, minerals and antioxidants.

Date fruit has calcium, serotonin, tannin, glucose that they are important for bleeding control4. It was concluded in a small clinical trial that the use of oral dates after delivery decreases bleeding more than intramuscular oxytocin and it is a good alternative in normal vaginal delivery4.

Date contains sterol compounds including cholesterol, campesterol, stigmasterol, beta-Sitosterol, and isofucosterol5. These sterol compounds are the production precursors of steroid glucocorticoids and estrogen. Progesterone and estrogen play a role in breastfeeding, evolution, and the proliferation of breast ducts and alveoli, and low doses stimulate prolactin secretion6. The study group who received date showed significant linear increase in the blood prolactin levels at days 10 and 22 of breastfeeding compared to the control group7.

 

Ginseng

Panax ginseng is one of the most commonly used and highly researched species of ginseng. This species, which is native to China, Korea, and Russia, has been an important herbal remedy in traditional Chinese medicine for thousands of years, where it has been used primarily as a treatment for weakness and fatigue8. Some components in ginseng, like polysaccharides and oligopeptides, with lower oxidative stress and higher energy production in cells, could help fight fatigue9,10. We often feel exhausted from all the caring and breastfeeding for the newborn, ginseng extract could be beneficial in restoring our energy levels.

 

Bee Propolis

Being rich in antioxidant, bee propolis works against bacteria, viruses and fungi. The anti-inflammatory and antibacterial properties of bee propolis make it beneficial in wound healing. It helps to stabilise mast cells, which is linked to inflammation and slowed wound healing process, and speeds up new healthy cell growth/ turnover.  Perineum wound in postpartum mothers given propolis will be healed faster than those who are not given propolis by 4 days (3.38 days vs 7.10 days)11.

 

Bird Nest

Bird nest is made by male swiftlet mainly through its saliva during breeding stage. Since ancient times, Chinese have cooked the tonic food which was well known as “bird's nest soup”12. Being the precursor to collagen synthesis, proline found in bird nest is critical to wound healing. Both proline and hydroxyproline are vital for collagen biosynthesis, structure, and strength13. Their cyclic structure constrains the rotation of the polypeptide collagen chain, creating and strengthening the helical characteristic of the molecule14.

 

Conclusion

Bringing a new baby home is one of the happiest times in a woman's life. The fourth trimester is what you’ve been waiting for — your baby has arrived and you are officially a parent! But it also presents both physical and emotional challenges. Be reminded to prioritise your own needs as it can be hard to strike a balance between taking care of yourself and tending to your baby. Remember, a healthy happy mother makes a healthy happy baby!

 

 

Reference:

  1. Kulsoom Zahara, Yamin Bibi and Shaista Tabassum. Clinical and therapeutic benefits of Centella asiatica. Pure and Applied Biology. Vol. 3, Issue 4, 2014, pp 152-159.
  2. Tholon L, Neliat G, Chesne C, Saboureau D, Perrier E, Branka JE (2002). An in vitro, ex vivo and in vivo demonstration of the lipolytic effect of slimming liposomes: An unexpected α (2) - adrenergic antagonism. J of Cosmetic Sci 53(4): 209-2.
  3. Lee J, Jung E, Kim Y & Park D (2006). Asiaticoside induces human collagen I synthesis through TGFbeta receptor I kinase (TbetaRI kinase)- independent Smad signaling. Planta Med 72(4): 324-8.
  4. Khadem N, Sharafy A, Robab LR, Hammod N. Comparing the efficacy of dates and oxytocin in the management of postpartum hemorrhage. April 2007. Shiraz E Medical Journal 8(2):64-71.
  5. Kikuchi N, Miki T. The separation of date (Phoenix dactylifera) sterols by liquid chromatography. Microchimica Acta. 1978;69(1-2):89-96.
  6. Freeman ME, Kanyicska B, Lerant A, Nagy G. Prolactin: Structure, function, and regulation of secretion. Physiological Reviews.2000;80(4):1523-631.
  7. Saeed EF, Mina H, Mohammad M. Effects of the date palm fruit (Phoenix dactylifera L.) on prolactin, IGF-1, and stress factors in lactating female rats andits impact on their litters’ development. Mediterranean Journal of Nutrition and Metabolism 10 (2017) 251–258.
  8. Kiefer D, Pantuso T. Panax ginseng. Am Fam Physician. 2003;68(8):1539-1542.
  9. Bao L, Cai X, Wang J, Zhang Y, Sun B, Li Y. Anti-Fatigue Effects of Small Molecule Oligopeptides Isolated from Panax ginseng C. A. Meyer in Mice. Nutrients. 2016 Dec 13;8(12):807.
  10. Wang J, Sun C, Zheng Y, Pan H, Zhou Y, Fan Y. The effective mechanism of the polysaccharides from Panax ginseng on chronic fatigue syndrome. Arch Pharm Res. 2014 Apr;37(4):530-8.
  11. Gangsar IL, Muhamad R, Firda F. Pemberian Propolis terhadap Mempercepat Penyembuhan Luka Perineum pada Ibu Postpartum. July 2020. Jurnal Kesehatan Metro Sai Wawai 13(1):27. DOI:10.26630/jkm.v13i1.1961.
  12. Chua K.-H., Lee T.-H., Nagandran K., et al. Edible bird’s nest extract as a chondro-protective agent for human chondrocytes isolated from osteoarthritic knee: in vitro study. BMC Complementary and Alternative Medicine. 2013; 13(1):p. 19. doi: 10.1186/1472-6882-13-19.
  13. Albaugh VL, Mukherjee K, Barbul A. Proline Precursors and Collagen Synthesis: Biochemical Challenges of Nutrient Supplementation and Wound Healing. J Nutr. 2017 Nov; 147(11): 2011–2017. Published online 2017 Oct 4. doi: 10.3945/jn.117.256404
  14. Grant ME, Prockop DJ. The biosynthesis of collagen. 3. N Engl J Med 1972;286:291–300.
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