Nourishing the New Mother: A Comprehensive Guide to Postpartum Nutrition

Written by: Marci Clow, MS, RDN

Given that it takes around 9 months to grow a healthy baby, it makes sense it would take ample time for a woman’s body to recover and adjust after giving birth. A nutrient-rich diet is critical during each trimester for supporting a healthy pregnancy, just as adequate nourishment in the hours, days, and months postpartum is critical for a mom’s recovery to provide the energy needed to care for a newborn and for breastfeeding moms to produce milk. Yet, there is an intense focus on prenatal care, whereas postpartum interventions are typically limited to a check in 6 weeks after delivery. This article will dive into the critical aspects and importance of nutrition for new moms during the postpartum period.

Why is postpartum nutrition so important?

The American College of Obstetricians and Gynecologists (ACOG) has dubbed the postpartum period as the “fourth trimester,” the time (typically 6-8 weeks) after birth that sets the stage for health and well-being for both moms and babies. Nutrition during this phase is critical to support a new mom’s healing and energy, and it also sets the foundation for fueling infant growth and ongoing development. From constipation to mental health challenges, failure to provide adequate postpartum nourishment can result in a slew of challenges for new moms. Additionally, a new mom’s nutrition can greatly impact a breastfed infant’s ability to thrive and hit developmental milestones.

What changes does the female body undergo after childbirth, and how might those changes impact nutritional demands?

Giving birth, whether a C-section or vaginal delivery, results in major physiological adjustments, both physical and emotional. To what degree and how long these postpartum changes will last is different for everyone. A healthy diet is essential to helping the body recalibrate, replenish nutrient stores, and get back to normal sooner. Common physiological postpartum changes include:

* Cramps and vaginal bleeding from the uterus shrinking
* Perineal soreness from vaginal birth; abdominal soreness from a C-section
* Hormonal shifts resulting in symptoms such as mood changes, headaches, hot flashes, and hair loss
* Painful swollen breasts resulting from milk production (engorgement)
* Swelling from extra fluids
* Fatigue
* Constipation
* Urinary incontinence

What is a good dietary strategy for optimal recovery and restoring energy after childbirth?

Eating a wide variety of nutrient-rich fruits, vegetables, whole grains, lean proteins, and healthy fats will help the body recover and provide the energy needed to care for a newborn. Calories come from macronutrients (the carbohydrates, proteins, and fats in foods) and are necessary as fuel for everyday functioning. During the postpartum period, adequate calories from a “balance” of carbs, protein, and fat are ideal for helping the body to heal and boosting recovery. Focus on fresh, whole foods, and try to limit packaged and processed foods and drinks that have added sugar and may lack nutrient value. The basic premise of a balanced diet is to fill ½ of the plate with fruits and vegetables, ¼ of the plate with whole grains, and ¼ of the plate with healthy protein. This easy-to-follow concept known as MyPlate was created by the United States Department of Agriculture (USDA) to teach people how to build a healthy balanced plate and is based on the Dietary Guidelines for Americans. MyPlate resources are offered in more than 20 languages and include culturally sensitive dietary recommendations.

Micronutrients (vitamins and minerals) are needed in tiny quantities. Unlike their macro counterparts, micronutrients don’t provide energy in the form of calories; however, many convert food to energy. Micronutrients are essential to the healing process. The USDA website provides a free tool to help individuals and healthcare practitioners determine calorie needs and macronutrient and micronutrient levels. Let’s break down each macronutrient and a few key micronutrients needed for optimal recovery and energy after childbirth.

Calories: According to the Centers for Disease Control and Prevention (CDC), breastfeeding moms should consume approximately 2,300 to 2,500 calories per day compared with 1,800 to 2,000 for nonlactating women. As a general rule, breastfeeding requires about 300-500 additional calories per day.

Pro Tip: What does an extra 300 calories look like?

Avocado toast with 2 slices of whole-grain bread, 2 tbsp of mashed avocado, 2 poached eggs, sprinkled with Everything Bagel seasoning
1 cup of Greek yogurt (unsweetened), 1/3 cup of granola, ½ cup of berries
4 ounces of salmon, a medium-sized baked sweet potato, ½ cup of broccoli

Fiber-rich carbohydrates: Carbohydrates provide glucose, which is the main fuel cells use for energy; we all need them. Sugary and starchy foods with low fiber, such as white bread, doughnuts, and sodas, are known as simple carbs; they are digested quickly and will make blood sugar spike higher and faster. Foods with fiber-rich carbohydrates (aka complex carbs) are digested slower because they contain starch and fiber, allowing for a gradual release of glucose into the bloodstream. Fiber-rich carbs like fruits, vegetables, beans, and whole grains help keep the digestive system moving and lessen the risk of issues like constipation.

Protein: Protein is essential for postpartum healing; it provides much-needed energy and helps with satiety. Good protein sources include nuts, seeds, tofu, lentils, beans, eggs, dairy, poultry, fish, and lean beef or pork.

Healthy fats: Healthy sources of fat include avocado, nuts and nut butter, seeds, olive oil, and fatty fish. Fats provide energy, help keep you full, and delay the absorption of carbs into your bloodstream.

Hydration: Consuming adequate fluid is critical during the recovery period, especially if breastfeeding. Aim for 12-16 cups of water per day!

Pro Tip: A good way to assess adequate hydration is to look at the color of your urine. Pale yellow generally indicates you are drinking enough fluid; darker urine may mean you need to increase your water intake. Let thirst be your guide, but shoot for refilling your 40-ounce tumbler at least twice per day, or try to drink a glass of water each time you breastfeed. Limit sugar-sweetened beverages and those that contain caffeine.

Key micronutrients for recovery: All vitamins and minerals are needed to support optimal health and recovery in the postpartum period, and the best way to get them is through a varied diet of whole foods. Key micronutrients include:

Iron—Foods rich in iron will help to replenish iron stores from blood loss during birth and postpartum. Iron in foods naturally occurs in two primary forms: heme iron and non-heme iron. The heme form is more readily absorbed. Animal products contain both forms of iron, whereas plant-based sources provide only non-heme. Good dietary iron sources include red meat, poultry, beans, lentils, spinach, and fortified breakfast cereals.

Vitamin C—Good sources of vitamin C include citrus, strawberries, kiwi, and Brussels sprouts. This vitamin supports the healing process and increases the absorption of iron.
Zinc—Sources of zinc include pumpkin seeds, fortified cereals, red meat, and seafood. This mineral plays a role in wound healing.

Are there any specific nutrients of concern during the postpartum period for those who consume a plant-based (vegan) diet?

Postpartum nutrient needs are the same regardless of whether one consumes animal products or not. Those who choose a plant-based dietary pattern simply need to be more deliberate in their food choices to ensure overall nutrient needs are met. Typically, the only nutrient vegans need to add as a supplement is vitamin B-12 because it is not readily available in plant-based foods. An algal-based omega-3 supplement may also be a good idea. Talk to your healthcare provider or see a registered dietitian if you’re concerned about the nutritional adequacy of a plant-based diet and if there might be a need to supplement with other key nutrients

Is there an increased need for specific nutrients during breastfeeding?

The female body is resilient, and even if a mom’s daily food intake is not nutritionally ideal, breast milk composition will still be amazingly sufficient. However, following the basic dietary recommendations with the addition of 300-500 extra calories per day, as outlined above, is the most proficient way to keep energy and milk supply up during lactation. That being said, there are certain nutrients that a new mom should ensure she is getting enough of’ ideally through her diet and, if necessary, through supplementation.

Choline: An estimated 90% of women don’t consume the recommended amount of choline, 450 milligrams, during pregnancy. During lactation, choline requirements increase to 550 milligrams to help replenish the mom’s stores and to supply an adequate level in the breast milk for the baby’s brain and nervous system development. Food sources of choline include eggs, meat, fish, poultry, dairy, peas, beans, lentils, nuts/seeds, whole grains, and cruciferous veggies like Brussels sprouts and cabbage.

Omega 3s: For new moms, the omega-3 fatty acid docosahexaenoic acid (DHA) is linked to healthy brain function and a lower risk of postpartum depression. For babies, DHA is essential for brain development and the eventual ability to learn, judge, and concentrate. There is a direct correlation between maternal DHA intake and the content of DHA in breast milk. Dietary DHA is most abundant in fish and seafood, although a small amount of alpha-linolenic acid from plant sources, like flax and chia seeds, and walnuts is converted to DHA. Certain brands of eggs and milk are also fortified with DHA, and it is widely available in dietary supplements.

Pro-Tip: Orlo’s Active Prenatal DHA, provides a mercury-free, highly bioavailable, vegan source of easily absorbed supplemental DHA with no fishy burp-back or aftertaste.
Vitamin D: Vitamin D is important for maintaining a baby’s blood calcium level and supporting bone growth. The body produces vitamin D when exposed to sunlight, but it is limited in the food supply to oily fish, eggs, and fortified products. At birth, infants typically have around 4 months of vitamin D stored. When depleted, they can synthesize it from sunlight or be given infant drops under the guidance of a healthcare practitioner. Breast milk contains very little vitamin D. Maternal supplementation can increase maternal blood levels, but a dose much higher than the daily recommended intake (600 IU) may be needed to increase vitamin D levels in maternal breast milk. In fact, research suggests that upward of 6,000 IU/d may be needed to satisfy a nursing infant’s vitamin D requirement. Breastfeeding moms may want to have vitamin D levels checked and discuss supplementation with their healthcare provider.

Iodine: Maternal iodine intake and status can impact that of breastfed infants. Iodine is critical for infant growth and brain development, and the requirement for lactating women (290 micrograms) is nearly double the pre-pregnancy recommended amount. Good dietary sources of iodine include seafood, seaweed, dairy products, and iodized salt.

Pro tip: Many sea salt brands, Himalayan salt, and Kosher salt don’t contain iodine. Iodized salt provides about 75 micrograms per ¼ tsp.

Should breastfeeding mothers continue to take a prenatal multivitamin?

It really depends on who you ask; however, as discussed above, the daily recommended intake for some nutrients increases for breastfeeding women. The CDC recommends the continuation of a prenatal vitamin only if a breastfeeding mom follows a restrictive diet. The World Health Organization recommends the continuation of prenatal vitamins for 3-months postpartum (if anemia is a risk factor), and the ACOG makes no definitive recommendations regarding the continuation of prenatal or other vitamins to be supplemented and at what dose. It is always a good idea for individuals to talk to a healthcare provider about their individual circumstances and if the continuation of prenatal vitamins or another supplement might be recommended.

What common postpartum issues might occur, and how might they be impacted by nutrition?

Recovering from childbirth, adjusting to changing hormones, and learning to care for a newborn can all contribute to some of the challenges that may impact a new moms nutritional status. Let’s break down some of the more common issues:

Postpartum baby blues/emotional eating: Because of fluctuating hormone levels and fatigue that most women experience during the postpartum period, feelings of anxiety, worry, and sometimes sadness are common. For most women, these feelings fade over time; for others, they can be severe and long-lasting, potentially resulting in postpartum depression. Some women with baby blues may turn to food as comfort; some may completely lose their appetite. Consuming regularly timed meals that include a balance and wide variety of nutritious foods is an important part of keeping up a steady stream of fuel to support mental health. Postpartum depression is a serious condition that can impact both mother and child, and it is important to seek help if struggling. There is some evidence, as mentioned above, that intake of omega-3s may help reduce the risk of postpartum depression.

Time constraints: In addition to postpartum fatigue, the time constraints of caring for a newborn, trying to get sleep when possible, and running a household can impact the ability of a new mom to prepare and consume nutritious meals. Every woman’s situation is different. For some, it works to set aside time each week to plan and prepare easy-to-grab snacks and nutritious meals for the week ahead, perhaps when your partner, neighbor, or friends are available to help with the baby. Grocery delivery and meal delivery services are also great options.

Constipation: Although babies seem to be endless little poop factories, for new moms, the ability to do their business can be impacted by stress, hormone swings, lack of sleep, less overall movement, and stretched muscles and medication from birth. Typically, bowel habits will return to normal after a few days, but for some women, constipation can be an ongoing issue. Staying adequately hydrated will help keep things moving, and consuming lots of fiber-rich foods will add bulk to stools and stimulate bowel movements.

Hemorrhoids: Pressure on the veins in the rectum and anal area during late pregnancy and postpartum can lead to painful and inconvenient hemorrhoids. Consuming foods high in fiber and drinking adequate fluids can help make stools easier to pass. Try not to sit for long stretches at a time, try not to strain when going to the bathroom, use a special hemorrhoid pillow, apply ice, take a warm bath, and, if the hemorrhoids don’t go away in a few weeks on their own, talk to your healthcare practitioner about your symptoms and other treatment options.

Low milk supply: The more a baby nurses, the more milk is produced. Some women are unable to produce adequate breast milk; some none at all. Regardless of what your body does or doesn’t do, it isn’t your fault! What you can do is be patient; sometimes, it just takes a few days for the milk to come in. Alternatively, formula has come a long way and is nutritionally closer than ever to that of breast milk. There is no magic nutritional trick for increasing milk supply, but be sure to drink plenty of water and consume a normal, healthy, balanced diet. Herbal remedies like fenugreek can support milk production, although the evidence supporting this benefit is limited. A lactation consultant can be extremely helpful for discussing other strategies for increasing milk supply.

What is a good strategy for postpartum weight management?

Social media influencers and some celebrities may have you believe that it is the norm to be back to your pre-pregnancy weight a few days after having a baby. Truth be told, there is no quick fix. How long it takes to bounce back is different for everyone. Restricting the body of fuel and nourishment to lose weight postpartum is not a good idea for a mom’s health or for that of a newborn. A good strategy is to give your body time to recover and consume a healthy, balanced diet with adequate calories, as described above, while gradually increasing your physical activity level.

From a public health perspective, what postpartum measures are important for both consumers and healthcare providers to be aware of?

Postpartum care tends to consist of an arbitrary check-in around 6 weeks after delivery. Traditionally, there is an intense focus on prenatal care. Many organizations, including the ACOG, are advocating for individualization of timing and comprehensiveness of postpartum visits as an ongoing process rather than a single encounter. Depending on where a woman delivers her child, and taking into consideration both cultural and socioeconomic factors, there is a great disparity in how much postpartum nutrition education and support many women receive. Healthcare providers can play a big role in helping women understand that postpartum challenges are normal, how to overcome them, and how to make informed food choices regardless of their personal circumstances. Potential considerations and tips to improve postpartum health through good nutrition might include:

Incorporate nutritional assessments and interventions into routine hospital discharge and postpartum care visits.

Provide meal planning guidance, share recipes for quick, nutritious meals that are easy to prepare, and direct new moms, their partners, and family members to online dietary resources or apps.

Advocate for further research and policy initiatives to improve postpartum nutrition education programs.

If available, collaborate with specialized healthcare professionals, including lactation consultants, mental health providers, and registered dietitians.
Take a personalized approach and consider each woman’s unique circumstances, including dietary restrictions, socioeconomic status, cultural preferences, and activity level.
Utilize resources such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), an organization that provides nutrition education, including postpartum support, for low-income families who may be at nutritional risk.

Key Takeaways:

Nutrition is clearly an important component of a new mom’s optimal postpartum recovery, overall physical health, and mental well-being. Nutrition education and interventions before and during the vulnerable postpartum period can empower women to address common postpartum challenges and help support breastfeeding success. Optimal nutrient intake in the postpartum period impacts a breastfed infant’s ability to thrive and hit growth goals and developmental milestones, laying the foundation for long-term health and well-being.

Additional Resources

Dietary Reference Intake Calculator: https://www.nal.usda.gov/human-nutrition-and-food-safety/dri-calculator
USDA MyPlate Pregnancy and Breastfeeding: https://www.myplate.gov/life-stages/pregnancy-and-breastfeeding
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): https://www.fns.usda.gov/wic
Postpartum Support International: https://www.postpartum.net/
American Academy of Nutrition and Dietetics: Find a Registered Dietitian https://www.eatright.org/find-a-nutrition-expert
Orlo Blog article: The Critical Role of Prenatal Vitamins


References

ACOG Committee Opinion No. 736: optimizing postpartum care. Obstet Gynecol. 2018;131(5):e140-e150. doi: 10.1097/AOG.0000000000002633

Beluska-Turkan K, Korczak R, Hartell B, et al. Nutritional gaps and supplementation in the first 1000 days. Nutrients. 2019;11(12):2891. doi: 10.3390/nu11122891

Brunst KJ, Wright RO, DiGioia K, et al. Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population. Public Health Nutr. 2014;17(9):1960-1970. doi: 10.1017/S1368980013003224

Dietary Guidelines for Americans, 2020-2025. 9th ed. U.S. Department of Agriculture and U.S. Department of Health and Human Services. December 2020. Accessed October 15, 2024. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf

Hamner HC, Nelson JM, Sharma AJ et al. Improving nutrition in the first 1000 days in the United States: a federal perspective. Am J Public Health. 2022112(S8):S817-S825. doi: 10.2105/AJPH.2022.307028

Hollis BW, Wagner CL, Howard CR, et al. Maternal versus infant vitamin d supplementation during lactation: a randomized controlled trial. Pediatrics. 2015;136(4):625-634. doi: 10.1542/peds.2015-1669

Likhar A, Patil MS. Importance of maternal nutrition in the first 1,000 days of life and its effects on child development: a narrative review. Cureus. 2022;14(10):e30083. doi: 10.7759/cureus.30083

Maternal diet and breastfeeding. Centers for Disease Control and Prevention. Updated February 9, 2024. Accessed October 8, 2024. https:/cdc.gov/breastfeeding-special-circumstances/hcp/diet-micronutrients/maternal-diet.html



Marci Clow is a registered dietitian nutritionist and the founder of Clowt Content, an organization which provides evidence-based content on a wide range of food and nutrition topics. The information presented here is intended only to be educational and provide readers with information; it is not an endorsement of the writer for any particular product. These statements have not been evaluated by the Food and Drug Administration. Dietary supplements are not intended to diagnose, treat, cure, or prevent any disease.