Body image postpartum: Healing versus “getting your body back”

Recovering from birth and adjusting to motherhood is an elaborate, long-term process.

Many mothers struggle with the way they look after giving birth, and women experience body dissatisfaction at a much higher rate during the postpartum period than pre-pregnancy or late pregnancy (1).

Typically, mothers go from being celebrated for their belly bump during pregnancy to experiencing internal and external pressure to “get their body back” as soon as possible after birth.

This blog will look at these pressures alongside the actual nutrition needs during postpartum and lactation.

Resisting comparison culture—the phenomenon where individuals compare themselves to others, often on social media—can be particularly difficult during the postpartum period.

Unfortunately, many people during the postpartum and lactation periods, especially those with previous body image issues, are eager to return to their pre-pregnancy size and shape and are, thus, undereating even based on the nutritional needs of a woman who is not lactating and recovering from birth.

The societal pressure put on women to “bounce back” is immense and begins immediately after delivery, if not before.

“Studies identified that even during pregnancy, women reported that society expected them to reclaim control of their body following the birth of their baby, and described this as a distressing and fearful prospect. The postpartum body was portrayed as a project to be actively worked on and controlled to get back to normal, with many women perceiving this to be a bigger goal postpartum than before pregnancy” (2).

Social media exposure in the #fitmom era significantly impacts self-perceived body image postpartum.

A novel 2022 experimental study found that women exposed to body-focused social media posts targeted at new mothers experience not only higher rates of body dissatisfaction but also cultivated an unhealthy relationship with food, resulting in eating less and feeling guilt after eating (3).

If you are a healthcare practitioner working with postpartum and lactating mothers, prioritize checking in with your clients via a food recall or brief food log to ensure they eat enough.

Women who under-eat in postpartum are at risk of missing out on many vital nutrients to prevent postpartum depression, anxiety, and psychosis, not to mention, more generally, trouble with milk production and healing from birth.

Undereating may also affect sleep quality, a vital factor that independently affects the metabolism and storage of body fat (4).

It is helpful to remind patients that our entire physiology runs on nutrition, including enzyme systems, detoxification pathways, hormonal balance, neurotransmitter balance, and the health and diversity of the microbiota, to name just a few areas.

Thus, we want our patients to focus on how they feel versus a number on the scale or a clothing size during this healing period.

Everybody’s metabolism is unique, and we must educate our patients with empathy, kindness, resources, and any external referrals that could be useful to them. It can make a world of difference to help patients with their body image so that they can reality-check themselves, especially in this age of anxiety fueled by social media about body image.

If you’re a healthcare practitioner working with postpartum patients, you’ll encounter many patients trying to cut calories to return to their pre-pregnancy weight.

However, even weight loss depends on nutrients, including every step of the Krebs cycle and glycolysis.

For instance, many postpartum patients want their metabolism to shift. As health care practitioners, we need to educate and guide our postpartum patients so their metabolism shifts correctly and they avoid playing into disordered eating and disordered thinking patterns regarding food.

Unfortunately, disordered eating is often veiled as healthy eating and is so pervasive that many practitioners may not even recognize those thought patterns in themselves and their patients.

Postpartum healing is extremely nutrient-dependent. For breastfeeding women, it is essential to emphasize that lactation requires more nutrients than pregnancy.

Lactating mothers need more calories, protein, and nutrients postpartum than in pregnancy. Caloric needs during breastfeeding are estimated at a minimum of 500 calories per day over non-pregnancy levels (5) and at least 200 calories per day over the requirements for pregnancy (6).

Critical nutrients during postpartum and lactation

For breastfeeding women, diet is essential in providing the baby with certain vital nutrients via breast milk, including vitamins A, D, B1, B2, B3, B6, and B12, as well as fatty acids and iodine (7). However, be careful not to overdo it with iodine, as excessive intake can cause severe issues postpartum, when your thyroid gland is particularly susceptible to inflammation and immune dysregulation. Read more here.

When we focus only on postpartum body image versus optimizing health, recovery, and breast milk quality, it is not uncommon for these to be under-consumed.

A helpful takeaway and motivating factor to share with breastfeeding mothers is that these nutrients benefit the baby’s development.

Protein

While many sources suggest that lactating women need to increase protein consumption by 25 grams per day compared to non-lactating women, this is almost certainly an underestimation of needs.

Protein requirements for lactating women are between 1.7 and 1.9 grams/kg of body weight/day to meet lactation needs and preserve maternal muscle mass (8).

Suppose a woman consumes a protein-deficient diet, as many women do unintentionally. In that case, her breastmilk will still contain adequate protein to nourish her baby, but at the expense of her muscle stores.

We cannot recommend protein intakes simply at a minimum value to keep the mother alive and produce adequate milk for her infant. We must recommend increased protein intake to preserve maternal muscle mass and support tissue repair postpartum.

Getting the optimal amount of protein can be challenging and often requires education about the protein content of various foods and suggestions for meal planning. For example, a 160 lb woman would need around 125 grams of protein daily during lactation, a goal that requires intention and planning. Read more about protein requirements for special populations here.

Minerals

Mineral intake is crucial during lactation, not only for the quality of breast milk but also for maternal bone health during and after lactation.

At least 200 mg of calcium is excreted daily into breast milk (9), and calcium excretion may be as high as 400 mg (10). During the first two to six months of lactation, the mother loses around 8% of her bone density.

However, in extended breastfeeding, PTHrP, or parathyroid hormone-related peptide levels, and increased estrogen (once menstruation returns) can help compensate for some of that loss (9).

After weaning, bone mineral density gradually restores; however, it has been observed that women with multiple children may be at increased risk of low bone mineral density and osteoporosis later in life (11).

So, supporting our postpartum clients with education about foods rich in bone-supporting nutrients like calcium, phosphorus, and vitamin D is vital for helping them protect their bone health.

Additionally, bone mineral density recovery may vary based on ethnicity and genetics. However, this needs to be studied more to better understand the impacts of multiple pregnancies on long-term bone health.

“Most studies of bone metabolism during lactation have been performed in Caucasian or Asian populations. However, there are well-documented differences in bone metabolism between African American (AA) and Caucasian (C) women. AA women tend to have lower 25-hydroxyvitamin D (25OHD) and higher circulating parathyroid hormone (PTH) concentrations compared to C women [21]. AA women also have lower levels of vitamin-D binding protein compared to C women, so that despite lower levels of total 25-hydroxyvitamin D, levels of bioavailable 25-hydroxyvitamin D are similar [22]. Furthermore, there is evidence that AA people have lower skeletal sensitivity to the resorptive effects of PTH, which could help to explain the higher bone mineral density (BMD) and lower risk of fracture that has been observed in AA as compared to C women [23, 24]. These findings raise the question of whether the AA skeleton might be resistant to the effects of PTHrP in lactation. Studies of lactation-associated bone loss in Black Gambian women have demonstrated similar lactation-associated losses in BMD between Gambian women and a comparison group of Caucasian women in the UK [25–27], suggesting that these losses occur regardless of race. However, the groups differed significantly in terms of intake of calcium and other nutrients” (9).

Other minerals are also essential to keep in mind during the postpartum period.

Iodine, chromium, selenium, potassium, and manganese are required in higher amounts during lactation than during pregnancy (12). Most women can meet their mineral needs through a varied, caloric-sufficient diet and a high-quality prenatal vitamin.

Vitamin D

As we know, vitamin D is a critical vitamin essential for numerous physiological processes. However, there is a lack of data on maintaining optimal vitamin D levels during lactation and postpartum.

Vitamin D deficiency is exceedingly common in pregnant women worldwide; in the United States and Canada, 64% of pregnant women are vitamin D deficient (<50 nmol/L), and 9% are severely deficient (<25 nmol/L) (13).

Severe maternal vitamin D deficiency is more prevalent in other regions; for instance, in the eastern Mediterranean, including Iran and Pakistan, up to 79% of pregnant women are severely deficient, and in the European areas, around 39% of pregnant women fall into this range (13).

In addition to vitamin D’s importance for bone health, there are other health considerations regarding vitamin D and the postpartum period. For instance, studies have shown low vitamin D to be a significant risk factor for postpartum depression (14). You can learn more about vitamin D during preconception, pregnancy, and postpartum here.

***Read more about specific nutrients and postpartum depression* *here.***

Breastfeeding infants who are not yet eating abundant complementary foods are nearly entirely reliant on breast milk for vitamin D (sunbathing can also improve the vitamin D status of an infant; however, most parents choose to keep their infants out of the sun).

Breast milk contains around 1.3-2% of maternal plasma vitamin D, so if a mother is deficient or insufficient, her milk will have little vitamin D for the infant (15, 16).

For this reason, public health experts recommend giving the breastfeeding infant a vitamin D supplement within the first couple of months postpartum.

However, an alternative solution is for the mother to supplement with at least 4000 IU of vitamin D daily (17) and possibly up to 6400 IU (18). This method will benefit her vitamin D levels and increase the amount in breast milk to meet infant needs.

Finally, Bernhardt et al. (2021) suggested that vitamin D supplementation postpartum may be beneficial for the prevention of postpartum breast cancer, although further research is warranted (19).

“In sum, the increased demand for vitamin D during pregnancy and lactation, in combination with potentially reduced vitamin D synthesis within the involuting liver, is anticipated to enhance vitamin D deficiency for postpartum women. Indeed, vitamin D deficiency is exceptionally common among postpartum women. Recent meta-analyses report that 18%–97% of pregnant and recently pregnant women are deficient for vitamin D, depending on the country and population studied. In the United States, vitamin D deficiency is observed in up to 72% of pregnant and recently pregnant women.

We speculate that the accumulated vitamin D deficiency of pregnancy, lactation, and involution that is prevalent post wean may exaggerate the tumor promotional attributes specific to the involuting breast and increase breast cancer risk in some postpartum women. Restoring vitamin D to optimal levels during pregnancy, lactation, and involution may offer a new therapeutic approach for the management of postpartum breast cancer” (19).

Omega-3s

Dietary omega-3 fatty acids, mainly DHA found in oily fish such as salmon and sardines, have numerous benefits for the postpartum mother and the breastfeeding infant (20).

Diets containing more omega-3 are beneficial for reducing inflammation and result in lower rates of postpartum depression and anxiety (21).

Women who regularly consume fish, especially salmon, have significantly more omega-3 fatty acids DHA and EPA in their breast milk than women who consume fish less often (22). In addition to fish, regularly eating pork may contribute to higher levels of EPA in breast milk (22).

Conversely, a higher intake of omega-6 fatty acids relative to omega-3 intake may reduce the amount of DHA and EPA in breast milk (22). Omega-6 fats-rich fats include cottonseed, corn, safflower, and soybean oils, all commonly found in ultra-processed convenience foods. In theory, overconsumption of fast food and convenience foods postpartum may result in less DHA-rich milk for the developing infant.

Being mindful of dietary fatty acid intake during lactation is essential because DHA is vital for the developing infant.

“Omega-3 FAs, mainly DHA, are important components of retinal photoreceptors and brain cell membranes. Therefore, DHA is essential for infant visual and cognitive development” (22).

Fiber

Dietary fiber has several benefits for mother and baby, most of which are secondary to the effect of fiber on the gut microbiota. These benefits include lowering the risk of postpartum depression and improving metabolic health (23, 24, 25, 26, 27).

Maternal diets rich in dietary fiber are associated with improved breast milk composition because maternal fiber intake supports human milk oligosaccharides (HMOs), prebiotics that enhance the infant microbiota and, hence, the infant immune system (28).

Additionally, the mother’s genetic expression may influence this as well, specifically the inactivation of the FUT2 gene, which may regulate how many HMOs are present in breast milk (28, 29).

For women highly motivated by improving their metabolism postpartum, fiber is an excellent nutrient to emphasize its importance due to its beneficial effects on body composition and metabolic function (26, 27).

Focusing on abundant fiber-rich foods versus fiber supplementation is preferred because foods provide many health-promoting compounds, such as polyphenols and antioxidants, for both mom and baby. These anti-inflammatory compounds are passed to the infant via breastmilk and benefit inflammation and infant development (28).

Healing after birth is about nourishment, not dieting

Healing after birth is about healing, stillness and connection, not about regimented boot camps to get back in shape.

Some women find grace in journaling or meditation focused on acknowledging their gratitude to their bodies for growing their babies, birthing them, and nurturing and nourishing them.

In my practice, I also help my clients connect with their goals concerning themselves, aside from their babies.

By reconnecting with themselves, they are more likely to appreciate their bodies than to seek outside validation or strive to meet arbitrary body image standards based on cultural trends.

I find it helpful to remind my clients that postpartum is a time for rest, where “fitness” may mean getting support from family, friends, or even a night nurse to sleep through the night. Taking gentle walks with the baby and getting targeted support for any structural issues such as pain, soreness, or pelvic floor dysfunction can also be incredibly helpful for new moms.

Help with body image postpartum

Some postpartum body image issues require the support of a mental health professional.

But if you’re simply stuck on how to incorporate the foods you need to heal your body and soothe your psyche post-delivery, I’m here to help.

Click here and schedule a free 15-minute call to see if we’re a good fit.

Click here to learn more about interpreting lab work during pregnancy in my masterclass, What You Never Learned About Bloodwork in Preconception, Pregnancy, and Postpartum.

References