Nourishing the Postpartum: A Traditional Medicine Look at the Importance of Blood in the Postpartum Period
By Tiffany J Harper (she/her/wina) Dr. Acu, TCMD, R.H, C-FSD/CBE
Our relationship to Blood is vital but often mysterious: it flows throughout our bodies although we often cannot see it or feel it, it connects us to generations of our ancestors through DNA, and we know that it is so essential that if we lose too much of it we can die.
During times of intentional focus, we feel our heartbeat and therefore the blood flow. We are reminded of its existence with injury, disease, or after vigorous exercise.
But most of the time, our Blood keeps circulating without our conscious awareness.
For those who menstruate, Blood enters the conscious awareness readily, with necessity, in the act of the containment and management.
During the time immediately following pregnancy, that awareness takes the stage again through the release of Blood, mucus, and uterine tissue called lochia, which people colloquially call “the longest ‘period’ of your life.”
Many of our cultural traditions and ancestral systems of medicine, such as those found in Traditional Chinese Medicine (TCM) and Indigenous traditions, know of the significance of Blood, especially during the time after childbirth and pregnancy, with importance being emphasized on nourishing and strengthening the Blood to support vitality.
Traditional Chinese Medicine and Blood Deficiency
In Traditional Chinese Medicine (TCM), a system of medicine with over 2500 years of written literature, Blood is one of the Five Vital Substances along with Qi (our life force energy), the body fluids, Essence (Jing, a precious fluid), and the Mind (Shen or spirit).
The Five Vital Substances are the essential nourishing and building blocks that support all of our organs and body functioning.
Blood, specifically in TCM, has the role of holding, housing, and creating the Qi (our life force energy) in the body. When Blood is impacted, through a condition that is called Blood deficiency (meaning not enough blood, a blockage, or low in the components that make up blood, such as Iron or B12), the result is tiredness and fatigue, or what is called Qi deficiency (life force energy deficiency).
Blood deficiency also impacts other areas of the body and can be seen in symptoms such as: paleness of the skin, pale lips, dizziness, blurred vision, insomnia, depression, anxiety, and numbness and tingling of the extremities due to the limbs not being nourished.
Impacts of Blood Deficiency
Other organ systems will be affected by the lack of nourishment from Blood deficiency.
Two areas that we see this profoundly is when we are confronted with disrupted sleep, a common experience for those with a baby (or continued into childhood), and with the demand on Blood to help produce human milk.
It is said that the lack of solid uninterrupted sleep disrupts the functioning of the Liver’s ability to nourish and regenerate the Blood at night. When our Blood is not nourished at night, this also impacts our Blood’s ability to nourish our tendons, sinews, and eyes, and impacts the Liver’s assistance in detoxification and metabolism. When Blood deficiency affects the Heart, from disrupted sleep and the role of the Heart in regulating sleep, it can result in Heart palpitations, blood pressure issues, insomnia, and anxiety.
In TCM it is stated that “When Blood is harmonized, the Mind has a residence.”
This stems from the belief that our Mind (also called Shen or spirit) is housed in the Heart. When our Blood is healthy, it nourishes and supports the Heart, and this supports good Shen, or a healthy Mind.
Shen (or Mind) disturbance due to the deficiency of Blood is a significant factor in the incidences of depression, anxiety, and Perinatal Mood and Anxiety Disorders (PMAD’s).
The nutrients extracted from Blood also play a role in human milk production, as according to TCM, human milk is derived from Blood. The impacts of Blood deficiency highlight the importance of supporting Blood nourishment to safeguard both physical vitality and emotional stability, especially during the postpartum time.
Setting the Stage for Blood Deficiency: Contributing Factors
There are many things that can set the stage for deficiency of Blood in the postpartum time. One of the most significant contributing factors is ongoing anemia or iron deficiency and its occurrence during pregnancy.
According to The Journal of the American Medical Association (JAMA), “In North America, the estimated prevalence of iron deficiency during pregnancy is reported to be greater than 50%, and nearly 12% of pregnancies are affected by iron deficiency anemia.”^1
This speaks to a larger issue at hand that I will only touch on briefly but is worthy of a whole article in itself.
In North America barriers created by systemic, structural, and institutionalized racism and discriminating policies affect access to healthcare, food security, and other care resources, and most significantly affect Indigenous and Black peoples.
According to the National Institute for Health (NIH), anemia is most common among Black and Indigenous pregnant and birthing peoples.^2
Poverty and access are significant factors, especially seen on Canadian First Nation Reservations and Canadian Northern communities. Many communities are located in food deserts, where “grocery stores” only provide convenience and packaged foods that are low in nutrients and high in processed food ingredients. In Canada’s northern and Indigenous communities, loss of access to “country food”–i.e.,nutrient-dense traditional foods–has a significant role in hunger and nutritional deficiencies.
Location is also a factor in one’s ability to access care: many Northern communities in Canada are fly-in only or are located far from urban centres.
There is also a higher tendency to avoid care due to historic and continued harms associated with medical “authorities” and fear of child apprehension.
Other physiological factors responsible for Iron deficiency and anemia may include:
Restrictive eating or diets
Heavy menstrual bleeding
Stomach or gastric ulcers
Genetic predispositions or inherited disorders
Nutrient deficiencies, such as deficiencies in iron, folate, vitamin B12 and/or vitamin C
Health conditions, including celiac disease, atrophic gastritis, hernias, ulcers, IBS, and other malabsorption conditions
Other factors that contribute to Blood deficiency after pregnancy include actual loss of Blood, such as in cases of hemorrhage, surgical interventions, surgical births (caesarean), tearing of tissues, uterus atony from prolonged labour, or precipitous labour.
Nourishing the Blood and Spirit
Traditional Chinese Medicine provides a language and system of understanding that confirms the importance of my own Indigenous cultural practices after pregnancy and childbirth.
Blood deficiency in TCM is a causative pattern that is seen in postpartum depression, anxiety, panic attacks, migraines, insomnia, human milk production difficulties, fatigue, exhaustion, and blood pressure issues, to name a few.
It is no wonder that our ancestors knew the importance of supporting the body by nourishing the Blood during the postpartum time.
This is evident in the use of traditional foods, practices, and herbals to nourish a birthing person. Bone marrow broths or soups and organs, all nutrient-dense and Blood-building foods, were commonly consumed. In TCM these foods contain bone marrow, heme iron, and protein to build the Blood, Essence (Jing), and Qi. Traditional herbals that are high in minerals, including iron, were consumed too, including the leaves of Red Raspberry (anoskanatik in nēhinawēwin/ Swampy Cree language) or other Rubus spp family plants, such as the leaves of the Blackberry, Salmonberry, or Cloudberry (depending on location) and Stinging Nettle (masan).
Other medicinals were used to help control bleeding like Yarrow (wapaniwask) or Red Osier Dogwood (mikopimakwa).
A note: It is important to understand and respect the relationship to these plants and Indigenous culture; they should not be removed from traditional lands without express permissions. Also note that not all plants are suitable for everyone. Please be sure to seek advice from a qualified health care provider before use.
Other practices were commonplace too, such as staying in bed, keeping warm, consuming only warm cooked foods, and staying out of the wind, which is explained in TCM as preventing us from exhausting our vital Qi that is needed to build back Blood.
It also prevents us from introducing cold into our systems with cold food, or the cold environment, which will stagnate blood and cause prolonged or increased bleeding. Staying out of the wind would help us avoid “catching wind,” which happens when our pores are still open and therefore more susceptible to the external elements.
When we “catch wind,” it can cause us to be sick, catch a cold or flu, or develop shakes. Many traditional cultures across the world share similar guidelines and practices for the postpartum time. As nokom (grandmother) would say: rest, stay warm, wear socks, cover up, and stay out of the wind.
Traditional practices may also include the nourishment of the spiritual body.
If we remember that Blood is housed in the Heart, and the Heart is the origin of our Mind, or Spirit, we can see the importance of nourishing the spiritual to also nourish our Blood. In my own cultural practices, we honour spirit with offerings to mark and celebrate the transition from one stage to another. This may involve an offering of tobacco (cistemaw), the planting of the placenta by a tree, ceremonial baths, feasts, naming, and other ceremonies.
Grounding in the Teachings
Traditional medicines are rich in the ways of self and community care.
The ancient history of Traditional Chinese Medicine shows us that our ways to build and strengthen Blood are most vital to this transformative time after pregnancy, childbirth, and postpartum.
Traditional medicines, systems, and ancestral practices knew of the importance of supporting birthing peoples with foods, practices, and medicinal substances that support the Blood.
Through TCM we see that when our Blood is deficient, we are more susceptible to conditions that make the postpartum time harder for recovery, that Blood deficiency impacts many areas of our bodies, and that it has a profound effect on our mood and sense of vitality.
It teaches us how to nourish the postpartum by supporting our Blood and therefore our vitality, something that nokom (grandmother) or our medicine carriers would have known.
The postpartum time connects us back to this precious substance that flows within our bodies that we rarely see or feel. It connects us to our ancestors through our Blood in the act of nourishing it. It reminds us that our Blood is alive, full of Qi and energy, and that even if it is not always in our conscious awareness, it is supporting us.
ninanāskomon ē-pimātisiyān
I am grateful that I am alive
Author, Benson, Ashley E MD., Author Lo, Jamie O MD., Author, Caughey, Aaron B, MD. JAMA Iron Deficiency and Iron Deficiency Anemia During Pregnancy—Opportunities to Optimize Perinatal Health and Health Equity. August 20, 2024.
Author, Igbinosa, Irogue I., Author, Stephanie A Leonard., Author, Francecsa Noelette., Author, Shantay Davies-Balch., Author, Suzan L Carmichael., Author, Elliott Main., Author, Deirdre J Lyell., Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity. 2023 Sep 7.
Author Note: The use of capitalization of the words Blood and the organs, such as Heart and Liver, are used to differentiate its functioning in TCM that is different from the Western physiological function.
Tiffany J Harper (she/her/wina) is a Maškēkowak (Swampy Cree) member of the Peguis First Nation of Treaty 1, living and raising her family in Moh'kinstsis (Blackfoot for Calgary Alberta Canada) in Treaty 7 territory. Professionally she is a Traditional Chinese Medicine Doctor (AAATCMD), a Registered Acupuncturist (CAA), a Registered Clinical Herbalist (American Herbalist Guild), a Certified Full Spectrum Doula (BADT), and a Certified Childbirth Educator (BADT). otenikanwellness.ca