Postpartum Nutrition

Emergency Landing
True story.
August 24, 2015. Madrid, Spain.

 A woman accompanies her pilot husband on their own

plane.
 The husband blacks out mid-flight.
 The woman, having never flown before, is barely able
to read the compass... flying above clouds.
 She is talked through how to read the instruments and
make the movements to bring the plane safely down
(with minor damage) in an orange grove near the
airfield.
http://www.cbsnews.com/news/spain-woman-with-no-pilot-experience-crash-lands-plane/
 Congratulations mom!

Which is more scary?

1. Flying a plane with no experience.

2. Raising a baby with no experience.

Yesterday - reading, imagining, hoping

Today - critical decisions with consequences!
 Meet Cindy and Declan

 Cindy is a postpartum mom

who arrives at WIC with her
son, Declan.
 She brings Declan for his
first WIC appointment 10
days after he is born.

Today we’ll focus on Cindy

and her postpartum nutrition
and health concerns.
Cindy comes to WIC 10 days after Declan is born. She looks
tired but smiles when she is greeted. She seems to have
trouble sorting through her things to find paperwork. She
looks a little overwhelmed.

 What kinds of changes has Cindy recently experienced?

 How may she be feeling emotionally?

Cindy comes to WIC 10 days after Declan is born. She looks
tired but smiles when she is greeted. She seems to have
trouble sorting through her things to find paperwork. She
looks a little overwhelmed.

 What changes may have occurred with her family and

friends since having a new baby?

 How do health and nutrition concerns affect Cindy’s

life right now?
Women in Cindy’s situation have concerns for baby and for
themselves.
If you were in Cindy’s place, how would you rank the following
from most important (1) to least important (8)?

 Healthy Eating
 Physical Activity
 Healthy Weight Loss
 Medical Issues
 Emotional Health
 Family relationships
 Physical Safety
 Financial resources
We know Cindy’s situation may be much different than we imagine.
Evidence and our experiences tell us about the common concerns
postpartum women like Cindy often have.

Looking at the list of concerns again, which topics do WIC Nutrition

Education messages address?

Which topics do we provide referrals for support?

 Emotional Health

 Women like Cindy may not return to the doctor

until Declan is 8-10 weeks old. At WIC we may
be the first providers to meet with Cindy after
she returns home with Declan.

 WHERE are the screening questions we ask

about postpartum mood disorders found?
Suppose Cindy answers “yes” to one or both of the
screening questions about postpartum mood disorders.

 Write how might you might ask permission to offer a

referral to a support group or a warmline for support.

 What are the resources you can offer moms like Cindy?

 What WIC Code should be assigned?

More about Baby Blues and Postpartum Mood Disorders

 Most new moms experience some form of “baby blues”

right after their baby is born. Baby blues usually lasts about
two weeks.
 Crying spells
 Overwhelmed, exhausted
 Nervous
 Emotional roller coaster
More about Baby Blues and Postpartum Mood Disorders

 If the baby blues last longer than a few weeks or becomes severe, then it
may be postpartum depression. Postpartum depression is one type of
PMAD.

 Around 10 to 20 percent of women experience postpartum depression.

 Some ways to recognize postpartum depression:
 Same symptoms as baby blues
 Anger, guilt
 Little interest in baby
 Feel disconnected
 Trouble focusing.
 Changes in appetite, sleep
 Nutrition Assessment

 After lab you’ve gathered ABCE information

 Next you take Cindy and Declan to your office to discuss
nutrition concerns
 You will cover D topics on the ABCDE guide
 What else will help you understand more about Cindy’s
situation that may affect nutrition?

 Work with someone near you to make a list of factors that

influence choices women make about postpartum health.
 Nutrition Assessment

As WIC Counselors we seek to understand the client by

exploring what motivations and emotions guide the
choices and behaviors clients make.

1. What are some open-ended questions to help you get a

better picture of where mom is coming from?

2. Write at least three probing questions you would ask to

explore mom’s situation.
 Probing questions

Probing Question Examples:

 What support do you have to care for yourself or the
baby?
 Who in your household makes decisions about
mealtime, grocery shopping, and daily planning?
 Tell me about any challenges you’ve encountered since
you’ve had the baby?
 What else, if anything, did you hope to discuss today?
Nutrition and Activity for Postpartum women
Evidence says…

 Losing weight following delivery is a primary concern

for many postpartum moms. Many women return to
a weight within 2-4 lbs of their pre-pregnancy weight,
but 15-20% will keep 11 lbs or more of the weight they
gained during pregnancy.
Nutrition and Activity for Postpartum women
Evidence says…

 Postpartum moms need to rebuild nutrient stores they lost

during pregnancy
 They still need extra energy for the daily activities of taking care
of a newborn baby. Especially important nutrients for recovery
are folic acid, calcium, iron, and fluid intake.

 332 Short Interpregnancy Interval (IPI)

 formerly known as Closely Spaced Pregnancies
 Short Interpregnancy Interval is defined as an interpregnancy
interval of less than 18 months from the date of a live birth to
the conception of the subsequent pregnancy
 Nutrition Education

Narrowing the field to offer Nutrition Education

Examples:
− If you could change anything about your living situation to help
you meet your own and baby’s needs better, what would that be?

− Imagine that in a month or two you had more energy, lost some
of your baby weight, were eating healthy, and baby was also
doing great. What can you do take steps toward that goal?

− What could we talk about today that would help you feel better
about keeping yourself and baby healthy?
 Nutrition Education
 Our conversation with mom helps us identify nutrition messages
that help mom to promote recovery.
 What she eats gives her the strength and energy to care for
herself and baby. Some topics that may be helpful to explore are:

 Eating breakfast.
 Healthy snacks and mini meals.
 Homemade meals prepared by family and friends.
 Cook large batches, creative leftovers.
 Foods lower in fat and calories.
 Fruit and vegetables
 Smart choices for convenience foods, reading labels
 Practice

How might you ask to explore whether you should assign 332 Short
Inter-pregnancy Interval?
 During what part of the appointment would you seek this information?

1. If WIC Code 332 applies for Cindy, how might you ask to offer
information about the impact of nutrition for women with a short
inter-pregnancy interval?

2. Under what circumstances would you offer information about

Short Inter-pregnancy Intervals? When would you decide not to
discuss short inter-pregnancy intervals?
 Physical Activity for Postpartum
women

 Physical activity can improve aerobic fitness, flexibility

and muscle tone even for women who aren’t trying to
lose weight.

 Activity helps improve mood and a postpartum

mom’s overall outlook on life.
 Physical Activity for Postpartum
women

 After a woman is cleared by her OB it is safe for her to

start to exercise.
 (Women are usually advised it is safe to begin at 6-8 weeks
postpartum, but this varies based on the type of delivery
and mom’s recovery.)
 Simple activities like taking the baby for a daily walk
or doing a yoga video at home while the baby is
napping is a great start to adding more physical
activity.
What kinds of questions could you ask to explore the
kinds of physical activity that may work for Cindy?

 Write or share aloud examples of questions you might ask

Cindy about activity.
 Suppose after you attempt to explore activity, Cindy politely
smiles and says, “I don’t know.”
 How do you respond?
Summarizing and following up – Individual Care Plan

 How will you decide when Cindy returns for her next
appointment? Consider…
 Is she a High Risk referral? (101, 111, 335, etc)
 Her goals and the type of support she needs?
 Next appointment type (health check, postpartum
hemoglobin check, nutrition education)
 Would you screen for PMADs when she returns?
 Build a summary

 Summarize the appointment with Cindy, letting her

know what to expect when she returns.

 What questions do you have about supporting

postpartum moms at WIC?
 Summary Example:

 Thanks for talking with me today about how things are going.
 It sounds like baby has been healthy so far and the doctor has no
concerns.
 You’ve been trying to make adjustments at home to balance
everything…
 You mentioned you’re working to figure out a new household routine so
you’ll be ready to start getting back in shape when you get the okay from
doctor…
 Is it okay if we check in with you when you come back next month to
check your hemoglobin? We’d like to see how you feel about things and
any new questions you might have.
 Next we’ll discuss your food package, Declan’s formula and issue your
benefits.
 What else would you like to discuss before we move on?