Postpartum Occupational Therapy: 3 Critical Areas Beyond Feeding That OTs Should Address
Why maternal health occupational therapy extends beyond lactation support—and how addressing mental health, nutrition, and sleep can transform postpartum outcomes.
If you're an occupational therapist curious about maternal health, you might assume the work centers on pelvic health. And while that's a significant piece, the scope of postpartum occupational therapy is much broader—and critically underutilized.
As an occupational therapist and IBCLC specializing in maternal health for the past 7+ years, I've seen how families struggle in areas that should be addressed prenatally but rarely are. Mental health. Nutrition. Sleep and rest.
These aren't "nice-to-have" conversations. They're foundational to postpartum recovery and directly impact lactation outcomes, parent-infant bonding, and long-term maternal health.
Here's what maternal health occupational therapy practitioners need to understand about these interconnected areas—and why they fall squarely within our scope of practice.
Why Maternal Health OT Matters (And Why It's Growing)
Maternal health occupational therapy spans fertility, pregnancy, birth, birth recovery, and the postpartum period. My expertise in postpartum care began after my own traumatic birth in 2017.
Through specializing in lactation as an OT, I've consistently seen three areas neglected by families and providers—areas where occupational therapists are uniquely qualified to intervene:
Mental health (mood regulation, coping, identity shifts)
Nutrition (fueling recovery, milk production, and impact on mental health)
Rest and sleep (differentiating rest from sleep, both critical for healing and again, mental health)
Before we dive in, let's connect back to the OTPF-4. These aren't "adjacent" topics—they're core areas of occupation that directly impact a person's ability to engage in meaningful activities, including parenting.
If you're a parent reading this, these insights can help you advocate for better postpartum care. If you're an OT, PT, or SLP, this is your reminder that maternal health is a viable—and needed—specialty.
1. Mental Health in Postpartum Occupational Therapy
The Misconception:
"Postpartum depression and anxiety are separate."
The Reality:
Mental health postpartum is directly linked to mental health in preconception, pregnancy experiences, and birth events. Physical recovery and mental health are inseparable.
What OTs Need to Know:
Physical pain predicts mental health struggles:
50-60% of women experience pelvic floor disorders postpartum (urinary incontinence, pelvic pain)
Persistent pain in the first 3 months postpartum doubles the odds of screening positive for postpartum depression
Severe acute pain in the first 8 weeks triples the odds of postpartum depression
Hormonal shifts are dramatic: After the placenta is delivered, there's a drastic hormonal flux:
Progesterone and estrogen plummet
Oxytocin increases (stimulates uterine contractions and involution)
Prolactin increases (transitions milk from colostrum to mature milk)
This hormonal drop is believed to trigger the "baby blues", but it also contributes to:
Cramping and afterpains
Constipation
Breast engorgement
Fatigue and brain fog
Identity and relationship shifts: Beyond physical recovery, new parents navigate shifts in self-concept, relationship dynamics, and role identity. Programs like Bringing Home Baby can help prepare couples, but OTs can facilitate these conversations too.
OT's Role:
Screen for perinatal mood and anxiety disorders (PMADs)
Address activity engagement and meaningful occupation during identity transitions
Collaborate with mental health professionals for integrated care
Educate on the connection between physical recovery and mental health
2. Nutrition: The Overlooked Foundation of Postpartum Recovery
The Misconception:
"Nutrition is just about milk supply."
The Reality:
Nutrition fuels tissue healing, hormonal regulation, gut health, and mental health. It's foundational to recovery—yet consistently deprioritized.
What OTs Need to Know:
Nutrition is consistently neglected postpartum: I've seen families prioritize laundry, returning emails, opening baby gifts, and shopping over eating. This is a failure of postpartum planning and systematic support.
The body is healing from major physical trauma: Birth is a physiological event requiring significant recovery. Proper nutrition provides the building blocks for:
Tissue repair (whether vaginal birth or cesarean)
Hormonal regulation
Immune function
Energy production
The gut-brain connection is critical:
The GI system moves slowly immediately postpartum
Antibiotics (common in cesarean births) disrupt the gut microbiome
Disrupted gut-brain communication is linked to postpartum depression
Nutrient deficiencies (iron, B vitamins, vitamin D, omega-3s) impact mood regulation
OT's Role:
Incorporate nutrition education into postpartum planning
Address barriers to meal preparation and eating (pain, time, support)
Modify meal routines to support slower digestion postpartum
Refer to dietitians or nutritionists when needed
Educate on the gut-brain-mental health connection
3. Rest and Sleep: Critical Occupations for Postpartum Healing
The Misconception:
"Sleep when the baby sleeps" is the only advice needed.
The Reality:
Rest and sleep are distinct occupations with different demands and benefits. Both are essential, but "sleep when the baby sleeps" isn't always possible—or sufficient.
What OTs Need to Know:
The OTPF-4 defines REST as: "Identifying the need to relax and engaging in quiet and effortless actions that interrupt physical and mental activity; reducing involvement in taxing physical, mental, or social activities resulting in a relaxed state; engaging in relaxation or other endeavors that restore energy and calm and renew interest in engagement."
Rest ≠ Sleep. Both matter.
Sleep is divided into:
Sleep preparation (bedtime routines, winding down, creating restful environments)
Sleep participation (actually sleeping, staying asleep)
Postpartum sleep challenges are multifaceted:
Difficulty falling asleep (even when baby sleeps)
Frequent night wakings (baby-related and independent)
Sleep deprivation paired with inadequate nutrition disrupts gut-brain communication
Sleep disturbances are associated with fatigue, depression, and impaired decision-making
The Web of Interconnection:
Lack of sleep → poor nutrition choices → disrupted gut health → worsened mental health → less capacity to engage in infant care → more stress → worse sleep.
See how easy it is to fall into this cycle?
OT's Role:
Differentiate between rest and sleep needs
Create sustainable rest routines (even when sleep isn't possible)
Address sleep preparation and participation barriers
Educate on realistic infant sleep expectations
Refer to sleep specialists (CBT-I) when appropriate
Why These Three Areas Are Core to Postpartum Occupational Therapy
Mental health, nutrition, and rest/sleep aren't "extras." They're foundational areas of occupation that impact:
Self-care
Infant care and feeding
Role participation (parent, partner, professional)
Social participation
Health management
And they're interconnected. You can't address lactation without considering mental health. You can't improve sleep without addressing nutrition. You can't support postpartum recovery without looking at the whole system.
This is exactly what occupational therapy practitioners can do.
How to Specialize in Maternal Health as an OT
If you're an occupational therapy practitioner interested in this work, here's what you need to know:
You don't have to wait until the baby arrives. Maternal health OT spans:
Preconception (fertility, preparing for pregnancy)
Prenatal (pregnancy adaptations, planning for postpartum)
Birth recovery (immediate postpartum, cesarean recovery, pelvic health)
Postpartum period (feeding, mental health, sleep, and more)
You need specialized training. While these areas fall within OT scope of practice, competency requires additional education:
Lactation certification (CLC, CBS, and IBCLC, to name a few)
Perinatal mental health training
Bodywork modalities (CST, MFR)
Sleep and nutrition foundations
Understanding of pelvic health (even if referring out)
Where to start:
Take the Maternal Health OT course through The Lactation OT continuing education platform
Shadow or mentorship with maternal health OTs
Attend perinatal conferences (GOLD, etc.)
Build relationships with midwives, doulas, mental health therapists, and IBCLCs
For Parents: How to Advocate for This Care
If you're pregnant or postpartum and reading this, here's what you deserve:
✅ Providers who ask about your mental health, nutrition, and sleep—not just your baby's
✅ Education on realistic postpartum recovery timelines
✅ Support addressing pain, discomfort, and physical healing
✅ Referrals to specialists when needed (mental health, nutrition, sleep, pelvic health)
✅ Recognition that YOU matter in the postpartum equation
If your providers aren't addressing these areas, advocate for yourself! Ask for referrals. Seek out trusted practitioners within your current support circle.
Key Takeaways for OTs
Postpartum occupational therapy extends far beyond one single specialty, such as lactation or pelvic health
Mental health, nutrition, and rest/sleep are core areas of occupation—not "extras."
These areas are deeply interconnected and must be addressed systemically
OTs are uniquely positioned to support postpartum families through this transition
Specialized training is essential for competency in maternal health OT
Want to learn more? Check out The Lactation OT for practitioners looking to expand into this specialty.
Questions or thoughts? Drop me a message—I'd love to hear from you.
