Postpartum – the fourth trimester.
The postpartum period is one of the most important times in a women’s life.
But often it is forgotten and overlooked by our society and even by women themselves. Still, this period is essential for the long-term health of a new mother and her baby.
In the past, old civilizations had their way of taking care of new mom and baby. Today, most of our care is focused on pregnancy and the health of a new-born. All that new mum gets is a 6 weeks check-up and even that is not done quite properly.
The days, weeks, and months that follow birth are a time of major physical, emotional and social readjustment and recovery. From physical changes to emotional mood changes, a new baby can also upset the balance within your family. All the family members need to adjust to their new roles and schedules.
That’s why postpartum period needs much more attention than a few lines in a pregnancy book.
Postpartum care is and should be essential in making plans for your birth.
I encourage you to read this throughout and make your own postpartum plan based on information I will share with you. That will allow you to prepare yourself for the best possible start of your motherhood.
Let’s get started!
In this article:
How to prepare yourself for postpartum?
I truly believe that you should prepare yourself for the postpartum period the way you would prepare yourself for the childbirth. Along with your birth plan, consider creating the postpartum plan as well.
The postpartum plan is quite different though because it’s designed for you, your family and friends. It needs to ensure that your (and your baby’s) needs are met in days following your birth.
It is important to discuss your needs and plans with your partner. You can then add them into your postpartum plan.
Postpartum is a period of recovery from birth. Getting accustomed to your new family. Establishing breastfeeding and bonding with your new-born.
Remember, during the postpartum period, your needs and the needs of your baby are most important. Make sure everyone knows and respect that!
Here are some things to think about when planning the postpartum recovery:
- Rest and sleep. Make this a priority for the first 4-6 weeks. Make sure you get as much sleep as you can. Practice skin to skin contact with your baby for as much as possible in the first weeks. Plan for this.
- Errands and chores. Life still goes on, think about the usual house duties such as cleaning and cooking. Who will take care of those while you are focused on yourself and the baby in the first weeks?
- Family visits and helpful tips. Make sure that your family and friends know the rules for visits. Create your own rules and make sure everyone respects them. This is your time!
- Breastfeeding assistance. Make a list of places that can help during the early breastfeeding period. These can be phone numbers, Facebook groups or just people you know will be helpful. It is essential to get the right help while establishing your breastfeeding so be sure you know where to find it.
Postpartum Plan
To create the postpartum plan, you need to consider a lot of things.
I have laid out some questions for you to answer below.
When developing your postpartum plan start with the answers to these questions. Then add additional information you collected during your pregnancy and your own research.
Here are some specific questions to help you think about your needs after the birth of your baby:
- What resources are available to help you prepare for the postpartum period? Books, courses, classes, forums and groups…
- Will you breastfeed your baby or bottle-feed? What help will you need with feeding the baby? Breastfeeding resources, books, the information you need…
- Who will take care of your older kids? Getting them to school/preschool and back? Preparing them meals and taking them to activities?
- Who will help with the housework? Cleaning, cooking, shopping…
- Who will be helping you? Is your partner going to be with you? A family member or friend? Are you considering paying for help, like postpartum doula?
- If you have problems and issues after birth, who can you call? If you are depressed or overwhelmed, who will you call? Note down these names and contacts.
- What equipment, supplies and preparation you need for you baby?
- What is going to happen with your work? When do you need to start working after birth? Will you work part-time or full time? Can your partner take time off work and for how long?
- Will you continue to breastfeed after going back to work? What do you need to make this happen?
- Are there changes in your family budget? Make your plans considering the new budget.
- Don’t forget to include contact information of people who can help you with postpartum care and breastfeeding. You’ll thank yourself many times for having all the important information in one handy place.
Physical Changes
After giving birth there are many physical changes that your body is going through.
Most of these changes are normal and expected.
Your body is just getting back to its old self. Here’s what you can expect.
Uterus
Your uterus and your cervix are returning to their original sizes during the first 6 weeks after birth.
Your uterus will contract during this period. As a result, you might experience some pain, especially during breastfeeding sessions. These afterpains are normal. They are the sign of your uterus returning to its original size.
Keep in mind that resting is the most important thing you can do during this period.
You will experience lochia. This is a bloody, fleshy smelly discharge that flows from your uterus and out of your vagina. Lochia is heavier when you are breastfeeding, being overactive, changing positions, etc.
This can be a great sign your body gives you to slow down.
Perineum
Your perineum often needs special care after vaginal birth. This is especially needed if you are bruised or swollen if you had stitches or episiotomy.
Here are some tips to help your perineum heal faster:
DO’s:
- Apply ice to reduce swelling
- Take Sitz bath to help relieve perineal soreness
- Take a warm Epsom salt bath to help with healing
- Use a peri bottle with warm water after urinating to keep the area clean
DON’Ts
- Don’t use tampons after birth
Bowel Function
Your bowel function can be affected by birth.
The birth may cause constipation due to haemorrhoids, loose pelvic and abdominal muscles, medications or perineal pain.
Make sure to drink a lot of fluids after birth, mostly water. Try to eat non-refined food. Adding magnesium supplements and flax seeds into your food can also help with constipation.
Haemorrhoids are very often after giving birth. Many women develop them during pregnancy and some develop them after vaginal birth. They may itch, bleed, sting or ache, especially during a bowel movement. Good news is that they usually disappear during the first postpartum month.
Here are some tips to ease the discomfort and to promote healing.
DO’s
- Take Sitz bath or lukewarm baths
- Use witch hazel on the area, just soak the pad with witch hazel and apply it on the vaginal area. For added benefits, put the pads into the fridge and apply them cold.
- Drink a lot of fluid to avoid constipation
- Rest as much as you can
DON’Ts
- Avoid processed food that can make constipation worse
- Avoid sitting and heavy lifting. They can make constipation worse.
Breasts
Your breasts will go through a lot of changes.
For the first 24-72 hours after the birth, your breasts secrete colostrum. This is a highly nutritious baby’s first milk.
Mature milk appears between the second and fifth day. That is usually the time when most women notice their breasts become engorged, heavy and warm.
The best thing you can do is rest and breastfeed your baby on demand during this time. For additional comfort, apply warm pads before feed and cold in between feeds to your breasts.
Read more on breastfeeding in the bonus breastfeeding guide at the end of this course.
Other Physical Changes
The postpartum period is a real rollercoaster of hormones that are drastically changing in your body. They can have an impact on your mood and your feelings.
After the delivery of the placenta, your Estrogen and Progesterone levels drop rapidly and remain low until your ovaries begin producing these hormones again. If you are breastfeeding, your production of Prolactin and Oxytocin increases, while Estrogen and Progesterone levels remain low until you begin to wean your baby.
Baby blues are common during this time. It is normal to feel sad, teary and sensible about yourself and your baby.
But this is temporary and should go away soon after birth. If it lasts longer don’t hesitate to ask for help as baby blues is often confused for postpartum depression.
During the postpartum period, you will lose all the fluids you accumulated during pregnancy. You can notice excessive sweating, especially during the night.
You will urinate often. This is the way your body is getting rid of the extra fluid.
Postpartum is an equally important period in women life as pregnancy.
As you can see, your body is still working very hard to adjust itself and go back to pre-pregnancy state. At the same time, it is producing breastmilk, feeding and nourishing your baby.
Give yourself and your body enough credit for all the hard work!
Emotional Challenges
The world we live in today most often paints a happy picture of a new mother with her beautiful baby with minimal or no signs of stress and fatigue.
But this picture is not realistic.
Postpartum is a very special time in a woman’s life. But it is also one of the hardest periods. Reality is that after giving birth, many mothers just try to get through the days and nights with their new-born the best they can. Many new moms need months to become confident and comfortable with their baby.
With their new roles of a mother.
Most women are dealing with challenges that the postpartum period is presenting. Some have even more challenging times.
A bumpy birth can make recovery much harder. Breastfeeding issues can sometimes be extremely difficult. Emotional complications like postpartum depression or anxiety, traumatic birth experience or problems in the relationship with a partner can make postpartum recovery much harder.
The world we live in today most often paints a happy picture of a new mother with her beautiful baby with minimal or no signs of stress and fatigue.
But this picture is not realistic.
Postpartum is a very special time in a woman’s life. But it is also one of the hardest periods. Reality is that after giving birth, many mothers just try to get through the days and nights with their new-born the best they can. Many new moms need months to become confident and comfortable with their baby.
With their new roles of a mother.
Most women are dealing with challenges that the postpartum period is presenting. Some have even more challenging times.
A bumpy birth can make recovery much harder. Breastfeeding issues can sometimes be extremely difficult. Emotional complications like postpartum depression or anxiety, traumatic birth experience or problems in the relationship with a partner can make postpartum recovery much harder.
Here are some of the most common challenges and my tips on how to survive them.
Baby Blues
Baby blues is a normal condition that appears usually in the first week after birth.
After giving birth, your emotions will fluctuate mostly because of extreme changes in your hormone levels. This can also happen due to fatigue, inexperience with baby care or breastfeeding, loneliness and isolation or complete change in your normal routine and your baby’s around the clock demands.
Mood swings may be caused or worsened by disappointing or difficult and traumatic birth experience. Unexpected illness or condition with your baby or yourself, personally stressful situation like social or financial issues or maybe the family history of mood disorders can also contribute.
Most women will experience baby blues and mood swings. They will mostly decrease within a few weeks.
Some signs of baby blues are:
- Sensitivity & starting to cry easily
- Feeling overwhelmed with the new situation
- Feeling exhausted, sad, teary or anxious
- Lacking confidence as a parent and feeling like everything is out of your control
- Even though baby blues will improve in a few weeks, here are some things you can do to make this time easier. Remember, if your symptoms are still there after a few weeks or they are increasing instead of decreasing, consider asking for help or visiting your doctor to assess your symptoms further.
- Make sleeping your priority. Sleep for as long as you can!
- Rest as much as possible. Ask for help with housework and childcare.
- Reduce any pain if you are experiencing it. This is not the time to try being a superhero. If you have any pain there are plenty (breastfeeding friendly) painkillers to take, ask your doctor or midwife for advice.
- Surround yourself with supportive family members and friends. Cut the visits from people who don’t make you feel your best. Don’t be afraid to say you need rest!
- Eat nutritious food and drink plenty of water.
Emotional & Mental Health
Some women, during their pregnancy and in the year after birth can develop emotional conditions that are much more severe than baby blues.
This can be postpartum depression, anxiety and panic disorders, obsessive-compulsive disorders, bipolar disorders or post-traumatic stress disorders.
Some women can develop more than one at the same time.
These conditions are much more severe than baby blues and can make postpartum much more complicated. They can be emotionally paralysing and cause feelings of hopelessness and isolation.
Our society presents pregnancy and postpartum as the time when expecting and new mum should be blissfully happy. That’s making things even harder for the affected mums. They can feel ashamed of their feelings and try to hide them or don’t seek the help they need and deserve.
Here are some of the most common conditions and their risk factors.
If you doubt that you can be dealing with one or a few of these conditions, please, don’t hesitate to ask for help. Talk to your doctor, midwife or a friend about your feelings.
Help is available, always know that!
Postpartum Depression
Postpartum depression can occur in pregnancy or up to around one year after giving birth. Women with a history of depression and the ones who already had postpartum depression have an increased risk of developing it after birth or during pregnancy.
Postpartum depression can begin anytime during pregnancy, but it is most common between two weeks to one year after birth.
Some symptoms of postpartum depression are:
- the feeling of hopelessness, despair or exhaustion
- lack of energy
- loss of interest in everything
- inability to sleep even when there is an opportunity to do so
- constantly crying
- overeating or not eating at all
- low self-esteem and doubt of your capabilities
- surprising and frightening outbursts of anger at loved ones
- recurring thoughts about hurting oneself or the baby
Postpartum Anxiety
Anxiety is more common after birth than though before. It has not been recognised as often as postpartum depression. That’s why many women who felt there was something wrong but didn’t fit in the postpartum depression symptoms list went untreated.
Here are symptoms of postpartum anxiety:
- fear of being alone with your baby
- irrational fear that something bad will happen to your baby, someone you love or to yourself
- irrational fear for your baby’s and your health
- fear of dying (yourself, your baby or someone you love)
- fear of leaving your home
- panic attacks including shortness of breath, dizziness, light-headedness, faintness, rapid heart rate, sensations of choking, chest pain, nausea, diarrhoea
Postpartum Obsessive-Compulsive Disorders (OCD’s)
A small percentage of women can develop perinatal and postpartum OCD. This is a condition characterised by obsessive or uncontrollable thoughts and compulsive rituals to protect their baby. Some women can show OCD symptoms during pregnancy as well.
All the mothers have an instinct to protect their babies, but these instincts are extreme with women suffering from OCD.
Some examples of OCD:
- fear for baby’s health
- fear of being a bad mother
- fear of hurting the baby
- fear of germs
- From these fears’ women can develop rituals that interfere with their normal daily life.
Some of them are:
- constant hand washing
- frequent house cleaning
- excessively checking on the baby
- constantly ensuring that all the doors are locked
- Risk factors
While no one ever can predict who will have any of these disorders above including the most often occurring postpartum depression (PPD), there are some risk factors. These are the factors that increase the risk of developing PPD or any other disorder during pregnancy and after birth.
If you have several of these factors and you are worried about developing PPD, consider getting extra support during pregnancy and after birth, making the postpartum plan and preparing yourself for a postpartum period as much as you can.
Risk factor for developing these disorders:
- History of mental health challenges including panic, OCD or bipolar disorders
- History of mental challenges in your immediate family
- Physical, emotional or sexual abuse
- Eating disorders
- Using drugs or living with someone who’s using drugs
- History of infertility or miscarriages
- Unplanned or unwanted pregnancy
- History of severe PMS syndrome
- Traumatic pregnancy and birth
- High needs baby or baby with a chronic medical condition
- Feeding problems with your baby
- Low self-esteem
- If you consider yourself a control freak
- Financial pressures
- Stressful life events like divorce or separation
- Losing job
- Moving to a new home
- Death in family
- Unsupportive partner or no partner
- Unsupportive family and friends
- Poor or no relationship with your mother
- Health issues like Anemia, thyroid disease, chronic health condition etc
Ask for Help
If you suspect that you are experiencing symptoms of postpartum depression or any of these disorders, please, ask for help! Discuss your symptoms with your caregiver, therapist or other professionals who are familiar with these issues. Seek help early, before your symptoms start to get worse and you have trouble coping.
The appropriate treatment depends on the severity of the symptoms. A mild case may resolve itself with just self-care, peer support or one to one therapy. Severe cases might require medication.
Here are some ideas on how to help yourself if you’re experiencing some of these symptoms:
- Get adequate rest and sleep
- Eat well and drink a lot of water
- Avoid alcohol and caffeine
- Take some time for yourself every day, even the short breaks are fine!
- Go for a walk to make sure you get enough sunlight and fresh air
- Start exercising regularly
- Try meditations or give Yoga a try
- Add supplements to your daily regimen. Try Omega-3 fatty acids, Magnesium and Vitamins B and D to make sure you are not deficient.
Traumatic Birth Experience and How to Deal With It?
Birth trauma is real for so many women. If the birth was worse than you expected (or it didn’t go according to your birth plan or your expectations) you may feel traumatised, sad, angry and confused.
These feelings may intensify as your baby grows and you have more time to think about your birth.
Sadly, many women are facing with these feelings and feel traumatised after their birth. Our society doesn’t make it any easier. You will hear comments such as: “Thank goodness you have a healthy baby!” or “Be happy that you are healthy!”
Comments like these can make you feel ashamed or try to ignore your true feelings.
Ignoring feelings of extreme sadness, fear, loss or anger won’t make them go away. An event such as the birth of a friend’s baby can unexpectedly bring up unresolved feelings you may have about your birth and postpartum experience.
Instead of ignoring your feelings, try to find help.
Talk with you caregiver or midwife about your birth experience to help you understand what happened. You can talk about it with an empathetic friend or find women who have been through that to share your experiences.
If you are feeling very negative about your birth experience, consider finding a counsellor to help you get through your feelings and experiences. This will be especially helpful if you are considering a new pregnancy.
Sometimes after the traumatic birth experience, it is possible to develop post-traumatic stress disorder (PTSD).
If you are dealing with issues such as these ask for help and talk to your caregiver or a knowledgeable person:
- flashbacks to your traumatic childbirth
- recurrent nightmares
- anxiety when thinking about your childbirth
- anxiety when thinking about the possibility of the new pregnancy
- constant thoughts of your childbirth
How to Take Care of Yourself During Postpartum Period?
Taking care of yourself after giving birth is of the most importance. Most mums forget about themselves as they are all into the care for their baby.
But the baby needs a healthy and happy mum. Putting your own needs higher on a priority list is important for your baby’s wellbeing as well as your own.
Here are some ideas on how to take care of yourself after giving birth to your baby.
Rest & Sleep
I know I’ve said this a lot of times already in this guide, but I’ll say it again because it is so important!
Fatigue and sleep deprivation can make your physical and emotional recovery much more challenging. Make sleep a top priority in those first weeks after birth. Take every opportunity to sleep. Even if you can’t sleep, simply resting gives your body time to heal properly.
Here are some tips to enhance rest during your postpartum period:
- Make sleep your top priority, right after meeting the baby’s needs. Everything else can wait until you’re rested.
- Keep your baby next to you or try co-sleeping. Having the baby next to you will help you both to sleep better as you will not listen for your baby to start crying in another room.
- Limit home visits. Ask your friends to visit you after you have settled into your new role and routine. Don’t be afraid to say no!
- Add relaxation time only for yourself. Ask your partner to take the baby while you take half an hour for yourself every day. Do something that makes you feel good and relaxed. Take a relaxing bath, go for a light walk or just take a nap.
Ask for Help
Sometimes it can be hard to accept the reality but after giving birth you will have your hands full with your baby. You will realise that you just can’t manage to do all the things you did before giving birth, like managing a household.
You might find it difficult to ask for help but sometimes this is exactly what you need. Having the right kind of help around can really speed up your recovery.
Accept any offer that will make things easier for you.
Someone can bring you food every day or do the dishes and laundry. Someone can go shopping for you or just take the baby until you manage to take a shower.
If you’re unable to have family or friends helping, seriously consider hiring part-time household help for a few weeks after birth. It will be well worth it!
Postpartum Nutrition
For all new mums, it is especially important that their nutrition is healthy, and they get much-needed nutrients. This is needed so they can recover and get stronger after birth.
If you are breastfeeding, that makes it even more important.
You need to nourish your body with healthy food as it’s working hard to produce food for your new-born.
During breastfeeding your body draws on your vitamins and minerals reserves to make milk.
Although your body can make plenty of milk no matter your nutrition, eating a poor diet may deplete your nutritional reserves over time. This can affect your health and your overall wellbeing.
What You Should Eat?
Make sure your diet consists of a variety of healthy foods. Some of the most important parts of a healthy diet are proteins found in meat and fish, foods rich in healthy fats, calcium and iron.
It is also well worth to check your iron levels as they can be very low after birth. Anaemia can make you even more tired and exhausted so check if you need to take additional iron supplements.
Drink plenty of fluids to stay hydrated. Water or healthy, non-sweet herbal teas are the best options.
Dieting
Remember that the postpartum period is not the time for dieting. Your body needs healthy foods to heal and recover and to produce breastmilk for your baby. Dieting can make you produce less milk and compromise your own nutritional health.
During breastfeeding, your calorie intake should be increased for about 300-500 calories per day as your body is working harder than ever.
If you are concerned about weight gain and wish to lose the extra weight you got during pregnancy try eating clean and healthy food. This way you will lose weight and still nourish your body properly.
I recommend that all new mums, pregnant women and those recovering from birth try clean eating. This is because of the health benefits that will bring you, not because of possible weight loss.
Clean eating is about health. Choosing healthy food to nourish our body and to improve our health.
Weight loss is something that often happens after we cut with not so healthy food. Real food is good for us and it will make us healthier and happier.
There are things you need to stop eating and the things you need to start eating.
Everything is based on your own lifestyle and you can eat clean as much as you decide to. This can be a full transformation of your lifestyle and changing all your eating habits for good. Or you can go slow, changing one thing at a time.
Postpartum Fitness
Immediately after giving birth, your body begins its recovery.
There are a lot of natural processes that are happening in your body during this time. Your uterus is shrinking to its original size, your body is getting rid of excess fluids, your muscles are working hard to get back to normal.
Early postpartum is not the time for exercise! It is the time to prioritise rest, healing and bonding with your baby.
Still, there are some things you can do to speed up your recovery.
In the early postpartum, it is important to think about healing and recovering your core and pelvic floor muscles.
After birth pelvic and core muscles can be weekend from birth and pregnancy. There is a possibility of some level of muscle separation. It is crucial to strengthen your pelvic floor and core muscles before you start any rigorous exercise program.
In case you start too early with rigorous exercises like running, jumping and plyometrics, your core and pelvic muscles (and uterine ligaments) won’t be able to adequately support your uterus and internal organs. This way you are risking uterine, bladder or rectal prolapses as well as incontinence, pelvic and abdominal pain, backache etc.
All of these are very important reasons not to hurry with exercises after birth and to instead strengthen your core and pelvic floor before jumping into any exercise program.
Early Days and Transverse Abdominis
Beyond resting, there are other things you can do to speed up your recovery and to start working on your core and pelvic floor in early postpartum.
One of those things is transverse abdominal breathing. We covered it in The Kangaroo Method and the Core Connect Program in great detail.
Exercises After Birth
Before starting any exercise program after giving birth be sure you have a green light from your care provider to do so.
It is important to start slowly and to build upon what you have.
Doing core exercises and learning how to breathe properly are the most important things after birth. Then you can slowly add other activities like walking.
Start with slow and short walks and try to walk a bit longer every day.
After you are cleared you can start with more challenging exercises.
It is important to note that if you have Diastasis Recti you should first work on healing it. Doing exercises like planks, push-ups, crunches or high-intensity exercises like jumping or running can make your Diastasis Recti worse.
If you feel ready you can add strength training 2-3 times per week with some cardio conditioning also. Start slow and learn the technique properly before starting with heavyweights.
Adaptation to Postpartum Life
Having a baby is a huge milestone in everyone’s life. But as a new mum, you may sometimes feel overwhelmed with your new life as a mother and yearn for your life before a baby.
You may wonder:
- When your life will be normal again?
- When you’ll recover from birth?
- When you’ll start to enjoy everyday life with your baby and new family?
- Will you ever be able to balance your new mum life with your old life?
- Let me tell you, at some point during your postpartum period you will find a new normal. Your life will become less challenging and more predictable.
- Parenting is a skill we learn, it is not instinctive as your maternal instincts. Your ability to parent will develop itself as your baby grows. Your baby is your best teacher.
Early weeks of parenting can be very challenging. But if you and your partner are well prepared with all the steps we talked about, this will give you time and energy to focus on both your baby and your everyday life.
Relationship With Your Partner
A new baby is not a big deal only for you, this time can also be hard for your partner. After the initial excitement about the baby, your partner can also feel challenges that a new life has brought.
They may feel frustrated that you can soothe the baby better than they do, especially if you’re breastfeeding. They might feel useless and very far from you. Or feel that the baby “has stolen” you and you don’t have time for the relationship like you used to.
It is important to keep open communication with your partner. Acknowledge that you are both under a lot of stress at this sensitive time. Talk about your issues and worries. Share parenting duties. This will help to strengthen your relationship during these challenging times.
Many times, the thing that’s missing is a bit of honesty and communication. Try to be as open as possible with each other. When the kids and new baby are asleep use those quiet moments to spend some quality time together. Watch a movie or just snuggle under the blanket and talk for a while.
Sex Life After Birth
Your sex life is one of those things that will also change after giving birth.
Many caregivers recommend waiting for the first 6 weeks to have sex again. But if you and your partner want to reassume you sex life sooner, it is probably safe if your stitches are healed and amount of lochia has decreased.
If you wish to wait longer than 6 weeks, that is perfectly normal. Please, allow yourself enough time to heal and to feel ready again. Don’t rush it and don’t feel pressured to return to normal before you are ready.
Whether you choose to have sex or not, remember that you can become pregnant again, even if you’re breastfeeding and not menstruating. During your 6-week check-up, consider your family planning method and ask your caregiver for help in choosing the right method for you.
