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Why didn’t anyone tell me? Postpartum

Why didn’t anyone tell me?

Scary (but completely normal) postpartum weirdness your doc may have forgotten to mention.

After months of pregnancy and hours of labor and delivery, many moms are left with a body they barely recognize. In your early weeks with baby, strange new happenings can leave you feeling confused and more than a little concerned about how your body and mind are handling all this change. Relax, mama! Here’s the heads-up on some common postbaby peculiarities.

Postpartum anxiety
Everybody knows about postpartum depression. But when you’re struck with debilitating anxiety or panic attacks, you might wonder if you’re losing your grip on reality or even aren’t cut out for motherhood. After all, you’ve heard of the “baby blues,” but no one said anything about the “baby panics.”

What’s going on?
“Biochemically, people who have anxiety are different than those who don’t,” says Linda Sebastian, psychiatric nurse practitioner and author of Overcoming Postpartum Depression and Anxiety.

The sudden hormone shift when baby arrives is the main culprit; it causes a physical change in the brain’s chemical makeup. So if you’re feeling like you’re not yourself, it’s because you really aren’t.

What can you do?
Recognize risk factors. If you suffered from anxiety or obsessive-compulsive issues before or during pregnancy, symptoms may escalate after baby arrives. A history of trauma may also present as anxiety.

If you can’t function, sleep or calm your mind, or if you have thoughts of hurting yourself or your baby, seek help. (A good place to start is your doctor or midwife; online, try postpartumprogress.org.)

Take heart that having postpartum anxiety does not mean you’re a bad mother. “It’s a physical illness, even though it manifests itself as behavior,” Sebastian reassures. “Fight the urge to blame yourself. Recognize that sometimes this happens, and it has nothing to do with your capability of being a mother or your love for your baby.”

Extreme fatigue
Nobody expects you to run a marathon with your newborn strapped to your chest. Still, most mothers aren’t prepared for fatigue so severe that everyday tasks feel daunting.

What’s going on?
“Ping-ponging hormones can leave a brand-new mama emotionally unstable and energetically drained—a combination that can quickly become overwhelming if ignored,” explains Heng Ou, founder of MotherBees.com and author of The First Forty Days: The Essential Art of Nourishing the New Mother.

Also, parents may revert to survival mode, neglecting mom’s nutritional needs. “Skipping meals or choosing quick hunger fixes over hearty, sustainable meals will sap a mother’s energy reserves,” cautions Ou.

What can you do?
Rest is the best prescription, but sleeping when baby sleeps has limitations—can you shower when baby showers and pay bills when baby pays bills? “Even if you can’t take an hour to drift off, commit to taking some quiet moments for yourself throughout the day,” Ou advises. “Gentle activities like taking a warm bath, getting a massage (this can be as simple and affordable as asking a friend to rub your feet for 15 minutes), or sipping on a warming cup of tea or mug of broth can calm the nervous system and reboot your energy reserves.”

Ou also recommends noshing on energizing eats to restore depleted reserves. “Try to consume a balance of protein and healthy fats (think avocado and coconut oil) with each meal.”

Take time for yourself, and shut the world out—forget social engagements and errands. At the same time, let the world in. Friends and family can be a tremendous help.

Looking pregnant forever
Gone are the days of modestly hiding baby bumps—mamas-to-be proudly display growing midsections. But after baby arrives, many are unpleasantly surprised to sport the second trimester look for months, even years.

What’s going on?
A long-term pooch signifies a condition called diastasis recti. “It’s a separation of the abdominal wall where the connective tissue that runs down the center stretches out and does not immediately reabsorb,” explains Kelly Dean, founder of and physical therapist with The Tummy Team. Main causes are outward pressure on the abs and abdominal muscle imbalance. “It’s exacerbated by pregnancy hormones that make everything a little more stretchy,” Dean says.

What can you do?
First, listen to your own mom: Stop slouching! Align the rib cage and pelvis, don’t hunch, and don’t sit on your tailbone. “Elongating your body throughout pregnancy and postpartum puts your body in better alignment and works the core better,” advises Dean. “It’s hard because most parenting postures have us very crunched.”

Second, minimize anything that pushes the abs out. Eliminate crunches, holding your breath, and bearing down and bracing. If you’re experiencing pain or can’t close your abdominal gap, try core rehab, which incorporates alignment work, stretches and professional support. “Because there aren’t a lot of people who treat this condition, we have an online program that is very effective, even 20 or 30 years postpartum,” notes Dean.

Bladder leakage
After pregnancy, sneezing becomes more about crossing your legs than covering your mouth. New moms are surprised that leakage doesn’t end when the bladder stops moonlighting as a trampoline.

What’s going on?
The bladder is physically stressed during pregnancy and delivery. “Months of uterine pressure on the bladder traumatize and somewhat paralyze it,” explains Tristan Emily Bickman, MD, OB/GYN and co-author of the upcoming book Whoa, Baby! A Guide for New Moms Who Feel Overwhelmed and Freaked Out (and Wonder What the #*$& Just Happened).

Hormones participate as well. “Estrogen levels go down if you’re breastfeeding,” says Bickman, “and estrogen is the hormone that keeps the urethra sphincter tight.”

What can you do?
“I would say 75 percent of … pelvic floor problems resolve almost if not completely with core rehab and neutral pelvic alignment training,” says Dean. The remaining 25 percent might need pelvic floor muscle retraining or trauma treatment.

Bickman suggests Kegel exercises—that is, squeezing the muscles responsible for stopping urine flow. Another option: “Use estrogen cream near the urethra to help strengthen the muscle.” Emptying the bladder as often as possible helps, too.

Afterpains
Every mama-to-be knows labor pains are intense, but when you’re hit with knee-buckling postpartum pains, it seems unfair. If you’re delivering a second, third or eighth baby, afterpains can be even worse.

What’s going on?
“Receptors on the uterus are still primed for oxytocin, the hormone that causes contractions,” explains Bickman. “They start to dissolve about two weeks after delivery.” Because nursing releases oxytocin, suckling triggers stronger contractions.

Here’s the good news: Afterpains return your uterus to its prepregnancy size and location. They also help prevent hemorrhaging by pinching shut the open blood vessels where the placenta detached.

The hurt is often worse for successive pregnancies because the uterus isn’t as toned and must work harder. “Also, you bleed more after subsequent pregnancies, so the uterus needs to be more effective,” says Bickman.

What can you do?
Although afterpains will gradually lessen, nothing stops contractions until they’ve accomplished their mission. You can, however, minimize discomfort.

Empty your bladder, especially before nursing, so the uterus isn’t fighting for space. During contractions, practice relaxation techniques. Some find uterine pressure or massage helpful, while others prefer a hands-off, grin-and-bear-it approach. Nobody’s auditioning for Wonder Woman, so don’t be ashamed to down ibuprofen with your doctor’s go-ahead.

Spotting and discharge
Most moms expect to bleed after delivery. When postdelivery bleeding switches to intermittent spotting of blood and brown “goo,” you may reach your gross-out capacity.

What’s going on?
A pregnant uterus lining thickens to support and nourish the placenta and baby. After-ward, the uterus sheds the excess lining, blood and bacteria, which has no place to go but out. “The discharge, called lochia, is residual uterine lining still coming out, because the mother is still contracting, still hormonal,” explains Bickman.

What can you do?
Lochia is a messy reminder that you underwent a life-altering phenomenon and should rest, even two months out, which is how long some women continue to notice discharge. Don’t panic if spotting stops and starts. Protect your clothing with panty liners.

If spotting persists after eight weeks, tell your health care provider. Bickman reassures that it’s generally residual sloughing, but let your practitioner determine that.

Postpartum weirdness isn’t abnormal and can stick around for several months. “It’s helpful to remember that while acutely postpartum is [defined as] six to eight weeks, postpartum effects happen to some degree the whole time you’re breastfeeding,” Bickman says. So worry less, rest more, and don’t be afraid to ask questions if anything seems strange.