What To Expect Postpartum

Expert Sources: Tristan Emily Bickman, MD, OB/GYN; Kelly Dean, PT; Heng Ou; Linda Sebastian, ARNP

After the life-changing journey of pregnancy, labor, and delivery, many birth parents barely recognize themselves come postpartum. In the early weeks with your infant, strange or unexpected new happenings can leave you feeling confused and perhaps even concerned about how your body and mind are coping with the changes. We’re here to help you take a deep breath and find some peace of mind before the big day. Here’s the heads-up on some common post-baby concerns and where to look for help.

Postpartum Anxiety

You’re probably familiar with postpartum depression, but when you’re struck with debilitating postpartum anxiety or panic attacks, you might wonder if you’re losing your grip on reality—or question if you’re cut out for parenthood. After all, you may have 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, a psychiatric nurse practitioner in Fort Myers, Florida, 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 previously suffered from anxiety or obsessive-compulsive issues before or during pregnancy, symptoms may escalate after birth. A history of trauma (including birth 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 professional help. A good place to start is your doctor or midwife at your six-week postpartum checkup, or booking a follow-up appointment sooner if needed.

Take heart that having postpartum anxiety does not mean you’re an unfit parent. “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 has nothing to do with your capability of being a parent or your love for your child.”

Extreme Fatigue

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

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

Also, when faced with this exhaustion, parents may revert to survival mode, oftentimes leading the birth parent to neglect their 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, having your partner rub your feet for 15 minutes, or sipping on a warm cup of tea or mug of broth can calm the nervous system and reboot your energy.”

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

Finding time to rest and recharge in the early days of parenthood is never easy, but it’s important for your well-being. Take what time you can get, and try to shut the world out for a bit—forget social engagements and errands. At the same time, let loved ones in; friends and family can greatly help.

Looking Pregnant After Birth

Gone are the days of modestly hiding baby bumps—parents-to-be proudly display growing midsections. But after newbie arrives, some birth parents are surprised to find themselves sporting the second trimester look for months or longer.

What’s going on?
A long-term protrusion in the middle and lower abdomen 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. The 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, try to be mindful of your posture; 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 in a very crunched position.”

Second, minimize anything that pushes the abs out. Eliminate crunches, holding your breath, bearing down, and bracing. If you’re experiencing pain or can’t close your abdominal gap, try a core rehab program, which incorporates alignment work, stretches, and professional support. “[These programs] are very effective, even 20 or 30 years postpartum,” encourages Dean.

Bladder Leakage

After pregnancy, sneezing becomes more about crossing your legs than covering your mouth. New parents 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 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 Dr. Bickman, “and estrogen is the hormone that keeps the urethra sphincter tight.”

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

Dr. 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 pregnant person knows labor sensations are intense, but when you’re hit with postpartum pains that stop you in your tracks, 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 Dr. Bickman. “They start to dissolve about two weeks after delivery.” Because nursing releases oxytocin, suckling triggers stronger contractions.

Here are the silver linings: Afterpains return your uterus to its pre-pregnancy size and location. They also help prevent hemorrhaging by pinching shut the open blood vessels where the placenta detached. (Sounds uncomfortable, right?)

The pain 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 Dr. 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. Additionally, ibuprofen can be helpful with your doctor’s go-ahead.

Spotting and Discharge

Most birth parents expect to bleed after delivery, but when post-delivery 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. Afterward, 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 Dr. 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, and be ready by wearing protective pads or period underwear.

If spotting persists after eight weeks, tell your health care provider. Dr. Bickman reassures that it’s generally residual sloughing, but let your practitioner determine that to stay on the safe side.

Postpartum peculiarities generally aren’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,” Dr. Bickman says. So try to worry less, rest more, and don’t be afraid to ask questions if anything seems strange.