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Postpartum: Expectations vs reality

There is a saying: it takes 9 months to grow the pregnancy body on, it takes at least 9 months grow it off.

Many mother’s and even their partners imagine that if all goes well, the bodily changes quietly snap back into shape without any bother. The emotional state of the new mother is expected to be of joy and enthusiasm moving into her new role. As we know from a long history of women having babies and from advances in medicine and psychology, this is not a realistic or healthy expectation.

The reality of the postpartum period is often more jarring due to the fact that it is not discussed nearly as much as the actual pregnancy and delivery are.

The grand event of meeting one’s baby can often be followed by a sense of being overwhelmed. The new mother may be exhausted in spite of the fact that they now have to care for the infant by establishing breastfeeding and bonding. If this process is not approached with gentle support toward the mother’s need for rest, replenishment and even privacy, it can trigger feelings of stress in some women. Unfortunately a woman feeling these mixed emotions may further judge herself as not having the appropriate emotional response to her baby. This can compound into deeper mood problems. It can also hinder breast milk production. It is important to discuss and even plan out how to approach these instances in a way that provides her with the coping skills, support, space and time she needs to adjust to the changes.

> Around week 1: estrogen levels plummet and are replaced prolactin. These hormonal changes can lead to emotional mood swings commonly known as the ‘baby blues’.

Symptoms include, feeling weepy, irritable or resentful toward the lifestyle changes, anxious about the baby’s health, fatigued or disillusioned.

> 80% of women will experience the baby blues. (If feelings of sadness persist into the second month she should be guided to get screened for postpartum depression.) 

Consider having a Postpartum Plan in place before birth.

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Doulas are excellent at guiding this process. Include family member and friends in this plan by thinking of tasks that the new mother would usually meet daily and delegating them for some time (see how to organize daily tasks during the postpartum period in our *FREE Planner). For instance, if a friend comes over to see the new baby, the mother should be aware to continue to take it easy and not fret over houseguests. If they offer to help, doing a handful of dishes/ laundry or running an errand is more appropriate than having the new mother try to juggle all these roles. If they ask if they can bring something, ask them to bring food for the new mother!

> Additionally, the immense hunger felt during pregnancy continues postpartum with some women even experiencing cravings. This is due to a demand for more calories especially if breastfeeding. The increased intake is also one of the body’s demands to support the healing process.

If she has other dependents in the family, they may still rely on her for daily meals. Making freezer meals ahead of time or organizing a meal train is a thoughtful way to support a woman in her early postpartum days. Good meal planning and grocery shopping planning is a lifesaver! (we offer these services in our Postpartum Doula Care plan!) 

> For the first 6 weeks postpartum: a mother’s energy levels are still lower than her baseline. This is due to the fact that the body has just been through incredible changes and is now adjusting to a more limited sleep schedule, rebalancing hormones and using up resources for breastfeeding if that is the case. The good news is, with enough rest and good nourishment, aerobic capacity increases up to 20 percent within the first 6 weeks postpartum.

> As far as the physical body adjusting, the initial shockers are the after pains and the bleeding. The uterus is shrinking gradually to control bleeding and return to its pre-pregnancy state. This causes abdominal cramps (after pains) as the uterus contracts to make descent back into the pelvis.

> Breastfeeding speeds up this process, by stimulating the production of oxytocin, which triggers contractions, shrinking the uterus back to its normal size. Some of this may be very uncomfortable and discouraging to some new mother’s. Educating and implementing comfort measures, like the application of a warm rice sock to the abdomen during breastfeeding and good posture for back support and good nursing positions for a good latch can be extremely helpful. (Watch a video on comfortable breastfeeding on our YouTube Channel here.)

> The uterine contractions also cause heavy bleeding (lochia), which lessens over time as it heals. The bleeding is a source of discomfort for many. It is important to prepare the new mother ahead of time on how much bleeding to expect and the best protection to use to save herself spare laundry if possible.

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(> Fun word: PADSICLES - a cross between a maxi-pad and an ice pack. DIY in free planner!)

> The pelvic floor and the genital area undergo trauma in the process of childbirth. If the woman had a vaginal birth, there will be swelling and soreness and there might be stitches from tearing or an episiotomy. This is a source of fear and anxiety for many especially when it comes to facing using the bathroom. Getting urine, which is naturally acidic, on tender skin can be painful. Reduce the discomfort by the use of frozen pads, sitz baths and sitting on a ‘donut’ if necessary. Another issue some women face is urinary incontinence after childbirth. This can be a source of embarrassment and worry especially if the mother thinks that it is a permanent change. Kegel exercises (click link to watch a video on that) strengthen the pelvic floor muscles. Thankfully, this resolves itself over time in the normal process of healing.

> The changes of pregnancy and the process of delivery slow the movement of food through the intestines. This leads to complications with bowel activity. New mothers may feel bloated, gassy or constipated. If breastfeeding, there is also an increased demand of fluids and so if the intake is not increasing, constipation ensues. The pressure to the pelvic floor causes some women to develop hemorrhoids. The best solution for bowel problems is prevention by ensuring adequate intake of fluids especially water and fiber. If not contraindicated a stool softener can be used to ease constipation and prevent impaction. As with all medicine, consult a healthcare provider first.

> In the case of cesarean sections, the incision is usually the most delicate part of physical postpartum recovery. It is crucial for the new mother to have the support she needs so she can follow her providers rules for bed rest and to avoid over exertion until she is cleared.

> Shortly after the birth of the baby, most women lose an average of 9 to 12 pounds (6 to 8 pound baby, 1 or 2 pounds of placenta weight, 2 pounds of blood and amniotic fluid). However, by law of nature, any other excess weight gained to support the pregnancy will take at least the same amount of time it took to gain, to lose. For this reason, it is very beneficial to be honest and open about the expectations for postpartum body image. Many women will struggle with the new way parts of their body appear. It can be a bummer to find that one cannot squeeze right back into their favorite pants.

> Decreasing estrogen levels may cause hair to thin. This is only temporary and it should grow and thicken by month 3.

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A focus of taking time for self-care simply for the sake appreciating oneself may ward off any feelings of poor self-esteem and help the process be a more self-loving one.

Never underestimate the importance of finding support and friendship through other local mother’s for example by joining a group on social media like Facebook.

> Encourage healthy eating habits, preferably, not strict diets and gentle exercises several times a week to begin feeling more and more like oneself.

> By week 6, most new mothers get the green light from their provider to be intimate. Apart from self-image as discussed above, there are many things that might get in the way of postpartum sexual intimacy. Sheer exhaustion, changed household schedules, nervousness about what her partner will think of her changed body and apprehension about whether it will hurt or if it will feel the same. A woman’s sex drive is naturally low in the period after childbirth due to hormonal changes that happen to facilitate recovery and successful breastfeeding. This has the likelihood to cause relationship issues for a couple unless openness and patience are employed. Encourage the woman to be honest with her partner about her own feelings, fears and process. Encourage the partner to be willing to learn and adjust to the differences in their sex life. If this is difficult, it may be advised to get counseling or consult a trusted peer.

'We live in a culture that displays celebrity mothers bouncing back to their pre-pregnancy shape almost instantly. It is easy for women without the right people and resources surrounding them to feel alienated during this transition into motherhood. It is helpful to know that this does not have to be the experience and a major role of the doula is to facilitate this education.'

What are your postpartum expectations that this article mentioned OR what did you not know?

Tell us your side of the story in comments below!