A Healthy Dose of Postpartum Truth

Adjusting to the “fourth trimester”
© Can Stock Photo / Bialasiewicz

Having a new baby should be all joy and happiness, right? I spent months envisioning this magical postpartum time with my new twin babies, suckling effortlessly at the breast and gazing into their eyes. It was to be pure motherhood bliss…

Compared to the focus I gave to the pregnancy, the birthing experience, and preparation for baby’s arrival, I was much less prepared for the postpartum period, also known as the fourth trimester. What I didn’t expect were the effects of sleep deprivation, my heightened anxiety over my new role and trying to get it right, and the challenges of breastfeeding, which were a far cry from the advertised: “latch them on, and off they go.” Mix that with a cocktail of different hormones and emotions circulating through my system and I found myself caught in the perfect storm.

Given the magnitude of change and completely new challenges it brings, the postpartum period should be treated as a time when mothers are in need of extra care and attention. Although our experiences will vary depending on circumstances, here are a few examples of what many of us experience during the fourth trimester.

All things postpartum

The baby blues

The emotional ups and downs that many of us experience after giving birth are often referred to as the baby blues. Instead of basking in motherhood bliss, you find yourself feeling weepy, anxious, and down. You may feel happy one minute and overwhelmed the next. You may cry at the drop of a hat, even at silly commercials. You may question your ability to care for yourself and your baby. The good news: this can all be a “normal” part of the postpartum experience.

Hormones appear to be one major culprit for the fluctuations in mood as the levels of estrogen and progesterone that rose during pregnancy suddenly drop after delivery. Other contributing factors can include stress, isolation, the sudden increase in responsibility of caring for a child, and of course, exhaustion.

Most women experience at least some of these symptoms within a day or two of giving birth. The symptoms generally peak around one week as hormone levels start to normalize and begin to diminish by the end of the second postpartum week.

Beyond the baby blues 

Although many mothers do not experience postpartum depression (PPD), depression during and after pregnancy is more prevalent than most people realize. Given the myriad of changes that take place, the difficulty in adjusting to the tremendous responsibility of becoming a parent and the intensity of the exhaustion, the signs of a serious depression can be difficult to distinguish from the baby blues and the expected challenges of the postpartum period, especially in its early stages.

New motherhood is challenging for all of us but it should not be consistently distressing or miserable. Although the symptoms of PPD are similar to those of the baby blues, they differ in intensity and duration. If by the end of the second week postpartum the symptoms persist or feel more intense, you may be experiencing PPD.

Symptoms of postpartum depression

PPD can start within four weeks and up to one year after birth. As with the baby blues, you may feel sad, tearful, hopeless, worthless, and/or alone. You may have some or all of the symptoms listed below. These symptoms may make it feel very hard to enjoy and live your life each day:

  • Anger or irritability

  • Inability to bond well with your baby

  • Anxiety that prevents you from sleeping (even when baby is) or eating appropriately.

  • Feeling overwhelmed, like giving up, and that there is no hope in things getting better

  • Feeling like you are going through the motions of your day

  • Unable to feel happy or interested in things you used to enjoy

  • Thoughts of harming yourself or your baby

Risk factors for PPD

  • Factors typically associated with an increased likelihood of developing PPD include:

  • A personal or family history of depression, anxiety, or PPD

  • Inadequate support in caring for the baby

  • Financial stress

  • Relationship stress

  • A recent major life-altering event (e.g. family tragedy, house move, job loss)

  • Complications during pregnancy, birth, or breastfeeding

  • Parents of multiples

  • Mothers who have gone through infertility treatments

  • Thyroid imbalance and other medical conditions

Fathers feel it too

Given the impact of change on a family/couple/individual, it may not be a surprise that fathers too can experience similar symptoms. According to pediatrician Dr. David Hill, 10% of fathers suffer from paternal postpartum depression. Given low rates of disclosure, the true incidence is likely higher.

Physical healing

Your body needs time to heal after the great marathon of pregnancy and birth! It may take up to six weeks for postpartum bleeding to stop and up to three months for other systems in the body to return to their “non-pregnant” state. Whether you had a vaginal or c-section birth, you will likely experience physical pain and discomfort. Although baby is no longer in your belly, it will not look that way! The uterus takes time to shrink back to its “non-pregnant” state and others may unfortunately comment on when baby is due. Stretch marks, sagging skin, and extra weight can all be part of the process. Let it take its course and take care of yourself. And don’t forget the peri-bottle! I strongly encourage you to use it when you go to the bathroom!

Learning new things

Your life will no longer be as you once knew it (which was kind of the point, right?). Along with baby comes new routines, tasks, and a need to not only figure out how to do these things (cloth diapers, changing, bathing, dealing with colic), but also how to integrate them into all the other things you still have to do.

Learning to breastfeed

Breastfeeding may be presented as pretty straightforward, but in reality there is a very real learning curve here—from getting milk production up to really sore nipples. When it is not working smoothly it can be a stressful experience; knowing that this may be your baby’s only source of food adds a distinct urgency. Hang in there and seek out resources like lactation consultants, LaLeche League, and people who have been there! When you and baby get the hang of things, the reward and resulting bond is worth it.

Dealing with emotions

Adapting to your new role (even if this is not your first child) can be stressful. The sense of responsibility, the worry over your baby’s health, or not knowing if you are “doing it right” can leave you feeling anxious and overwhelmed. Even if having a child is what you always wanted, the challenges are very real and ever-present. Remember that most mothers deal with moments of doubt, worry, and excessive web searching—you are not alone!

Sleep deprivation

Newborn sleep patterns and sleep deprivation can be tough to deal with and many new parents are taken aback by how exhausted they feel. With good intentions, others may remind you that one day baby will soon “sleep through”, which may give you something to look forward to. Unfortunately these well-meaning comments don’t help much in the present moment when there is no apparent end in sight. Take the sleep you can get whenever you can get it, regardless of how many dirty dishes are in the sink.

Adjusting to relationships 

When baby comes along, all relationships will be impacted. An older sibling will have to adjust to another child being in the house and your relationship with your partner will undergo its own changes. Many couples identify the first year after a baby is born as being one of the most difficult times in their relationship. Further, with your hormones out of whack, exhaustion, and the physical changes that you are adapting to, sex is likely to be the furthest thing from your mind. This transition period can be stressful and it will take time to adjust to the new dynamics. Ensuring effective communication around these feelings will be important.

Navigating all the postpartum things 

The postpartum period can certainly take any woman by storm, no matter their birth experience, post-partum mood, or situation. Preparing for this period with the same gusto that you prepare for labour can set you up with realistic expectations and tools to help you thrive, and not just survive! Consider the following suggestions to help you prepare for your postpartum period:

Acknowledge your feelings 

Recognizing that feeling anxious and overwhelmed is part of the process can help alleviate pressure. Comparing yourself to how “together” all the other mothers in your baby and mom group appear to be will not. Conflicting messages about what motherhood should be can make it difficult to avoid the trap of self-judgment and to share your feelings. Try not to be afraid to talk about the challenges you’re facing, and how they make you feel. Talk to your family, friends and/or your partner. Look for new parents’ groups or counselling support for an opportunity to express how you are feeling. Once you open up, you may find that others share their experiences with you, which can be very comforting.

Discard the idea of perfection

Try to keep realistic expectations in mind and be gentle with yourself knowing that it takes time to adjust to your new role and to better understand your baby’s needs (and your own!). You are not alone in feeling that you have no idea what you are doing! Although nothing can fully prepare you for parenthood, prenatal classes that focus on caring for your child can be a good start. Prenatal classes also provide an opportunity to develop a support network with other expectant parents.

Get organized beforehand 

Although there is no way to be even remotely prepared for parenthood, getting the nursery ready, stocking up the freezer, sorting out the logistics of parental leave, having a “support plan” in place of who will help with what, and open discussion with your partner/family about expectations around visitors can all help alleviate stress once baby arrives. Resist the urge to do much else and have a “babymoon” period.

Go slow 

Having a newborn and taking time to slow down? The two don’t necessarily sound like they can co-exist. Nonetheless, a mother’s role should be to rest, recover, bond, and help feed her child. Postpone efforts to get “back into shape”, to get back to your “regular life.” Take the time needed for your body to heal and to create space for bonding with your new baby.

Enlist the village!

Recruit as much support as possible to help care for you, your family, and the baby. Everyone loves to hold the baby but what you and your family likely need are meals cooked, the house cleaned, and laundry folded. Holding the baby can be reserved for times when parents get to catch a nap or for some much needed time to themselves. You may consider hiring a mother’s helper to take the baby out for walks in the stroller or contact your local College/University for ECE students who may be looking for credit hours to help care for a new baby or assist your family in what needs to be done.

Get a new “best friend” 

Lactation consultants, postpartum doulas, and community health nurses can be a great support to guide you through learning how to breastfeed. Knowing that trying to figure it out on your own can lead to further anxiety and frustration, take advantage of services offered through hospitals, your health region, or postpartum doulas for ongoing support. Find a lactation consultant or breastfeeding meet-up group in your area before your baby is born so you know exactly who to call and where to go if help is needed.

Communicate with your partner

When you are exhausted, communication can feel like the last thing you have energy to do; however, it will likely be one of the most important factors in helping navigate through this transitional period in your relationship. Expressing your needs openly to your partner will help him or her to better understand how to offer support. Communication also provides an opportunity for your partner to express their feelings through this time as your partner is also trying to adapt to their new role.

Get help for postpartum depression

Thoughts, feelings, and symptoms associated with PPD can be painful to experience and many women can be overcome with shame, especially when the postpartum period is generally idealized in the culture and media as a time full of happiness. Women may be reluctant to speak about their experience for fear of being judged and may feel shame and guilt for not feeling “grateful and happy” to have a new baby. PPD can feel like a personal failing when it is in fact a medical condition and a reasonable response to a very difficult and stressful period of life. Do not hesitate to get professional help!

Natural wellness and nutrition

There are many ways to support your health and mood safely in the postpartum period. Here are some top suggestions to get you started, but as always, we suggest seeking guidance from a health professional for appropriate dosing and products.

Balanced whole foods diet 

Get all the nutrients you need to support energy, mood, and healthy hormone and neurotransmitter production

Pre-natal vitamins 

If you're still breastfeeding, the nutrient demand is even more now than in pregnancy! Keep up with your pre-natal vitamin every day for optimal energy stores.

Omega-3s 

These healthy omega-3 fatty acids are integral for mood support. This is one of the top researched supplements for PPD.

Adaptogen herbs

Adaptogenic herbs support your adrenal (stress) glands, helping you feel more balanced in energy and more resilient to daily stressors. Not all are safe while nursing so first seek guidance from a naturopathic doctor.

Exercise

Once you can find time and energy, exercise is the number one treatment for low mood. Even better? Get outside to do it. Weather permitting, try taking you and your babe out for a walk every day to soak up fresh air, sun, and the mood boosting magic of movement.

The postpartum period or fourth trimester will be different for everyone. Check in with yourself daily and seek out the support you need. Even if it's just someone to come over to hold baby while you shower—you deserve it!


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