"I Gave Birth – Now What?”: Navigating the Postpartum Period

The time after giving birth can be a joyous time filled with marveling at one’s baby, but it can also be a period of quite an intense and overwhelming adjustment to this new addition to the household. You may wonder what to expect after coming home and how to traverse the new (and everchanging) norm.

Coming home from the hospital:

The post-childbirth period can be a challenging time of navigating one’s own healing post-delivery, while also providing care to one’s newborn (and other family members). You may have thoughts and feelings associated with the delivery, for example you may feel scared or disappointed if you intended to have a vaginal birth and instead needed to have a cesarean section, or if your baby arrived prematurely and required care in the NICU before being ready to come home. You may need support from your partner with managing your pain medication schedule initially when you arrive home following a c-section delivery since it is easy to lose track of time while caring for one’s newborn on little sleep. If one’s baby lost 10% of their birth body weight at discharge, you may be asked to bring your baby to multiple follow-up medical appointments during their initial 2 weeks of birth to monitor their weight, and you will be asked questions about their feeding and toileting schedule, which will all need to be tracked (another task to seek support from your partner towards tracking). If one’s partner is unable to provide this support, you may need to track this information using paper logs, or electronically on your phone for easy reference during these appointments, as well as set reminder alarms on your phone. Immediately after bringing baby home from the hospital, you may find that there is literally no predictable routine, with baby feeding every 2-3 hours or sometimes cycling through rapid cluster feedings, resulting in you being quite sleep deprived. Lactation difficulties during this period can be particularly stressful and lead to tears—for both baby and mother—until a solution is devised, whether through lactation consultations to support latching and feeding, breast pumping, and/or the decision to utilize formula to bottle feed baby. It takes time to develop a plan and new routine, and oftentimes that routine needs to be adjusted, sometimes multiple times throughout the course of those initial months following birth. It is important to not feel guilty if you are unable to produce sufficient breastmilk to breastfeed exclusively, or if your baby is unable to latch well; remember that you are doing everything in your power to keep baby healthy while also maintaining your own wellbeing as a mother, and you are not a failure. If able and choosing to pump exclusively, which can be very time intensive, it can be useful to ask one’s partner to feed the breastmilk bottles to your newborn, since infant feeding times may not always sync with the periodic and frequent pumping times required to build up a consistent milk supply.

Postpartum worries:

As a parent of a newborn, it’s not unusual to have some worries arise. Some first-time mothers feel a sense of panic when discharged from the hospital, wondering how they will care for their newborn on their own. The responsibility for caring for a delicate, tiny human being who is utterly dependent on you can be stressful. You may doublecheck the car seat straps multiple times to ensure that your baby is secure. You may find yourself standing over your baby’s bassinet in the middle of the night to verify that they’re breathing normally. You may worry that the milk bottle temperature is too cold or too hot. You may rightfully worry about your baby becoming ill from contact with well-meaning visitors who are eager to share in your joy and celebrate baby’s entry into the world, and you may need to tactfully communicate boundaries. You may fret that in their excitement, your older child is a little too “rough” when engaging with their newborn sibling, or you may worry about your older child’s poor adjustment to their newborn sibling. You may feel guilty about now having to divide your attention between your older child and your newborn, and you may even grieve the 1:1 time you had with your older child.

It is also typical to second-guess yourself at times, particularly if you are a first-time mother and you are offered a plethora of differing advice from well-intentioned individuals. There may be moments of feeling competent and other moments when one is feeling quite insecure as a parent. It may take time to “learn” your baby—to differentiate between their differing cries and translate their needs, to understand their preferences, and to adjust accordingly. There may be moments when you think you know exactly what works to soothe them, and suddenly they change, and you must adapt anew. It is not always easy to “go with the flow” or try to follow baby’s lead and cues, especially when one’s baby is sending some mixed, disorganized messages, but try your best and trust your instincts. And if there are times when you miss things or get things wrong, try not to beat yourself up about it. Your baby is and will be OK.

The emotional ups and downs:

Maternal emotions fluctuate moment to moment, and this is normal. You may go from feeling such intense joy, marveling at your newborn’s beautiful eyelashes while they’re peacefully sleeping, to feeling quite overwhelmed and frustrated in response to their high-pitched cries when hungry or needing a burp for the fourth time during the night, wondering why they just won’t sleep. You may shift from seeking to hold your baby continuously, cradling their perfect body in your arms, to desiring to hand them off to your partner or placing your baby in the bassinet, in order to take a much-needed break. These emotions and desires for connection and separation are quite normal and should not be taken as an automatic sign of disconnect or failed attunement to one’s newborn. Be gentle with yourself and remind yourself that you are doing your best and it’s also OK to ask for help and take a break to recharge. Everyone needs a break!

It takes a village:

Leaning on a support network during this time is critical. For parents who are accustomed to being independent and self-sufficient, it can be difficult to be vulnerable, and to accept one’s limitations and need for assistance. If you are accustomed to being the giver and caretaker in relationships, it is an adjustment to learn to ask for and accept receiving support. If you are someone whose needs weren’t always met in a consistent and predictable manner as you were growing up, it can also be difficult to trust that others will dependably come through for you and that you don’t need to “do it alone.”

For others, the challenge is not so much about asking for or accepting help, but rather, the physical distance from family and friends poses a barrier. It may be a good idea to ask if extended family and close friends can visit and stay with you temporarily after you give birth, and to stagger their visits, providing some direct care for you and your family over extended time. However, if far away from you and unable to visit, there may still be things that family and friends can do to support you—e.g. they can send gift cards for meals and diapers, ship needed items to you, call or send a quick message of support, etc. If you can afford to or budget for it, it may also be a good idea to hire help or outsource tasks, for example utilize a cleaning or laundry service, at least temporarily, until you are back on your feet and can take it on. It may be a good time to subscribe to a meal delivery service. Finally, it may be helpful to let go of unrealistic expectations during this period, such as maintaining a tidy home, making homemade meals, or keeping up with laundry, if these are tasks that you cannot get support from others within the household to complete. In time these are tasks that one may be able to fit in during baby’s nap times, but during the initial postpartum period there may be little breaks to prioritize such tasks, and that’s perfectly acceptable.

Baby Blues versus Postpartum Depression (PPD)/ Postpartum Anxiety (PPA):

Following birth, mothers go through hormonal changes which contribute to their mood fluctuations. It is not unusual to experience changes in one’s mood, including irritability and sadness, during the stressful postpartum period, especially when sleep deprived. “Baby Blues” are common during the initial postpartum adjustment period, and are transient, not requiring medical or psychological treatment. This feeling of sadness typically resolves within 1-2 weeks post-birth.

In contrast, Postpartum Depression (PPD) and Postpartum Anxiety (PPA) persist longer than 2 weeks after giving birth, and include mild to severe symptoms, requiring professional treatment. According to Postpartum Support International (PSI), 1 in 7 mothers and 1 in 10 fathers suffer from postpartum depression. They can include the following symptoms: frequent crying, mood swings, irritability, extreme fatigue, difficulty concentrating, sleep challenges, loss of sexual interest, pervasive anxiety, appetite changes, negative fearful thoughts, feelings of inadequacy, ruminating, hopelessness and despair. In addition, you may be experiencing thoughts of suicide and feelings of anger, rage, shame and guilt. If so, it is critical to inform your healthcare provider and to seek therapeutic support. Help is available and with treatment these symptoms can resolve.

Take it all in:

As you transition home and adjust to your new life with your newborn, take in the bliss of your beautiful baby and celebrate this blessing. Know that you will be undergoing hormonal changes and there will be stressors as you adapt to your new norm, and your mood may fluctuate as a result. Be kind and patient with yourself. Remind yourself that you’re doing your best and it’s good enough. Seek support as much as possible, and if you experience lasting symptoms of depression and/or anxiety, seek professional care.