The Essential Guide to Postpartum
If you’re a type-A over-achieving planner like me, then I’m guessing you have read all the books, blogs, parenting accounts, you’ve gotten all the stuff for the perfect nursery and newborn essentials, your hospital bag is packed and you probably even have your postpartum care package put together.
Yay for you and (sorry to burst your bubble), you’re likely missing a very big aspect of postpartum.
YOU.
The Postpartum time
Preparing for baby is often very baby-focused. Even with today’s increased focus on birth plans and postpartum physical care, there are still huge gaps in how prepared women are to become mothers. And I’m not talking about how they care for their baby, I’m talking about the developmental, emotional, and identity shifts that happen upon becoming a mother.
If you find yourself in this place, either you’re about to become a mother or are newly a mother, having a better understanding of the huge changes that occur during postpartum time and developing a postpartum support plan.
What is the Postpartum Time?
The postpartum time, also called the Fourth Trimester, begins from birth till about 6 to 8 weeks. However, at Happy Moms Therapy, we are going to argue that the postpartum time is actually a lot longer than that and would define it as the first year after baby is born (and in all honesty, may even push it for the first 2 years).
Why do we think the Postpartum Time is for 1+ year?
That first year of your baby’s life will have a lot (and we mean A LOT) of changes. You too, will have a lot of changes as you are healing, adjusting, and transitioning to motherhood.
The idea that you should be “back to normal” 6 to 8 weeks after giving birth is laughable at best and actually dangerous at worst. If you’re expecting to feel back to “yourself” at that 6 week appointment and find yourself far from that, it can feel like something is wrong with you.
For that 6 week follow up appointment with your doctor, they are mainly concerned that you are physically healing as you “should be”- checking your uterus to make sure it’s returned back to its normal size and that the bleeding and cramping has stopped (or is close to stopping). They will also typically ask you about your mood and then review birth control options for you. While this is all great, it really is just scratching the surface.
Did you know that it actually typically takes about 6 months to be fully physically recovered from childbirth? According to a study published in 2010 by the Journal of Perinatal Medicine, changes to the genitourinary system (covering our genital and urinary systems and includes the pelvic floor), take much longer to resolve than the 6-8 week timeframe, and sometimes they never fully resolve to the state of pre-pregnancy.
Hormonally, you’ll continue to go through changes depending on if you are breastfeeding, pumping, or not.
Most likely, baby will still be waking up frequently throughout the night and they aren’t going to be on a typical schedule. This will likely mean that you are experiencing sleep deprivation which can certainly throw things off for you.
You are also likely still trying to learn and figure out what baby’s cries mean, how to soothe them, how, when and how much to feed them.
If you are partnered, your relationship is likely still adjusting to this new “normal” of having a baby. Who is doing what, how each person is responding to baby and to each other, and how each person feels about this big change.
A survey done in 2018 found that it took moms almost 5 months before they reported feeling more comfortable with motherhood, while a research study found that it took 6 months for mothers to report more confidence.
If you browse through Reddit, you’ll find this question of when to feel like yourself again after giving birth to be common and the answers range from 8 months, a year, 18 months, 2 years, more than 2 years (and then starting all over again if they have another child).
Here at Happy Moms Therapy, we recognize that the postpartum period is much longer than that typical 6-8 weeks and instead think of it as at least the first year of baby’s life. And if it’s been more than a year for you and you’re still feeling like you’re adjusting to this whole motherhood thing, that’s completely okay!
What are the Common Struggles in Postpartum?
The postpartum time has a lot of changes and transitions happening and it takes time to adjust to it all.
In my experience in working with lots of mothers (and including myself and my postpartum experience), I have found the following to be some major points of struggles in the postpartum time:
Lack of sleep
Feeding baby
Changes to your body
Changes to your relationships (partner, friends, family)
Managing and responding to your emotions
Your Identity
Dealing with the Mental Load
Understanding and being prepared for these common struggles can smooth out some of the bumps. It will still be hard, but at least it won’t take you for such a surprise.
Lack of Sleep
No matter how tired you think you’ve been before baby, nothing compares to the tired you feel in that postpartum time.
I’m sure you’ve already gotten the advice-
“Sleep now before baby comes as you’re never going to sleep good again!”
Or
“Sleep when baby sleeps.”
While both statements are well-meaning, they aren’t particularly helpful as there isn’t a clear plan for how to make that happen.
The first one- it’s not like you can “save up” on sleep before the baby comes and then use this extra sleep build up to not be tired. Sleep doesn’t work that way- there’s no sleep bank. Plus, if you were like me, I highly doubt you were sleeping well those last couple weeks of your pregnancy!
The other advice about sleeping when baby sleeps- again that’s great in theory, however it doesn't really address how to make this actually happen.
For one, baby is not going to magically sleep for long periods of time throughout the day. It’s pretty random, especially those first couple months. Also, depending on your baby, getting them to actually sleep can be hard and most are going to want to sleep on you. If they actually fall asleep in a bassinet, then I’m guessing it may be the one free time you have to take a shower, get something to eat, just do anything.
So often this idea of sleeping when the baby sleeps- while it’s sounds good, it’s really not that simple.
With all that said, it is imperative (like really, really important) that you do develop a plan for sleep. Sleep is really important for physical healing and emotional regulation, which are two things we really need during that early postpartum time.
Some examples of sleep plans include the following:
Take shifts- one person goes to bed early to get extra sleep then wakes up early, while the other goes to bed later and gets to sleep in.
If you’re pumping and/or breastfeeding, it can still be important and helpful to have your partner assist you with nighttime feedings. This may include having a bottle prepared for them to do one night feeding and/or getting up to burp and change baby’s diaper after you feed so you can go straight back to sleep
Make a plan during the day to get a solid nap. This will include having a bottle for baby available. If possible, it may be best for your partner to take baby out of the house, so you can’t hear them fuss or cry, so that you can sleep.
No matter how nice it feels in the evening to have some “me time” when baby is sleeping, it’s much better for you overall to go to bed early. I totally get the need for time to yourself, and while this is important, getting adequate sleep more important. I know I always feel so much better during the day when I’ve gotten more sleep.
Feeding your Baby
Feeding your baby has unfortunately become a very controversial and polarizing area of motherhood and early postpartum time.
There has been so much focus and highlight around breastfeeding and yes, there are some great aspects of it AND it’s not going to be for everyone. Sometimes, you can try so hard and do all the right things and it just may not work out.
Some of the most guilt and shame that I see with working with moms comes up around feeding their baby. Even though we often intellectually recognize that “fed is best” and that it’s perfectly okay to feed your baby formula, we can still struggle with our own personal emotional acceptance of it.
We often think-
“It’s okay for others, but not for me. I should be able to do this.”
As a therapist who sees mothers in the postpartum time, I have seen time and time again, how hard breastfeeding your baby can be. Unfortunately, this can cause a lot of harm to your mental health.
I get it, we see so many health benefits of breastfeeding- it gives your baby all these antibodies, it boosts their immune system, they have better gut health, it’s the best source of nutrition for baby, it helps with bonding, with some claims touting it will help a baby emotionally and physically through their entire life.
While some of these benefits have truth to them, the amount of benefit over formula can be a bit over inflated. Per Emily Oster, an Economics professor specializing in all things motherhood, baby, and parenting, when looking at causal effects (so that breastfeeding causes the following rather than correlated to), breastfeeding seems to improve digestion in the first year and lowers rashes for babies. It also appears to reduce ear infections in young children. For mothers, it can help with lowering the risk factor for breast and ovarian cancer. So while these things are important benefits, you can have a perfectly healthy and thriving baby on formula.
If the cost of breastfeeding your baby becomes at the expense of your mental health, then I say, without a doubt, those “benefits” are not worth it. It is more important for you to be mentally and emotionally well than it is for you to breastfeed your baby.
If this is an area you’ve been struggling with, I highly recommend for you to get support and not just through a lactation specialist, but with a therapist who specializes in working with moms in the postpartum time. Processing through your emotional experience around how you are feeding your baby can be really important for your overall well-being.
Changes to Your Body
Your body goes through so many changes during pregnancy and then in the postpartum period. Who you were physically and mentally before being pregnant and who you are after birth is just different. This idea of “bouncing back” to the same body pre-birth is just not feasible.
Adjusting to and accepting these changes can be really difficult. Also, your hormones will continue to adjust and change during the postpartum period which can create different body effects.
Some of the many body changes that mothers experience after childbirth include:
Changes to your breasts in size, shape, and even nipple size, shape and color
Foot size and shape
Hair loss and then regrowth
Wider hips/pelvic area
Joint changes (more flexibility)
Skin changes
Weight changes
Growing and birthing a baby is an incredible feat. Your body is going to naturally change through this process. Just as our body should change as we continue to grow older. We are not meant to stay the same size and shape throughout our life.
Changes to Your Relationships
Your relationships are going to change, especially the one with your partner. You now suddenly have this new being in the midst of your relationship who is very demanding, takes up much of your time, energy, and attention. Suddenly your relationship gets put on the back burner as you are trying to attune to and meet baby’s needs. This of course can cause a lot of strain on the relationship and unfortunately around 67% of couples report a decline in relationship satisfaction after baby is born.
Relationships with your extended family and friends are also going to naturally change.
A common area of struggle is issues around what types of boundaries to set with family and how. Extended family members may have very different opinions on how your should raise your baby and how often and where they should be involved. You and your partner may also disagree with these answers.
It is also common for friendships to take a hit, especially those with friends who don’t have children or have children at different age groups.
While all these areas can be ones of big transitions and can cause some turmoil in it, you can come out to the other side feeling good. Getting more clear on your communication and needs, identifying and setting boundaries, and working on continuing to connect with important relationships are all important ways to get through it.
Managing and Responding to Your Emotions
Having a baby is a big, BIG deal and of course you’re going to feel it! Also, your hormones are going through some rapid changes and adjustments after giving birth, which are also going to amplify the feels.
It’s all okay. Where this can get tricky is how we make sense of our feelings. We are by nature, meaning-makers. We want to make sense of everything, so our brain takes in the information we have (so the emotions we are feeling) and creates a story about why we are feeling that way.
Here’s the thing, the postpartum time is a lot- you’re sleep deprived, your body is healing, and you are (for lack of a better word) hormonal. It can be really easy to create meanings such as-
“I’m not cut out for this.”
“I can’t do this.”
“I’m a bad mom.”
This is not the time to try to make sense of your emotions and definitely not to create meaning.
Instead, here are some strategies to try to help you better manage the rollercoaster of emotions that can come up:
Journal how you’re feeling
Change your environment- go for a walk, go outside, go into another room, etc. (P.S. this works for baby too when they are fussy)
Do some breathing exercises. Focusing on your breath can help calm your body and settle your mind.
Talk it out with a trusted loved one.
Give it time to pass. Emotions will come up and they will go. Allow yourself to feel it. Acknowledge the feeling (aka- “I’m feeling sad.”), tell yourself you’ll be okay, and give it time.
Your Identity
Becoming a mom is a huge, huge change. For many of my clients- before becoming a mom they were career-focused, often climbing the ladder at their job, they are highly educated, hard working, reliable, independent, etc. After having a baby, they are now at the mercy of this tiny being, they can’t do all the things they did before, and the top things on their minds are how many dirty diapers their baby had, how to get their baby to nap, how much to feed them, etc.
It’s very common to wonder- who are you anymore in the midst of this. That person you were before giving birth can feel so far away and while they are still a part of you, you are also very different. It takes time to sort through this new identity of motherhood and it’s okay to not quite know who you are in this moment.
The big task for you is not to create any big meanings (see Managing your Emotions above), get curious about what is coming up for you. Journaling can be a great resource to explore different parts of you. Also, taking time for yourself can also be really important during this time. Time to yourself allows you to either engage in activities you enjoyed before, get some space from all things baby, and even start to explore new possibilities/interests for yourself. I know that can feel really hard to do and prioritizing this can be imperative for your mental health.
The Mental Load
One of the top struggles I see my clients go through is managing the overwhelm of the mental load that comes with having a baby.
The Mental Load has certainly become more popular the last several years thanks to resources like Fair Play. For those that aren’t as familiar- The Mental Load is basically all the “behind the scenes” information in your head regarding all the tasks you need to do for your baby, family, household, etc.
Oftentimes when we think of sharing tasks, it’s around the actual execution of the task, so- making dinner, doing the dishes, doing the laundry, cleaning the house, etc. However, in order to do those tasks, there are a lot of things happening before the task is actually done.
Take for example, making dinner. Before you can make dinner, you first have to think that there is going to need to be a dinner made. This may seem obvious, however if it’s obvious to you, it’s probably because you are the one taking on the mental load of this task. Many times, there is one person of a partnership that is carrying most of the mental load and when that happens, the other person doesn’t have to worry about it.
So if you are thinking that there is a need to make dinner, you are probably also planning what that meal will be (which may include looking up recipes online, looking at cookbooks, checking your saved Instagram Recipe folder, etc.), you’re making a grocery list, and you may also be doing the task of going to the grocery store.
And then we get back to the original task of making dinner.
A lot of times, there may be a share of the execution of tasks- maybe your partner makes dinner a couple times a week, or they go to the grocery store. However, the mental aspects of 1) anticipating a task that needs to happen and 2) researching and/or planning out the task are disproportionately held by one person (spoiler alert to no one, this is typically the mom).
Male partners often don’t understand this mental overwhelm that their female partners are experiencing because they just see that they are helping out to execute a share of tasks. They aren’t realizing all the mental pre-work that goes into it. That mental pre-work is often what creates a lot of overwhelm and burnout.
When tasks aren’t clearly assigned to individuals within partnership, often each person will fall into a pattern for what they do. In my experience working with hundreds of women, women are typically holding most of the mental load while their partners are sharing in the execution of the tasks, but they are relying on the other one to tell them what needs to be done, how to do it and when.
A lot of times this is sort-of manageable in a partnership before baby comes. Also, because both partners are often working full time, there is a more share of the execution of the tasks.
However, once baby is here, there are a ton of additional tasks that are now added to the partnership. There is also A TON of mental load added in the areas of learning and researching about baby development, baby needs (such as feeding, sleeping), baby items (diapers, bottles, sleep items, clothes, etc.), etc., etc. And guess who does that? Yes, the mom.
This quickly turns from something that is manageable to something that becomes too much.
Also, add in that mom is likely on maternity leave and when dad goes back to work (which may just be a couple weeks in or less), mom is now home all day and starts to take on more tasks. Now, instead of sharing a lot of the execution of these tasks when both are home from work, it becomes mom’s task to do during the day while she is home with baby and dad is at work.
Unfortunately, this doesn’t change when mom returns to work as the pattern gets developed and more deeply ingrained. If mom stays home with baby, this often becomes “her job.” I will argue that this is typically detrimental not only to the couple's relationship, but also to the woman’s mental health, and it also decreases the connection and involvement of dad with child.
The Mental Load and more equitably sharing of household and family tasks between partners is a really important and imperative area to address in order to have a healthy relationship.
Some ways to start to tackle this is to have very frank and open discussions with your partner about tasks and get more clear about who is doing what. If possible, it can be helpful to have one person “own” a task completely (including all the pre-work) so that the other partner can release it.
For example- taking the trash out. One partner takes it on and they have to pay attention to when the trash gets full (those diaper genies can only hold so much), then they need to take it out promptly (without being asked) and replace the bags. They may also be the one responsible for ordering new trash bags and diaper genie refills. Maybe they are also the person that takes the large trash cans to the street for trash day and they bring them in.
Try to look at these tasks and all these things that go into managing a household like a job and get clear on what is under each person’s responsibility. Then it can be helpful to have regular meetings to check in and see how things are going, do things need to change, do you now have new tasks to add in, some to take off, etc.
What is a Postpartum Support Plan?
A postpartum support plan is a plan you make about how to best support yourself after the birth of your baby. Just like your birth plan details your preferences and support for birth, a postpartum support plan is going to do the same for you for the postpartum time.
The main parts of a Postpartum Support plan will include important areas that often cause a lot of struggle for postpartum moms (and their partners).
Why do you Need a Postpartum Support Plan?
A Postpartum Support Plan can be really important to have as it gives you direction on how to best support yourself. If you are partnered, it’s important to make this plan with them, so that they know how to best support you. Having a detailed plan in place can also ward off many of the misunderstandings and communication breakdowns that can often happen during that early, sleep-deprived postpartum time.
It’s also important to continue to come back to your Postpartum Support Plan and adjust it so that it continues to work best for your family.
When to get Help | Therapy for New Moms
If you find yourself struggling in some (or all of these areas), getting extra support in the form of therapy can be really helpful. Having a therapist that understands all that comes up for new moms and in the postpartum time, can really help you navigate these areas more smoothly. Even if you aren’t at a point of struggle, but just want someone to talk through these things that are coming for you as a mom, therapy again can be really helpful.
Today, with the availability of online therapy, it can be really easy to get support from the comfort of your home. Many therapists for moms, including myself, are okay if you need to tend to baby or nurse/feed baby during your session. While childcare can be really helpful and may be needed for more intensive therapy sessions, I know I’d much rather have you get support sooner rather than wait or never get support due to childcare difficulties.
If you are in California and interested in my therapy services for moms, please reach out or schedule a free consult to get started.
Get Your Own Fill-in Postpartum Support Plan
Are you ready to create your own Postpartum Support Plan? Get your own downloadable fill-in guide below.
Are you wanting more support? Our therapy services may be the right fit for you! We offer individual therapy sessions for moms, new moms, postpartum depression therapy, therapy for anxiety, and a specialized therapy called EMDR for processing through birth trauma and other traumatic and painful experiences.
Therapy services are for those that live in California. Reach out today for schedule a consultation.
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Disclaimer: This is not a replacement for a therapeutic relationship or mental health services. This is for educational purposes only and should be in used only in conjunction in working with a licensed mental health professional. If you are in California and looking for a professional therapist feel free to use the contact me to request an appointment or search Psychology Today for local therapists in your area.
