What to expect from the postpartum period: how to recover with the support you need.

During what’s widely accepted as one of the most anticipated times in a woman’s life – the months following the delivery of a baby she has grown for around 40 weeks – most women struggle. A lot.

Whether they encounter challenges like postpartum depression and anxiety or not, a wide body of evidence supports that many women, regardless of the number of times they’ve given birth, feel overwhelmed.

However, a growing awareness of postpartum care needs is reflected in the American College of Obstetrics and Gynecology’s guidelines, which have recently been updated to reflect the importance of individualized postpartum support.

And arming yourself with information is one way to help prepare. To give you a better idea of what to expect and how to recover well during a postpartum period, we talked with Dr. Meredith Mitchell, an ob-gyn at Riverside Women’s Care Bluffton, South Carolina.

First, her big takeaway: The biggest thing I want to tell all postpartum moms for all of this is: Give yourself some grace. Every postpartum experience is different, and every person is different.

The postpartum period feels like a mysterious time we don’t have a lot of insight into. What can we honestly expect from the initial postpartum months?

I would say part of the reason this time feels so mysterious is because it is so different for every woman and for every kind of birthing experience. Somebody that has just had their fourth baby and delivered with two pushes, little blood loss and no stitches, is going to have a very different postpartum experience from a first-time mom who experienced extra challenges.

There are some general things you can expect during the immediate postpartum period: While you’re very tired by the end of pregnancy, labor, and delivery, many mothers get a little wired for a little while. It can be hard to calm down and hard to sleep with this new person.

Additionally, the first time you do most things right after a delivery – the first time you get up and walk, the first time you go to the bathroom, the first time your baby latches to breastfeed – can be a little rough for most people, even if this is not your first time giving birth.

Are there any symptoms during the postpartum period that can act as red flags to let new moms know something might be seriously wrong?

Absolutely. If you had a C-section:

• Your pain gets worse instead of getting better.
• You get redness around your incision that isn’t going away.
• Heavy bleeding from the incision, or soaking through a pad of fluid from the incision.

No matter what kind of delivery you had, we want to make sure you watch out for:

• Bleeding that gets heavier over time instead of lighter.
• Painful, red hot or tender breasts.
• Fevers.
• Mood changes.

So right after you deliver, your hormones are at the highest levels they’ll ever be, and then they plummet sharply, especially if you’re breastfeeding. Not only can this lead to physical changes, like hot flashes, but it can lead to normal mood swings. We’re looking for mood changes that get to the point where you’re not sleeping, you’re taking no pleasure from things that normally make you happy, or you’re having a hard time functioning.

Lastly, sometimes women can have blood pressure problems after pregnancy. We watch for that really carefully during pregnancy, but it can also happen as the fluid that used to be in your uterus goes into the other blood vessels in your body, causing high blood pressure. This is called postpartum preeclampsia.

Signs for this include:

• Severe headaches
• Pain in the right upper abdomen
• Nausea
• Vomiting

There’s a bit of a sensationalized notion that a mother will bond instantly with her baby, and if that doesn’t happen, something’s wrong.

That’s definitely something that can happen – not bonding the moment your baby is placed in your arms. It’s perfectly normal. Consider that pregnancy changes your body so significantly, delivery is tough, people may experience scary complications, and some people just do not do well with sleep deprivation. If you're not 100% in love from the first second, that does not make you a bad mom.

What changes to the body can women expect to see, and how can they set themselves up for successful postpartum recovery?

Every woman who gives birth goes through such intense changes that things are likely never going to be exactly the same. Part of it is that it takes a long time to heal. Your tissues have changed significantly, and they can’t snap back into place like a rubber band.

For successful postpartum recovery, I advise women to start with gentle walking as they feel ready and to transition to gentler movements, such as yoga, at six weeks. I’m also a proponent of waiting three to four months, rather than the traditional six weeks, to return to high-impact movement. Above all else: Listen to your body.

You touched on where the line is between normal mood changes and mental health issues. Can you speak more to the difference between normal mood swings and signs the mom is struggling?

Difficulty maintaining your mood or having bouts of irritation in the first few weeks is normal. However, if you find that you're overly anxious about things that other people don't seem to think are a big deal, that could be a sign of postpartum anxiety. Or not. After all, it’s hard to not to be anxious about your first baby. There’s a lot to figure out.

When you find you can’t sleep because you’re staring at the baby, you get up to check on the baby multiple times, or you feel like you can’t leave the house, those are definitely some red flags for postpartum anxiety.

On the other hand, if you feel like you are so low or depressed that you don't want to shower, eat, you can't sleep when you have the chance, or you're sleeping all the time and say, “Oh, somebody else can take care of the baby. I'm not going to. I can’t get up.” Those are big red flags for postpartum depression.

Is there any advice you’d give to new mothers trying to breastfeed?

I’d advise first-time moms, particularly, to get resources on breastfeeding. I recommend the American Academy of Pediatrics breastfeeding book. Novant Health also offers strong support for breastfeeding mothers, including lactation consultants, breastfeeding classes, support groups and other resources to support breastfeeding.

Breastfeeding is not all-or-nothing. If it is not working at first, that doesn’t mean it won't work. If it’s not affecting your mental health and you want to keep trying, you should.

How long should mothers genuinely be given to recover from pregnancy and birth?

I can tell you that 12 weeks is not enough. I don’t know the exact “right” amount of time – I imagine a recovery period that is long enough will differ a bit from woman to woman. I’m inclined to say a year, though.

If a woman wanted support after her six-week checkup, what resources are available to her?

You can always can reach out to your ob-gyn. We say we’ll see you in six weeks as standard practice. But when I'm discharging someone from the hospital, I always say that if you have trouble with bleeding, pain, mood or breastfeeding, call us, and we will be happy to see you.

There are also emergency resources that are always available, like the National Maternal Mental Health Hotline, 833-852-6262. That’s a 24/7 resource you can call or text at any time. And of course, you can come into the emergency room if you need to.

I would encourage expectant mothers to look for local mom groups via social media. You can often find ones on Facebook or the Meetup app – and local support groups for the different experiences that come with motherhood, like pregnancy and breastfeeding, and even postpartum support groups.