Your Maternity Journey Vol. 7

After Delivery: What Should I Expect?

Welcoming your newborn is a very special time, and a time when you will go through immense changes, physically, mentally, and emotionally. After giving birth, you may experience some postpartum challenges, and being prepared can help you recognize health concerns and get the help you need.

Postpartum Depression and/or Anxiety

Feelings of sadness, worry and exhaustion, often called the “baby blues” are common after childbirth. Your body has just undergone an enormous physical change, your hormones are fluctuating wildly, and your sleep is disrupted. You may be moody, weepy, anxious, or have difficulty sleeping. This is perfectly normal for a few weeks after delivery. According to CDC research, about 1 in 8 women may experience a more serious and long-lasting condition known as postpartum depression, which can occur during pregnancy or up to a year after giving birth. Watch out for the following symptoms:

• Depressed mood, severe mood swings, irritability, intense anger, excessive weepiness
• Difficulty bonding with your baby
• Withdrawing from loved ones
• Changes in appetite—overeating or not eating at all
• Insomnia or sleeping too much
• Severe fatigue and lack of energy
• Reduced interest and pleasure in your favorite activities
• Feelings of shame, guilt, and inadequacy and fear that you are not a good mother
• Hopelessness
• Confusion and problems concentrating
• Excessive energy and agitation
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

Postpartum depression is serious, and can rob you of the joy and bonding experiences with your baby. Fortunately, there are many different treatments and options that can help. If you experience any of the above symptoms, call your doctor as soon as possible. If you have thoughts of harming yourself or your baby, immediately seek help taking care of your baby and call 911. Don’t hesitate to call the National Suicide Prevention Lifeline at 1-800-273-TALK.

If you are coping with sadness, anxiety, or other emotional challenges postpartum, MarinHealth’s Pathways Virtual Support Group may be a good option for you. This group meets weekly via Zoom for a six-week series. It’s a great way to get some extra support and connect with other women who are going through similar experiences. Classes start quarterly, and registration is required. Learn more.

Separated Stomach Muscles

As your uterus grows during pregnancy, it weakens your stomach muscles and pushes them apart. After birth, you may notice a gap in between the rectus abdominus—the two large muscles that run down either side of your stomach. This normally resolves itself naturally within a couple months after delivery. If the gap is still obvious two months postpartum, contact your healthcare provider for a physical therapy referral.

Incontinence After Childbirth

Involuntary loss of urine, or urinary incontinence, is a common postpartum issue that affects 40% of new moms. The most common form of post-pregnancy incontinence is called stress incontinence. If you experience leakage when you laugh, cough, sneeze, jump, exercise, or lift something heavy, this is likely stress incontinence. You have an increased risk for urinary incontinence after delivery if:

• You experienced urinary leakage during pregnancy, especially if it began as early as the first or second trimester
• You had a long delivery and/or needed forceps or vacuum during labor
• You have a high body mass index (BMI) or difficulty losing pregnancy weight
• You are a smoker
• You had an episiotomy or experienced a vaginal or rectal tear during delivery

Stress incontinence often subsides as your body heals and pelvic muscles regain strength, but it can take up to a year or more. If leakage is still a problem six weeks after delivery, talk to your doctor. The treatment of incontinence depends on your individual circumstances, but can include pelvic exercises known as kegels, physical therapy, bladder training, nerve modulation, and other therapies. Learn more about incontinence and treatments.

When to Call Your Doctor

Postpartum complications can occur AFTER you go home with the baby, and it’s important to understand the warning signs. Call your doctor immediately if you experience any of the following:

• Bleeding that soaks through one pad an hour
• Passing blood clots the size of an egg or larger
• An incision that isn’t healing
• A red or swollen leg that is warm and/or painful to the touch
• A temperature of 100.4 F or higher
• A headache that won’t go away after taking medication or is accompanied by vision changes

If you experience any of the following, call 911:

• Chest pain
• Obstructed breathing or shortness of breath
• Seizures
• Thoughts of hurting yourself or your baby

Your postpartum health is important for both you and your new little one. The American College of Obstetricians and Gynecologists recommends that postpartum care be an ongoing process, not just a single visit after delivery. Make sure you get a comprehensive postpartum examination within 12 weeks after delivery, and don’t hesitate to call your OB or midwife with questions or concerns.

Plan Now for the Support You May Need

Whether this is your first baby or your fifth, it’s easy for new moms to feel overwhelmed, isolated, and uncertain. The excitement you’ve experienced for months can quickly give way in the face of sleep deprivation and the demands of newborn care. This is no time to try and be a hero—it’s a time to take care of yourself and reach out for the help and support you need. When even a five-minute shower is tricky, a 30 minute bath may seem overly indulgent, but making time for yourself—reading, going for a walk with a friend, napping, or relaxing in a tub with a few scented candles—is exactly the kind of self-care you need. It may seem counter-intuitive, but taking time for yourself will refill your cup and make you a better parent. Chances are, you have a friend or family member who would love to take over baby duties for an hour or so to give you some time to yourself.

Joining a support group is another way to form connections and get helpful advice and reassurance when you need it most. Check out MarinHealth’s free Mom’s Support Group, which covers different topics such as nursing, newborn care, and parenting each week. Weekly meetings are conducted via Zoom, and no registration is required. We also offer Pathways, a paid six-week virtual support group focusing on postpartum mood issues and tools for ease the challenges you may experience during this time.

Other options for finding a sense of community and getting emotional and social support include:

• Marin Mommies is a great resource for family-friendly activities and ideas for kids of all ages.
• The Red Tricycle has an extensive list of Bay Area parent groups by location.
• MeetUp has a well-organized list of groups you can join, from groups focused on getting fit or practicing self-care to dealing with relationship problems, separation, and divorce.