Caring for ourselves during the fourth trimester and beyond should not be an afterthought. In order to cope with the intense hormonal shifts and stressors of postpartum, we must provide our bodies with the necessary foundation from which to function. This means feeding ourselves, prioritizing sleep, moving our bodies, and building and maintaining meaningful social connections. Oftentimes, overwhelmed with the endless job of caring for a newborn, new parents will put their basic needs on the backburner; planning ahead, then, removes a barrier and makes caring for ourselves a less insurmountable task.
Communicating with your partner/support person(s)
Having a conversation (or many conversations) with your partner or support person prior to the arrival of your baby about division of labor can help ensure that both of you are getting adequate support and time to care for yourselves. A larger conversation about role expectations is important to set the stage: what are your expectations for early parenthood? What are your expectations of your partner or your support person(s)? Are these aligned with their expectations? These conversations may be challenging to have when you don’t know exactly what you’re getting into, but getting (relatively) on the same page as your partner can help ease the transition.
The conversation about division of labor is more about the specifics. The middle of the night when your baby is crying is not the best time to decide who is going to get up to change her diaper. So, before baby comes, organize a (flexible) plan with your partner regarding responsibilities. Who is feeding baby during the night? During the day? Who is changing diapers at night? Who is washing pump parts? Who is responsible for meals? Get as specific as you can. Maintaining openness to flexibility is important, understanding that your baby will probably throw wrenches in your plan. But, planning ahead will provide you with a basic structure from where you can improvise. Get down to the nitty gritty so each task doesn’t become a question of who is responsible.
Caring For Yourself
The importance of caring for our basic needs during the fourth trimester cannot be overstated. Sleep, nutrition, hydration, movement, and connection to others all signal to our bodies that we are safe. Keeping our bodies in a state of safety allows us to function and arms us with resilience. At a time when our bodies are flooded with intense hormonal changes, new and additional stress, and - for many - physical exhaustion following birth, it is imperative that we do everything we can to support our bodies at this most basic level. Resilience becomes the key to staying afloat.
So, what to consider?
Nutrition & hydration: Particularly if you are breastfeeding (or bottle feeding and pumping), staying fed and hydrated is critical. Our bodies need this support to heal from birth, to produce milk, and to help protect us from the inevitable stress and exhaustion of postpartum. When we are hungry or thirsty, we’re less able to cope with stress, our mood can become dysregulated, and our functioning in general deteriorates. A few things to consider, then:
Sleep: Parents of young children might laugh at this. I get it. Sleep is really hard to come by in the postpartum period. But hear me out. Sleep is our most important defense against illness, emotional drainage, and stress. And while you may not be able to get those elusive eight hours of sleep each night anymore, you can prioritize sleep. If you can:
Movement: Once you are ready (and cleared by your provider), movement/exercise can make a world of difference in both your physical healing and in your emotional state and ability to manage stress. Providing us with feel-good endorphins, exercise is a relatively simple way to improve your mood. And while your pre-baby exercise routines may no longer be realistic for you, there are many ways to adapt. You might consider:
Social support/connection: Coming into parenthood is perhaps the most intense transition one will ever go through, and we are not meant to do it alone. Finding community during this time shields us from the isolation that so many new parents feel. This does not mean that you need to resume your regular social life, or even that you need to welcome family into your home immediately after the birth of the baby. Setting boundaries are critical to your wellbeing. What prioritizing social connection does mean, however, is that we ask for help, we find community, and we seek companionship in others who understand the complexities of postpartum. There are several ways to do it:
If you can, identify your support systems prior to the arrival of your baby. Consider how you might meet other parents, and identify within your existing social networks who will be a source of support for you. You may even have a conversation with a few family members or close friends about how you anticipate you might need support and how they are willing to support you.
Postpartum Mood Changes
For many women, basic self-care practices are enough to keep our minds and bodies in a state of relative safety, despite the intense external stressors accompanied with having a newborn. For many others, however, these practices are simply not enough, and reaching out for additional mental health support is critical.
Many moms (up to 80%) will experience Baby Blues, a normal, physiological reaction to having a newborn, characterized by sensitivity, irritability, sadness, frequent tearfulness, and feelings of being overwhelmed. Baby Blues generally do not require professional intervention; typically, these feelings resolve on their own within two weeks post-birth and do not significantly interfere with a person’s ability to function and bond with their baby.
However, for some, symptoms of Baby Blues persist beyond two weeks, and make daily functioning difficult, indicating, perhaps, a more serious postpartum mental health issue. Studies show that up to 20% of childbearing women will experience some kind of perinatal mood or anxiety disorder (PMAD), making PMADs the most common childbirth complication. Importantly, we know that PMADs are treatable with therapy and/or medication.
The most common PMADs fall into the following categories based on the symptoms one might experience. Oftentimes, symptoms will not fit perfectly into just one category, and you may notice that you’re experiencing symptoms from several different categories. This is normal, and a mental health professional should be comfortable treating the full range of your symptoms.
Postpartum Mood and Anxiety Disorders can develop due to an array of factors, including genetics, hormonal shifts, trauma, social stressors, and even sleep deprivation. And while PMADs can impact any individual, it’s important to understand the risk factors so that you can educate yourself and plan ahead if you think you might be at an increased risk for developing a PMAD.
You may be at an increased risk for a PMAD if you:
Considering your own risk factors, and thinking about how you typically manage stress, are important ways to prepare for some of the mood changes that you might experience postpartum. If you are concerned about developing a PMAD or anticipate that you might need or want additional mental health support post-baby, establish care with a therapist or psychiatrist during your pregnancy. If you’re feeling good, great! You don’t need to see them often. But having a professional “in your back pocket” just in case you do need the support can be tremendously helpful. Waiting until you are perhaps exhausted, stressed, and feeling down is not the best time to begin a search for a mental health professional.
Signs & symptoms
Discuss with your partner or support person before the arrival of your baby the signs and symptoms of PMADs. How will they know if you are not OK? How can they support you if they suspect you are developing a PMAD? Below are some common signs and symptoms, though it can be helpful to think about how you, specifically, have expressed distress in the past.
Summary
Anticipating and planning for the changes of postpartum can be tremendously helpful in lessening the practical burden and mental load of caring for yourself in the postpartum period. Organizing your priorities while you are still pregnant can help remove barriers that may become seemingly insurmountable obstacles when we are sleep deprived and short on time. Remember that caring for your basic needs - sleep, nutrition/hydration, movement, and social connection - is not a luxury. It is not “treating ourselves” to fuel our bodies with food, take naps, move our bodies, and see a friend while caring for a newborn; quite to the contrary, it is necessary during this time. For some new parents, prioritizing basic self-care will be sufficient to support wellness during postpartum, while for others, particularly those who develop a PMAD, basic self-care practices will not be enough. Planning ahead by educating yourself, talking with your partner/support person, and pre-arranging additional emotional support and professional help if you are to develop a PMAD can go a long way in ensuring that you do not suffer alone.
If you are interested in developing a postpartum wellness plan, RPC will soon be offering a Life With Baby postpartum wellness planning series! This series includes four prenatal sessions and one postpartum session with an RPC therapist where you can deep dive into your postpartum wellness plans.
A big thank you to the authors of Life With Baby: A Postpartum Workbook for Self-Care, Support and Emotional Well-being, Amy Tucker, Postpartum Doula, and Erin Fassnacht, LCSW, for inspiring much of the content in this post.
Emily Obront, LMSW, Certified Doula
Brexanolone is a novel treatment for PPD, learn more about it here.
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By Sarah Rivers Deal, PhD, LPC With Perinatal Loss month in October, I wanted to introduce myself through this blog as well as cast a light in the often dark places that hold this kind of silent, disenfranchised grief. As a psychotherapist that specializes and has been trained in infertility counseling, I too experienced my own reproductive trauma. Five years of fertility and alternative medicine treatments yielded a roller coaster of emotions, existential crises, and ultimately, two small graves in our back yard. Allow me to share something I wrote after my first miscarriage. We read to know that we are not alone – and – you are not alone. If you’re like me, the struggle to create life took over my life. It was all I thought out, dreamt about, planned for, spoke about, made exceptions for, ate for, stopped drinking my favorite red wine for – you name it. Life became hinged on hypotheticals – What if we get pregnant after I accept this new position? What if I accept this invitation then can’t travel in a few months because I’m pregnant? Should we buy the house in the better school district or wait until little one is here? What if little one never gets here? As much as I tried to balance my life, infertility crept in at every turn. In her insightful memoir, The Art of Waiting, Belle Boggs describes this all-consuming experience, calling it the Take Over – “…the problem with infertility is that it is not a patient, serene kind of waiting, not a simple delay in your plans; it happens for many of us in the context of consuming struggle, staggering expense, devastating loss.” Deciding to pursue fertility treatments put my barrenness on the front burner, making it difficult to escape. After five years in fertility clinics, more people had seen my vagina than the inside of my home. What was supposed to be private and magical between my partner and I was now public and scientific. All around me, women were “blessed” with babies, flaunting them as little “miracles.” These terms are especially painful for those struggling to conceive, as it implies that certain people are chosen while others are not. As much as I tried to participate in the world, being around pregnant women or infants was hazardous to my mental health. I remember attending my first baby shower in several years, believing I was safe now because my partner and I were months away from our daughter (by way of adoption) being born. Hope had begun to blossom again in my heart, as I believed that soon I would be a mom too. While I was emotionally prepared for my friend Serena to be eight months pregnant (after years of trying and two miscarriages), I wasn’t informed that the shower host was visibly pregnant too, and to boot – after only one round of I.V.F. with the same doctor I used. As we munched on our blue painted cookies shaped like pacifiers, I learned that the champagne drinking host had a 9-year-old son already, and became recently engaged after finding out about the pregnancy. I wish I could say I genuinely celebrated her happy news, but on the inside, I was fuming. On the drive home, with no other car in sight, I blasted the radio and screamed bloody murder. Despite various challenging life experiences up to this point, I still somehow believed in the concept of justice – a philosophy of how fairness is administered. To put it simply, it seemed unfair to me that this host woman was pregnant and going to be a mom – for the second time – and all I had to show were memorial stones in my yard commemorating two pregnancy losses. Unfair that I had earned high marks for effort and still wasn’t getting to graduate. Unfair that I wasn’t stroking my own belly, marveling at the miracle of science and creation itself. Infertility or perinatal loss may be experienced as an existential crisis, planting seeds of doubt in life questions you thought you had basically addressed, figured out, or had plenty of time to answer. What legacy will I leave behind? Who will carry on my values? Who will remember me after I’m gone? Am I broken? Dr. Anne Malavé, mental health expert in the field of infertility, wrote – “Infertility is like trying to find your children. The child, the imagined and expected child whose presence is palpable yet missing, feels near. It feels like searching for a lost child–you keep looking and searching around every corner. To stop trying can feel like an abandonment of an actual baby, of “my/our own baby.” Pamela Mahoney Tsigdinos in her raw, genuine book Silent Sorority, poignantly captures this existential crisis – “One instant you are like everyone else. The next, you’re not. Your DNA now ends with you. You are infertile. Your branch of the family tree will forever be just a truncated twig. You’ve been denied a rite of passage, a biological imperative. You had no say in the matter. It wasn’t a conscious choice. The comfortable sense of continuity and legacy others take for granted disappears in an instant.” After experiencing perinatal loss in 1999, Amy Douglas poetically wrote: “A life inside me, a love so strong. She died inside me, but the love lives on. It broke my heart for her to go. I love her, I need her like she’ll never know.” If infertility and/or pregnancy loss have ever been downplayed as a less significant human loss, Tsigdinos, Malavé, and Douglas legitimize the profound aftershocks of devastation experienced by those affected. From my personal and professional experience, I want you to know that the takeover is part of the journey. Well- meaning partners and friends might advise you to find a hobby to try to get your mind off of it, to relax, but that probably won’t help. It IS where you are right now, and that’s okay. Most people will be uncomfortable with your discomfort, and you’ll likely receive your fair share of unsolicited and unhelpful advice. Being the recipient of said advice, I tried to remind myself to listen to their intentions, not words. Week after week, clients that struggled with infertility would say something like – “These next few weeks I want to focus on my work and getting back into exercise” or “I want to start hanging out with my friends again and expanding my social circle.” We would set vague or concrete goals, depending on the client, and vow to focus on balance and self-care. And then, week after week, these same clients would come in ashamed, embarrassingly admitting that even if they did go to the gym or see an old friend, the ghost of infertility haunted them. They wanted to be more present in the here-and-now, they really did. Although I truly believe the takeover must run its course, there may be some coping skills and strategies to help it along. And I’m certain that whatever I tell you won’t always work. Some days the takeover will allow some wiggle room to remember the other aspects of your life; other days – it won’t. If you’ve felt quite low more days than not, and for an extended period of time, please check it out with a doctor. I will share with you the most salient professional (and personal) guidance here, and hope that on a few days, it might help. But please, don’t beat yourself up if it doesn’t. Honor the takeover, but also look for windows where you can see the larger picture. 1. Do something that has direct, observable results. You likely have felt powerless for a while. I want to you to do something, no matter how simple, where you can see results. Start with something easy. Make your bed. If you feel relatively competent cooking, use a recipe to create something, then share it with someone. Plant something that you can watch grow. Start with a plant that’s native and more likely to survive; you do not need a failure right now. Rearrange furniture in your space; a new look often evokes new feelings. 2. Practice Self-Compassion Breaks. I adopted this idea from the lovely Dr. Kristin Neff, a self-compassion researcher and professor from my town in Austin, Texas. Here’s the step-by-step process: a) When you notice that the Take Over has happened, say to yourself: “This is a moment of suffering” or “This hurts.” (It may help to place one hand over your heart = self-soothing gesture) b) Then say, “Suffering is a part of life.” c) Then, “May I give myself the compassion or understanding that I need right now.” Then breathe in and out, consciously and with intention. 3. Mindfulness (paying attention on purpose) is an Eastern practice, but its application has hit Western shores, and I’m a firm believer that it’s a necessary healing tool in your toolbox. You can become a conscious consumer of your mind, observing with a curious and gentle sense what’s going on in there. None of us would believe that a face cream could make us look a certain way after a few applications. However, we often experience our thoughts as facts, then experience powerful emotions as a result. It’s important to get some space from our thoughts, and see them for what they are – potentially unhelpful narratives. Use the letters N-N-R to remember the steps: a) Notice. Your mind is an active, interesting narrator that tries to piece information together but often falls short. Become a neutral, curious observer of your mind. Think of it as a radio, always playing music (some songs on repeat). b) Name (thoughts, feelings, body sensations, urges). For example, you may be ruminating (circular thinking that goes nowhere except down) something like “It’s not fair Tamara is pregnant. She didn’t even want another baby” and so on. As soon as you notice you’re stuck on a loop, say to yourself – “That’s a thought” You may notice tightness in your chest. Ask yourself what your feeling. Then say, “I’m having a feeling of sadness.” Noticing and naming gives you critical space to honor what’s going on with you without letting it suck you in automatically. c) Re-engage: Get back to what you were doing before you got caught in the loop. Re-engage in the moment. 4. Make a playlist or soundtrack for various themes throughout your fertility/infertility journey. For example, weeks before my 2nd I.V.F. transfer, I made a compilation of uplifting songs, burned them on a CD that I titled “Hope,” and played it every chance I got. A week after my first miscarriage, I made another playlist, calling it “Coping.” These songs were instrumental in helping me process the often contradictory emotions I experienced. Your body’s limitations don’t define you. Focus on what your body CAN do for you right now. Can you walk, jog, skip, hop, swim, or hug someone? It’s easy and completely understandable to get caught on a failure-loop narrative. But you’re not a failure. This is your roadblock, your life challenge, your grief and sorrow, your call to action. Answer the call, my friends. Above all, be patient with yourself. You are not alone. (Originally written September 2017; Revised September 2020) Dr. Sarah Rivers Deal is an Austin-based licensed professional counselor that specializes in infertility and reproductive trauma. She’s a member of the American Society for Reproductive Medicine (ASRM) and has participated in numerous trainings on infertility counseling and perinatal loss.
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