Many new mums are 'cleared' six weeks after birth. But the postpartum period isn't over
Postpartum care for mothers should be a rolling process that covers at least one year
Six weeks after I gave birth to my first daughter, I found myself in my OB/GYN's office for my postpartum checkup. After a quick conversation and a physical exam, my doctor told me that I was "cleared." I could resume all regular pre-pregnancy activity
I went home, fed my baby and went on a run - and had to stop after a half-mile. My pelvic floor felt like it was going to give out and - although once an avid runner - I felt clumsy. That night, I lay awake, milk-stained and sweaty. Nothing about me felt "cleared."
Despite the fact that in 2018, the American College of Obstetricians and Gynecologists recommended that, to optimize women's health, postpartum care should become more of a rolling process rather than a single encounter, for many new mums, the six-week postpartum appointment remains the only touch point with the health care system that birthed her baby.
If Latin America has la cuarentena - a 40-day period when women take care of a new mom while she rests - and the ancient Indian medical system of ayurveda teaches us that we must nurture women for 42 days postpartum for the health of her next 42 years, the culture of the west, traditionally, has this: one lone appointment that, in many senses, gives a message of closure to the fragile and monumental postpartum period.
"The four- to six-week time frame has historically been thought to be enough time for women to be able to go back to do more physically demanding jobs, like farming, without having any serious medical issues," explains Heather Irobunda, a board-certified OB/GYN. Your uterus has usually shrunk back to a pre-pregnancy size, lacerations have healed, soreness from birth has resolved.
But physical changes persist for longer - probably six months or so, says Kecia Gaither, director of perinatal services at NYC Health+Hospitals/Lincoln. Around then, pelvic floor and abdominal musculature tone returns, changes in hair normalize, and the menstrual cycle might become more regular (if it's returned).
Some research even suggests women wait 12 months to conceive again. But how long does it take for the body to recover? It depends on where you look.
How long does it take for women to recover post-birth?
The Centers for Disease Control and Prevention, for one, says that a "pregnancy-related" death is a death of a woman while pregnant or within one year of the end of pregnancy, but "maternal mortality" is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of the end of pregnancy.
The Diagnostic and Statistical Manual of Mental Disorders, often called the "bible" of psychiatric health conditions, defines postpartum depression as depression "with postpartum onset: defined as within four weeks of delivering a child." But, says Cindy-Lee Dennis, a professor at the University of Toronto who studies the postpartum period, "it's fairly standard in the research literature to consider postpartum depression up to one year postpartum." (Take a landmark 2013 study published in JAMA Psychiatry of 10,000 mothers: It found that 1 in 7 women develop PPD within the first year postpartum.)
Birdie Gunyon Meyer, a registered nurse and director of certification for Postpartum Support International, a nonprofit group that lobbied to extend the period following delivery in the definition of PPD, says: "I don't think anybody really believes that the postpartum period is over at four or so weeks, but we give that impression when you come in for your four- or six-week checkup."
The truth is, the adjustment to parenthood takes time. It takes more than a couple of weeks and more than a couple of months. Researchers say Year One is critical for children and parents alike. "For the child, the brain is growing rapidly and the experiences that happen and the neurological pathways that are developed stay with the child for a lifetime," says Dennis.
For the child, the brain is growing rapidly and the neurological pathways that are developed stay with the child for a lifetime
And while there are many factors that play into this, parenting is a biggie. And a lack of support, sleep or resources throughout the first year (all of which can impact new parents) feed into anyone's ability to parent, she notes.
Dennis highlights a mismatch here in viewing the postpartum period as just a few weeks and existing national and international recommendations, such as the WHO's recommendation for exclusive breastfeeding for at least six months. "By defining the postpartum period in such a narrow window, we miss opportunities to really impact some of these outcomes," she says. For example, she just finished a clinical trial regarding exclusive breastfeeding where lactation consultants provided support to mothers. She found that one small "booster" call from a specialist at three months postpartum increased women's confidence to continue breastfeeding, helping them meet the WHO recommendations.
To this extent, policies - on maternity leave, for example - matter. "We've taken the big perspective on postpartum, recognizing that it takes time to recover from childbirth, learn about a baby and adapt. I think that is needed if you want to have a broader perspective of postpartum. It's hard to say that the postpartum period is a year but then expect women to go back to work after six weeks or less."
Supporting women through the first year postpartum also requires a switch in how we prepare people for parenthood to begin with.
"When you're pregnant for the first time, you don't have a clue how your life's going to change," says Gunyon Meyer, adding that, throughout the years, woman after woman has said to her - right there in the delivery room - what do I do now?
It's a big question that we need a better answer for.
"More people focus on that 24-hour labour and delivery experience than the decades that you're going to be taking care of this child," says Dennis.
"We simply don't prepare for parenthood," adds Gunyon Meyer. "And I think that's a lot of what we really need to do. There's way more to prepare for than decorating a nursery."
How to set yourself up for postpartum success
So how do you set yourself up for success in the year postpartum? Many experts point to support - something that's certainly more challenging than ever in the age of the coronavirus. But here are some recommendations to take with you before you deliver and long after your postpartum follow-up appointment.
- Assemble your support system
In many countries, people gather around new mums to take care of them. Before you have your baby, think through who can help (a partner, a virtual lactation support, a teletherapist). Many women underestimate how much help they'll need and for how long they'll need it, Gunyon Meyer says. Have a hard time asking for help? Many mums do. Keep a list on your fridge of things you need done - laundry, dishes, groceries - and ask others to tackle them. If you have a new mum friend in your life? "Don't forget them after the balloons are in the yard and after everybody brings over food for two weeks," says Gunyon Meyer.
Also, ask friends and family members to educate themselves on symptoms of perinatal mood and anxiety disorders such as PPD. "I rely heavily on families and friends to let me know if there is something that I need to be made aware of in the postpartum period," says Irobunda. "Recovering from birth and taking care of a new baby is difficult and can cause a woman to not even notice that she may be having a hard time." Sometimes, having a family member spot something that's off helps you get the support or treatment you need.
- Consider a support group
Support groups are one of the places where women are honest about the struggles of new parenthood, says Gunyon Meyer. And talking about what you're feeling and experiencing is an important part of adjusting to motherhood, she notes. Groups such as Out of the Blues and Breastfeeding Q&A UAE on Facebook are excellent resources, while The LightHouse Arabia, Thrive and Babies and Beyond all run UAE-based support groups for pregnant women and new mothers, which are currently being held online during the pandemic.
- Work together with your partner
If you have a partner, taking an online course (companies like Love Parenting UAE and Babies and Beyond offer everything from infant sleep to meal planning for new parents) can help you prepare for some of the unexpected. Make time for you and your partner every week, too, to strengthen your bond and how supported you feel - both of which are of crucial importance in that first year, says Dennis.
Cassie Shortsleeve is the founder of Dear Sunday, an online platform that helps women adjust to new motherhood.