Planning Ahead for Postpartum Wellness

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:

• Anticipate where you will be feeding your baby (nursery, living room couch, bedroom, etc). It will probably be in a few different places. Set up these “stations” accordingly: keep a small box of nutrient dense snacks (nuts, protein bars, apples, etc) and water bottles at each station, and ensure that these boxes are always stocked. Perhaps this can be your partner/support person’s job.
• List out some of your favorite, easy-to-prepare meals and snacks, and make sure the fridge is always stocked with those ingredients  (again, this might be your partner/support person’s job).
• Consider preparing and freezing hearty meals (like soups, lasagna, casseroles) prior to the arrival of your baby.
• Consider organizing (or asking a friend or family member to organize) a meal train where people can sign up to deliver you meals (and remember, this does not mean these generous folks need to join for the meal, or even come in the house. Front porches are great drop spots).
• Consider adding UberEats/Favor/Doordash gift cards to your baby registry so that ordering take out is easy and not as financially draining.

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:

• Resist the inevitable pull towards productivity if you are tired and you have the opportunity to sleep. Sleep is productive; remember that there are few things as important to the wellness of you and your baby as your sleep. Each little bit of sleep adds to your reserve and moves your body towards a state of safety.
• If you have the resources, hire a postpartum doula to spend the night and care for your baby while you sleep.
• Negotiate a sleep plan with your partner to ensure that you are both getting in naps and/or significant stretches of sleep while the other is caring for your baby (think: conversation about overnight feeds, diaper changes, and soothing).
• Remember that there are many places that a baby can sleep, and choosing a safe sleeping place that maximizes sleep for both you and your newborn is important. You do not need to worry about your newborn developing “bad” sleeping habits - for now, maximizing sleep should be the focus.

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:

• Wearing your baby on a walk. This provides both you and your baby with closeness and bonding, and will likely also give them a nice nap while you get a chance to move your body in a gentle way. (If wearing your baby doesn’t feel good on your body, or your baby doesn’t like to be worn, strollers, of course, work too.)
• Doing yoga or stretching while your baby lays next to you. She’ll enjoy watching your movements and listening to the soothing music.
• Wearing your baby for at-home and class workouts, once you are able and wanting to do more vigorous exercise. There are many babywearing workouts you can find on YouTube, and lots of gyms and exercise studios offer “Baby & Me” exercise classes.

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:

• Join a postpartum group (online or in person). Many hospitals, birthing centers, doula groups, etc. offer these. Surrounding yourself with other parents in approximately the same stage as you are can feel tremendously cathartic. To be able to text a fellow parent at 3:00 am when your baby won’t sleep to just complain feels good.
• Allow (and ask) friends and family to help you. Whether this means bringing you food, doing your laundry, or even just coming to your home to spend time with you, this kind of support is critical.
• Join in on different new parent activities in your community or go to playgrounds and other places where you can meet parents with young children.

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.

• Major Depressive Disorder: parents might experience difficulty enjoying their children, develop feelings of guilt or inadequacy, experience sleep disturbances, appetite disturbances, and unwanted intrusive thoughts, often about death.
• Generalized Anxiety Disorder: often experienced as constant and excessive worry about the health and safety of the infant, racing thoughts, panic attacks, and disrupted sleep.
• Obsessive Compulsive Disorder: parents might experience unwanted intrusive thoughts that take over their thinking and lead to compulsive behaviors.
• Post-Traumatic Stress Disorder: this may occur after life threatening complications during childbirth, and present as flashbacks, hypervigilance, mood disturbance, and avoidance of triggers.
• Psychosis: postpartum psychosis is extremely rare and is considered a serious mental health issue. Symptoms may include hallucinations, delusions, rapid mood swings, hyperactivity, and a feeling of detachment or unreality. If you experience any of these symptoms, it’s important to immediately contact your mental health provider.

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:

• Have previously experienced mental health issues (like anxiety or depression) or had a PMAD during or after a previous pregnancy
• Have a family history of mental health issues, especially Bipolar Disorder
• Were taking psychiatric medication prior to your pregnancy and stopped when you learned you were pregnant
• Have experienced a pregnancy loss, stillbirth, or infant loss
• Have had a difficult pregnancy and/or birth
• Have experienced trauma in childhood or adulthood
• Have experienced fertility issues, or are having a baby through adoption or surrogacy
• Have stressful life circumstances, including limited support, a strained relationship with your partner or support person, a teen pregnancy, or financial difficulties
• Had a baby with a NICU stay
• Had an unplanned or unwanted pregnancy
• Are a perfectionist or an introvert

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.

• Difficulty sleeping (sleeping too much or too little)
• Significant changes in appetite
• A loss of pleasure or interest in things you normally enjoy
• A loss of motivation
• Feelings of sadness, hopelessness, or worthlessness
• Uncontrollable worry
• Irritability
• Panic attacks
• Not wanting to hold or bond with your baby
• Difficulty concentrating and making decisions
• Isolating yourself
• Thoughts about harm coming to your baby
• Thoughts about killing or harming yourself or someone else (this is an emergency - if you are experiencing suicidal or homicidal thoughts, please call 911 immediately or go to your nearest emergency room).

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

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