What Even Is Postpartum? We Made You A Guide For The Other Side Of Childbirth
During pregnancy, there tends to be a heavy focus on labor and birth, with far less emphasis on what happens when you get home.
I was obsessive about preparing for labor throughout my pregnancy -- to the point that there was no room to think about what would happen afterward. My plan was to read up about all things postpartum after I got through the birth.
I regretted that decision immediately after I got home, which marked the start of an anxiety-induced insomnia that lasted two weeks. It felt like one ridiculously long day in which the sun kept rising and setting.
My main activities during that time included:
- Obsessively searching the internet for information about breastfeeding as tears streamed down my face
- Hallucinating that my baby was injured
- Dreading the pain/gore that accompanied every trip to the bathroom
And then there was the overwhelming, judgmental narrative running through my head: I am definitely screwing this up. I am definitely doing this wrong.
This is why, when we received a suggestion that KPCC/LAist should do a story about how to prepare for the postpartum phase, I was like, YES.
We talked to a doctor, a doula and a lactation consultant, but the first step was talking to all of you. We asked if anyone wanted to share their experiences -- from the ghastly to the glorious -- and over 70 of you responded with stories that were raw, candid accounts of those first weeks after birth.
And while there are some common themes, everyone's postpartum phase is different. Every parent is different. Every infant is different.
While I experienced heightened anxiety, one colleague told me she heard so many postpartum horror stories that she was concerned when her experience was not as intense as she expected. She took her 2-day-old baby to a farmer's market.
Below is a collection of your stories, some tips from the experts, and a blueprint for preparing for the postpartum phase.
"OUR SOCIETY IS NOT SET UP TO CARE FOR US"
Many countries and cultures have practices to ensure moms get the rest they need after giving birth.
There's the Latin American custom called la cuarentena, a period of 40 days of rest, or the Chinese zuo yue zi, or "sitting the month," a month of staying inside the house, abiding by strict rules, and eating a special diet. Many countries have over a year of maternity leave or provide maternity nurses who visit your home.
But in the US, nearly 1 in 4 employed mothers return to work just two weeks after giving birth.
"Our society is not set up to care for us and to give us time to care for our babies in the way that we need," says Dr. Sayida Peprah, a psychologist who specializes in maternal mental health. "If you feel like you need more help, unapologetically get help. Don't feel like you should be able to do this by yourself."
ASSEMBLE A TEAM FOR ESSENTIAL NEEDS
Peprah recommends having someone visit or be there every day -- for at least a month -- to help take care of you and the baby.
She says the level of support you get directly impacts your emotional state and ability to cope with the tidal wave of changes during this period.
When planning for your basic needs during this time, consider these aspects:
- Recovery. You may have mobility limitations whether you have a cesarean birth or a vaginal birth. Who will help you get around and bring you what you need?
- Sleep. You will be feeding the baby every two hours. Who will take care of everything else at home in between so you can sleep or rest?
- Meals. Who will be cooking? Who will actually be ordering food? This may mean assembling a meal train to have friends and family deliver food to you.
- Breastfeeding support. If you decide to breastfeed, many moms need help.
- Emotional support. Who can you weep to or text at 2 A.M.?
- Returning to work. If you do work, how will your workplace accommodate you when you return?
"I would advise new mothers going into it to plan your postpartum better than your birth," says mom of one-month-old Carina Lieu. "I don't know if it's the product of living in a competitive society, but one of the things that annoys me about pregnancy is how much everyone tries to pull off an image of having a great time. I don't mean to scare people or rain on anyone's parade, but postpartum is really hard."
Many moms talked about the saving grace of supportive partners, parents, and friends.
Reader Maya Iñigo-Anderson told us, "The absolute life saver that helped me to become my old self again... was my family and my friends -- the forever loyal way-back-when friends and also new friends from my Mommy and Me group."
BRACE FOR "THE HALLWAY IN 'THE SHINING' "
"The biggest question I kept asking myself was, 'Why didn't anyone tell me?'" wrote reader Kiki Burger. "You feel like you prepare with books, classes, a baby shower, etc., but what you really need for yourself and your own healing is never talked about! It's crazy that friends don't even tell other friends. I'll never forget leaving a two-day-old home and driving in basically a diaper to CVS to try and find more of the products I needed. Spoiler alert: CVS doesn't carry them."
Reader Laura Cohn described physical recovery as "a veritable tidal wave of I don't know WTF afterbirth viscose liquid keeps seeping from my vagina -- for SEVEN WEEKS. It was like the hallway in 'The Shining.'"
What happens to you physically after childbirth can look and feel alarming, but it can be an indicator that your body is doing what it should be doing to heal. (Of course, do not hesitate to call your doctor to confirm, or if you think there might be a problem).
Dr. Margaret Lynn Yonekura, director of LA Best Babies Network and a high-risk OB specialist says, "As your uterus shrinks down, it is going to cramp. Every time we breastfeed, oxytocin is released, which causes your uterus to cramp. And so people wonder, what the heck is going on here? But actually, that's a good thing. Your uterus has to go from the size of a watermelon to the size of a lemon over the course of six weeks."
LEARN THE RECOVERY SPECIFICS
Many sites provide detailed descriptions of physical recovery -- the specifics for you will depend on your birth experience, whether you had a vaginal delivery or a c-section, and what particular things happened during the birth.
The important thing to remember is that childbirth is a very big deal, it takes time to recover, and you will need help to get the crucial rest you need.
Here are just a few areas that will need time to recover -- and other things to keep in mind:
- Perineum: If you have a vaginal birth, you'll likely feel pain in the space between your vagina and your rectum. This will vary depending on whether or not you had an episiotomy or had a vaginal tear -- and how many stitches you received. Ice, pain relief spray and sitz bath can all help with the healing process.
- Constipation: The first bowel movement after birth can be intense. Things that can help are eating foods high in fiber, avoiding foods that constipate, drinking water, and taking stool softeners.
- Hemorrhoids: These can appear during pregnancy and from pushing during labor, and they can be worse if you had them before. You may need Tucks or pads soaked in witch hazel.
- Cramps, bleeding and vaginal secretions: As your uterus shrinks back to its original size, you'll feel cramping, accompanied by bleeding as your body gets rid of the blood and tissue that was inside your uterus. It's heavy and can include blood clots.
- Incision: If you have a cesarean birth, you will feel pain internally and at your incision. To prevent infection, you will need supplies to protect and care for the incision. You will also need to to do things like hold a pillow against your abdomen have if you have to cough or sneeze. Depending on the type of stitches, you might need to return to the doctor's office to remove them.
- Circulation: It will be important to walk around after a c-section to prevent blood clots.
- Fatigue: Just reading this list is exhausting. And after childbirth, your body will be tired. You will have also lost a lot of blood -- typically more if you have a c-section. You will start immediately feeding your baby every two hours. You will be tired.
- Sex: This may be one of the last things on your mind. But also it's not allowed for your health. It can interfere with your perineum healing in the first four to six weeks. Sex after a cesarean delivery is also prohibited until cleared by your doctor, typically after a six week follow-up appointment.
Some people advise creating your own recovery kit to help with your comfort, and to make sure you have the supplies you want and need at the ready. Many people will also tell you to take home any supplies that aren't bolted down in your hospital room -- diapers, ice packs, oral syringes, mesh underwear, gauze, etc.
OH, THE EMOTIONS. (THEY MAY NOT BE WHAT YOU EXPECT)
Physical recovery is rough. Emotional recovery can sometimes be harder.
Many moms think that they will feel an immediate attachment to their baby after birth, and worry when they don't feel that instant bond.
Reader Stacy C. shared, "When they placed my baby on me after birth I didn't even know what to do. I wasn't crying like I thought I would be and I was holding this slimy alien creature asking the nurses to take him off of me."
She says it took weeks, but little by little she began to bond with her baby and her love for him continues to grow exponentially.
Sonia Torres works as a parent educator for The Whole Child, which is one of several home visiting programs in Los Angeles County that deploy coaches to visit moms during pregnancy and after birth, throughout early childhood.
She finds herself reassuring new moms to let them know that it's normal to feel strong emotions. "There's a stigma of, 'I have a baby, I have to be happy. I have to feel good about it.' So [moms worry when they have thoughts like], 'I'm a little sad. I'm worried.'"
It's totally normal to feel a whole range of emotions, and many of these came up in the stories moms submitted.
Many explored themes of inadequacy (i.e., I'm not doing this right), comparison (i.e., why does it seem so easy for other moms I know?), permanence (i.e., oh no, my life is like this now FOREVER), and loneliness.
Many moms also talked about dealing with the massive identity shift of becoming a new mom.
"I cried all the time because I wasn't sure who I was," says reader Amber Norwood. "Before I was pregnant, I would stay out late, closing down bars and smoking, writing poetry and teaching. All of a sudden, I didn't have the emotional wherewithal to take out the garbage."
Reader Hailey Persinger says, "The lowest point of postpartum was truly the inability of my friends to relate. At one point, we were asked by one of our very closest friends whether we were going to Costco that week and if we could pick up liquor for a party. Our daughter was two weeks old. It was flattering that everyone thought we had things under control, but the truth was that we were struggling."
Intersecting life events or dynamics can compound the emotional stress of the postpartum phase.
Many new parents spend the early weeks of their baby's life with them in the newborn intensive care unit (NICU).
LGBTQ+ parents sometimes have to negotiate rigid gender roles or gender dysphoria, particularly when breast or chestfeeding.
It's also not uncommon for new moms to have to negotiate family and partner relationships, job changes, and housing instability.
Gloria "Becky" Alvarez, said that when she became a mom at 16, she was undocumented and in an abusive relationship. When her second child was born, she was homeless.
"My postpartum experience was filled with shame and fear--basically a sink or swim situation," she says. "I share this because today I look back as a current college student and it pains me to not have known that it was not OK that I felt lost and helpless. I hope my story is useful to moms who did not finish high school. It is possible."
Sometimes a birth is traumatic, or doesn't go as planned and the early weeks can mean the beginning of processing difficult events.
"My memory of my daughter's birth is like the memory one has of a severe car accident," says reader Hannah Sandstrom, who underwent a c-section without adequate anesthesia. "I don't even remember my mom and husband being there. The pain was so severe that my only defense was psychological collapse. And I carried that into my postpartum experience."
In these cases, Peprah says it's helpful to talk through your birth as soon as you can with someone who was there with you and can help confirm the facts and answer questions. This can help paint a fuller picture of what happened and perhaps resolve feelings of self blame.
You can also arrange to see or speak with a therapist, or ask someone you trust to help you set it up. Or set it up ahead of time.
Intense crying is also common, particularly within the first couple of weeks. However if it persists, it may be a sign that you need more support.
Peprah says that another sign is if you worry about being alone with the baby, and feel a heightened sense of anxiety when others leave the room or the house.
As Priska Neely reported in a previous LAist story, 1 in 7 moms deal with some form of postpartum anxiety or depression, though because many moms do not report it, this number could be much higher.
Carmen Boatwright, mom of two, says, "I wish someone had told me there is no 'normal.' What is OK for you and baby is OK. And if something doesn't feel right, no one can say it's what you're "supposed" to be doing. I wish I had talked to someone about how I was feeling early on, instead of "powering through." Women, and even more so women of color, are charged with and expected to carry the load, suck it up and be strong. I wish someone had said it's OK to feel weak and vulnerable and you're not the first to feel this way."
She says one of the best resources for any mom, whether or not you are feeling big emotions, is to seek out other moms. There are postpartum support groups throughout the city (see resources below) -- some you pay for a series, and others are free or low-cost. In all such groups, moms share their experiences, resources and information.
Hearing other mothers tell their stories can help you feel like you're not alone in what you're experiencing.
GIANT, SHINY AND ENGORGED
How are you going to nourish this baby? As Michelle Faust Raghavan reported in a previous LADYist piece on breastfeeding, that question can be quite complicated:
There is no shortage of boob science about the nutritional benefits of breastmilk and its role in reducing the risk of developing things like diabetes and asthma in kids. For moms, it's linked to a lower risk of breast and ovarian cancers. In short, it's healthy.
There's also no shortage of reasons why some women don't breastfeed. Some women don't want to do it. Some don't because of work. For others, it's not physically possible. It may not be an option at all for adoptive parents, women who've had surgery on their breasts, or radiation, or who have hormonal conditions.
Many new parents shared their stories about the shock of realizing the magnitude of the difficulty of one of the most central human needs.
In the first few days, your boobs go through an incredible transformation. Whereas initially you might be panicking from the few drops of colostrum that drip out, all of a sudden, at day 3 to 5 when your milk comes in, your breasts are enormous and as hard as rocks.
"I remember walking around with exposed giant, shiny, engorged boobs," says reader Katrina Valliere. "I was so miserable from the pain. I tried pumping, warm showers on my back, cabbage leaves... Nothing worked but time."
And then, if you are trying to breastfeed, you have to figure out how to get that milk from your breasts into the baby.
Depending on how your baby is latching, this can be painful and challenging.
Reader Beth Biron says, "Two nights after we got home from the hospital, baby was irate. She was at the breast but it was obvious from her cries of distress that she was hungry. I lost it. Insane with sleep deprivation and mom guilt, I bawled while whispering to the baby how sorry I was that she had me for a mom, and how much I wanted to be better for her. My husband found us just like that on the couch at 2:30 in the morning."
While some women struggle with undersupply, others have milk everywhere.
Reader Ashley G. says, "When I was feeding, my daughter would get choked on that amount of milk being expelled at once. Then she'd unlatch and milk would spray all over her face. Your bras will smell like sour milk."
Brandi Jordan, pregnancy and postpartum expert and board certified lactation consultant says one of the most important things moms-to-be can do to prepare for the postpartum period is to get some kind of breastfeeding education, whether that's through a class or having real and honest conversations with friends and family members.
Jordan told us, "It can feel like what you're experiencing that first seven to 14 days is what it's going to be like forever, and it really isn't. Things open up around three weeks, which can feel like an eternity if you don't know."
There is often a lot of concern at first about whether the baby is getting enough. But, said Jordan, "If you know, from your prenatal breastfeeding class, that your baby pretty much needs about a teaspoon of milk in that first 24 hours, the moms are less concerned if they see just a few drops coming out of their breasts."
When it's hard, ask for help. Ask a friend, a family member, a board certified lactation consultant, or all of the above. (Jordan says don't be surprised if your OBs may not have all the info you need around breastfeeding because that may not be their specialty).
Many moms also shared how difficult it was to make the choice to use formula.
Reader Taylor Hamp said she's a foodie writer with a nutrition minor and was determined to make breastfeeding work. Yet despite lactation cookies, supplements, diet, over 100 ounces of water a day, and power pumping every hour and a half, she still was unable to produce enough milk to satiate her daughter's hunger. She finally switched to formula.
Says Hamp, "If I could give any advice, from someone who was fiercely devoted to breastfeeding: If it doesn't work out, give yourself grace. Do what you must so that you'll never think back and regret that you could have done more. But don't hate yourself for not living up to your expectations. A full baby is a happy baby and a healthy baby."
Jordan agrees. She says it's important for moms to think about what's most comfortable for them, "I always tell people check with yourself each day. Don't make a plan of, 'I'm going to breastfeed for three months or five months or six months.' Really just go with the flow and see what's working for you and baby. And reach out for help."
YOU CAN DO IT. YOU'RE DOING IT ALREADY.
We received lots of advice from the stories you submitted. Of course, some advice contradicted other advice -- e.g. "Stay off your phone!" "Google is your best friend!" And that's because, again, every person is different. But, the overwhelming sentiment was the same.
You will get through this, as millions all over the world have done before you. And you'll come out stronger than you ever knew you could be.
Reader Hailey Persinger told us, "I wish someone had told me that the child that will be in your room with you after delivery is your child. Your baby. No one else's. You are all that baby needs. When the nurses tell you that you should hold the baby one way to nurse, but it isn't working, trust your instincts. When you don't feel respected by a doctor, demand a new one. Trust your instincts. When you know that with just a little bit of help, you could definitely get this breastfeeding thing, trust your instincts: call the lactation consultant. You know more about your baby than you think you do. Trust yourself."
Others also reaffirmed the idea of trusting your intuitions. "My mom told me something somewhere in the haze of those tough first months that I have since adapted and turned into my motherhood mantra," says reader Amber Norwood. "'Raise the baby you have, being the mama you are.' It's what I tell every new mama in my life."
- Postpartum Support International (PSI) - 24 Hour Hotline: 800-944-4PPD (4773)
- Maternal Mental Health NOW - Hosts a directory of providers and services in L.A. County
- National Suicide Prevention Lifeline - 800-273-TALK (8255)
- Compassionate Friends - Support for parents dealing with loss
- National Women's Health and Breastfeeding Helpline - 800-994-9662
- BreastfeedLA - Provides education and outreach for breastfeeding in Southern California and hosts a map of local breastfeeding resources
- La Leche League
Home Visiting Programs
L.A. County has several free programs with home-based visits to support families with new babies, available depending on hospital, zip codes, and other criteria.
- Home Visiting Programs - First 5 LA's overview of the "Welcome Baby" program and participating hospitals
- Home Visiting Program Directory for L.A. County
Support groups/mom groups
The best way to find one of the many support groups and parent and me classes that exist throughout Southern California is to search online for groups in your area. You might also find these groups through your hospital or places where you find breastfeeding gear. It sometimes helps to look for activities you enjoy (eg. yoga, swimming, dancing) and see if they have "baby and me" classes.
These are just a few resources:
- 211 - Provides information and referrals for all health and human services in LA County, including a query for "parent programs."
- CinnaMoms - Support circles for black women hosted at six WIC centers in the L.A. area, with the goal of breaking down barriers to breastfeeding.
- Kindred Space - A hub for midwifery care, doula support, lactation consulting and support groups.
- LOOM - Provides pregnancy, breastfeeding classes, and a doula directory.
- Pumpstation - Offers a variety of parent and me classes
- Two Doulas Birth - Offers childbirth education, a doula directory, and free monthly walks and support groups at Echo Park Lake and Kenneth Hahn State Park.
For Black Moms-to-Be
- What Pregnant Black Women Need To Know To Have A 'Safe And Sacred Birth' - Priska Neely's guide for expecting black moms
- First 5 LA's parenting site - Centralizes resources on a wide range of early childhood topics
LAist Associate Editor Lisa Brenner contributed to this report.
A version of this story was on the radio. Listen to it on KPCC's Take Two.