The Postpartum Period

Postpartum Period Lasts for approximately six weeks Mom’s body goes back to its nearly pre-pregnant state A time of physical and psychological adjustment to the process of childbearing

Physical Adjustments Estrogen and progesterone drop sharply and remain low until ovaries start producing hormones again Mom may either have a great deal of energy or feel exhausted and let down. Loss of sleep is a huge stressor. Involution: the process of the uterus returns to its pre-pregnant size Uterus contracts from 2-3 pounds immediately after pregnancy to 2 -3 ½ oz. Nursing helps contract the uterus.

Notice Kate's postpartum tummy

Postpartum issues with Mom Vaginal bleeding (called lochia) occurs for up to 6-8 weeks. Small clots are normal, but large clots may require medical attention. Episiotomy or tearing wounds take time to heal. Sitz baths and ice packs are helpful. Uterine contractions can be painful (reminiscent of labor) as uterus shrinks back to size. Urination may be painful or difficult for a few days. If Mom isn’t breastfeeding, breasts become swollen and painful for several days.

The Baby Blues At least 70% of new mothers feel anxious, depressed, moody, and upset starting 2-3 days after birth. Peaks around 3-5 days but these feelings can come and go for weeks or months or even the 1st year. Probably related to the drop in estrogen & progesterone. Women vary in their sensitivity to these hormonal fluctuations.

Postpartum depression A more serious bout of the baby blues that affect between 10-15% of new mothers (41% of mothers who have had PPD before). Most women who get it have had a previous bout of depression or were depressed during pregnancy. Persistent feelings of sadness turn into a major depressive episode Onset is usually about 4 weeks after delivery and interferes with daily functioning Less than half of the women affected seek help. Some antidepressants are safe for breastfeeding moms. Cognitive-behavioral therapy and exercise can also help.

Video about Postpartum Depression http://www.youtube.com/watch?v=MJ6ALUrwSRM

Effects of postpartum depression on the family Children of depressed moms are 2-5 times more likely to develop behavior problems. Mom’s interaction with baby and older children suffers when she’s depressed; less emotionally available Insecure attachment pattern is more common in babies of depressed mothers. The more extreme the mom’s depression and the more stressors in her life, the more the parent-child relationship suffers.

More about postpartum depression By the time a baby is 6 months old, he/she shows emotional symptoms such as negative, irritable mood and attachment difficulties. Depressed mothers have inconsistent discipline, leading to adjustment problems in children. Children may become clinically depressed themselves or mimic their mother’s anger, becoming antisocial, impulsive, and aggressive. Marriage suffers as well.

What about Fathers? Fathers have considerable adjustment after a baby is born, although most find wife’s pregnancy more stressful than either the birth or the postpartum period. May feel resentful and jealous of attention baby gets from mom; some feel replaced by baby. Father’s support & caring can buffer Mom against postpartum depression (Persson et al., 2011). Women who have a lot of support from the father have a lower incidence of postpartum depression (Smith & Howard, 2008).

Depression in New Fathers As many fathers as mothers have symptoms of depression after the baby’s birth. Depressed dads interact less with their children and report having a lack of social support First-time fathers are stressed and often disappointed by their post-baby sex life. Almost all couples experience a dip in marital satisfaction after the birth of a child, and this pattern remains in place for at least 4 years after the child is born (Doss et al, 1999; Lawrence et al., 2008). Planned pregnancies are related to less stress & depression & less marital dissatisfaction.

Postpartum Psychosis Affects about 1 in 500 women, especially those with certain risk factors (e.g., bipolar disorder before pregnancy) http://www.youtube.com/watch?v=a4WBaO4g83c