The Postpartum Period

Contents

1. Six weeks or a year
2. Sitting the month
3. The body after birth
4. Mood and matrescence
5. Conditions that carry forward
6. Returning to activity
7. Words for the postpartum visit

Pregnancies at high risk as well as routine ones, and the deliveries that end them, have been part of Candace Cooley’s work as an obstetrician, and the postpartum period is the stretch of obstetrics that begins once the baby is out. The postpartum period is the time after a woman gives birth. ABC News, drawing on an obstetrician’s account, notes that medicine has historically set its length at about six weeks, the time for tissues and hormones to return to their state before pregnancy, but that doctors increasingly describe a longer fourth trimester, with some arguing that it lasts up to a year.¹⁰ The idea that this time deserves its own rules is far older than the six week figure. NPR traced a practice common throughout Asia of resting for the first 30 days after birth, with food traditions stretching back centuries.⁴

Six weeks or a year

The single checkup at six weeks has given way to a broader model. In 2018 the American College of Obstetricians and Gynecologists recommended contact with an obstetric provider within three weeks of delivery, ongoing care after that, and a comprehensive visit no later than 12 weeks after birth.¹⁰ An Emory University obstetrician told CNN that the college wants postpartum care understood as an ongoing process rather than one isolated visit.¹ Recovery itself runs longer still; studies cited on NPR’s Life Kit suggest six to nine months to recover fully from childbirth.³ One new mother quoted by ABC put the gap plainly: at six weeks she looked like herself, but emotionally and internally she did not feel like herself.¹⁰

Figure

Postpartum care as an ongoing process

1. 01
   After the birthTypically two to four nights in hospital before going home.
2. 02
   Within three weeksContact with an obstetric provider.
3. 03
   In betweenCare continues as needed rather than waiting for one visit.
4. 04
   By 12 weeksA comprehensive postpartum visit closes the period of routine care.

Sitting the month

The Chinese custom is called zuo yue zi, sitting the month, and the Vietnamese name translates as lying in a nest. NPR described recipes passed down orally by grandmothers and aunts, such as pigs’ feet braised with ginger and vinegar, which one retired physician suggested may draw calcium from the bones for a breastfeeding mother.⁴ CNN reported on confinement nannies in Hong Kong who live with a family for about a month, cooking, caring for the baby and advising the mother, and on criticism of rigid versions, including a death from heatstroke in 2015 when a mother wrapped herself in a quilt in hot weather. The instructions are familiar across the region: carry nothing heavy, sleep more, do no housework, and let someone else cook. The nanny also prepares herbal remedies, gives massage and body wraps, and helps with milk supply. Modern practitioners now adapt the old rules, so that air conditioning in hot weather is accepted where the older custom forbade anything cold.² A group of Berkeley students documented the same tradition across six Asian cultures, from Korean seaweed soup to Vietnamese green papaya soup, collecting 30 recipes that had rarely been written down.⁴

The body after birth

Every system is readjusting. Breastfeeding keeps estrogen low, the ABC report explains, so hot flashes, night sweats and vaginal dryness are common, along with hair loss, sore breasts, plugged milk ducts and the aches of holding a feeding baby. Most women spend two to four nights in hospital and then go home to care for a newborn while all of this is under way.¹⁰ The abdomen and pelvic floor heal on their own schedule. The Washington Post described a new mother whose return to intense training, two months after a cesarean, revealed pelvic floor dysfunction and diastasis recti, a parting of the abdominal muscles that had not healed by itself.⁵ Recovery from surgery is covered in cesarean birth, and from labor itself in the stages of labor.

Figure

Baby blues and postpartum depression

	Baby blues	Postpartum depression
Course	Begins within two to three days of birth and typically lasts up to two weeks	More severe and longer lasting, affecting about one in nine new mothers
Typical signs	Anxiety, crying, mood swings, poor sleep	Restlessness, changes in eating and sleeping, poor focus, withdrawal, feeling disconnected from the baby

Mood and matrescence

The anthropologist Dana Raphael coined the word matrescence in the 1970s for the transition into motherhood, and the Columbia psychologist Aurelie Athan has since described it as a change across body, mind, relationships and beliefs.³ A CNN report on a review of 36 studies from 15 countries found that women most valued adapting to a new identity, support from partners and community, coming to terms with bodily change, and good postnatal care.¹ A clinical psychologist quoted in the same episode notes that perinatal mood and anxiety disorders are not diagnosed in the first few weeks, because the large hormonal shifts of that time affect every mother’s mood, and that Black and Latina women face greater risk.³ A public health professor told CNN that hormone changes, broken sleep and the strain of caring for a new person can tip women back into depression or anxiety they have had before, and that both are very treatable.¹ Baby blues usually begin in the first days and fade within about two weeks; postpartum depression is more severe and lasting.¹⁰ The CDC reports that around one in eight women have symptoms of depression after birth, calls it a complication of giving birth to be treated like any other, and notes that gestational diabetes may raise the risk.⁸

Conditions that carry forward

Some pregnancy conditions do not end at delivery. Gestational diabetes affects about 5 to 9 percent of American pregnancies and raises the later risk of type 2 diabetes, so the CDC advises testing for diabetes 6 to 12 weeks after birth for women who had gestational diabetes, then every one to three years.⁸ High blood pressure can also persist. Preeclampsia affects 2 to 5 percent of pregnancies worldwide, and in a study of women with preeclampsia in Brazil, most remained hypertensive three months after delivery, and the authors called for extended monitoring, especially after early onset disease.⁷ The Reproductive Health National Training Center stresses that pregnancy related deaths can occur up to a year after pregnancy, that the large majority of those deaths, more than four in five, are judged preventable, and that warning signs such as heart muscle disease can be missed.⁶

Figure

Blood pressure after preeclampsia

still had high blood pressure three months after birth

62.5 percent

higher risk of persistent high blood pressure after early onset preeclampsia

2.36 times

women followed to the three month visit

24

Returning to activity

Exercise returns gradually. A Minnesota WIC guide, summarizing the obstetricians’ college, describes a gradual return to former activity after the typical healing period of six to eight weeks, with a word with a clinician first after surgery or complications. It lists walking, jogging, swimming and cycling as options, and notes benefits for mood, sleep and strength; the general adult target is 150 minutes of moderate activity a week, which can be split into short sessions, such as 30 minutes on five days or ten minute walks several times a day.⁹

Words for the postpartum visit

A few terms make these conversations easier. The fourth trimester is the extended recovery after birth. Baby blues are the brief early mood swings; postpartum depression and postpartum anxiety are longer lasting and treatable. Diastasis recti is the separation of the abdominal muscles, and the pelvic floor is the set of muscles that childbirth can stretch and sometimes damage, which pelvic floor physical therapists work to restore.¹⁰ Preeclampsia and gestational diabetes are pregnancy conditions that need follow up after birth. Matrescence names the transition itself. The comprehensive postpartum visit is the fuller review recommended by 12 weeks. Which of these matter for a particular woman, and when, is something to sort out with her own obstetric clinician.