Well-Being//

The Forgotten Trimester: An OB-GYN’s Guide to the Postpartum

Each year, it’s experienced by over 4 million in the United States and over 130 million women worldwide — yet most women still know very little about the postpartum.

The V Word Podcast: Breastfeeding Episode (clip)

1. What happens to my body?

The new mother’s body is amazing.

Your body changes faster than at ANY OTHER TIME IN YOUR LIFE.

Immediately after delivery, you lose approximately 10+ pounds (placenta, fluid, baby!). In the 1-2 weeks after delivery, women typically lose another 4-8 pounds from shedding of extra fluid.

You also lose about 200 – 1000 mL of blood as part of the delivery. Have no fear: your body is ready for it. New mothers have more clotting factors than any other time in a woman’s life precisely for this reason. This also contributes to the risk of blood clots in the first 3 months postpartum.

Meanwhile, as soon as your placenta is out of your body, your body has a rapid drop in a hormone called progesterone. This drop helps signal your breasts to start producing milk. The first milk is called colostrum and is highly concentrated fat, protein, and immune cells. More on breastfeeding below.

2. What actually happens after birth?

Check out our podcast episode on the Postpartum for more!

The placenta delivers. After your baby is born – through vaginal delivery or cesarean delivery – the placenta or “after birth” is delivered. Sometimes this requires an additional push, but usually the contracting uterus is enough. Your caregiver’s job is really just to guide it out in one piece.

The repairing phase. You may need stitches if you’ve had a vaginal delivery and definitely if you’ve had a C-section. Your care provider will spend some time assessing this and repairing.

Check out our podcast episode on the Postpartum Vagina for more!

The Golden Hour. Recent research has shown that spending continuous time with your baby for at least the first hour after birth is good not just for the baby – but also for moms. This interaction helps with bonding, helps stimulate breast milk and orient the baby to breastfeeding.

In the hospital (if you birth in the hospital). A typical postpartum hospital stay in the US after a vaginal delivery is 1-3 days, and after a C-section is 2-4 days. It’s good to tour not just the labor floor but the postpartum floor as well if possible so you can get a sense of where you’ll be/where to tell family and friends to go to see you after your delivery. Obviously you might stay longer if you have complications.

The first week postpartum. This is a very tender time period for most women. The focus is on orienting to your new role, figuring out breastfeeding, and figuring out sleep.  Breast milk tends to “come in” 2-5 days after delivery, bringing with it engorgement and a feeling that life is now broken into 2-3 hour breaks between breastfeeding (if you’re lucky).

*Check out our podcast episode on Breastfeeding for more!

You’ll see your Pediatrician within 1 week of delivery so that she can check on the baby, especially her weight. Your Pediatrician will also talk to you about breastfeeding and your general well-being.

The second week (and beyond). Each week, healing should improve. Vaginal bleeding should get less as the uterus “involutes” or goes back to a smaller non-pregnant size. Every woman’s healing process is different.

Three weeks after delivery. New guidelines suggest that women should see their Obstetric care provider within 3 weeks of their delivery and then again before 12 weeks. Not all practices have adjusted to this, but you should feel empowered to ask.

3. How can I prepare for the postpartum?

We are so focused on delivery that we often don’t prepare enough for the postpartum.

First, make sure you have help. We were not meant to raise children and figure out parenting alone. If you are partnered, talk about a plan for your family so that you feel supported. Ask your family and friends to help bring you food. Pay/ask someone to clean your house, do your laundry, get your groceries. ETC ETC ETC.

Second, make sure you’re hydrated and eating well. We think of pregnant women as “eating for 2”, but you actually burn more calories AFTER delivery. In pregnancy, women burn approximately 300-500 extra calories a day. Women who are breastfeeding and in the first few weeks of recovery are burning double that amount. Have a water bottle you love nearby at all times, especially while breastfeeding. Set up a friend/family food cycle, hire a food delivery service, stash food in your freezer while you’re pregnant that will be easy to defrost.

Third, set up some safe, cosy spaces for yourself in your house. A regular space for breastfeeding (or bottle feeding) is nice – though soon you’ll be able to do it anywhere. Make sure you have a water bottle nearby. You’ll be spending more time in your bathroom than before – make sure it’s pleasant. Consider having a body wash with a lovely scent. We joke that for a new mom, a 5 minute shower alone can feel like a day at the spa. Make it the best spa.

Fourth, remember this is a time of great adjustment and leaps in learning for you as well as your baby. Even the things that seemed basic (sleeping, peeing, pooping) are new and different. Give yourself space and time to adjust. If the first week all you do is get up, shower, and go outside, it’s a win.

Five, find a community. This is probably the most important thing women can do for themselves to prepare for this time period. Find a prenatal yoga class, participate in centering-in-pregnancy (group prenatal care), set up weekly or bi-monthly dates with your closest friends (to come to you), sign up for mommy-and-me ANYTHING, figure out your local library baby story times. The postpartum can be very lonely so the more women can do to ready their supports the better.

4. What about the “adulting” part of postpartum?

It will be magical. It is also a major life event that requires some actual adulting.

  • Figure out childcare. Discuss with your partner, your family, and see what’s available in your area. There are lots of options and doing your research when you are not sleep-deprived is very helpful. Plus, lots of places fill up quickly.
  • Order your breast pump. All insurance in the US has to cover a breast pump. Ask your care provider or insurance carrier how to order your free electric breast pump.
  • Figure out maternity leave. The US is one of the few developed countries without guaranteed paid maternity leave. Each job will have different options. FMLA is a way to keep your benefits (and not lose your job) while on maternity leave, but it doesn’t mean you’ll get paid. Learn more about Maternity Leave 101 here.
  • Birth control. Figure out what kind of contraception you’re going to use as some types can be started right after delivery. The WHO recommends spacing births at least 12-18 months apart but many women get pregnant quickly after a delivery because they’re not thinking about pregnancy prevention. Learn more about birth control after delivery here.

Check out our podcast episode on Birth Control for more!

5. When should I talk to my care provider?

The short answer is any time you have a question or feel like something is not right. Also, around 3 weeks postpartum and again

Also, if you’re having any of the following symptoms, talk to someone ASAP:

  • Heavy bleeding (heavier than the day before)
  • Fevers and Chills
  • Breast pain preventing breastfeeding
  • Difficulty breathing
  • Sadness or ambivalence about your baby

For more information, check out our Podcast episode on Postpartum Depression as well as the Resources tab of our website www.vwordpod.com

Check out more from The V Word by following us on instagram and twitter @vwordpod.

*This should not substitute for actual medical advice. Please contact your care provider with individual questions.

Photo: Mikaela Shannon Photography


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