Postpartum Health: What New Moms Need to Know

During pregnancy, you see your care team regularly to ensure everything is on track. You might take classes and read books to get ready for the baby or write a birth plan and make checklists of supplies to buy. Still, nothing can truly prepare you for bringing a newborn home, where there may not be a plan to follow.

“Having a baby is by far the biggest transition that any of us make, but there are a lot of unknowns,” says UNC Health certified nurse-midwife Meg Berreth. “You don’t know how your delivery will go. You don’t know how breastfeeding will go. You don’t know if you’ll have an easy baby or a more difficult baby. It’s a lot of unknowns at a time when people expect you to be blissfully happy, and that can be a lot to handle.”

Although much focus will be on the baby, new mothers need physical and emotional support as they recover from childbirth. Berreth encourages new parents to have a postpartum plan that includes elements of self-care.

We talked to Berreth and UNC Health certified nurse-midwife Stacie Walker about what new moms can do to help their postpartum recovery.

Prioritize Rest

You might want to spend all your extra moments staring at your new baby, but Berreth and Walker agree that taking time to rest is essential in the weeks after childbirth.

“It’s easier said than achieved, but you have to protect your sleep and focus on rest to recover from labor and deal with all the ups and downs of the first few weeks,” Walker says. “It’s vital to your health.”

Even though you might have people around to help, this is not the time for you to take on more duties.

“In the first two weeks, I always say no cleaning, no cooking, no shopping in stores, no driving,” Berreth says. “If you’re doing any of those things, you’re probably doing more than you should be when you have a newborn. You have to rest.”

If you’re feeling well, you can resume some activities. Walking and stretching are OK, but you should avoid high-impact activity to allow your pelvic floor to heal.

Accept Help

To have time to adequately rest, you’ll need people around to share the responsibilities. If you find it hard to ask for help, you’re not alone.

“New moms have a lot of expectations for this time, and it’s easy to become disappointed if you feel like you’re not meeting them. Reaching out is really important,” Walker says.

If you’re not comfortable asking for help, make a list of what you need and give it to someone else to manage.

“Tell the person managing your list if you need a meal or someone to take your dog for a walk, and they can put it out there that you need something,” Berreth says.

Expectations and challenges related to breastfeeding are often the biggest issues for new moms. If you’re struggling in this area, reach out to a lactation consultant or your healthcare provider. Walker also recommends a postpartum doula, who can provide emotional and physical support and information after birth.

“People think about doula care for delivery, but you often need more help after delivery than during,” Walker says. “Doulas are skilled in providing emotional support and often pick up on signs of postpartum depression as well as lactation issues. They are a great advocate for women and families in this vulnerable time.”

Focus on Quality Nutrition

When you’re caring for a newborn, finding time to eat—let alone eat well—can be daunting; still, a balanced diet is key to your recovery.

“There’s a lot of emphasis on how to eat during pregnancy, but your diet is really important in the postpartum period as well,” Walker says. “Focusing on intake of protein, iron-rich foods and fiber while drinking plenty of water will aid in recovery and prevent added fatigue.”

If you’re breastfeeding, you should aim for an additional 300 to 500 calories per day, Walker says, due to the gradual weight loss that will take place and the energy that is required for you to make breastmilk. She shares some examples of healthy snacks: overnight oats, oatmeal energy balls, carrots and hummus, an apple with nut butter, a protein bar, and Greek yogurt with fresh fruit.

Your provider probably will recommend that you continue to take a prenatal vitamin or an iron supplement, B12 and choline during this time.

Know That Bathroom Issues Are Normal

Pregnancy and childbirth put a lot of pressure on the pelvic floor, and it’s common to have nerves about going to the bathroom after delivery.

“If a new mom has a history of constipation, we might advise her to use a stool softener every day for the first 30 days,” Walker says. “If a woman doesn’t have a history of constipation, then she’ll probably be able to recover with a healthy diet, lots of water and the occasional stool softener.”

If you have an epidural during delivery, you might experience some numbness afterward, making it difficult to empty your bladder, and a nurse can recommend a catheter while you’re in the hospital. At home, it may be tough to tell when your bladder is full.

“I advise that you empty your bladder before you feed the baby,” Berreth says. “If you’re breastfeeding, a full bladder can cause really bad cramping.”

In the first few weeks after childbirth, you may experience urinary incontinence when you cough, sneeze or laugh. If issues with bladder control persist after six to eight weeks, your provider might suggest that you work with a pelvic floor physical therapist.

“We recommend pelvic floor physical therapy for all women who have delivered, whether by vaginal route or cesarean,” Walker says. “A pelvic floor physical therapist will create a specific regimen to strengthen your core and pelvic floor muscles. It will help prepare you for future pregnancies, or for the rest of your life if you’re done having children. The incontinence is normal at first, but not for the rest of your life. Ask your provider for a recommendation and referral.”

Watch for Signs to Get Help

After delivery, you can expect some bleeding, soreness and changes in mood, but there are several symptoms that require immediate attention.

Bleeding: It’s common to bleed or spot for as long as six weeks after delivery. But if you’re saturating more than a pad an hour or passing large clots, you should be evaluated immediately.

Pain: “Pain that comes and goes is normal,” Walker says. “Pain that is persistent or that gets worse is a red flag that needs to be evaluated. If you experienced a tear during delivery, call your provider if it doesn’t feel like it’s getting better.”

Also call your provider if you feel pain at the site of your cesarean section incision or notice any signs of infection, such as redness, warmth to the touch, discharge, odor, fever or chills.

Ice packs, heating pads or ibuprofen can be helpful if you’re experiencing mild soreness or cramps.

Mood: “It’s normal to have ups and downs, to feel easily emotional and to become frustrated easily,” Berreth says. “It typically resolves in the first few weeks as the baby sleeps more often and you become more confident.”

About 1 in 7 women experience postpartum depression, which can affect their ability to care for themselves and their baby. Reach out to your provider if feelings of sadness or anxiety are affecting your daily life and ability to sleep.

If you have a history of depression or anxiety, your provider may ask you to have a postpartum check-in at two weeks to monitor your transition.

Postpartum preeclampsia: “Many women are unaware that preeclampsia, or high blood pressure during pregnancy, can occur anytime after delivery and as far as six weeks postpartum,” Walker says. “Red flags include a severe headache that doesn’t go away, blurry vision, changes in vision, pain in the upper right side of the belly and shortness of breath. Sometimes women report it as ‘something just doesn’t feel right.’ If you experience any of those symptoms, call your provider; you may need to go to an obstetric emergency room.”

Blood clots: If one leg or ankle is more swollen than the other, with pain or tenderness not caused by an injury, you might have a blood clot. Other symptoms include fever and shortness of breath or chest pain. These are medical changes that need to be evaluated immediately.

If you’re ever unsure whether something is normal, reach out to your healthcare provider. If all is going well, you’ll have a postpartum check-in with your provider four to six weeks after delivery.

If you’re concerned about your health after having a baby, talk to your provider. Need a provider? Find one near you.