By Cassie Shortsleeve| July 14, 2020
"Six weeks after I gave birth to my first daughter, I found myself in my OB/GYN’s office for my postpartum checkup. After a quick conversation and a physical exam, my doctor told me that I was “cleared.” I could resume all regular pre-pregnancy activity.
I went home, fed my baby and went on a run — and had to stop after a half-mile. My pelvic floor felt like it was going to give out and — although once an avid runner — I felt clumsy. That night, I lay awake, milk-stained and sweaty. Nothing about me felt “cleared.”
Despite the fact that in 2018, the American College of Obstetricians and Gynecologists recommended that, to optimize women’s health, postpartum care should become more of a rolling process rather than a single encounter, for many new moms, the six-week postpartum appointment remains the only touch point with the health-care system that birthed her baby.
If Latin America has la cuarentena — a 40-day period when women take care of a new mom while she rests — and the ancient Indian medical system of ayurveda teaches us that we must nurture women for 42 days postpartum for the health of her next 42 years, the United States, traditionally, has this: one lone appointment that, in many senses, gives a message of closure to the fragile and monumental postpartum period.
"The four- to six-week time frame has historically been thought to be enough time for women to be able to go back to do more physically demanding jobs, like farming, without having any serious medical issues,” explains Heather Irobunda, a board-certified OB/GYN in New York. Your uterus has usually shrunk back to a pre-pregnancy size, lacerations have healed, soreness from birth has resolved.
But physical changes persist for longer — probably six months or so, says Kecia Gaither, director of perinatal services at NYC Health+Hospitals/Lincoln. Around then, pelvic floor and abdominal musculature tone returns, changes in hair normalize, and the menstrual cycle might become more regular (if it’s returned).
Some research even suggests women wait 12 months to conceive again. But how long does it take for the body to recover? It depends on where you look.
The Centers for Disease Control and Prevention, for one, says that a “pregnancy-related” death is a death of a woman while pregnant or within one year of the end of pregnancy, but “maternal mortality” is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of the end of pregnancy.
The Diagnostic and Statistical Manual of Mental Disorders, often called the “bible” of psychiatric health conditions, defines postpartum depression as depression “with postpartum onset: defined as within four weeks of delivering a child.” But, says Cindy-Lee Dennis, a professor at the University of Toronto who studies the postpartum period, “it’s fairly standard in the research literature to consider postpartum depression up to one year postpartum.” (Take a landmark 2013 study published in JAMA Psychiatry of 10,000 mothers: It found that 1 in 7 women develop PPD within the first year postpartum.)
Birdie Gunyon Meyer, a registered nurse and director of certification for Postpartum Support International, a nonprofit group that lobbied to extend the period following delivery in the definition of PPD, says: “I don’t think anybody really believes that the postpartum period is over at four or so weeks, but we give that impression when you come in for your four- or six-week checkup."
The truth is, the adjustment to parenthood takes time. It takes more than a couple of weeks and more than a couple of months. Researchers say Year 1 is critical for children and parents alike. “For the child, the brain is growing rapidly and the experiences that happen and the neurological pathways that are developed stay with the child for a lifetime,” says Dennis."
By: Ash Spivak Natalia Hailes
"It's no secret that the postpartum period is just hard. After growing and carrying a human for almost 10 months, you perform what is likely one of the most challenging physical and emotional feats of your life—birthing that baby. And then you find out you're just getting started!
During postpartum, you're healing physically and emotionally while a new, adorable human is entirely reliant on you (and requires way more work than while you were passively growing them). Add in little sleep, changing hormones and doing this all during a pandemic.
Becoming a parent forces us to confront some of our biggest fears—loss, lack of control, change, the unknown. But here's the thing about being in the postpartum period during this pandemic. You are sharing those fears with a whole lot of people out there: all of us are being forced to confront them.
It's like we're arriving at a jungle with no paths and no maps. But whether you recognize it or not, you are already starting to pave your way.
We have no control over how long this pandemic will last or what the outcome will be. The only thing we do have some control over is how we move through it.
One guaranteed way to move through postpartum during a pandemic with more grace and ease is to prioritize your own well-being. Taking care of yourself is taking care of your baby. The actions we are being asked to take to minimize the spread of COVID-19 mimic those that are necessary in the early postpartum days: stay home and slow down (if you have the privilege); care for yourself so that you can care for others. Just like on the airplane, you need to put your mask on first.
For some, circumstances will make this even more challenging (those who have lost jobs, are working full-time and homeschooling and in the postpartum period, those needing to return to the frontlines, and those in essential jobs). While our capacity may be great, we are also only human. We never really know the path. We can only focus on how we move through.
Here are some ways to prioritize your postpartum well-being right now, even during a pandemic.
Ask for help
You can't do it all on your own. While the physical isolation from your support systems is no joke, it's important to remember that you are not isolated in this experience. Even during these times there are ways for others to pitch in. Have someone set up a meal train or set up a fundraising page if you are in a tough financial time. Therapists, postpartum doulas and lactation consultants are all working virtually. Book appointments and put it all on your new baby registry—way better than another onesie!"
By: Katelyn Denning
"When was the last time you felt overwhelmed? Last week, yesterday, earlier today? My guess is, it probably wasn't that long ago. If your triggers are anything like the moms I work with, overwhelm can hit you at any point and in any situation.
Sometimes it's in the middle of the workday when the responsibilities and stresses of the job get to be so much that you think there's no way you'll ever climb out of this hole, let alone your inbox.
Sometimes it's in the evenings when you look around at the mess in your house, a pile of laundry and no certain plan for dinner that you feel like you've let your family down and what you should really do is quit your job so you could actually stay on top of all of it.
Sometimes overwhelm shows up when you're surrounded by two children who are wallowing in their own overwhelm of emotions, crying and whining, that you think life will be this way forever. And you're overwhelmed by the fact that you are the adult here.
Or sometimes, overwhelm waits to hit you until the craziness of the day has ended and you have your first quiet moment to yourself. When you finally sit down, exhale a big sigh of relief, and think about doing it all over again tomorrow, the crushing weight of overwhelm sits on you making it hard to breathe.
Can you relate?
No matter how it shows up for you, overwhelm feels heavy. It creates the feeling of being out of control in terms of practically everything you can think of. And like the temper tantrums we often witness in our children, it can be hard to snap out of.
Trust me—we have all been there and some of us probably more frequently than we would like to admit.
But just like we're taught how to approach and calm a toddler who is stuck in an emotionally overwhelming moment which often manifests as a screaming fit, there are things that we can do to help ourselves snap out of it, too. Things that can help us stop spiraling into that feeling of being out of control, and instead, grounds us in the present moment.
You will get through this.
Everything is not lost.
This is only temporary.
You've got this.
So the next time you feel that feeling, you know how it goes—your breath becomes short, your head starts to feel heavy, you can't see past your own nose and you just might break into tears if anyone asks you if you're okay—try one (or try all) of these things to catch your breath and reset."
No, lying flat after sex won't increase your chances of conception.
By Jen Gunter, MD| April 15, 2020
Photo: Armando Veve
"As an ob-gyn, I’ve personally encountered many fertility myths in my office or online — some of them even during my training. Why do they persist? Sex education, particularly about the physiology of reproduction, is typically incomplete and subpar. And when we do talk about fertility and reproduction, we don’t talk about it directly — euphemisms for the uterus, menstruation, the vagina and the vulva are still common, and when you can’t use a word, the implication is that the body part is shameful. And, of course, many myths persist simply because they’re alluringly fantastical, and we’re inclined to believe these tall tales over the stodgy facts. Here are seven fertility myths that need to be forgotten.
1. Phases of the moon affect menstruation
This is not an uncommon belief-some women even refer to menstruation as their "moon time." The confusion is understandable: The 29.5-day lunar cycle (from new moon to new moon) is very close to the average 28-day menstrual cycle. But studies show no connection between the moon and menses. Moreover, it is hard to envision how a moon-menstruation would be biologically beneficial to human reproduction.
2. Reproductive hormones need to be ‘in balance’
This is a common modern myth in gynecology exam rooms all across North America-and it results in a lot of unnecessary testing of hormone levels. The truth is that, for women of reproductive age, the hormone levels for FSH, LH, estrogen and progesterone change not only day to day, but also often hour to hour. When a women has certain symptoms-for example, an irregular menstrual cycle or infertility-hormone testing may be recommended to make a diagnosis. But in these situations, doctors will look at individual levels in conjunction with symptoms, rather than comparing levels with some mythical "balance." Being "in balance" may sound natural, like a person who is "in tune" with her body. But it is simply not a factual statement, or even a good analogy, for what happens biologically."
By Kristen Rogers, CNN
April 22, 2020
"(CNN)Becoming a mother is a variable experience, fluctuating in its joys and challenges before, during and after birth.
These phases are of equal importance, but the postnatal period (post-birth) is key to a mother's well-being, her adaptation to changes and the formation of a positive relationship with her baby.
The postnatal period is also an underserved aspect of maternity care, receiving less funding, service and attention from health providers, according to a new review on what matters most to women after giving birth, published Wednesday in the journal PLOS ONE. Add to that a worrisome pandemic, and it becomes even more crucial to prioritize a woman's well-being during this time of adjustment.
"Once the baby's out healthy, then people are kind of less bothered," said co-author Soo Downe, a professor in midwifery studies at the University of Central Lancashire in England. And commercial hospital systems may not see as much profit in keeping up with the wellness of the mother after birth, she added.
"There's all this intense focus on women's health during the three trimesters of pregnancy and then women deliver and there's really very little support after that," said Dr. Denise Jamieson, chair of the Department of Gynecology and Obstetrics at Emory University and chief of gynecology and obstetrics at Emory Healthcare. Jamieson wasn't involved in the study."
By Carmela K Baeza, MD, IBCLC| Art By Ken Tackett
"Some dyads (mother-infant pair) start their breastfeeding relationship in harsh circumstances. Frequently, due to medicalized births and unfavorable hospital routines, there are so many interferences to initiate breastfeeding that by the time mother and baby arrive home they are already using bottles and formula – despite mother having desired to exclusively breastfeed.
These mothers often feel that they do not make enough milk and that their babies prefer the bottle. They will make comments like “my baby doesn't like my breast”, “I cannot make enough milk”, “the more bottles I give my baby, the less she likes me”, and so on. This can become the road into postpartum depression.
Those mothers who are intent on breastfeeding will often look for support, and may find it in a midwife, a lactation consultant or a breastfeeding support group. These health care professionals or counselors may offer the mother to work on her milk production by expressing milk from her breasts (either with her hands or with a pump) and feeding that milk to the baby, as well as putting baby on the breast.
And this is what we call triple breastfeeding.
Imagine: mother puts baby at her breast. Baby suckles for an hour and a half, falling asleep frequently. Mother will tickle him, speak to him, encourage, often to little avail. After an hour and a half, mother will unlatch the baby (he never seems to come off on his own), put him in the crib, set up her breast pump and begin pumping, going for at least 15 minutes on each breast. Halfway through, the baby wakes up and cries – he´s hungry. But he was just on the breast for almost two hours! Mother turns off the pump (and so little milk has come out!) and feeds her baby a bottle of formula. She cries. She feels exhausted, useless, and unable to meet her baby´s needs. She has not left the house for days, because she is immersed in a never-ending cycle of breast-pumping-feeding."
Facing parental burnout? Use the magic word.
By Pooja Lakshmin|October 18, 2019
"While swapping horror stories of PTA wars, overscheduling and toddler meltdowns, parents these days will inevitably ask one another, “But, are you taking care of yourself?”
Self-care has become the panacea for an over-exhausted, workaholic American culture. And if there’s one job that spells constant fatigue, it’s being a parent. But how does self-care happen in a country where more than half of married couples with children have two parents working full time, and mothers are not only spending more time at work but also more time taking care of children?
It doesn’t help that the images we’re sold of self-care include meditation apps and Peloton binges. For mothers in particular, with self-care just an app click or exercise class away, there is a haunting sense that if you feel burnt out, you must not be taking care of yourself. Cue more stress and guilt."
By Penny Simkin| October 27, 2009
"Author/lecturer, doula, childbirth educator, Penny Simkin, PT, talks about pain in labor and the concept of "when pain becomes suffering."
By Penny Simkin| Oct 30, 2015
"Author and educator, Penny Simkin offers an introduction to the serious topic of traumatic childbirth including symptoms of PTSD and suggestions for facilitating postpartum recovery from a traumatic birth experience.
Traumatic childbirth occurs in as many as 25-34 percent of all births. Approximately one-third of those women may develop Posttraumatic Stress Disorder (PTSD).
For more information, visit pattch.org. Penny is one of the founders of PATTCh, Prevention and Treatment of Traumatic childbirth, whose vision is "a world where women, infants and families, experience optimal physical and mental health in pregnancy, childbirth, and the postpartum period."
Research on this condition is only about 10 years in the making.
By Julie Revelant
"When I had my first child six years ago, I was grateful breastfeeding turned out to be, for the most part, a smooth ride.
After a visit with the hospital lactation consultants, who showed me the best breastfeeding positions and gave me the support I needed, I was on my way, and continued to breastfeed exclusively for the next 12 months.
In those early months, though, I'd experience something odd-and often frightening-that I never told anyone about. When my daughter latched on and my milk let down, an intense feeling of anxiety, panic, and doom would wash over my entire body. For a brief moment-about 20 to 30 seconds-I had a sudden irrational fear that something bad was going to happen.
And as quickly as the feelings came, they went.
It was always unsettling and, at times, scary, but becuase I had struggled with anxiety for as long as I could remeber, I chalked it up to biology and hormones.
When I gave birth to my second child two years later, I wasn't surprised those same feelings surfaced once again. It was still unsettling, but thankfully, it didn't affect my ability to breasfeed her for 13 months.
Yet it continued to nag at me, and as a health journalist, I wanted to know why I'd often write about breastfeeding, and when I asked my sources if this was common, most of them had no idea what I was talking about. Then one day, I spoke with a lactation consultant and she told me what I had experienced was real and it had a name: D-MER: Dysphoric Milk Ejection Reflex.