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."