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How to Navigate the Postpartum Period & Find Your Strength
The body goes through many significant changes during pregnancy. The heart pumps more blood through the body, increasing cardiac output and resting heart rate. The kidneys are taxed with filtering a nearly doubled blood volume. Respiratory rate often increases to supply more oxygen, and the uterus presses against the organs of the gastrointestinal tract, slowing down digestion.
Further changes take place during delivery. Hormones are responsible for each key step of the process. Oxytocin triggers uterine contractions, while beta-endorphins are released to help mitigate pain. Adrenaline and noradrenaline levels surge before delivery, stimulating the body’s fight or flight response to boost energy for the final push. Heart rate and blood pressure spike, and there is a 50% increase in cardiac output during the second stage of labor.
These kinds of changes in the body aren’t limited to pregnancy or labor. After delivery, there is still a lot going on at the physiological level. Hormonal fluctuations have a big impact on both physical and mental health during the postpartum period. Knowing what to look out for and how to track these changes can make navigating the postpartum stage easier.
What is Considered Postpartum?
The beginning of the postpartum period is marked by childbirth. Traditionally, the term ‘postpartum’ has been used to encompass the six weeks following labor and delivery. The postpartum period has also been conceptualized as consisting of three stages, which can last much longer than just six weeks:
- Acute Postpartum — This stage consists of the 24 hours following placental delivery. During this initial postpartum period, there is usually direct supervision from healthcare providers to monitor vitals and screen for potential complications including bleeding, eclampsia, and amniotic fluid embolism.
- Subacute Postpartum — The subacute postpartum stage can last anywhere from 2 to 6 weeks after giving birth. Many changes take place during this secondary stage as the body begins the recovery process. Research has found that around 90% of women will deal with at least one health issue during this stage.
- Delayed Postpartum — Delayed postpartum is the final stage of the postpartum period, and is estimated to last between 6 weeks to 6 months after delivery. The recovery that takes place during this stage is highly individualized and often takes time. Restoration of muscle tone and connective tissue is a major part of this stage.
When it comes to recovery after giving birth, each body is on its own timetable. For years, the standard advice has been that postpartum recovery takes six weeks and that a woman is ‘cleared’ for intercourse after this time has passed. It can take significantly longer for the body to heal fully and be cleared for exercise. According to some schools of thought, a woman’s body isn’t healed until 18 months postpartum. Even then, the body will still be dealing with the lasting changes of pregnancy and giving birth.
The Hormonal Changes of Postpartum
It’s no secret that hormones drive the changes of pregnancy and delivery, but they also play a large role in the postpartum period. During each stage, fluctuations in hormone levels can significantly impact the body and overall well being. It can take between three to six months after delivery for hormones to return to pre-pregnancy levels. Key hormones to be aware of during the postpartum period include:
Progesterone and Estrogen
Progesterone and estrogen are two of the main female reproductive hormones. The levels of both of these hormones are much higher during pregnancy because they support healthy development and help ensure delivery occurs at the right time. Progesterone and estrogen levels both fall dramatically right after birth during the initial postpartum stage. This sudden decrease can result in mood swings and feelings of anxiety or depression.
As estrogen and progesterone levels are falling following delivery, levels of the hormone oxytocin begin to increase. There is an initial increase in oxytocin during birth to induce contractions, and this hormone continues to be produced afterwards to support mother-child bonding. Oxytocin has also been linked to stress-relief.
Prolactin is released after delivery to stimulate milk production. Elevated prolactin levels after birth have also been associated with feelings of well-being and calmness. Prolactin levels remain high with breastfeeding, but will quickly drop and reach normal levels in one to two weeks without breastfeeding.
Production of the stress hormone cortisol often increases after birth. Labor and delivery takes a serious physical toll on the body, and caring for a newborn can be both mentally and physically tiring. Together, this can place a lot of stress on the body, maintaining high cortisol levels for weeks or months into the postpartum period. Elevated levels of cortisol have been associated with increased fatigue, worry, and depression.
These hormonal changes, combined with the stress and lack of sleep from taking care of a new baby, can make sticking to your regular routine difficult. It can be challenging to perform everyday tasks around the house, or find the time and motivation to fit in workouts.
The Physical Changes of Postpartum
Going through labor and delivery is a huge physical feat. As a result, most key body systems undergo changes in the postpartum period, including the cardiovascular, respiratory, musculoskeletal, gastrointestinal, reproductive, and urinary systems. These changes range from acute to temporary to much more long-term. These are some of the ways physical health is impacted during the postpartum period, broken down by how long they last:
During the acute postpartum stage after birth, there are widespread adjustments in the body as various levels and processes begin to normalize. The immediate physical impact of giving birth includes changes in these key systems:
- Cardiovascular — Heart rate is increased during labor, and this elevation can continue in the hours following delivery. Heart rate typically returns to a more normal level the day after birth. It’s common for blood pressure to rise during delivery, but it should quickly lower afterwards. Low or high blood pressure after giving birth can indicate complications.
- Respiratory — Breathlessness is common during pregnancy, as elevated levels of progesterone trigger fast, deep breaths. The respiratory rate and tidal volume can also increase when pregnant. It usually takes between two to three days after birth for respiration to normalize.
- Reproductive — After giving birth, the uterus shrinks until it reaches the size it was prior to pregnancy. It does so by contracting, and these contractions are referred to as ‘after pains’. They are often compared to menstrual cramps and typically last for three to five days post-delivery. There is also bloody discharge after delivery. It’s usually heavy for a few days, before lightening over the next several weeks. This flow can last for four to six weeks.
While acute adjustments in body systems take place in a matter of hours or days, there are also changes that occur in the span of a few weeks after birth. These temporary changes are part of the subacute postpartum stage, and include:
- Back Pain — The core muscles are weakened after pregnancy and delivery. As a result, more demand is put on the back muscles, which often leads to back pain. The body’s posture changes during pregnancy to accommodate extra weight and the growing uterus, and these postural adjustments can become a habit afterwards, contributing to backaches. It’s normal to see a return to pre-pregnancy posture around six weeks after birth.
- Urinary Incontinence — The process of giving birth stretches the muscles and tissues that make up the pelvic floor. The pelvic floor plays a major role in supporting the bladder and uterus. The stretching of pelvic floor muscles, combined with postpartum hormonal fluctuations, can make bladder control difficult and lead to leakage and urinary incontinence. These issues usually resolve within a few weeks, but can last for months in some cases.
- Night Sweats — As progesterone and estrogen levels drop after delivery, it’s common to experience night sweats. As the body works to regulate its temperature amid hormonal fluctuations, feeling hot and sweating at night is typical. Natural fluid loss after pregnancy also contributes to night sweats. Night sweats usually ease up after two weeks and then go away within a few weeks.
While many adjustments in the body are temporary, there are also changes that can last for months after delivery, or that are permanent. Long-term shifts can take place in the delayed postpartum stage, and can also last beyond it. These kinds of changes can affect:
- Hair — Increased levels of certain hormones during pregnancy can increase hair growth and thickness. When these hormone levels fall in the postpartum period, hair loss can occur. This can last for a few months, but hair growth and appearance usually normalizes within six months to a year.
- Feet — The arches can flatten during pregnancy due to weight gain. The feet can also lengthen due to loosening of the muscles and ligaments, which occurs in response to production of the hormone relaxin. It’s common for shoe size to permanently increase as a result of pregnancy.
- Energy Levels — It’s natural to feel exhausted immediately after giving birth. Low energy levels that last for weeks or months after birth, however, are categorized as postpartum fatigue. Research has found that poor sleep quality, financial difficulties, and lack of a support system can contribute to postpartum fatigue.
Postpartum Exercise and Physical Health
A regular exercise routine can help support overall recovery after giving birth. In addition, it can improve specific physical changes during the postpartum period. For example, physical activity boosts muscle strength. Targeted exercises can strengthen muscles in the back and core, reducing back pain and promoting better posture. Pelvic floor exercises can also support recovery from urinary incontinence. Overall, exercise can also increase energy levels, benefit sleep quality, and provide stress-relief — all of which can mitigate postpartum fatigue.
The Mental Changes of Postpartum
Changes during the postpartum period are not exclusive to physical health. Recovering from giving birth also has a major impact on mental health. Rising and falling hormone levels and the stress that comes along with taking care of a new baby can lead to significant mental changes. These are some of the ways mental health is affected during postpartum:
The majority of new mothers will experience the ‘baby blues’. According to the American Pregnancy Association, 70-80% of new mothers deal with some form of this. The baby blues is a temporary period of negative emotions that starts right after or within a few days after giving birth. It is characterized by symptoms including:
- Mood swings
- Trouble concentrating
- Feeling overwhelmed
- Feeling restless or impatient
- Fatigue and trouble sleeping
When these symptoms strike, they are often short-lived and aren’t constantly present throughout the entire day. The baby blues don’t usually last more than two weeks into the postpartum period. It’s theorized that many factors play into the baby blues, including hormonal changes, sleep deprivation, adjusting to a new routine, and dealing with the mental and physical impact of delivery.
Postpartum depression is a more serious mental health condition that has longer lasting effects. Some of the symptoms of postpartum depression can initially seem like the baby blues, but if symptoms persist beyond two weeks, it’s more likely postpartum depression. In contrast to the immediate onset of the baby blues, the symptoms of postpartum depression can also show up weeks or months into the postpartum period. They include:
- Feelings of hopelessness and worthlessness
- Intense anger
- Social withdrawal
- Shame and guilt
- Trouble bonding with the baby
- Difficulty thinking and making decisions
- Sleeping too little or too much
- Reduced interest in favorite activities
- Thoughts of harm or death
- Anxiety and panic attacks
The symptoms of postpartum depression are more severe than the baby blues and are a more consistent presence. Postpartum depression can drastically impact quality of life and everyday functioning. It’s essential to seek treatment and care from a healthcare provider for postpartum depression, because symptoms will continue to worsen without attention.
Postpartum Exercise and Mental Health
The stress that comes along with adjusting to being a new mother and managing physical and mental postpartum changes can make finding time for exercise difficult, but consistent exercise is an investment in long-term maternal health. Research has found that exercise can be a vital preventative measure in lowering the risk of experiencing depressive symptoms during and after pregnancy. Individuals who exercised regularly were less likely to develop depression than those who were physically inactive. The endorphins released by regular workouts can also boost mood and support relaxation.
Track Changes with WHOOP
WHOOP can help you track changes in your body as you go through each stage of the postpartum period. With the WHOOP Journal, you can log the specific symptoms you experience as you recover in the weeks and months following delivery. You can also see how key metrics are impacted by these symptoms, such as HRV, respiratory rate, and sleep performance. As you implement a fitness routine, you can see how these metrics change and get recommendations for improving your recovery.
Get unparalleled insight into postpartum changes with WHOOP.