It wasn’t until I had my own baby that I realized how little support and preparation is available to new moms. While postpartum is the most joyous, love-filled time, it can also be incredibly challenging in many (often unexpected) ways.
When I was pregnant, I did everything I could to prepare for my baby’s arrival. I was the first of my friends to have a baby, so I was largely flying blind and focused on what I thought were “necessities.” Things like, setting up the nursery, washing the baby clothes, and organizing all the baby supplies.
After my son was born, I realized I was completely unprepared for all of the things I would go through during postpartum and beyond. After 9 months of growing my baby, there was no talk of what recovery would look like or what I would need in the year to follow.
I was unprepared for the sleep deprivation, the emotional rollercoaster, the physical healing, hair loss, brain fog, and simply how long recovery would take. I spent countless hours searching for any solutions that would make me feel better or more like “myself” again.
Throughout my research, I discovered that there was actually a lot I could’ve done to set myself up for an easier transition into the postpartum period. Looking back, I would’ve prepared for my own healing, as much as I prepared for the baby. I would’ve considered things like outsourcing for more help around the house, lining up postpartum specialists for myself, and having a nutrition and movement plan in place that would build me back to a place of feeling strong.
It became clear that new moms needed more resources around postpartum preparation and more support during that fragile period. While postpartum is challenging, there are things you can do to make the experience easier.
My goal with these handbooks is to take the mystery out of the postpartum experience, by making it simple for moms to know exactly what to expect, how best to prepare, and get the things they need to feel better- all in one central place.
What is this
Your handbook to everything postpartum: helping you prepare for and recover after birth. Studies show 85% of new moms feel blindsided by postpartum recovery, but it doesn’t have to be this way. We’ve put together this comprehensive handbook of all the things no one told you about what postpartum is really like.
How to Use This Handbook
As you prepare to welcome your little one into the world, it’s important to also prepare yourself for the postpartum period. This handbook is designed to provide a high-level guide to the postpartum experience. Here, you will find valuable information and tips on what to expect, how to prepare, and the tools you need to ensure a smoother transition into early motherhood. For even more comprehensive and detailed guides, please refer to the supplemental Nutrition and Movement Handbooks.
What you’ll learn
This handbook is designed for:
- Moms-to-be who are focusing on their own postpartum prep, in addition to preparing for baby’s arrival.
- New moms early in the postpartum experience who are looking for guidance and tools to get through this stage with a bit more ease.
Through this handbook, you’ll gain insight and confidence as we demystify the postpartum experience, by diving into what’s really going on with your body during those early days and weeks. Specifically, we’ll cover everything from the immediate post birth experience, physical and emotional recovery, to the best ways to heal through nutrition and movement. Each section also includes relevant links to the best products, experts, and resources to support you through this season.
- Section 1: Post Birth 101 — What the postpartum period really looks like
- Section 2: Support System — The importance of building your support network
- Section 3: Physical Recovery — What physical recovery looks like and how to heal
- Section 4: The Mom Registry — A one stop shop for all the items you really need.
- Section 5: Emotional Wellbeing — Acknowledging the emotional toll and how to get help.
- Section 6: Nutritional Care — Food is healing. A primer in the essential nutrients.
- Section 7: Postpartum Movement — Getting back into movement safely.
** Please note, both the Nutritional Care and Postpartum Movement sections are intended to provide a high level overview. For a more detailed deep dive, please see the accompanying Nutrition and Movement Handbooks.
Section 1: Post Birth 101
The postpartum period, often referred to as the “fourth trimester,” is a crucial phase that begins after childbirth and lasts for the first twelve weeks (and really, beyond). During this time, your body undergoes significant physical and emotional changes as it adjusts to the demands of new motherhood, all while recovering from the effects of pregnancy and birth.
In this section, we pull back the curtain on the realities of the postpartum experience and the physical and psychological changes that come with it.
Understanding the Postpartum Period:
Anthropologists call the transition into motherhood “matrescence,” similar to “adolescence,” because of how massive the change can be. It is a time of great physical and emotional transformation that marks new beginnings and the birth of a mother. It’s an incredible time, and truthfully, the shift into motherhood can also be quite challenging. It’s essential to recognize that postpartum recovery is a natural and gradual process, and giving yourself the time and care you need is paramount.
While every woman’s experience is different, there are some common changes typically observed during the first six weeks postpartum:
- Uterine Contractions and Involution: During pregnancy the uterus expands to 500x its normal size. After delivery, the uterus contracts to help reduce its size and prevent excessive bleeding. Over time, the rate of contractions slows and becomes less noticeable. By around 6-8 weeks postpartum, the uterus should be back to its pre-baby size (about the size of a pear).
- Lochia Discharge/Postpartum Bleeding: Lochia (postpartum bleeding and discharge) is heaviest in the initial days and gradually decreases in volume. It starts out a bright red and lightens in color over time, eventually becoming more watery. This process typically lasts around 4-6 weeks, but can last up to 12 weeks in some cases.
- Breast Changes: Breasts start to produce colostrum in the early days, the first milk, and can become engorged. Engorged breasts feel full, hard or lumpy with tightly stretched skin that can look shiny or red. They often feel warm, are uncomfortable and painful to touch, and may be accompanied by a low-grade fever. 67% of women report feeling engorged by day 5 after birth. Over the next few weeks, breastfeeding becomes more established, and milk supply adjusts to baby’s demand.
- Perineal Healing: If there was perineal trauma or stitches, the healing process occurs during this time as these tissues begin to repair. The duration of perineal healing can vary from person to person, depending on factors such as the extent of perineal trauma, individual healing capacity, and the care provided during the postpartum period. Most women experience significant improvement in perineal comfort and healing within a few weeks after childbirth, but complete recovery may take several months.
- Hormonal Changes: The postpartum hormone drop that occurs in the first 48 hours after birth is the single largest hormonal change over the shortest time period that a woman experiences in her life. During pregnancy, the placenta produces progesterone levels that are 70x normal levels. Once the placenta is delivered, these levels fall to a baseline of zero by 2 days postpartum. Estrogen levels also plummet 90-95% after delivery. These hormone fluctuations are one of the reasons contributing to the “baby blues” that new moms often experience, which manifests as moodiness, depression, anxiety, and other psychological issues. In more severe cases, this can contribute to Postpartum Depression.
Sleep Deprivation
Without a doubt, lack of sleep is one of the hardest parts of those early postpartum days. While you’re recovering from giving birth, adjusting to having an infant at home, and dealing with all of the emotional and physical challenges of the postpartum period, you also have to function with poor sleep quality and fewer hours of sleep. That’s because newborns require care every two to four hours and have no sense of day vs. night.
How long does this last?
It varies baby to baby, but generally speaking, the first three months are the hardest when it comes to sleep. While newborns sleep a lot (we’re talking 16 hours in a 24-hr period), they have no concept of day or night and need to be tended to every 2-4 hours.
Generally, around the three month mark, babies are able to stretch longer between feedings, so sleep starts to improve. See chart below for more details on baby sleep needs up to 2 years:
| Age | Total sleep hours | Total hours of nighttime sleep | Total hours of daytime sleep |
|---|---|---|---|
| Newborn | 16 hours | 8 to 9 | 8 |
| 1 month | 15.5 hours | 8 to 9 | 7 |
| 3 months | 15 hours | 9 to 10 | 4 to 5 |
| 6 months | 14 hours | 10 | 4 |
| 9 months | 14 hours | 11 | 3 |
| 1 year | 14 hours | 11 | 3 |
| 1.5 years | 13.5 hours | 11 | 2.5 |
| 2 years | 13 hours | 11 | 2 |
Given the impact of sleep deprivation (on top of everything else), taking care of yourself during the postpartum period is not a luxury; it’s a necessity. Your well-being directly impacts your ability to care for your newborn and adapt to your new role as a mother. Prioritizing self-care helps you heal physically, emotionally, and mentally. Remember, you can’t pour from an empty cup, so making self-care a daily practice is a gift both to yourself and your baby.
How to prioritize self care during the postpartum period:
Rest: Easier said than done, but the best thing you can do to help yourself heal is sleep. Rest is essential for your body’s recovery. If napping is realistic, try to sleep when the baby is sleeping. Even just closing your eyes and resting is beneficial. During night feeds, take shifts with your partner if you are bottle feeding. If you are nursing, have your partner manage the diaper changes and getting the baby to sleep, so you can get back to bed a bit earlier. If it’s within your budget, a night nurse can also be a huge help here in enabling you to get as much rest as possible.
Nutrition: Fuel your body with nourishing foods that provide the energy and nutrients you need. Focus on a balanced diet rich in whole grains, lean proteins, fruits, vegetables, and healthy fats. More on this in the Nutrition Handbook.
Hydration: Drink plenty of water to stay hydrated, especially if you’re breastfeeding. Dehydration can affect your energy levels and milk supply. You might want to think about adding in electrolytes, which are necessary nutrients for optimal body function. During pregnancy you lose more electrolytes and trace minerals than at any other time. Replenishing electrolytes and trace minerals are also needed to support lactation.
Identify your Support Team: Having coverage in the first weeks postpartum will allow you to prioritize your rest and will make recovery easier. Before you give birth, make a plan for what your support team will look like and assign roles (making meals, household chores, caring for the baby). Your support team can range from just your inner circle of close friends and family to outside help from doulas, night nurses etc.
Gentle Movement: Once cleared by your doctor, engage in light, gentle exercises to promote circulation and aid in healing. Consult your healthcare provider before starting any exercise routine. More on this in the Movement Handbook.
Professional Help: If you experience persistent feelings of sadness, anxiety, or depression, seek help from a healthcare professional. Postpartum mood disorders are common and treatable.
Remember that every mother’s postpartum experience is different. It’s okay to ask for help, take breaks, and adjust your routine as needed. By practicing self-care, you’ll be better equipped to provide the love and care your baby deserves while taking care of yourself in the process.
Section 2: Creating a Support System
Postpartum recovery is one of the most challenging phases in a woman’s life and often many new moms don’t have a plan in place for their own recovery. After childbirth, the changes that happen during pregnancy don’t disappear overnight, leaving many moms incredibly depleted. Having a baby starts a new stage of physical, hormonal, and emotional recovery that can last years. The care and support a woman has that first year is critical for her long term health.
In this section, we’ll discuss why it’s essential to set up your postpartum support system, what that can look like, and how to get the support you need.
Identifying Your Support Network:
Building a strong support network is crucial during the postpartum period. Surround yourself with people who are understanding, empathetic, and willing to lend a helping hand. Your support network can include:
- Partner: Lean on your partner for emotional support, assistance with baby care, and shared responsibilities.
- Family and Friends: Reach out to close family members and friends who can offer practical help, companionship, and a listening ear.
- Healthcare Professionals: Establish a good relationship with your healthcare provider, midwife, or doula, as they can provide guidance and address any concerns.
- Online Communities: Join parenting forums and online groups where you can connect with other new moms who are experiencing similar challenges.
- Support Groups: Attend local support groups or workshops focused on postpartum well-being and parenting.
Communicating Your Needs:
Open communication is key to receiving the support you need. Be honest with your loved ones about your feelings, challenges, and requirements. Don’t hesitate to express what would be most helpful to you, whether it’s assistance with household chores, preparing meals, or spending quality time with you and the baby.
Hiring Professional Help:
In some cases, hiring professional help can significantly ease the postpartum transition. You may want to consider some of the following services in your postpartum preparation:
- Postpartum Doula/Night Nurse: A postpartum doula/night nurse provides emotional support, practical guidance, and assistance with baby care and household tasks. They are especially helpful at night, feeding and changing the baby so the parents can get some much-needed rest.
- Lactation Consultant: If you plan to breastfeed, a lactation consultant can help you overcome breastfeeding challenges and ensure a successful breastfeeding journey. For more support, this is a great place to start.
- Housecleaning Services: Hiring a cleaning service can alleviate the burden of housework during the early weeks of motherhood.
- Meal Delivery Services: Consider using meal delivery services, preparing freezer meals, or having family organize a meal train before the baby arrives to ensure nutritious meals without the added stress of cooking.
Remember that seeking and accepting help is a sign of strength, not weakness. Having a strong support system in place can make a significant difference in your postpartum experience and overall well-being.
Section 3: Physical Recovery
Childbirth is a major medical event and it can take a year or more for the body to repair itself. Your nutrient stores are depleted faster than in pregnancy, which impacts energy levels, mood, milk supply, skin and hair loss, and overall recovery. Layer on the impact of stress, low sleep & breastfeeding and you’re at a major deficit.
In this section, we’ll uncover what to truly expect from both vaginal and cesarean births, the best ways to heal, and how to get the support you need.
Vaginal Births:
If you’ve had an episiotomy or tears, proper care is essential for a smooth recovery. Research shows that 85% – 90% of first-time births result in vaginal tears.
How long does recovery last:
The length of recovery depends on the type of tear. There are four degrees of tears, with the vast majority (94%) being first- and second-degree minimal tears. First-degree tears typically don’t require stitches and heal quickly (in a few days to a week). Fourth degree tears can take several months to heal.
How to heal:
- Relieve Pressure: Sit on a pillow or padded doughnut-shaped cushion, to ease discomfort. Prevent sitting on hard surfaces that restrict blood flow and slow healing.
- Cool it Down: Keep the area dry and cool with an ice pack or a chilled witch hazel pad. A numbing spray or cream can also provide significant relief.
- Keep it Clean: Use a squeeze bottle/peri bottle to clean the area.
- Medications: Consider an over-the-counter pain reliever. Additionally, talk to your health care provider about using a stool softener or laxative to prevent constipation in those early weeks.
C-Section Births:
A c-section is a major abdominal surgery that involves delivering an infant through an incision in the lower abdomen. Over 30 percent of babies born in the US are delivered by Cesarean section.
How long does recovery last?
Following a c-section, you’ll stay in the hospital for three to four days post birth, for immediate recovery, pain management and post-surgical care. Once home, you’ll need to keep the incision clean, and not to pick up anything heavier than your baby to prevent stressing the incision site. Short term recovery is typically about six to eight weeks, although this can vary greatly.
Longer term, many women report much longer cesarean birth recover times. Some studies have found that 60% of women have pain at the incision site up to 24 weeks after birth. Some women may also have pain deep in the abdomen or back pain, as part of the recovery process. Remember, this is a major surgery and recovery needs to be thought of in terms of months.
How to heal:
- Clean It: Gently clean the incision site with mild soap and water. Pat it dry with a clean, soft towel.
- Monitor for Infection: Watch for signs of infection such as redness, swelling, increased pain, or discharge. Contact your healthcare provider if you notice any concerning changes
- Avoid Heavy Lifting: Refrain from lifting heavy objects or engaging in strenuous activities that could strain your incision site. Typically, the recommendation is not to lift anything heavier than your newborn.
- Rest: Your body needs time to rest and repair itself from surgery. Try to rest and sleep as much as possible.
- Movement: Rest is incredibly important, but so is moving around. Don’t push it, but try to get some light movement in when you feel ready.
Pelvic Floor Exercises:
Pelvic floor exercises, also known as Kegel exercises, can aid in the recovery of pelvic muscles and prevent issues like urinary incontinence:
- Identify the Muscles: Practice stopping the flow of urine midstream to identify your pelvic floor muscles.
- Perform Kegels: Squeeze your pelvic floor muscles for a few seconds, then release. Gradually increase the duration and repetitions as you get stronger.
- Incorporate into Routine: Perform Kegels throughout the day while sitting, standing, or lying down.
- Consult a Specialist: Consider consulting a pelvic floor physical therapist for personalized guidance.
Diastasis Recti:
What is it?
Diastasis recti is what happens when the abdominal muscles, which separate during pregnancy to make room for the uterus and growing baby, remain separated after delivery. Usually harmless and very common in those who are pregnant or postpartum, diastasis recti often resolves on its own, but there are ways to help it along.
How common is it?
Research suggests that diastasis recti affects 60% of postpartum women six weeks after birth, and 30% a year after birth.
How do I know if I have it?
You can usually check by looking in the mirror: A wider waistline indicates mild separation. It can cause a bulge in the middle of the abdomen where the two muscles separate and may be more noticeable when you move from lying down to sitting up.
Common complaints with this condition are a sensation of heavy pressure on the pelvic floor, lower back pain, constipation and/or urinary incontinence. Diastasis recti ultimately weakens ab muscles, which can lead to back pain and make daily activities, such as lifting and standing with good posture, more painful and difficult.
Set a reminder to ask your doctor to check you for diastasis recti at your six-week checkup.
How long does it last?
Diastasis recti is most pronounced in the year after birth, with symptoms reversing visibly between six weeks and 12 months postpartum.
What can I do about it?
There are programs and exercises that can resolve diastasis recti with regular practice guided by a physical therapist or a fitness or Pilates instructor. (Your ob-gyn is a great resource for a physical therapist referral.) There are also online programs to join.
Research shows that while diastasis recti isn’t preventable, actively working toward a strong core pre-pregnancy and continuing appropriate core exercises during pregnancy is vital to post-delivery recovery.
What not to do if you have diastasis recti:
Classic crunches, bicycle crunches, ab exercises that lift both legs at once when you’re lying on your back, and any movement that bulges the abs forward or twists the abdominals could all make the condition worse.
Get Support:
An online exercise program that alleviates back pain, diastasis recti, leaky bladder and prolapse symptoms.
An education and movement course that will give you a thorough understanding of the pelvic floor and deep core system.
If you’re looking for a pelvic floor provider in your area, this is a great resource.
Section 4: The Mom Registry
Many moms aren’t being honestly informed or prepared for the emotional and physical challenges they’ll face in the first year after childbirth. They are fully prepared for the baby’s arrival but have no idea how to care for themselves or what they’ll need to heal. That’s why I put together the Mom Registry- a comprehensive list of the things you actually need.
This section takes you through all the items you need to prioritize your own recovery and wellbeing. From post-birth healing essentials, to breastfeeding must haves, to critical supplements and services, it’s all here for you.
For Vaginal Birth
A plastic tub that you can fill with warm water and fits over a toilet seat. It helps promote healing and cleansing of the perineal area. We like these or these soaks to use in the sitz bath. These are clean of harsh chemicals and help soothe sensitive areas.
This is a squirt bottle that helps with cleansing the perineum. It also helps if you experience burning during urination, which can last a few days or even weeks after giving birth.
Disposable Postpartum Boyshorts
Super stretchy underwear designed to keep pads and all other recovery layers in place without compromising comfort.
An instant ice pack and pad in one. These are incredibly soothing on any sore areas. Can even be used on c-section incisions.
Witch Hazel Cooling Pad Liners
Full-coverage medicated pad liners, delivering front-to-back cooling relief in a single sheet. Instant pain cooling relief to help with discomfort and speed up healing.
Super lightweight and subtle, these are a great option once postpartum bleeding begins to taper a few weeks in.
These help to support the pelvic floor and core while it recovers. They offer gentle compression to help reduce swelling.
Once you just need a pad and not the full disposable underwear, these are great and are infused with essential oils that help with healing and discomfort.
Made with medicated witch hazel – no dyes or fragrances. Speeds up post-birth healing and reduces swelling.
Includes all the products discussed above (disposable underwear, instant ice maxi pads, cooling pad liners, healing foam). The perfect starter kit for new moms, to make it through those first few weeks of recovery.
A kit of elevated birth recovery, postpartum and breastfeeding essentials that you didn’t know you needed.
The best for a reason.
Grab a few extras from the hospital to take home. Instantly soothes discomfort.
For Breastfeeding
Can be used both hot or cold- hot for relief from postpartum cramping or milk clogs, cold for pain relief from post-birth pains.
The Original Silver Nursing Cups
Silver nursing cups for sore nipples are a newborn must have for new moms, who need help with healing and soothing sore nipples.
Organic Nipple Butter Breastfeeding Cream
A good nipple cream is a staple for nursing moms in the early days of breastfeeding. This one is made with organic herbs and oils that are traditionally used to soothe and moisturize.
Day 1 Breastfeeding Essentials
IBCLC-approved essentials for evidence-led breastfeeding support from the first moments
While nothing will replace breastfeeding best practices, including brewers yeast into your diet can definitely help increase milk supply.
For C-Section Recovery
Postpartum High Waisted Underwear
Super stretchy and high waisted, designed to not roll down over incision bandage during c section recovery.
Full coverage protects your incision scar plus firm outer layer protects from bumps. Includes a front and back pocket to slip in targeted hot/cold therapy packs.
After 9 months of pregnancy, it takes several months to regain core strength in postpartum. In the weeks immediately after delivery, compression and support are essential in providing comfort and aiding the recovery.
Designed with 3 adjustable straps to help provide your core structure and compression where you need it. Helps with mobility post c-section.
C-Section Silicone Scar Patches
Medical-grade silicone to help treat and and reduce redness plus discomfort associated with c-section scars. Patches hydrate plus protect scars to help improve their look and feel through recovery. Reuse each patch for up to 7 days.
This is a squirt bottle that helps with cleansing the perineum. Helpful for c-section recovery, to reduce the amount you bend over.
They do what they say- a catch all for postpartum healing.
Frida Mom C-Section Recovery Kit
Rather than buying each piece individually, this kit comes with a Peri Bottle, disposable C-Section Postpartum Underwear, a Postpartum Abdominal Support Binder, Skip The Shower Wipes, NS Silicone Scar Patches- all included in an essentials bag with grippy socks for the hospital.
The kit contains 12 research-backed products and two pocket guides—one for you and one for a supporter—offering the perfect solution to help you or a loved one feel prepared.
Mother the Mother:
The perfect gift for expecting & newly postpartum moms, this set includes 3 non-negotiables for helping her recover and feel her best. Includes Nipple Balm, Postnatal Multivitamin + Omega-3, and their Recovery Tonic.
Needed Collagen Protein Powder
You need extra protein during the postpartum period. Collagen can help with tissue repair after giving birth, and a whole host of other things.
Postpartum tonics created with the nervous system in mind; combining nervine and adaptogenic herbs in every formula (all breastfeeding safe).
An organic, postpartum meal delivery service- providing frozen meals directly to your door.
A postpartum meal program to adapt to where you are in your journey. Foods are focused on healing and rebuilding your body during this critical time, so that you can feed and care for your little one.
A cash fund baby registry that gives growing families the gift of whole family wellness. Friends and family can contribute funds towards the things you need the most, like essential support in the form of doula care, breastfeeding support, meal deliveries, and so much more.
Organize meals for a friend after birth.
Section 5: Emotional Well-being
After giving birth, it’s common to feel a swirl of emotions and exhaustion. Your body just went through a huge transformation, your hormone levels are ebbing and flowing, you’re likely experiencing a severe lack of sleep, and you’re now in the thick of a completely new chapter. It’s common to experience anxiety, postpartum depression, and fatigue.
It’s easy to dismiss new symptoms and challenges as part of the postpartum process, but it’s important to understand that hormones play a significant role in our physical and mental well-being. Below, we go deeper on common postpartum symptoms and the best way to manage hormonal changes and your mental health.
First, a quick rundown on postpartum hormones:
The postpartum hormone drop that occurs in the first 48 hours after birth is the single largest hormonal change over the shortest time period that a woman experiences in her life. By the third trimester, our estrogen and progesterone levels peak at about 6 times their pre-pregnancy levels. Once the placenta is delivered, these levels fall to a baseline of zero by 2 days postpartum. Meanwhile, the hormones prolactin and oxytocin stay elevated to support breastfeeding and bonding with the baby. Needless to say, all of these changes can play a huge role in our mental and emotional well-being postpartum.
A more detailed breakdown below of the role of hormones during pregnancy and in postpartum:
- Estrogen and progesterone play the most pivotal role. During pregnancy, they support the growing fetus and your rapidly changing body. When you’re expecting, progesterone levels rise significantly early on, preparing the endometrium and its vessels to provide nutrients to the fetus. Progesterone also blocks uterine contractions to prevent preterm birth.
- Prolactin stimulates milk production, and it remains in the body for as long as you are breastfeeding. It influences behavior, metabolism, immune system functioning, and fluid regulation.
- Oxytocin is another hormone that’s important for labor and breastfeeding. It starts the uterine muscle contractions for delivery, then moves milk into the breasts when it’s time to nurse. Research from several studies has shown that oxytocin also impacts social behavior. Specifically, oxytocin helps you stay tuned in and respond to important signs in your environment. For example, oxytocin may promote feelings of trust and bonding (such as mother–infant bonding or intimate connection) or contrary reactions such as defensiveness.
- Relaxin is secreted by the ovaries, placenta, and uterine lining throughout pregnancy. In the first and second trimesters, it inhibits muscle contractions, preventing premature labor. Later, it promotes the rupture of membranes surrounding the fetus before softening the cervix and vagina and loosening pelvic ligaments to ease delivery.
When will my hormones go back to normal after postpartum?
Every woman is different and every experience is different. Typically, by around 8 weeks postpartum, you may notice that your hormones start to regulate but that doesn’t mean you’ll feel “back to normal” by any means. Having a newborn is exhausting and overwhelming at times – even if your hormones are balanced! Stress & lack of sleep can also cause an increase in your stress-response hormone, cortisol — in turn, melatonin and serotonin levels will decrease which can negatively impact your mood.
Generally, by around 6 months postpartum, progesterone and estrogen should be back to pre-pregnancy levels. However, women who are breastfeeding may find that their hormones take a little longer to return to normal. The hormone relaxin, which loosens your muscles to prepare for pregnancy and labor, can stay in the body for up to 12 months post-birth.
Possible Impacts of Hormonal Imbalance:
If the progesterone and estrogen levels do not normalize and remain imbalanced long term, it can have a cascading effect on other hormones as well. The following conditions can occur:
- Hypothyroidism – Estrogen dominance can interfere with thyroid function by limiting the availability of the thyroid hormone in the blood, which means they can’t be used as energy for the body. The thyroid plays a role in metabolism, temperature regulation, and weight management. Symptoms include loss of energy, fatigue, difficulty losing weight, cold intolerance, dry skin, hair loss, poor memory, slow wound repair, constipation, loss of libido, and depression.
- Adrenal fatigue – Cortisol is produced by the adrenal glands in high numbers during pregnancy and birth, which can often deplete the nutrient stores that are required to make the hormone. The adrenal glands are unable to keep up with the body’s demands and become worn out, leading to symptoms including severe fatigue, low blood pressure, lightheadedness, decreased immunity, headaches, mood swings, and irregular cycles.
If you are concerned about a long term hormone imbalance, make sure to reach out to your doctor for support. They can run simple tests to check your hormone levels.
Recognizing Baby Blues vs. Postpartum Depression:
What is it?
As we discussed, during pregnancy, a variety of hormones increase dramatically, peak during childbirth, and then crash back down to pre-pregnancy levels immediately after birth. Since these hormones are linked to emotional states, someone who has just given birth typically experiences an emotional rollercoaster. This can range from mood swings and crying spells to a spike in anxiety and difficulty sleeping.
How common is it?
The emotional changes that accompany the postpartum period are normal and extremely common, with 70%- 80% of women experiencing some degree of emotional upheaval in the weeks following birth.
How to distinguish between Baby Blues and PPD?
Often, the emotional ups and downs of this time period are referred to as the “baby blues.” However, it’s important to differentiate between the baby blues and postpartum depression (PPD):
- Baby Blues: Occur within the first two weeks after childbirth and involve mood swings, irritability, weepiness, and mild anxiety. These feelings usually subside on their own.
- Postpartum Depression (PPD): A more prolonged and intense form of emotional distress that may develop within weeks or months after childbirth. Symptoms include persistent sadness, overwhelming fatigue, anxiety, changes in appetite, difficulty bonding with the baby, and feelings of worthlessness. If your symptoms do not subside after a few weeks, please seek professional support.
| Baby Blues | Postnatal Depression | |
| Occurrence | As many as 8 of of 10 women | Roughly 1 in every 10 women |
| Avg. Duration | Peaks after 4 or 5 days, typically subsides after 2 weeks | Can persist for months, if left untreated |
| Onset | Within a day or two of giving birth, following the rapid hormone changes | Can occur at any point during the first year after birth |
| Treatment | Self care, ask for support so you can get some rest | Seek professional care, possibly medication or therapy can help |
If you are concerned you may be experiencing PPD, this online questionnaire can be a good place to start.
What can be done about PPD?
Seeking Mental Health Support:
- Professional Help: Consult a mental health provider experienced in postpartum issues. Therapy can be effective in treating PPD.
- Medication: Your doctor may suggest antidepressant medications, which act on the brain chemicals that are involved in mood regulation. There are breastfeeding-safe options, if that is a concern.
- Community: Share your emotions with a trusted friend, family member, or mental health professional.
- Support Groups: Join postpartum support groups to connect with other moms who are facing similar challenges.
Finding Community:
Feeling understood and supported by others who are going through similar experiences can be incredibly beneficial for those suffering from any type of postpartum hormonal imbalance. Here are a few ways to approach this:
- Join Mom Groups: Support groups can be incredibly helpful during this time, especially if you don’t have many friends who are currently pregnant or new moms. This universalizes some of the challenges you may be feeling and allows you to see that you are not alone in the difficult transition to motherhood.
- Virtual Mom Groups: If it feels hard to leave the house, there are also a number of virtual mom groups you can join.
- Stay Social: Maintain connections with friends and family members who are supportive and uplifting.
Build Your Village:
These are a few of our favorite online resources for finding community and support postpartum.
Prioritizing postnatal recovery through health coaching, acupuncture, and postpartum prep services.
Whole-body collaborative care from trying to get pregnant through motherhood. Akin connects you to health care providers to support you on your motherhood journey (ex: pelvic floor therapy, acupuncture, mental health therapy, nutrition, infant feeding).
CircleMoms provides support and connection for mothers in the first 3 months after birth. Through location-specific support groups, CircleMoms is the essential, built-in village that every mom needs postpartum.
A maternal mental health community providing a space to learn, grow, and heal. A community of mothers and moms-to-be who are working together to make lasting lifestyle changes, improve their mental and physical well-being, and devote space to themselves.
Be kind to yourself. Remember that adjusting to motherhood is a significant life change, and it’s normal to experience a range of emotions. Taking care of your emotional well-being is just as important as taking care of your physical health. As always, don’t hesitate to seek help if you’re struggling, and remember that you’re not alone in this journey.
Section 5: Nutritional Care
After birth, your body needs to replenish everything it gave to grow and birth your baby. Postpartum, your body requires higher levels of 15 key nutrients versus during pregnancy due to the increased demands of postpartum recovery and lactation. Your mood, energy levels, brain function, and even mental health all take a hit postpartum as a result of hormone fluctuations, sleep deprivation & elevated stress. Proper nutrition is essential for your postpartum recovery and to support your body’s healing and breastfeeding needs.
In this section, we’ll discuss how to prepare your kitchen for your postpartum healing and recovery. Food is medicine and proper nutrition is essential to replenish your depleted nutrient stores.
The following is meant to be a high-level overview. For those interested in a deeper dive into nutrition (including nutrient guides, pantry prep and recipes), see the Nutrition Handbook or Supplement Handbook.
Diet:
- High-quality foods: Consume a variety of nutrient-dense foods, including lean proteins, whole grains, fruits, vegetables, and healthy fats.
- Warming Foods: After birth, your body needs as much easy to digest, warming, liquidy and grounding food as you can give it. Especially for the first month after birth, choose warm over cold. Think warm soups, stews, and teas.
- Cooked Vegetables: While you may think reaching for a salad is the healthy choice, it’ll actually be hard on your recovering digestive system. Your organs are still moving back into position and need as much support as we can give. During this immediate postpartum time, cook your vegetables to make them easier to break down.
- Fiber-Rich Foods: Incorporate fiber-rich foods to prevent constipation, a common postpartum issue. Consider foods like dried apricots, prunes, nuts, and seed-based crackers.
- Iron-Rich Foods: Protein is important to the speed and effective repair and replenishment of body tissue, so do your best to incorporate iron-rich, blood-building foods into at least two of your daily meals, especially while you are still bleeding. Consider foods like liver, red berries, red meat, dark and leafy greens, soups, stews, broths, nettle tea, red beans, sesame, and tahini.
- Omega-3 Fatty Acids: Include sources of omega-3 fatty acids, such as fatty fish (like salmon), flaxseeds, and walnuts, to support brain health. If you aren’t a huge fish eater, make sure to take an Omega-3 supplement.
Hydration:
- Water Intake: Staying hydrated is crucial for both your recovery and breastfeeding success. Postpartum moms need at least 16 glasses of water per day, in order to flush toxins from your body, speed up healing, and support a steady breastmilk supply. Keep a water bottle handy to remind yourself to stay hydrated.
- Fluid-Rich Foods: Consume water-rich foods like fruits (watermelon, oranges) and vegetables (cucumbers, celery).
- Limit Caffeine and Sugary Drinks: While some caffeine is okay, excessive consumption can affect your hydration levels. Sugary drinks should be limited.
Supplements:
Consult your healthcare provider before taking any supplements, but you may consider the following:
- Prenatal/Postnatal Vitamins: Continue taking prenatal vitamins to ensure you’re getting essential nutrients, especially if you’re breastfeeding.
- Vitamin D: Many postpartum women have low vitamin D levels. Sunlight exposure and supplements can help maintain adequate levels.
- Iron and Calcium: If recommended by your healthcare provider, consider iron and calcium supplements to support your recovery.
- Vitamin C: After birth, hormones are plummeting, organs are repairing and wounds are healing. All of this requires extra vitamin C to help form new tissue and produce collagen.
- Omega-3: Healthy postpartum Omega-3 levels are critical for breastmilk nutrient content, maternal mood, brain function, hormone balance, and overall postpartum recovery.
Remember, nourishing your body with the right foods and staying hydrated will contribute to your overall well-being, energy levels, and ability to care for your baby. For more detailed guidance and meal planning during the postpartum period, please refer to our Nutrition Handbook.
Section 6: Gentle Movement
Pregnancy and birth are the two most physically demanding events your body will ever go through. It takes time to grow a baby and it takes time to heal and to rehabilitate your pelvic floor and deep core muscles.
Proper training, including strengthening and releasing of the pelvic floor, is critical in the first year postpartum. For new moms, pelvic floor issues during pregnancy, birth and postpartum can lead to back pain, hip pain, leakage and more. To avoid long term impacts and alleviate symptoms, proper recovery and healing is reliant on what you do in those early months postpartum.
In this section, we discuss ways to approach early postpartum movement, how to know when it’s safe to do so, and some actionable exercises you can try at home.
First, a quick rundown on how pregnancy affects the musculoskeletal system
As the belly expands, the abdominals stretch and the back muscles shorten. The connective tissue in the abdomen thins and separates. The ligaments and joints in the pelvis become very unstable. The pelvic floor often weakens under the weight of the fetus. Resuming movement postpartum is not just about strength, it’s also about regaining proper function and core stability.
When is it safe to work out again?
Whether you birthed your baby vaginally or via C-section, it’s important to remember that your body has gone through a physical trauma, and for some women, major abdominal surgery. The initial weeks post-birth are a critical time for you to rest, heal, nourish, and restore your body as you bond with your baby.
The American College of Obstetrics and Gynecology recommends new mothers resume normal physical activity and exercise 6 weeks after vaginal delivery and 8 weeks post C-section. You can start with some gentle exercises to reclaim some strength earlier than 6-8 weeks.
How to approach early postpartum movement:
When supporting your postpartum recovery, there are some simple but effective things you can do, even before getting cleared by your provider. In fact, doing nothing for six weeks, then jumping right back into your “normal” exercise routine, is not an appropriate way to get back into exercise after having a baby. The good news is there’s a lot you can do before being medically cleared that is safe, effective, and beneficial for your body’s recovery.
Rest
Rest may not technically seem like an “exercise” to do postpartum, but it is one of the most crucial pieces in setting you up for a strong, smooth recovery. Rest should be your top priority in the first 1-2 weeks. You’re probably still bleeding as your uterus contracts down to its pre-pregnancy size, and the internal wound on the uterine wall left behind by the placenta starts to repair. Begin to reconnect with and become aware of your alignment, your posture, and how you’re sitting or standing.
Walk
Walking is crucial in regaining your body’s natural function. It is a low-impact activity that helps improve blood flow, decreases clotting risk, loosens up tight joints and muscles, and helps build back core stability. Gentle walking can assist with the recovery of your pelvic floor muscles, which may become weakened during pregnancy and childbirth.
Breathe
Our breath is how we connect to our core. During this time, you can begin to safely stimulate the deep core muscles with a simple breathing technique called “360 breathing” or diaphragmatic breath. When performed correctly, it’s the best abdominal exercise you can do for your body right now. Gentle enough to be performed in the days immediately following birth, it simulates the body’s relaxation response and helps slowly build your mind-muscle connection.
360 Breath: Here’s how it works:
- This can be performed lying down, sitting, or standing. Begin in a neutral spine.
- On the inhale, your belly inflates as you relax your core and pelvic floor. You’ll feel your rib cage and abs open.
- On the exhale, your belly deflates as your core engages, abs and rib cage close, and the pelvic floor lifts. Hold for 5 seconds.
- Work up to 5-10 breaths with the abdominal contractions several times a day.
Light mobility and stretching
Our bodies can get so tight and strained from daily motherhood tasks like breastfeeding, sitting, and carrying our babies. This can cause aches and pains in areas like our upper neck, back, hips, etc.
Adding 10-15 minutes of intentional stretching and mobility in these areas can help ease these pains. These could include: cat/cow pose, child’s pose, and neck rolls.
Deep core and pelvic movements
It will also be beneficial to add deep core and pelvic floor-specific movements to aid your recovery. These movements are when you match the diaphragmatic breath to intentional movement. You’ll want to start simple, then increase the difficulty as you get comfortable synching the breath, core, and pelvic floor together. The following moves will help improve strength, stability and coordination.
Heel Slides: Here’s how it works:
- Lie on the floor with knees bent, spine neutral and arms at sides.
- Begin with the basic 360 breath to engage the abs. Then, slowly slide one leg out (inhaling) until it is parallel to the floor, and then exhale as you slide it back into the starting position.
- Alternate sides, extending the other leg out and then back in to complete one rep.
Leg Extensions: Here’s how it works:
- Lie on the floor with knees bent, spine neutral and arms at sides.
- Begin with 360 breath to engage the abs. Exhale to raise one leg to tabletop position.
- Inhale to slowly extend the lifted leg out as close to the floor as you can without arching your back. Then return leg to tabletop position, then bring foot back down to the starting position.
- Switch sides. Progress over time until you can hover your leg about 2 to 3 inches above the floor.
The core and pelvic floor went through so much throughout your pregnancy and birth, so it is essential to prioritize slow, progressive, and intentional deep core and pelvic floor movements during this recovery phase.
Body weight functional movements
After you’ve accomplished the connection breath, gotten comfortable with your short walks, and feel good with your stretching, mobility, deep core, and pelvic floor movements, you can consider adding functional bodyweight movements.
Depending on your recovery circumstances, around the 4-6 week mark is when these may feel appropriate to add to your routine. This timeline will be longer if you had a c-section birth.
These include exercises like squats, short step-ups, light shoulder presses, and others that resemble everyday tasks.
How do you know if it’s too much too soon?
As you begin exercising postpartum, your body will give you signs that you’re exerting yourself too much and need to back off. Pelvic pain, pressure, excessive bleeding, or leaking when you’re running or jumping can be signs of pelvic floor dysfunction. If you’re experiencing any of this discomfort, it’s important to consult a pelvic floor physical therapist, who can build a personalized plan to help to heal your core and strengthen your pelvic floor.
Some of our favorite virtual resources for physical rehabilitation:
Recover smarter postpartum with 700+ on demand fitness classes. Join our community of moms and redefine your relationship to exercise.
Every Mother creates a personalized daily exercise regimen tailored to address your unique core and pelvic floor needs at any life stage, whether you need help with one or multiple symptoms.
An online exercise program that alleviates back pain, diastasis recti, leaky bladder and prolapse symptoms.
Helping women prepare their mind and body for pregnancy, motherhood and beyond, through evidence-based, barre-inspired movement classes.
Pre and post natal experts who know what your body is capable of. They specialize in 1-on-1 personal training (in SF and NYC) that prepares women for the demands of pregnancy, labor and motherhood. Also offering virtual services.
The Postpartum Prep Checklist
You’ve packed your hospital bag, decked out the nursery, and installed the carseat. But are you prepared for your postpartum healing and recovery? Now that we’ve gone through each section in detail, let’s make sure you have everything covered:
- Support Systems in place
- Family
- Friends
- Baby Care (Night nurse, doulas etc.)
- Specialists (lactation consultant, sleep consultant)
- Physical Recovery
- Vaginal birth supplies
- If planned, c-section birth supplies
- Breastfeeding supplies and support
- Emotional Recovery
- Create your village
- Friends/family support/childcare
- Postpartum mom groups (in person or virtual)
- Know the signs of baby blues/PPD
- If needed, reach out to your provider for help
- Things to consider: Therapy, medication etc.
- Create your village
- Nutritional Care
- Prepare your kitchen with these key elements:
- Nutrient-rich, warm, cooked foods
- Fiber is critical
- Hydrate, hydrate, hydrate
- Supplement when necessary
- Meal delivery service/meal train lined up
- Prepare your kitchen with these key elements:
- Easing into Movement
- Plan in place for early postpartum movement
- Pelvic floor therapist scheduled (if not working with one while pregnant)
- Know the warning signs if you are moving too quickly
Sources and Inspiration:
- Hellopostpartum.com
- Journals.bmj.com
- Llli.org
- Cdc.com
- Ncbi.nlm.nih.gov
- Thematrescence.com
- Withakin.com
- Thisisanya.com
- Perinatology.com
- Drmaehughes.com
- Fourthouse.com
- Circlemoms.com
- ACOG.org
- Pelvicrehab.com
- NASM.org
- The Postnatal Depletion Cure, Dr. Oscar Serrallach
- Mothernutrient.com
- Flo.health