What your doctor doesn’t tell you about the postpartum period

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IN THIS ARTICLE

Trigger warning: This blog post mentions suicide.

As a board-certified OB-GYN, startup founder, physician executive, and mother, I wear many hats—but I am especially interested in centering parents in the journey of growing their families.

It’s crucial to nurture not only our children, but also ourselves during this process. I’m passionate about how we can improve the overall physical and emotional health of the entire family during pregnancy, birth, and postpartum.

Each family’s story is different, but if you’re preparing to bring a child into your life, here’s what I would tell a friend about safeguarding their mental health after their child arrives.

1. Everyone needs a postpartum plan.

You hear a lot about the birth plan, but don’t forget about those first few weeks after the baby. Below are some strategies.

Start planning early.

By the start of your third trimester, figure out what your support system will look like for your first month with your baby. Do you have people you can call? Are they going to stay with you or nearby for a period of time?

You may decide to adjust your plan, but having some structure in place, so it isn’t just you, or even just you and your partner if you have one, for the first month or two can make an enormous difference in your well-being. 

Ask for support so you can support your child.

We can shift our frame of reference away from just being centered on the baby—without the guilt of feeling selfish!

We can shift our frame of reference away from just being centered on the baby—without the guilt of feeling selfish!”

I love the trend of friends and family coming together and creating meal trains, so parents don’t have to worry about cooking or preparing food for themselves. If you support, nourish and feed those parents, they will be better equipped to care for their child. 

Anticipate your outsourcing needs.

Every family will have their own challenges, but it’s important to think carefully about the ones that yours might face, whether it’s breastfeeding, recovering from a Cesarean birth, returning to work, or other issues.

Try putting even just a little bit of thought into that because even if you don’t feel comfortable making decisions before the baby arrives, you can do some planning. For example, you could research and create a list of postpartum doulas, lactation consultants, or house cleaners in case you need additional support.

Connect with other parents.

parents chatting

Even if you’re stuck at home at first, it’s important to have regular outlets that make it easy for parents to ask questions, like small online communities.

Parents should have something to plug into, whether it’s an in-person group or an internet forum where they feel safe asking questions. Maybe it’s an experienced mom or dad friend who can chat by phone regularly. Setting up those channels in advance will help.

Did you know?
In other countries, they have weekly postpartum support groups as part of your health plan.

Did you know?

In other countries, they have weekly postpartum support groups as part of your health plan.

We don’t have that baked-in infrastructure in this country, so you’ll have to take the initiative to create that support yourself.

2. Sleep issues often exacerbate postpartum mental health challenges, but they are normal and treatable.

The biggest thing I worry about is the risk for self-harm among not only birthing parents, but also supportive partners. We know that suicide is a significant driver for the high maternal mortality rates in the United States.

Here are some things to know about your mental health so you can show up not only for your family, but also yourself.

Sleep is a major factor.

Everyone knows that the postpartum period is defined by a lack of sleep. Newborns tend to sleep for up to 18 hours a day. You may get long stretches for the first week, but after that you’re pretty much on a cycle with your infant feeding every two to three hours. 

Going from your normal adult circadian rhythm, where you’re sleeping hopefully eight to 10 hours every night, to sleeping the way an infant sleeps, which is getting up every two to three hours, is a shock to the system.

Going from your normal adult circadian rhythm, where you’re sleeping hopefully eight to 10 hours every night, to sleeping the way an infant sleeps, which is getting up every two to three hours, is a shock to the system.”

If you’re breastfeeding, especially exclusively, that’s also part of the equation. Are there feelings associated with having to respond? If you have a partner, how much are they involved?

So many things are wrapped up in fatigue and sleep during this time. Sleep has an impact on mood, and mood has an impact on sleep. 

But help is out there. I always encourage patients to get information through local classes on newborn care and at least speak to a postpartum doula who can help educate them during this time when their sleep schedule is going to be unpredictable.

This might also be a time that you look back at the postpartum resources list you made—do you need a postpartum doula or night nurse? Or can a friend watch your baby while you and your partner catch up on sleep? Should you outsource the dog walking?

Postpartum mood changes are normal and treatable.

If you’ve given birth physically, you’re going to likely experience some feeling of the blues in the first couple of weeks of the postpartum period. Others will experience more serious and lasting perinatal depression or anxiety.

If you have blues beyond the two-week mark, tell your doctor or midwife, and ask to be screened for a mood or anxiety disorder if you haven’t been already.

The goal would be to get connected with therapy and/or medication, which you may just need for a period of time.

If you’re able to advocate for yourself when you notice these symptoms, you’ll understand that you’ll be able to break the cycle and feel better. The more you seek help, the more help you can access.

It’s not just women.

Today, families are more diverse than they’ve ever been. You might have single fathers, single mothers, single non-binary individuals, gay couples having children, and all sorts of arrangements.

All parents are impacted by having a baby enter their lives, especially nowadays when there are more expectations for the non-birthing parent. As our society is evolving to shift some of the burden off of birthing parents, the non-birthing parents are subject to similar stimuli and stressors that birthing parents have traditionally been.

We’re seeing peripartum mood disorders in about 10 percent of fathers. They’re absolutely affected by lack of sleep, feeding schedules, and other things that put them at risk for mood disorders.

We’re seeing peripartum mood disorders in about 10 percent of fathers. They’re absolutely affected by lack of sleep, feeding schedules, and other things that put them at risk for mood disorders.”

All parents should be screened for these symptoms and have outlets for help. 

Partners should be on the lookout.

Loved ones can usually spot red flags for birthing parents. Things like, are you really able to rest? Are you having trouble falling or staying asleep? Are you eating regularly? Do you have an appetite? Are you preoccupied with things you can’t get out of your mind?

If you’re having trouble moving through the day, feel like you want to hide under a rock, or can’t interact with loved ones, those would all be warning signs for a mood issue.

There are also screening tools like the Edinburgh Postpartum Depression Scale your healthcare provider can give you to get a sense of how you score.

3. Lean into technology in a way that works for your family.

Technology can be a game changer for supplementing the “village” we once had.

Our villages have scattered.

Most families don’t have live-in relatives for on-demand childcare, unlike other countries where there may be more multi-generational homes. Here, we’re left to our own devices—literally—so you need the devices that help you make it work. 

Technology can teach us.

I fully support parents using smart cribs like Cradlewise to help encourage healthy sleep patterns.

I fully support parents using smart cribs like Cradlewise to help encourage healthy sleep patterns.”

I love that you can get regular information about how your baby is doing and see the tools your little one needs to get better sleep. Using the crib as a facilitator, you learn what works and doesn’t.

And the faster you learn what your child needs to sleep, the better it will be for everyone. These are not shortcuts but rather the next steps in how we parent.

Tech is our friend—we use it in every other part of our life.

For example, technology is represented in our latest medical advancements—no one would ever question getting a more advanced antibiotic or the newest high-end breast pump.

Whether you’re talking about technology or something else, there can be so much judgment in parenting, particularly toward women, who are often criticized for their actions.

Remember to shut out the noise. It’s your family, so do what you need to do—because you’ve totally got this.

Meet the author

Dr. Chitra Akileswaran MD

Dr. Chitra Akileswaran MD, MBA, is a board-certified OB-GYN and the proud mother to her son, Prem. She is currently the president and chief executive of the East Bay Medical Group, a 300-provider multi-specialty group in Oakland, California. She holds a faculty appointment at Harvard Medical School and is also the co-founder of Cleo, a venture-backed digital health platform.

Meet the Author

Dr. Chitra Akileswaran MD

Dr. Chitra Akileswaran MD, MBA is a board-certified OB-GYN and the proud mother to her son, Prem. She is currently the president and chief executive of the East Bay Medical Group, a 300-provider multi-specialty group in Oakland, California. She holds a faculty appointment at Harvard Medical School and is also the co-founder of Cleo, a venture-backed digital health platform.

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