Can I be real with you for a moment? Postpartum recovery isn’t always easy. I know, I know; we love to pretend it is. We want to believe the women who swear they were up and loving life just hours after birth—especially natural birth.

I’m not saying that can’t happen. I know it can; I’ve lived it. But I’m also not saying the opposite can’t happen. I know that can, too; I’ve lived it. I’m not so sure the mechanics of childbirth are always completely easy on us moms.

Maybe it’s because I’m a bit older now and it was with babies number three and four. Or perhaps recovery was a little tougher because both were in the 9-pound range, but yes, it took me some time to “bounce back” after having a baby. And it wasn’t all physical, nor all about my feelings.

Ideally, there should be just as much thought and preparation going into your postpartum recovery plan as there is going into your birth plan. The key to coping with postpartum recovery and getting through the transition with as much ease as possible is understanding what to expect and why it’s happening. Every tool you need won’t come on a store shelf.

How Long Does The Postpartum Period Last?

It may take you a while, too. No, I don’t just mean in the stereotypical, when will you get back into your pre-baby jeans way. I just mean the time it takes to feel like you again may be longer or shorter than what it was for someone else—and that’s okay.

Just as we don’t all go into labor at 40 weeks 0 days, and we don’t all labor for the same number of hours, we don’t all snap back at the same pace. Even if you’re back into those jeans before you realistically expected to be, it might not feel like you’ve got your whole body back.

Keep in mind that while many sources tout the fourth trimester ends when your baby reaches three months of age, many of the issues a woman can encounter after having a baby can extend beyond that.

What Should You Remember Going Into The Fourth Trimester?

No one warns you about the fourth trimester. We have placed a considerable amount of focus on pushing for more support of new mothers—especially in America. We also go above and beyond to make sure women know it’s okay to take all the time they need to lose the weight, and they are aware of the signs of Postpartum Depression, which various studies peg as impacting 5 to as much as 25 percent of women. (Source)

But There’s A Lot We Aren’t Telling Women About

While there is no doubt that new mothers need all of the resources we have to protect against postpartum mood disorders and more, there are events that many women stumble upon in those early weeks and months that no one ever told them to expect.

Being caught off guard at a time like this—when you’re already a bit hormonal, not sleeping through the night, and just trying to revel in the new motherhood bliss between crying spells—isn’t ideal. Thus, we aim to prepare you for the things no one knows they need to prepare for, and it requires a bit more mental application on your part than what you can toss into a shopping cart.

1. You might never have the same body shape again, even if you lose all the weight.

There’s this idea out there that all you need to do is get back to your pre-pregnancy weight and you’ll be just like your old self again. That’s not really how this works. At least not for the majority of us. Let me break it down for you.

You know how certain brands of jeans just fit you the best? There’s that specific brand that seems like their models must be shaped just like you. Get ready for that to change. Even when the pounds come off, they don’t seem to come off in all of the same places that you put them on.

Your hips may always remain a little wider than before each child. Your butt might be larger—or smaller. Your tummy may be flat again—or never again. Your breast size may never be the same again either, and they might not exactly be in the same place you left them at conception.

And remember that all of this is perfectly normal. You are still the perfect you—stretched skin and all. You’ve just put on your best superhero uniform yet—the natural birthing mom. I assure you, her confidence more than overcomes any lump, bump or stretch mark.

2. You may feel deeply alone in the first few weeks, but it’s not abnormal.

You might think you’re in the clear when the baby blues phase passes and you start to feel nothing but joy every time you look at your bundled baby. But then something happens. Something triggers a flood of tears and you suddenly realize the bits of anxiety you’ve felt here and there were rooted in what seems like the silliest of emotions: loneliness.

Yes, you might feel lonely at a time in your life when nearly everyone you know is crowded around you, stopping by with a dish from a meal train, texting their best wishes, and tending to your needs (if you’re so lucky).

How does this happen? Loneliness is the absence of something and you seem to have everything right now. What’s missing? It’s attention. I know, there’s plenty of that going around—so much that you sometimes wish the Facebook notifications and phone calls would stop.

What we’re missing, though, is the attention we were getting before the baby arrived. It’s not attention in itself—but the kind of attention—that matters. Our society treats mothers almost as though they’re disposable after birth. The baby is here. Good job! You did your part, now everyone focus on the baby and forget about her.

It really can feel like that. Then, as the phone calls do start to decrease in frequency, the meal train comes to a screeching halt, and your partner goes back to work, you are forced to face the reality that life is moving on. You’re still stuck in the land of I just had a baby, but for everybody else, they’re settling back into their routine. All the while, you’re left wondering what your routine is even supposed to look like.

If the loneliness comes, recognize it for what it is. Let is wash over you; cry if you need to. Express your feelings, and know that it’s only temporary. You will move on at your own pace and it is important that no one—not even you—rush it.

3. You may have anxieties and weepy moments, and that doesn’t mean you’re developing a mood disorder.

There are times in our lives where our hormones aren’t balanced. Those ratios of estrogen to progesterone are going wild, and as a result, so are we. It’s important to understand that there is an underlying purpose though.

Approximately 80 percent of new mothers experience a temporary period of sadness known as the baby blues. (Source) It is usually not an on-ramp to more serious mental health issues, but bolstering your environment and making sure you have plenty of support is the best way to make sure it doesn’t become something bigger.

When we’re newly postpartum, we aren’t supposed to be in the calm hormone state we would be in during the follicular phase of our menstrual cycle. Nor are we supposed to be in the progesterone-heightened state we are in while pregnant. Postpartum is its own ball game with its own trajectory.

Those sex hormones that plummet after the placenta is birthed are supposed to plummet. That’s how we’re able to produce prolactin and make milk for our little one. Those high prolactin levels also keep estrogen and progesterone suppressed, and if we’re following all of the standards of ecological breastfeeding, we may be able to rely on this somewhat as birth control for a bit. (Source)

Nonetheless, the ups and downs those hormones bring have the fewest side effects on our mood when we are fully supported—emotionally, mentally, physically, and spiritually. While those hormones are perfectly in place for where you are at this place in your life, you will feel the least effect from them if everything else around you in running more smoothly. Push for that.

4. The issues that can set in during postpartum aren’t limited to depression and anxiety.

Again, there is whole lot of focus on Postpartum Depression and Anxiety. Why shouldn’t there be? After all, around 10 percent of new mothers struggle with Postpartum Anxiety alone. (Source) That being said, there are other issues that can creep up during this time in your life that very few people talk about.

Postpartum Psychosis

Enter, Postpartum Psychosis. Roughly 1 to 2 out of every 1,000 women will experience this side effect of postpartum life. (Source) There seems to be far less tolerance for the topic of Postpartum Psychosis than there is for depression and anxiety. No one really wants to talk about the raw emotions that can lead to harming oneself or their children.

That’s understandable, but as a mother-to-be, it’s still important that you understand, should you become one of the few who develop this condition, that it isn’t a reflection of who you are, but rather, of what has happened to you. Many studies have suggested a link between Postpartum Psychosis and Bipolar Disorder, but the evidence is still inconclusive. (Source)

What is very clear is that thoughts of harming yourself or someone else, depersonalization, delusions, hallucinations, paranoia and more are not a normal byproduct of having a baby, and their arrival often requires stronger interventions. Do not be afraid to speak up if you feel like you’re losing your grip. Staying silent won’t make your reality any less true, but it can expose you and others to potential harm.

Pre-Menstrual Dysphoric Disorder

Speaking of feeling like you’re losing it… Pre-Menstrual Dysphorical Disorder is yet another issue that often rears its ugly head when we’ve just recently had a baby, and no one really knows why. While women often report the onset of this disorder with menarche, some don’t develop it until after they’ve used hormonal birth control, and others report developing it postpartum.

While PMDD usually doesn’t surface until your first post-baby period has appeared, it can indeed invade your life before then when your cycle is trying to return. Symptoms of PMDD range from a depressed mood or anxiety to extreme irritability and even rage. Women with PMDD often report feeling like they hate their partners during the luteal phase of their cycle, and they don’t feel those loathsome feelings lifting until they begin to bleed. (Source)

Around 3 to 8 percent of women struggle with PMDD, and unfortunately, it’s the gift that keeps on giving. (Source) I know; I battled it myself after a pregnancy. While I am now recovered from PMDD, most women don’t find relief after onset until they reach menopause, and sometimes even later in life. (Source)

Lactational Vaginal Atrophy

Also referred to as Lactational Atrophic Vaginitis, this condition rattles many women to their core. So what is vaginal atrophy? It’s the thinning of vaginal tissues that can lead to tears in the skin’s surface, narrowing of the birth canal, fusing of the labia and more.

While atrophy is most common in post-menopausal women due to very low levels of estrogen, it can also occur in the nursing mother for the same reason.

So what do you need in your tool kit for recovery when it comes to LVA? A handheld mirror is a good place to start. Many women are terrified to look down below after birth. The inital swelling can be alarming, but after the first few days, it’s a good idea to get in touch with yourself down there.

What kind of changes are you looking for? Keep an eye out for thinning of the skin—especially on the vulva and around the clitoris. When estrogen is very low, the tissue in these areas is most fragile. The skin may often rip or tear into tiny fissures—even just from wiping after using the bathroom. Disposable pads or adult diapers commonly used postpartum may further irritate these areas. When urinating, fissures may burn; and when healing, they may itch.

You’ll also want to look out for fusing of vaginal skin. The labia may begin to slowly fuse to the rest of the vulvar skin. At first glace, it may appear as though the labia is just shrinking in size. In actuality, it is fusing to the vulvar wall, almost like the vulva is absorbing it.

Last but not least, one of the telltale signs of LVA can also be lightening of the skin on the vulva, perineum or anus. These areas may take on a gray tone as they lose pigment. It can occur in isolated areas, multiple splotches or be widespread. Women with LVA may also have difficulty urinating if fusing begins to interfere with the urinary tract.

If you’re nursing, you’ll want to take a peek every other day or so. LVA is tricky; the changes are subtle. So it’s not likely you’ll just see a change one day that wasn’t there the day before. Some women even take photographs every few days or every week to monitor any potential change.

It may sound like to overkill, but for the woman who’s been through LVA before, it’s downright scary to see your lady bits eroding away. Treatments range from super holistic (like boron soaks) to more medical-based interventions, such as topical bioidentical estrogen creams that are usually safe in small doses for breastfeeding mothers, or steroids. Early intervention is best.

Dysphoric Milk Ejection Reflex

This condition, also known as D-MER, impacts around WHAT. Most women expect that breastfeeding will be a glorious experience; that’s what all the books are touting anyway. Sure, there might be hiccups along the way they need help with, but it will all shake out. Except when it doesn’t.

For moms with D-MER, they struggle with feelings of loneliness and often of inadequacy. The condition produces psychological side effects, but it is not mental in nature. Rather, those pesky hormones can get in the way of a momma being able to even tolerate the nursing experience—much less enjoy it.

Women with D-MER typically experience a sudden onset of loathsome feelings upon the letdown of their milk. This can last only seconds and lasts for a few minutes. They may suddenly feel anxious or depressed and might even cry or become very irritable.

No new mother expects to feel sadness when breastfeeding, but it a very real and troublesome condition. Fortunately, many mothers will see the condition improve after the first four to six months of nursing, but some will put up with the relentless mood shifts up until the child weans.

Some mothers experience very intense symptoms while others are milder. Treatment for D-MER primarily consists of educating the mother and reassuring her that this is not her fault. Mothers are encouraged to pay attention to outside influences that could potentially worsen the condition, such as caffeine or a lack of sleep. It is suspected that the hormone dopamine is the primary problem-maker behind D-MER but research is ongoing. (Source)

5. Your body will continue to change in very physical ways.

Ah, postpartum life. The day might start with you practically falling over yourself to get to the bathroom. Hey, it takes a bit before that bladder gets itself back in line and enables you to “hold it” for more than a minute.

By the time you stand up from the toilet and make your way to possibly brushing your teeth, the baby is making those grunting noises signaling they’re waking up—and your boobs are leaking right on queue.

Rushing back to the bedroom isn’t exactly in the cards. Your joints feel like Jell-O. You’re wobbly and feeling a little rickety; you may be for several weeks. The hormone relaxin flooded your body before birth to make sure your pelvis could open wide to allow baby to pass through, and you’re feeling the effects of that in overdrive now that you’ve lightened your load.

As you sit down to nurse the baby, you’re greeted by your new breasts. They’re credited with the new back pain you’ve developed, but in time you’ll buy new nursing bras that actually fit, and you’ll figure out the best positions that work for both of you to remain supported while feeding.

The engorgement was something they warned you about, but the way breastfeeding might feel wasn’t. It’s a learning curve for nearly all of us at one point or another. You wouldn’t be the first mom who doesn’t love the way a letdown feels or wishes someone else could feed the baby so you could get something else—anything else—done. Forgive yourself and move on.

By the time baby’s back to sleep and you’re more than ready for a shower, you’ll be face-to-face with your new mom bod in the mirror. Why is the hot water taking forever? This is longer than you wanted to stare at yourself naked. Go ahead and do it anyway, and do it in the way that you hope your husband still will. Don’t wince and look away; marvel at what your body just did and how it’s recovering on its own without step-by-step instructions.

By the time you get used to the feeling of a belly that literally hangs out with you, it could be gone. So take care of every bump during that hot shower. Know that the faint smell of lochia will eventually be gone, but you’ll never forget it’s earthy, mustiness. Oh, and do your hubby a favor and remember to take the clumps of hair you’re shedding with you when you exit the shower.

6. Dad Might Get Depressed, Too.

No one ever sees this one coming. There are a few reasons that it does. Just like the focus has been pulled away from the new mom to center all of it on the new baby, the new dad has also lost all attention. His needs aren’t being met. Yes, even that need. Intimacy and physical contact are important in any relationship and the sudden pause in such—while practical and understable—is still hard for some men to cope with.

But it’s more than that. An estimated 4 to 25 percent of new fathers develop depression in the first two months after their babies are born. (Source) Dad needs support, too. He needs to know your lack of patience with him has more to do with the lack of sleep you’re getting at night than his lack of skills as a father. He needs to know you like the way you tend to the baby more than the way he does only because you’re worried about doing everything right so badly that you’ve become a bit of a control freak.

Remember that this is a time when the whole family needs support. If his mom wants to visit a little more than you’d like, take advantage of her visits by letting her have the baby while you have a nap or a hot shower. Make it worth your while. Do the same for Dad. When you’re feeling good, give him some downtime, too—even if you’re the one who’s up all night nursing. The family unit thrives the best when both Mom and Dad are doing well. There’s no room for criticism or battling over who’s working harder right now.

Every family needs to find their balance when welcoming a new child. Hormones are flying in every direction. No one is sleeping as well as they’re used to. There doesn’t seem to be enough time to prepare healthy meals that really nourish everyone. Money may seem tight if mom is off from work for a while. Having to devote a lot of time to nursing and diaper changes usually equates to not having as much time for household chores and staying on top of the laundry.

It doesn’t take much for a the pre-baby household to feel like it’s crumbing around you. Take advantage of help wherever it is available. You’re going to need it. Then pay it forward in the future when someone you love has a baby and they need you.

If you have had any experiences not listed here and/or have additional tips comment below and help other mommas out. Please also share or pin this post to spread the word that the fourth trimester can be a very challenging period of time.

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